Our guide to making sure your patients get the best online care.
Providing telemedicine consultations and how best to carry them out came into sharp focus with the COVID-19 pandemic.
Although providing health care at a distance, instead of face to face, seemed to fit perfectly with lockdown restrictions, the take-up was never as high as expected.
Technological barriers to the take-up of video existed pre-Covid but the pandemic caused providers to accelerate development to the extent that now it almost seems unthinkable that video consultations could not occur just a couple of years ago.
Telemedicine appointments allow patients to communicate with healthcare professionals in real time using tried and tested video conferencing technology.
Making video a key part of healthcare tech and Telemedicine Consultations
Many GPs are undoubtedly put off holding video consultations for want of some basic guidance, so we’ve compiled a series of tips which aim to help provide effective and compassionate care during video/online consultations while maintaining professionalism and privacy.
Being prepared builds confidence
- The internet connection must be reliable, and, preferably, you need a backup plan if connectivity issues do occur
- Check that your computer has a high-quality camera and microphone for clear audio and video
- Be familiar with the video conferencing platform you will be using. If necessary, colleagues can trial a dummy consultation or two as a way of ironing out any unforeseen problems.
- A little preparation will go a long way in building confidence that you can cope with any glitches or change approach, if necessary
Create a suitable environment
- Make sure that the place you will be using is quiet and well-lit
- Minimise distractions and background noise, if possible
- Ensure that the background is free of personal items so it looks as professional as possible
Use the personal touch
- Most patients will appreciate a personal touch, so begin the consultation by putting them at ease with a warm greeting and introduction to yourself
- Making eye contact is a good way to help establish a rapport. Looking at the camera, rather than the screen, will be necessary for this
- Using the patient’s name frequently will help personalise the experience
- Be prepared to offer assistance to less tech-savvy patients and have a troubleshooting plan if issues arise, which may involve using a phone call for the consultation instead
Privacy and security
- The connection needs to be secure, as specified by the NHS
- Confirm the patient’s identity and date of birth
- Remind the patient to ensure their own privacy during the consultation
- Take notes instead of recording a video
Communicate clearly
- Speak clearly and at a moderate pace
- Avoid using medical jargon when explaining diagnoses and treatment plans
- Offer opportunities for patients to ask questions
Active listening
- Do pay attention to the patient’s concerns and questions
- Verbal cues such as ‘I understand’ or ‘I see’ as well as nods, will show empathy and engagement
Visual Examination
- Train to conduct a visual assessment by video effectively
- Ask patients to show specific body parts, if necessary, as long as they are comfortable with doing this online
Watch the clock
- Do your best to keep your telemedicine consultations on schedule. This respects your time and the patient’s
- Set clear time limits for the consultation and allow time for questions
Patient Education
- Screen sharing can help display relevant images or diagrams
- Summarise key points and treatment recommendations in writing for the patient to refer to later
Following up
- Discuss any follow-up plans and schedule a home visit, if necessary
- Send any prescriptions electronically to the patient’s pharmacy
- Update the patient’s electronic health record (EHR) promptly
Why get on the learning curve?
During a video consultation, clinicians can assess and diagnose patients’ conditions remotely while discussing their symptoms, medical history and concerns within certain constraints.
Healthcare professionals who are confident with their findings during an online consultation can prescribe medications and also make referrals for in-person tests, treatments or specialist consultations.
Sometimes, healthcare providers may provide patients with chronic conditions with remote monitoring devices, such as blood pressure monitors and glucose meters, that transmit data. This enables adjustment of the treatment based on the information being submitted.
Online consultation growth is continuing
Although the percentage of consultations remains low, there is evidence that it’s becoming an important complement to telephone and face-to-face appointments.
In August 2023, nearly 598,000 video/online appointments were carried out – up by 444,000 in August 2022 – indicating that telemedicine is not going away.
So, although representing only 2.11% of the 28m appointments carried out in general practice in August 2023, the numbers seem to be growing. In contrast, the number of telephone appointments saw a slight decline.
There were 250k video consultations delivered in Wales from the inauguration of the service up until September 2021.
An evaluation recorded particularly high ratings of patient and clinician satisfaction, with a 92.4% rating for ‘quality’ (Excellent, Very Good or Good) for patients and a 71.9% rating for clinicians.
This research also showed that patients expressed enthusiasm for saving on travel and parking time and costs (92%), avoiding the need to take time off work/school (81%) and enjoying improved convenience and access to care.
Nearly everyone said they would use the service again…
Meanwhile, clinicians in Wales, although indicating lower levels of satisfaction, did highlight benefits such as the ‘more efficient use of their clinical time/space’ (75%), ‘increased access to care’ (72%), ‘reduced waiting times’ (69%) and ‘reduced Did Not Attend rates’ (61%).
In Scotland, the number of video consultations has grown from 40k video a month in 2022 to 20k a week.
Users surveyed estimated that such appointments save an average travel distance of 36 miles each time.
When asked if they would use the service again, 97% of respondents rated positively, while 92% found the system easy to use.
Technology can support patients in their homes
A good example of where technology is supporting urban patients is in the London borough of Newham.
Technology supports people in managing their condition, maintaining health and wellbeing, and enabling them to live independently for longer.
Careful management of long-term conditions, including high blood pressure, heart and breathing problems, is essential to prevent illness and keep hospital visits and admissions minimal.
In Newham, patients’ readings go to a centre where they are automatically logged and checked so that they can be contacted or visited if any concerns arise.
Patients are reviewed monthly over the phone and an ongoing evaluation process is in place.
For most clinicians, their experience with telemedicine will be more similar to that in Wales and Scotland through online services offered by healthcare service providers including Silicon Practice, NHS Attend Anywhere and AccuRx.
Whichever system your practice uses, there are advantages to being familiar with how it works.
Conclusion – is telemedicine at the ready?
While the take-up of telemedicine, in particular video consultations, has been slower than anticipated, it remains an area with huge potential.
The number of video/online consultations is increasing, making it an increasingly important means of delivering consultations. This shouldn’t be underestimated as it acts as a complement to other forms of appointment rather than replacing them.
Those who gain skills in using video consultations now may gain an advantage in the unfortunate event of another global outbreak that restricts the movement of clinicians and patients.
Our video consultation system allows the clinician to schedule appointments or start them immediately, perhaps while speaking to a patient on the telephone.
Once patients book an appointment, they receive a message with a clickable link to access the session.
Clicking the link at the start of the appointment time takes the patient to a virtual waiting room, where clinicians can send messages if there are any delays.
Patients can join the consultation when the clinician is prepared.
During the appointment, the clinician retains control, with the option to conclude it when finished or enter ‘Privacy’ mode, which deactivates both video and audio while keeping the session open, ready to begin again.
Clinicians can make notes during the appointment and transfer them to the clinical system after the session. Please note that, for legal reasons, video consultations cannot be recorded.
For training videos, please see our YouTube channel.
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post by Bruno Clements
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