Hi, I'm Joshua Elder. I'm an Emergency Physician and Medical Director for our Direct-to-Consumer Telemedicine at UC Davis Health. I'm here to talk to you today about how you can be an effective provider and participant in telemedicine. We're going to talk about understanding best practices as a provider during the telehealth visit. We're going to talk about communication and hand-offs and their importance in providing great clinical care during and after the visit. We're going to talk for a period of time of HIPAA and regulation and evolving space that requires vigilance from health systems and providers to know that you can be effective and safe in this clinical space. Telehealth visits. Who is talking? There's a lot of different ways a telemedicine can be provided, can be direct-to-patient and can be provider-to-provider. Differences are important to discuss. But today we're going to take this through the lens more of a direct-to-patient encounter, but highlight a few differences here so that you understand how that might apply to a program that you might be setting up. For a direct-to-patient encounter, provider is usually at a clinic, patient usually at a home, and provider is responsible for ordering, entering prescriptions, etc. For provider-to-provider consultation, the distant site provider provides recommendations only for the most part. Originating site provider with the patient, really the patient's primary care provider is responsible for all treatments recommended. There are differences in expectation. They're important things to look. Or if those expectations are not meeting the needs of a service or program that you'd want to set up, we want to talk about that early in the program. Let's talk about getting started for our providers. It's really important that the location be private, quiet, and is HIPAA-compliant. We'll talk more about HIPAA standards toward the end of this module. Suffice to say, achieve the same carence in this space that you do in a hospital. Background should be clean, professional, not look busy. The focus should be on you talking to that patient. You want the focus to be on the patient and being able to understand their concerns and their clinical needs. You want to have adequate lighting and avoid a backlight can often darken and create shadowing effect that can be disruptive to the patient experience. Provider attire and etiquette. It's just important to avoid patterned clothing, wearing a white coat. I preferentially wear a white coat. I think it sets a certain standard of care in that clinical space and it's easier to achieve a similar view from the patient standpoint for every clinical encounter you have independent of the type of shirt or tie you may be wearing. Badge visible. I think this is important just as a standard to meet that patient so that they know who you are. If possible, having the badge in a place where they can see you and see your credentials for that clinical encounter. It's very important and it can help guide the conversation too. Our program currently has a vast number of different types of providers and can provide some insight to that patient as to the background and the specialty that the provider may have. Really important to have familiarity and confidence with technology. Taking some time ahead of time, ahead of a shift, having a program, spend time with that on-boarding experience, having real-time support staff that can help both patients and providers to deal with some of the technology issues that may emerge, even under the best attempts to not have any issues arise. Broadband can be a consideration. There's a lot of different variables that can come up in this clinical encounter that can mitigate communication in those seeing the patient as you may need to for that clinical space. Testing ahead of time can mitigate a lot of the challenges upfront. Definitely turn off the cell phone, and this is a clinical care space and your undivided attention should be there. Avoid eating or drinking. I think this is just a way to professionally connect with that patient and just meet the needs that they have and not distract from you. Contingency plans. Certainly having a both programmatic expectation, but programmatic step-wise fashion of saying how videos should be done, how many attempts should be done before converting to an alternative telemedicine halfway, and then monitoring that to ensure consistency within your program. Getting started from the patient's standpoint, we're focusing on the providers. But I do think some work needs to be done both from the health system standpoint and from some of the patient education standpoint to really enhance their experience. Explaining and scheduling the visit upfront in a scheduled telemedicine encounter or an unscheduled telemedicine encounter that having patient-facing materials so that they can be successful. Often times there may be a lag between when the patient logs in and when the patient starts their care as much as possible trying to get that patient their technology set up and running however you want to achieve that within program can pay dividends, whether it's when they're downloading their my health chart or whether it's when they're downloading the platform they may use. Some patient-facing materials rather to help them with that experience and help them with that on-boarding ahead of that visit, almost in a similar way to what we want to do for our providers, can really enhance that experience. Patients I often find can get very frustrated with the difficulty in getting through to the IT platform and that can mitigate their interests in using it again or mitigate the value or have some blind spots from both patient and provider and not really understanding the clinical needs of that situation. Some ways that you can do this is having the patient ensure they have a strong and secure Wi-Fi connection. Often find broadband stability to be an important bedrock to obviously a great telemedicine encounter. You want to avoid distractions and background noise during the visit when possible. Obviously, you want to have your own privacy if possible as a patient, and being prepared just telling up front that the patient is often going to encounter copays or fees depending on their insurance coverage. Being as clear as possible and what that looks like and what to expect can really help mitigate a lot of challenges. Sometimes I often say for patients early on or with our IT teams that are reaching out to these patients, prepare a list of questions you might have and also have access to your current medication list. Those are some of the tools of the trade for our patients I feel like to improve their experience. I think it's important we communicate that as health care providers and as telemedicine experts to make sure that they also engage in this space. The visit itself, we talked about being prepared. But from the provider standpoint, it's really important to review pertinent medical records prior to. I can't tell you how much time providers can waste really in asking a lot of questions and clarifying points or patient risk profiles that may emerge from looking certain things up can help indicate recent set of vital signs, can help indicate a recent medication change, can help indicate who is allowed to speak on behalf of a patient in terms of a proxy axis account. Being prepared and seeing that medical record, I always spend, independent of how busy I am in a telemedicine encounter, I always spend at least two to three minutes reviewing some basic aspects of that patient's profile before I start that visit to really understand and emerge and be most helpful in that patient engagement. Introduction and confirming patient identifiers, just like any other clinical space. Again, one of the pillars I'll say over and over again in the videos that I'm sharing with everyone is really around not doing anything different in this space than you would in a typical clinical encounter. Sometimes there's limits to what we can do. But if there isn't, there shouldn't be. I think that is a value standpoint and as a bedrock to how to engage can really help augment the care experience that we provide patients. Confirming audio and video are sufficient and then having contingency plans if either is insufficient. I've spent a lot of time in programmatic development focused on this exact piece. Because there are patients that are not able to access video for whatever reason and so you want to make all attempts to achieve that end. But again, access is access and certain patients may need to have access through audio in certain situations. But consent and proxy considerations around the visit are really important. Getting consent for the visit to talk, to make sure the patient is in a secure private space, and then sharing your own credentials of who you are and who you are to that clinical encounter. In proxy considerations, if someone else is calling on behalf of someone else, obviously confirming and verifying to every extent who is on that call on that video rather and to making sure that the experience and the safety of the patient is put first.
