Telemedicine Tips

Hello and welcome to my newest installment with HippoEducation! You guys are used to my weekly Urgent care blogs from last year, which covered HippoEd's CME course Urgent Care Bootcamp. We had a great response so I'm happy to be back with these. 

These will focus on HippoEd's urgent care rap, which is a monthly podcast which usually has 12-14 chapters and runs about 3 hours. I usually listen to chapters/episodes while driving. UC rap is available via subscription ($195/year). As always there is absolutely no pressure to buy, in my collaboration with HippoEd, all my blogs are free & will provide snippets of episodes. 

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With COVID19, we saw a rise in telemedicine visits. If you're like me, telemedicine is something we didn't quite go over in school. How do I document? What do I include? What happens if I hav to transfer? Had some help from my job but was left figuring a lot of these things on my own. I found this episode so helpful so below are some tips & tricks from HippoEd's UC podcast:

Logistics

• Physical set up—ensure a quiet/professional ambiance and a strong internet connection
• Dress from head to toe--no PJ bottoms
• During telemedicine visits, you lose the personal connection of a physical exam so you have to ensure that the patient sees your facial expressions. Look towards camera, remember that at times the patient's picture is off to one side 

 
Physical exam/encounter:

• Ensure a HIPPA complaint space (both you and the patient)—if there is someone in the patient’s background, gather information on their relationship toward patient (spouse/mother/father/friend/sibling) and whether patient is comfortable with this person being able to listen. Gather information on the patient’s setting--home/work/etc (you may want to document this)
• If using a peripheral device—mobile stethoscope/otoscope—set up device beforehand & send instructions. Questions to ask yourself: is this patient an appropriate candidate for it? (is he/she tech savvy? Or will it produce more of a burden?)
• Introductions: introduce yourself & title, ask for the patient’s name/DOB, and which state they are currently in. The last question is important because you want to be sure that you are seeing a patient in a state that you are licensed in!
• Know that there will be a lot of instructions & prompting patient how to perform an exam—verbal cues & communication are important. Remember that you can also demonstrate how to do a physical exam
• Similar to regular physical exam, you will be gathering a lot of information from the first moments of the encounter—is patient WNWD? In apparent distress? mentally stable? A&O? Tachypneic? Document these
• If you do not trust what you are seeing, know you can always escalate it to a higher acuity setting—have them visit UC/ER

Documentation:

• Establish rapport and a sense of connection with the patient—try not to document during the visit—the clicking of the keyboard may be a sense of distraction and you want to be an active listener/communicator
• Your note should include if it was audio/visual or audio only as well as a description of the quality of connection (good, poor, several interruptions during encounter, or if unable to view rash/joint/etc due to quality)
• Document descriptions according to patient: e.g. patient reports tenderness when palpating xyz, reports rash is erythematous with irregular borders
• Informed consent—document that patient realizes this is a telemedicine visit & limitation associated with it
• Document if patient is being transferred to a higher level of care
• Recap of symptoms, observations, diagnoses, patient education

Emergencies happen:

• This is where asking which state/knowing which setting they're in is crucial
• Continue talking with patient until 911/EMT shows up, continue with assessment, wait for an official hand off to EMS
• Ask if there is an emergency contact you can reach out to

See you all next week!