Conducting a Telehealth Session 

On the day

Make sure in advance that: All appointments have been confirmed

All written material and test results are collated and ready

A “do not disturb sign” at hand

The patient has received information on Telehealth consultation

The patient has given consent (verbal or written)

The room and equipment are set up – enough chairs, camera angle and sound tested

You know how you will take notes

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You need an appropriate field of view: wide enough to show all the people and close enough so the view can see faces clearly

Chair placement

Camera placement

Zoom

Ensure people fill the screen not the surrounding room

The View through the Camera

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Lighting and Contrast The room needs to be well lit. Normal room lighting will often

do. If extra light is needed, bounce light off the wall onto the

patient and clinician. Don’t shine it in their faces.

Good lighting Too dark due to back light Too bright Uneven lighting

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Lighting and Contrast (continued)

Contrast between a patient’s complexion and clothing colour might affect the clarity of pictures.

White clothes/dark skin or black clothes white skin - might be difficult to see facial features. Sit the patient closer to the camera.

Simple backgrounds and plain clothes require less bandwidth to transmit.

  Three good examples of plain backgrounds and clothing

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Sound

Microphones aren’t good at filtering out sounds (fan, air conditioning, traffic)

Don’t rustle papers near the microphone

Speak clearly and at reasonable volume and ask the person at the other end if the volume is right

Remember the need for privacy

 

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Getting organised for the consultation

Have the patient in the room and ready 10 minutes early

Check:

The camera angle and chair placement – consider if eye contact is appropriate for your patient – make sure the specialist knows what is appropriate

Any patient worries related to the room or screen image (address these)

Any other worries - discuss and address

The video quality and lighting

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Doing the consultationThe technology The technology is working nicely – all checked at the beginning

Picture of patient and clinician on screen? Check view occasionally

The people

Confirm you have the right person on the other end. They need to confirm that you are the right person

Introductions

One person at a time – proceed as usual

Short time delay

Body language – less obvious over video8

Doing the consultation (continued)

Physical examination The clinician with the patient will need to do this – best

discussed before the session begins

Develop protocols for particular types of consultations

Around 10% of Telehealth consultations need an a follow up due to the limitations of ability to do physical examinations

Finishing up

Make sure you both know who is doing what – tests, scripts, follow-up

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Doing the consultation (continued)

Feeling awkward

May feel quite “intense” due to extra concentration required

Might be disconcerting seeing yourself on-screen. (Also for the patient.)

Practice with friends/family/colleagues on Skype to begin with

Remember that patients are generally very positive about their Telehealth consultations (higher than clinicians). The patient is probably feeling better than you about it.

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After the consultationPatient evaluation It is important to find out how the patient felt about the session – use

a standard form to allow comparison between responses over time and to compare to other patient’s experiences.

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After the consultation (continued)

Billing and follow-up

Bill the patient in the same way as for any other service

Next appointment?

Prescriptions?

Tests?

Trouble shooting

Two common problems are:

1. Failure to get started

2. Poor quality picture or sound or call failure

Solutions: Check everything is plugged in – cables connected

Try restarting

Use a speaker phone for the sound to improve overall picture and sound quality

Adjust the frame rate down to about 12 per second

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 http://www.rrmeo.com/misc_files/acrrm/acrrm_video/morayfield_consult.mp4

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An example of a video consultation

Questions and discussion

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