Hello, telemedicine students, Rebecca Canino here we're going to talk about getting patients ready. I'm the Administrative Director for Johns Hopkins Medicine Office of Telemedicine. Let's talk about what patients need to get ready for telemedicine visit. Now the first thing they're going to need, is they're going to need the tools to connect. Patients are going to use what they have in their home. They're going to use their smart phone. They're going to use their tablet, they're going to use their laptop. Some patients will add a webcam. Some patients will have some fancy peripheral set were either given to them by their healthcare provider or that they already had. They can include a smartwatch and sending their steps over to their provider and their heart rate. If they took big deep breaths, they could have a blood pressure cuff at home. They could have a Bluetooth scale that sending their weight every day to their provider. They could have an oxygen saturation monitor sending what their O_2 levels are. Now some health systems are going to want patients to come in through their health portal. Here at Hopkins, are coming in through there MyChart app. Some health systems we'll be integrating with health apps already on patient devices like Apple Health or Google Healthcare. But however they connect to you, they're going to get to you digitally. Now there's ways to get patients ready for their video visits. We send out reminders through their MyChart app. These are some of the tips for successful video visit. Login before your appointment time. Make sure your lighting is right so your provider can see you. Make sure the space is private because we're going to be discussing your private medical information. Now it's interesting to take note that some patients do not have a provider, have a private space, and so they may be doing their visits in their car. That may be their only space that is private. They may have to drive somewhere where they can get public Wi-Fi, and so providers will see patients in their cars. Here at Hopkins, we have a policy that the patient can't be driving while we see that patient. But your health system and your private practice may have different standards, but you want the patient to know what those standards are. We also have a policy, dress appropriately as if you've gone into the office. We have had patients open up their video visits and they are stark naked. In those situations patients maybe were ready for a derm appointment and they were going to do a full body check. But just make sure that you've alerted your patients for how you want them to be dressed and how you want them to present. We do find it helpful that patients can write down what they want to talk to about their provider before the visit. We ask them that they test their device and this will allow plenty of time for the actual patient visit rather than doing IT troubleshooting. Some ways that you can get your patient's ready is that patients are different learners, and so we have a YouTube video out to get patients ready. This is platform agnostic, so it doesn't matter the platform, this is just helping patients get ready. The testing for a video visit is so important. We have a few ways that we get patients ready. We have a test your video visit button right in the app. We have step-by-step instructions for folks that like a manual way to do this, and so we have those in English and in Spanish. We have YouTube videos on how to get ready. Those YouTube videos can be agnostic like in the one that I just showed you before this slide. We have specific ones to our application and we find that those are very helpful to patients. A lot of issues you're going to run into is the same thing that you as a learner are running into is your audio setup. Can you be heard? Can you hear? Is it pulling the right video feed? Thing like that. Now we go through the patient and the provider, the basic steps of a video visit. For the patient, we want them to have a smart device that they can both do audio and video. We want them to have a scheduled visit to click into. We would like them to have a patient portal enabled, and this is for a multitude of reasons. There are benefits to doing it through a portal. You can have your consenting process be automated, you can get co-pays are automated. You can have them upload their insurance card. All those things are going to happen at each check-in, and that's super-important to have. You do want to have a way for patients to start their video visit outside of the portal, and this is so important around equity, and we'll talk about that later. But you want to make sure that they can start that video visits. In our portal you can see on the screen it's the green. Start your video visit. The patient clicks in, it opens a window, the patient is in the waiting room. I have various thoughts about the use of a waiting room. Do we really need a waiting room in the virtual setting? Couldn't we just send the patient a text that we're ready to see you. They connect right there and we eliminate the waiting room. This goes to how to set up your program and not to bring in your old ways into your new virtual ways. But that's something we'll cover later, that's a little more advanced, but just start thinking, what are the non-value add steps that we haven't person and how can we eliminate them in the virtual realm? The patients in the waiting room, the provider allows them in and the start to have their video visit. Here is the no patient portal way. The patient can get a text message that says, here is your link. They click into it, it opens up. Once again, unfortunately brings them into a waiting room. Why? This is something you should revisit in your own setup. Then you have the video visit. Who gets the patient ready? This is huge and this is what folks are grappling with now in the new normal. There are many different functions to getting a patient ready for a video visit. It goes all the way from scheduling to after the visit, getting them scheduled for their referrals and follow-ups. This in our institution, you can see on the screen, we have central folks doing this, local folks doing this. We mapped out each one of these steps and said who's doing it? Then what are the resources needed to do that? Are these incremental resources that we need to assign or these existing resources that we have. There are modules within this learning session or within the entire setup, that's going to talk about support teams. Just to touch on it here, will your central people be doing it or will your actual clinic people be doing it? Then what are those roles and then how do you redefine those roles? It is a mistake to go into telemedicine and think that you're not going to have to redefine your roles and responsibilities because this is a whole new frontier. People that roomed patients physically, may not be the person that rooms patients virtually. You're going to have to look at that. What skill set do these team members need in order to function? Then how are you going to reimburse them? Are you going to build this into your existing models, change your job descriptions, update the financials, or are you going to put this under duties as assigned and just move into this new world? However you move into that new world, you are going to have to educate that role on how to do things. You're going to have to make sure they have the tools that they need and the connections that they need in order to help the patients through. It is a mistake to think that you are not going to have to beef up your infrastructure to help patients in this new realm of care. One of the things that we did at Hopkins is that we instituted a video risk score to automate some of this. What this does is it looks at the patient's history and it says, are they MyChart active? They'll probably do better on this. Have they used the E-check in feature in MyChart within the past seven days? Have they had a video appointment within the last three months or have they had a phone appointment? We're using phone here as a proxy for unsuccessful video appointment. All of those questions have scores associated with them, and it goes on a 0-5 model. Once you hit a four, you are in the red zone. The red zone, blood is either the centralized group or the clinic individual support model be able to say, if I only have time to make five patient phone calls and get patients setup for video visits, where should I be putting my efforts? Who is at risk for video visit failing? This is how we do it here at Hopkins, and so that the team member can quickly go on and say, okay, I need to call patient 3 and patient 10 here. They are the ones most at risk, and patient 10 has a 9:00 AM appointment, I should call them first. The 2:30 appointment I can call later in the day when I have time. This is a sample workflow of how your folks can use it. Anyone with a video risk score of 0-1, you don't need to do anything. You can assume that they're going to sail through. You can also look at it as, has the patient E-checked in? Any patient that hasn't checked in 15 minutes prior, you could send them a text saying, are you all right? This is how you do it or if you can't get into your MyChart, this is how you can join the visit from a text. Anyone who hasn't E-checked in from five minutes before, you can call them, remind them to check in. You can send them the text, this is how you do it, or you could just send them the text to the visit and allow them to check in. Again, this is just a sample. You're going to have to look at your staffing ratios, who you have available, and what's the best way for them to use something like this. Now, what's really important when you build any program, is you really want to look at what are the patient barriers that your patients are up against? Do they have language? Do they have access to Internet? Do they have the right bandwidth to do a video visit? Do they have the right devices they need? Do they have a private setting? All of these are things that you're going to need to look at, and are going to be very important because you want to, in whatever program you built, and as you get your patient's ready, you want to lessen disparity, you want to ensure that they have access, and you want to increase equity. This is so important that you look through this lens as you're building your programs, and that you're making sure that your patients are ready for their telemedicine visits.