Telehealth Experience

It’s important to consider who the training is for and the key pieces of information the audience will need to successfully support a telehealth visit. This may require different trainings targeted for specific staff such as schedulers, front office staff, medical assistants, nurses and physicians.

Including mock consultations as part of training will help give office staff and care providers valuable practice prior to their first telehealth visits with patients. In addition to mock consultations, here’s a list of topics to include in a training program for care providers and staff:

Telehealth overview

An overview of the telehealth visit program including benefits to care providers, staff and patients. Ensuring staff and physicians are on board and support in the telehealth service delivery model is vital.

Telehealth technology

Provide an orientation of the functionality of the technology so the front office staff, support staff and clinicians know how the technology works from start to finish. Examples of the technology details include:

• Which web browsers and devices are compatible with the telehealth platform
• What the patient sees, and what notifications they may receive
• What to do if internet connection isn’t fast enough or working properly during a visit
• Who to call for technical support

Eligibility

Provide information on checking eligibility and assessing patients. Example details to include to help identify patient eligibility:

• How, when and with whom telehealth visits will be offered and conducted.
• How patients qualify for a telehealth visit and how they can schedule telehealth appointments.
• How to check patients' insurance benefits through the telehealth solution, if the feature is available.

Consider the following:

• Provide an explanation of staff roles in telehealth scheduling and visits to ensure every staff member understands what their role is.
• How care providers will be reimbursed and what patients are responsible for paying.
• How to handle follow-ups appointments and/or services (schedule appointments, refer to specialists, fill prescriptions, order labs, document in EMR, etc.).
• How and where to document notes. Because providers may have to engage with the patient while simultaneously documenting the visit, they may want to learn how to best position applications on their screen.

Service

Consider the following:

• How to manage issues that prevent a consultation from being completed. Provide instructions on what to do if, for example, a clinician realizes partway through a consultation that the patient should be seen in person or if a technological problem prevents the consultation from being completed.
• Professionalism while conducting a visit:
• Providers to introduce themselves at the beginning of the visit with patients.
• Maintaining a professional environment that respects the patient’s privacy and confidentiality.
• Making sure the area that can be seen on camera is neat and organized, with distracting photos and inappropriate decor eliminated.
• Ensuring cellphones and office phones are muted.
• Providers letting the patient know if they’re working on a second screen, so the patient doesn't feel the provider is inattentive.

Additional Considerations

• Have a telehealth champion present in the office location when telehealth visits are newly implemented in a practice.  The champion can help set up the first visits, review provider questions following the visit and encourage other staff members to promote telehealth services.
• Update clinic workflows to include telehealth.
• Have schedulers and front office staff set up a mock video visit in a patient role so they can better describe technology set-up to patients.

Online training sessions for care providers:

• American Medical Association (AMA) STEPS Forward -Telemedicine - Facilitate Access to Care For Your Patients

A high-quality telehealth interaction can occur when the patient and the provider feel prepared and comfortable with the telehealth visit. Below are a few actions to consider taking when preparing for and conducting a telehealth visit.

Advice to Share with Patients

• Recommend the patient find a quiet, well-lit space in their home.
• If the patient will be using a phone or tablet, recommend that they prop it up so their hands are free.
• Recommend that the patient wear comfortable clothes that will allow them to show their provider areas on the body they will need to assess.
• Have the patient log into the telehealth application 10-15 minutes prior to the visit so they are able test out the sound and camera on their device.
• To prepare for the visit, the patient should also:
  • Have their complete medication list available or have medication bottles available to view during the visit.
  • Write down their list of questions for the provider.
  • Obtain basic vital signs (weight, heart rate, respiratory rate) just prior to the visit.

Provider Visit Location Set-Up

• Have a private, well-lit area that is designated for telehealth visits. 
• Indicate that a visit is in progress with a flag on the office or exam room door.
• Do not have any personal health information from other patients visible to the patient. Providers should clear their desk and close computer screens not in use that may be angled towards the camera.
• Set up the video visit on the same screen or directly next to a screen where you’ll be viewing the patient's chart.
• Mute all phones and personal devices. 

Tips for Telehealth Visits Delivered from a Clinic Setting

• Designate a patient room or another private space for telehealth appointments.
• Consider having a medical assistant or nurse "room" for a telehealth visit, similar to an in-person visit.
  • Greet the patient and review the purpose of the visit.
  • Gather any vital signs the patient has done at home or guide them through taking their vital signs.
  • Review medication list.
  • Inform the patient that their care provider will join them shortly.
• Care providers should look into the computer camera to create the impression of eye contact. The providers should let the patient know when they are looking at a second computer screen, so the patient knows why they are looking away from the video visit screen.
• Refer the patient to laboratory, imaging and specialty services as appropriate.
• Send an email with care instructions or direct the patient to the patient portal for the visit summary and care plan.
• Following a telehealth visit, have front desk staff contact the patient to schedule necessary follow-up appointments.

Telehealth Clinical Workflow

• Schedule a patient visit and verify that the patient’s medical policy covers telehealth. Be sure the patient gives consent to conduct the telehealth visit.
• Verify the patient has access to your preferred telehealth platform.
• Provide patients with step-by-step instructions on how to access your telehealth platform.
  
• Assign support staff to confirm that the patient can access the telehealth platform and understands how to use the technology prior to their scheduled visit.
• Meet the patient in their home virtually and conduct the visit.
• After the visit, consider scheduling a follow-up visit using telehealth, if appropriate.
• Complete the relevant documentation about the visit.
• Submit the claim with the place of service code and a telehealth modifier, as appropriate.

Telehealth Visit Considerations

• Providers should connect with laboratory and radiology facilities to perform tests and send results back to the practice when ordered for a telehealth visit.
• Interacting with members who have a health care power of attorney or caregiver attending the visit:
• Make sure to direct questions to the appropriate person in the encounter.
• Although it may seem unnatural, looking directly into the camera rather than at the individual will help patients and their loved ones feel they’re connecting with you.
• Interacting with members who speak a different language:
• Traditional video conferencing with translation services will not work.
• Providers who use translator phone lines with three-way calling capability are more likely to have a meaningful interaction with their patients.
• Enlist family members or caregivers to support and assist patients with low technology literacy to use telehealth.
• Not all patients may be good candidates for telehealth, such as:
• Patients without access to technology platforms
• Patients with vision and/or hearing impairments
• Encourage audio and video whenever possible.