Dear Friends and Colleagues,
Are you still wondering how this telehealth thing is going to work out?
Here are some thoughts based on several years of providing telehealth services that I haven’t seen shared. If you’ve been wondering, video works very well with actual data to show it’s comparable to a face to face interview. You can pick up things like akathisia, tics, tremors and you can also get a unique opportunity to see the patient’s environment and meet their pets.
1. After you have picked your HIPAA/BAA compliant telehealth platform (VSee -used by many ERs-, Zoom, Doxy.me, etc) be mentally prepared to have to consider a non-HIPAA compliant platform like Skype or FaceTime. Patients may struggle to install or make your preferred platform work (not what we should do, just being pragmatic). Have several of these free HIPAA-compliant platforms available and be familiar with them. For example, some patients may have been using Zoom to talk to their family or to participate in other online activities. On this note, be ready to walk your patients through installation and troubleshooting (ie cameras may be “captured” by other video apps and may not be available to work with the platform you use – have patients close all other programs and then open your platform). This is not trivial, we have provided countless hours of admin time to make these systems work.
2. Have the patient’s phone number and a landline or cell phone available. Network congestion, especially now that people will be working from home, watching Netflix or doing their doctor appointments online, is going to be a MAJOR problem rendering your video application useless. Connect with the patient over the phone (not an internet connected phone) to have the audio and get the video you can get over the internet, at least this way, you can have a reasonable session and still comply with regulations (system that provides two-way, real time audiovisual conferencing between a patient and the provider). When you do this split method remember to mute mic and audio on the computer to avoid feedback.
3. Try to hardwire your computer/device to the internet (as opposed to WiFI) – as in use a network cable connecting your device directly to the router or switch. If you can only use WiFi set yourself up closer to the router. At least this way one side of the conversation will have better connectivity.
4. Encourage your patients to avoid any public connections, these are generally not private and are even more congested.
5. Encourage your patients to be still in one place as connectivity will fluctuate and freeze video and audio. It will also prevent you from getting dizzy.
6. Tell your patients to be online and ready for YOU to call them. It’s very difficult to wrap up a session when someone is frantically calling you 2 minutes before their session begins.
7. Make sure your system is NOT set to automatically answer calls. Think of the situation described above and now you have two patients on the same call with their names exposed.
8. In my experience, maximize the screen and sit a little further out. This will make it more like an office situation. It has been generally more tiring to do videos all day than to see the same number of patients at the office.
We only use telehealth for established patients. Phone sessions are not generally reimbursable for those of you who suggested switching to phone. I’m happy to answer any questions.
Stay #coronasafe and let’s continue working together to help our patients.
Gonzalo Laje, MD, MHSc, FAPA