Lights, Camera…

So with the recent health crisis, global economic collapse and all-around doom, physicians are faced with a challenge — How can you deliver care when you can’t be in the same room as your patient? Or your staff? As a surgeon, how can you offer procedures to patients who need them? What criteria are you using to determine what is “time sensitive” and what isn’t? And how the heck is a private practice or elective doc supposed to keep the business running??

Sigh…

So I am a vascular surgeon by trade. Much of my practice is devoted to our vein center and to wound care these days, but I still take emergency call 50% of the time. Usually, my partner and I are not overwhelmed by our call load at our community hospital; however, we still need to be healthy and available. If something particularly complicated or nasty comes in, our tertiary centers are overwhelmed. We may not be able to transfer that patient out easily. We need to be ready! But… that does leave us with some time on our hands.

Furthermore, my partner and I are not salaried. We keep what we kill, so to speak. When elective patients get cancelled, so does our entire practice. And what about the aftermath? Once we can start seeing patients again, our clinics may burst at the seams! I can’t even imagine the backlog we are generating right now… So what can we do in the meantime?

As we do have patients who need to be seen for various time-sensitive issues in the world of vascular surgery, we still have to go to work. Someone from our staff needs to answer the phone, at least some of the time. But can we fill those gaps with other meaningful work in a way that keeps everyone safe?

YES!

Hence, the jumpstart of our video visit program! One of our other partners had been pioneering the telemedicine program for the past few years, but it hadn’t really caught fire. This week, we decided to make the flame burn! I am generally not a selfie kinda girl, but I have committed to getting over my Bad Hair Camera Moments and figure this out. This week, I would like to share my experience with you. I am hoping that this will spark some ideas or smooth the path for those of you who are also trying to learn this on the fly. My health system uses Epic, but I would like to keep this as neutral and broadly-based as possible. My only comment about our current software platform is that it works well and is easy-to-use once you get things set up. Feel free to reach out to me directly if you would like to chat about more specifics. I do not represent Epic or any other software platform directly, nor do I receive any benefit from them.

So how to get started with video visits? The first thing I had to learn was that not all telemedicine is the same. Where your visit takes place matters. The basic definitions I had to learn at the onset of this were the following:

  • Telemedicine — takes place between at doctor at one site and a patient at a different site within the health system, possibly facilitated by an RN/MA

  • Video Visit — takes place between a doctor at one site and an unchaperoned patient who is initiating this visit on his/her own, often through a personal device [moblie phone, laptop]

In this case, we are asking patients to contact us directly from their own devices, so the Video Visit is the specific case to which I refer here. With the COVID-19 crisis, all bets are off with billing rules. Generally, CMS requires that both physician and patient be present in the same state to prevent licensing conflicts. I will discuss coding/billing and attestations later this week. For now, let’s get started with the basics.

If you’re going to do a Video Visit, you will need a private place that protects your patient privacy, just like a standard exam room. If your EHR software allows you the option to connect through their platform [in Epic, this version of their software is called WarpDrive], this will also help you to maintain privacy protection. Another advantage to using your EHR software may be that you can capture images directly into the patient’s chart using the camera connection. Even if you do have your EHR installed on a computer that you plan to use for your visits, make sure all of the software components are correctly installed before you start. Different upgrades and plugins may be needed in order to make the magic happen here.

Audio and visual capabilities are key! If you haven’t done a test encounter with your own office staff, do that first! My medical assistants and I found multiple issues with webcams, speakers and microphones on our video-ready workstations that we were able to address before we tried this out on a real patient. These little details add up. You want this to be a good experience for your patient! If she can’t hear you or if your internet connection is spotty, you may not get the high-quality encounter you want.

That brings up another great point — not all patients are going to be cut out for this type of visit. Often our older patients are not tech-savvy. If your patient has a flip phone, he should probably wait until the clinic reopens. If you patient requires an interpreter, will you be able to provide that service adequately over a video conference? Careful screening may be helpful before you start loading up your virtual schedule. You want to keep these encounters meaningful, so make sure you can deliver the right kind of care in this format to each patient. Some prep work for your patients may also be necessary. For instance, you should have your assistant scheduling this patient remind her not to be driving a car while attempting to video chat with you. If you plan on having your patient show you his leg or incision with his camera, he needs to be appropriately dressed for the occasion. And he might want to be in a private area himself if he needs to focus on the visit from home while cooped up with his kids. Those are just a few of those little things that your patients might need to think about before they log on. And what if your patient accidentally gets disconnect? Will she know what to do? Some simple instructions or an email/handout ahead of the visit might prevent some of these mishaps.

For today’s Downloadable Goodness, I offer a checklist to help you get set up with your virtual clinic before you start committing to patients. I’m sure I’ll forget a few things, so please feel free to reach out to me if you think of something else that should be included!

Over the next few days, I’ll post some updates about my experience with this as it evolves. I’ll also try to share some documentation and coding tips to help get you started.

Until then…

— TLS

Downloadable goodness:

The Lonely Surgeon’s Virtual Visit Checklist

Photo credit: geralt / Pixabay

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