The current COVID-19 pandemic has negatively impacted all healthcare systems. This disease has touched not only major hospitals but also small clinics and private practices.
While telemedicine has been in development for a few years now, the use of digital tools to care for our patients remotely has increased exponentially since 2019.
Many primary care physicians, nurses and specialists have found it urgent to start remote consultations by digital tools such as Telegram, Zoom or other platforms. Given the suddenness, it becomes crucial to guide online consultations to achieve the change successfully, offering a quality service practical for both the physician and the patient.
FIRST LET’S IDENTIFY!
As physicians and/or allied health practitioners, we need to ask ourselves three questions:
- For which patient do we want to create the online consultation?
- Do we want to move all face-to-face consultations to online consultations or only a particular one?
- Our goal with the online consultation is to free up schedules, use telemedicine as a supplement, or serve only a group of patients?
Each question will allow us to identify the patient group, the goal of the online consultation and the problem we seek to solve with this consultation.
Write everything down on a piece of paper or a file and move on to the next step.
CREATE A WORK PLAN
The schedule will serve as a service protocol. The work team must answer questions such as: Will the agenda alternate between face-to-face and non-face-to-face visits, or will it be a single non-face-to-face one?
Once set, you should draw up the timetable. It would be best if you defined whether there will be an auxiliary or assistant staff or not, whether the service will rotate among the physicians or whether it will be exclusive to a single professional.
DON’T FORGET ABOUT COMMUNICATION
This step consists of choosing which type of platform you will use for the remote consultation. For this, we must take into account three communication forms: synchronous audio and video services (real-time communication between doctor-patient), asynchronous services (time-delayed care between doctor-patient) and telemonitoring.
Synchronous is real-time communication. In consultations that require conversations as the basis for treatment, synchrony is the ideal way.
Asynchronous (time-delayed) care may be a better tool for pediatric cases, such as simple question forms for parents or supplement to synchronous audiovisual consultations. Asynchronous communication is done through apps or websites and improves organization freeing up schedules.
On the other hand, telemonitoring involves real-time assessment of a patient’s clinical status, either through direct video monitoring or through real-time remote monitoring of health parameters such as blood pressure, heart electrical activity, heart rate, glycemia, or imaging studies. It is ideal in intensive care.
DEFINE THE PLACE OF CONSULTATION
Although many people think that doctors should do online consultations at any time and in any place, the most professional idea is to define the area where they will take place. It can be at home or at the clinic itself.
The place selection should depend on the needs and conveniences of the work team. Still, according to international guidelines, private spaces are recommended, without noise and free of interruptions.
CHOOSING THE TECHNOLOGICAL PLATFORM
After choosing the type of communication and the online consultation goals, the first step to implement any software is to become familiar with the systems available in the market. The most popular option now is the purchase option, where a monthly payment is made to use a platform designed by specialized companies for physicians.
COUNT ON THE RIGHT DEVICES
For a remote consultation, you will need a smartphone, tablet or computer, either laptop or desktop (if it does not have a built-in camera, you will need a camera), headset (if necessary) and microphone.
A stable infrastructure that facilitates high bandwidths (good internet) and service stability over time for better consultation is recommended. The best option is Fiber to The Home (FTTH) or in the facility and 5G technology.
Direct wired connections between the device (laptop or computer) and the router are also recommended, and no WiFi (it can slow down the transmission).
You must consider all these factors to ensure that the service is efficient for the staff and provide maximum patient care.
STAFF TRAINING
This step is crucial because the success of the online service depends on it. If there is no instruction to the staff and the patient after all the planning, the consultation can fail.
For this, you must take into account the following considerations:
- Please, involve the staff. This is imperative. Many employees do not have a good grasp of technology, and many are new to smart devices. If the staff is involved initially, they are more likely to support the process and ensure no errors in the service execution.
- Non-face-to-face patient care. Online consultation is not the same as remote consultation in terms of care. There are certain limitations that healthcare workers must learn to control. For example, online patient care must be explanatory (since for the patient, the online consultation is something new), very polite and always empathetic.
INVOLVING THE PATIENT
Suppose you still offer face-to-face care and will be starting online consultations soon. In that case, it is ideal that you place informative signs in your office or inform all your patients about the upcoming change, so your patients will get used to the terms and how to handle the platform.
If, on the other hand, you have already made the switch, but your patients are not yet familiar with the online consultation, you can create training videos for patients, info graphics or patient guides on how to use the platform, what services you offer, and how to start the first consultation, practically and simply, without technicalities.
SET-UP OF SPACES AND PRE-TESTS
Make sure the lighting, furniture, verify connections and equipment operation to start the first tests. If, after the first tests, you detect errors or inconveniences in the process, modify the structure of the failing areas and continue with the system monitoring.
We recommend baby steps first: start with realistic goals such as offering a single service and gradually expanding the range of services according to your needs.
REFERENCES
1. American Medical Association. (n.d.). AMA Telehealth quick guide. Retrieved May 19, 2021, from Ama-assn.org website: https://www.ama-assn.org/practice-management/digital/ama-telehealth-quick-guide
2. CDC. (2021, April 19). Using telehealth to expand access to essential health services during the COVID-19 pandemic. Retrieved May 19, 2021, from Cdc.gov website: https://www.cdc.gov/coronavirus/2019-ncov/hcp/telehealth.html
3. England, N. H. S. (2020). Using Online Consultations In Primary Care. Implementation Toolkit. https://www.england.nhs.uk/wp-content/uploads/2020/01/online-consultations-implementation-toolkit-v1.1-updated.pdf.
4. Hussain, A., Shah, S., Dave, S., Ramkisson, R., & Quadri, M. F. A. (2020). Remote consultations: The new norm. Sushruta Journal of Health Policy & Opinion, 13(2). doi:10.38192/13.2.11
