…and Action! The Virtual Reality of Patient Encounters

So there I was! I had spent the past several days in scrambling to figure out how to convert my elective varicose vein practice into a telehealth model to keep my business afloat… I had staff to pay. I had empty office space to use. And I had a schedule in the next few weeks that was packed to the gills with patients waiting to be seen… The thought of what my clinic would look like when all of these restrictions are lifted made my stomach churn. I would be easily doing twice my usual volume with no additional resources to help! If I didn’t find a way to start getting some patients seen now, I could envision my financial and psychological ruin from the aftermath.

Fortunately, my health system had some resources already. None of us had really explored them, but this seemed like a good time to start! My staff and I went through the mechanics of setting this up as I mentioned in my previous post, but what then? How would I physically make the virtual work?

I decided to start with a single patient. I picked a simple follow-up patient who was fairly tech-savvy. She had already undergone a procedure in my clinic, so she was very familiar with my staff and she felt comfortable speaking with me. We reached out to her to ask, and she said yes. Easy enough, right?


Our first hurdle was with getting her on the schedule. As it turns out, my schedule template in our EMR needed some configuring and some permissions. Only one of my team members currently had that kind of access, and she had been redeployed to door guard duty on the day we were trying to coordinate this. Several phone calls later, we were able to solve our IT issues and move forward.

How long should the appointment be? Usually, I spend about fifteen minutes total with a patient like this. We allowed a thirty minute slot, just to be on the safe side. Fortunately, we had lots of time on our hands, so this wasn’t a problem… but if I scheduled five or six patients, how much time should I include for technical and connection issues for each? I’m betting that a little padding will be needed as this scales up.

So when my assistant and I logged on with our patient, things were relatively smooth. We did have some issues with internet delay. Also, we hadn’t anticipated as much trouble with our speakers as we encountered… Our pre-testing wasn’t quite thorough enough, and I didn’t think to grab a plug-in headset to improve the audio quality. Fortunately, it was good enough to have a conversation.

Our patient didn’t have as much prep as she probably needed. When I asked her to please point the camera at her leg so I could see how she was healing, she wasn’t quite wearing the right clothing to make that happen. Also, she was fumbling a bit as she tried to get the right camera angle. The front-facing “selfie” camera is not adequate for image capture! And my patient, although good with her smartphone, struggled to switch to her rear camera to improve photo quality. Just little details, but they added significant time to our encounter.

Eventually, we muddled through all of the issues we needed to address. She seemed satisfied that we had covered her questions and concerns. I felt that we hit all of the main topics that we would have covered in a face-to-face encounter. I do have some thoughts on documentation and coding, but I’ll save that for later…

In short, this is very similar to your standard encounter, BUT! You should be aware that this will take a little more time than you anticipate! You might be an expert in telemedicine after a few tries, but there’s a good chance that your patient will be a newbie. Careful patient selection, some pre-encounter instructions and reliable technology make all the difference in the world. I know I included many of these in the Virtual Visit Checklist from my last post, so please be sure to download a copy and look it over as you set up your virtual clinic. Even with my amazing staff and all of my preparation, ehh… There were things that could have been a little better. Next time!

Over the course of the couple of posts, I will focus more on the documentation and coding issues associated with telehealth visits. Buckle up and hang on!

Until then…


Photo Credit: DWilliams / Pixabay

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