Virtual practice refers to healthcare services that take place virtually using communications technology. Through video and audio connectivity, practitioners can meet with patients in real-time, from practically any location.
At its annual assembly in 2018, the World Health Organization (WHO) adopted a resolution on digital health, calling on governments to assess their current and potential use of digital technologies for health and on the WHO Director-General to develop a global strategy. (13)
In March 2019, a draft of the global strategy for 2020–2024 was released, (14) and this was followed by a comprehensive guideline on digital health interventions in April 2019. (15) The vision of this global strategy is to: “Improve Health for everyone, everywhere by accelerating the adoption of appropriate Digital Health”. (14)
While technologies to deliver health care through means other than face-to-face contact have been around for decades, it is only recently that integrating virtual health into care models has become increasingly important.
There are many benefits to virtual care, and they extend to all members of the healthcare continuum, including:
- Patients, who enjoy greater convenience and elimination of the need to travel for face-to-face visits
- Doctors, nurses, and caregivers, who experience more flexible schedules and improved access to patients and information
- Healthcare administrators, who can lower medical expenses and boost operational efficiency
Let’s take a look at how to extend practice into the virtual world.
Connecting with patients and being transparent about the transition to a virtual practice is always advised in the early stages of the process.
Considerations for moving your practice virtually
An important first step to consider before starting a virtual practice is to check with your professional association for specific guidance on the laws and regulations surrounding virtual health care in your practice. This includes such things as privacy and security, consent, and online prescribing.
To implement a virtual practice, the American Medical Association (AMA) recommends that you:
- Set up a team that will help implement virtual services for your practice
- Check with your malpractice insurance carrier to ensure that your policy covers virtual care
- Become familiar with payment and policy guidelines that apply to virtual practice (2)
Getting started with virtual care
Consider the steps below when getting started with virtual practice.
Obtain patient email addresses and mobile numbers
Email addresses can be used to communicate virtual care services to patients, and depending on the virtual care tool, can be useful for sending out the virtual visit URL to patients. Mobile numbers are useful to communicate with patients in case of any issues with the virtual visit, or to ensure that they are ready for their visit.
Inform patients
Patients should be made aware of what virtual care services are being provided and how these services will be communicated (e.g., email, text message, invite via specific application). Consider outlining the process of signing up for virtual care on your website, along with a list of conditions that are eligible and excluded.
Obtain patient consent
Similar to in-person visits, practitioners should obtain informed consent from the patient prior to their initial virtual appointment. While a patient’s signature is preferable, verbal consent should be obtained and documented in the patient chart at a minimum.
Update patient charts
Ensure that all interactions with patients, electronic or otherwise, are documented in the patient chart. (1)
Privacy and safety safeguards
According to the Doctors Technology Office, many safeguards regarding privacy and security should be in place before conducting virtual consults. These safeguards include the session and technology safeguards outlined below.
Session safeguards
- Always ensure that the patient is ready to have a confidential conversation. Begin the virtual consult with clear introductions and by confirming the patient’s identity.
- Conduct the virtual consult in a private space.
- Be aware of who is in the room with the patient. Establish the level of patient comfort and follow the same principles as you do for in-person visits.
- Do not leave the connection unattended and/or set on automatic call answering. Once the consult is over, disconnect from the call immediately.
Technology safeguards
- Do not use unsecured public wireless networks.
- All systems, applications, and devices should be behind the firewall with adequate anti-malware and anti-virus software installed.
- Ensure that software devices used are updated regularly as they are made available.
- Avoid recording virtual consults containing personal or clinical information unless it is absolutely necessary.
Cameras and microphones should be disabled when not in use. (9)
Workflow and tooling
Successful implementation of a virtual practice involves consideration of clinical workflows in order to seamlessly integrate virtual consults into the day-to-day organizational process. Some of the common questions and considerations are highlighted below. Below, we have outlined common considerations and questions pertaining to implementing virtual appointments.
Team engagement
Getting staff on board is key to success. Consider holding an internal meeting to discuss changes, workflow, and responsibilities. Schedule time for staff to receive training on the tools and skills they will need to support a virtual practice.
Patient FAQs
Creating an FAQ document for your patients to help them navigate virtual consults might be useful. Include things such as how to book virtual consults, technical tips, troubleshooting, and patient etiquette.
Practitioners can always video record instructions and answers to frequently asked questions.
Allowing patients to email back to the clinic
Do you currently have an email address to allow patients to communicate via email? If not, consider setting one up for this purpose.
Patient suitability
Which patients or types of visits are suitable for virtual consults? Each individual has unique needs and circumstances, and virtual consults may not be accessible to all patients. Consider putting a plan in place to address accessibility issues and provide alternative ways of communication.
Schedule planning
Consider how virtual consults will work with existing schedules. Will specific days and time slots be used for virtual consults?
Booking virtual visits
How are patients going to book virtual consults? Consider staff triaging the booking of patients for in-person or virtual consults to determine the suitability and address any accessibility issues.
Setting up the room
Do you have the essential items for virtual consults including a webcam, microphone, and speaker? Where will the EMR screen be placed in relation to the video screen? Can they both be displayed on the same screen or will you need two screens?
Virtual visit etiquette
Think about the space that the patient will view during a virtual visit. Ensure your space is clean, free of clutter, and visually pleasing for patients.
As you conduct your virtual appointments, keep in mind that you may need to clarify your actions to the patient if you are not looking at them. For example, “I’m just typing up notes on the EMR”.
Starting a virtual visit
How are consults going to begin? Does the patient need to call and check-in? Will you have a virtual waiting room or send out individual consult links? Will an office assistant contact the patient ahead of time to set up the visit for the practitioner on the computer?
Visit notes
Charting the patient encounter for video consults is very much the same as for an in-person visit. Consider standardizing a method for recording that the consult was conducted over video.
Sending documents
How are documents such as prescription, lab, and imaging requisitions going to be transferred? Does the patient need to have access to a printer?
Billing
Will your patients be paying out of pocket or will their visits be covered by an insurance provider? If their appointments are covered by insurance, determine the process for submitting claims (e.g., direct billing vs. submitted by patient). To provide a seamless experience, consider discussing payment options with patients prior to their virtual visit.
Follow-up visits
How will the patients arrange a follow-up visit? Consider booking the next appointments in advance at the end of each virtual visit to save time and help keep patients adherent. (9)
Telemedicine tools
Virtual care technologies differ from other information technology projects, such as electronic medical records. These other information systems are records of patient/provider interactions. They store data and make it available for future use in formats that assist care and health planning. Virtual care tools, on the other hand, are the actual channel by which care will occur.
There are many virtual tools that can be used to help provide the best care. Health-specific platforms are usually regulated, in that they are privacy and security compliant. More readily available applications, such as Skype, FaceTime, and Zoom Basic, on the other hand, are unregulated and do not comply with are not privacy and security requirements. (1)
EHRs can be a great tool for practitioners who want to transition their practice to a virtual practice. They offer a variety of tools to satisfy each practitioner’s needs.
Check with your existing Electronic Health Record system (EHR) vendor to see if there is telehealth functionally that can be activated. According to the AMA, if you’re introducing new technology, there are a few things to consider:
- Ensure the Health Insurance Portability and Accountability Act (HIPAA)-compliance
- Make sure you understand who can access and who owns any data collected during patient consults
- Make sure that you are clear on the pricing structure. Is there a monthly flat rate for using the technology or is it a fee per call/visit structure? (2)
Some of the popular virtual health tools used by practitioners are summarized below.
Jane
Jane is a cloud-based booking platform that helps clinics with workflow management, practice management, scheduling, billing, patient recordkeeping, and documentation. Features of this platform include:
- Claims Management
- HIPAA compliant
- EMR/EHR
- Inventory management
- Multi-office
- Multi-physician
- Patient billing
- Patient portal
- Patient records
- Patient registration
- Patient scheduling
- Physician scheduling (7)
Practice Better
Practice Better is a complete client management platform for nutritionists, dietitians, and wellness professionals. Features of this platform include:
- EMR/EHR
- HIPAA compliant
- Patient billing
- Patient portal
- Patient records
- Patient registration
- Patient scheduling (4)
Doxy.me
Doxy.me is a web-based HIPAA-compliant telemedicine system. Free for individual clinicians, features of this platform include:
- HIPAA compliant
- One-to-one messaging
- Multi-provider practice
- Video conferencing (6)
OptiMantra
OptiMantra is a practice management solution designed to help medical and wellness centers of all sizes handle clients, prepare health records, and more. Features of this platform include:
- Appointment scheduling
- Charting
- Compliance tracking
- E-prescribing
- Self-service portal (8)
Cliniko
Cliniko is a complete practice management application designed to help manage schedules, treatment notes, invoices, payments, and much more. Features of this platform include:
- Appointment reminders
- Appointment scheduling
- HIPAA compliant
- One-to-one messaging
- Multi-provider practice
- Practice management
- Video conferencing (5)
Setting up your staff
Staff will serve on the frontline, reviewing clinical data and engaging with patients. Thus, it’s important for them to understand their role and responsibilities when it comes to implementing a virtual practice.
Proper staff preparation will ensure that:
- Staff understand their key responsibilities
- New procedures are understood, correctly followed, and documented
- Data is collected, analyzed, and presented to physicians/providers in a clinically relevant manner
- Staff are prepared to impart the skills, knowledge, and mindset patients will need to be successful with the program (3)
Ensuring that staff has all the right equipment to provide virtual consults, as well as training them to understand the perspective of the care team and patient will help to ensure that they can support the clinical workflow and patients in using their remote monitoring system. (3)
The vendor of your telemedicine tool may also be able to provide or support this training. (3)
Setting up your patients
With the popularity of smartphones and video chat, many of your patients may already be familiar with the basic functions needed to conduct a virtual health care visit. However, it is still important to clearly communicate with them so they know exactly what to expect, the benefits of virtual care and how they can get started.
First things first, ensure that patients are prepared by having support staff proactively reach out to patients announcing changes in your practice.
Ensure that they’re prepared through a patient-centered initiation process. As you plan to educate patients about the program, ensure there is adequate time to set expectations, answer questions, and discuss how remote monitoring can assist them in reaching their goals. (3)
You can also advise your patients on wellness apps that help with their overall wellness and health goals.
Digital marketing
Strategies to generate more business include an effective website, easy access to virtual consults, original content, a referral network, and word of mouth.
An effective website
A good website is more than just a static home page. You’ll want to create multiple pages dedicated to different aspects of your business, such as a detailed catalog of your products or services, and a blog section for company updates. Each page should support the primary goal of the website, have a clear purpose, and include calls to action. (11)
Easy access to virtual consults
Virtual consults might be a foreign concept to some, so help people understand what working with you looks like. Include these details on your website, as a handout, or as a quick video explaining how appointments will be carried out. (10)
Original content
This includes blog posts, podcasts, videos, and social media posts to support your mission to help your patients. (11)
A referral network
Even though you’ve gone virtual, it doesn’t mean that you can’t still foster relationships with medical providers, community organizations, and other businesses where your clients might be. (11)
Word of mouth
A referral is the best compliment! Providing a great patient experience overall can not only improve patient outcomes but increase the likelihood that patients will recommend you to others who may benefit from your services. (12)
The bottom line
Extending the office across the virtual world in light of the current global health crisis is important to allow practitioners to continue to provide care and connect with patients in a meaningful way.
There’s a lot to consider when transitioning to a virtual practice. It may require changes to policies and procedures within the facility. Additionally, the facility, staff, and patients must be prepared to make the transition to virtual consults.
It’s important not to forget that the same standard of care that patients receive in face-to-face consults must also be maintained in a virtual practice.
