Virtual health services could help you:
Virtual health services such as providing remote inbox management, remote nurse team support, remote consultations and pre-appointment triage are effective and safe ways to provide alternative access to care avoiding face-to-face consultations.
Setting up a remote connection from home to your PMS can be difficult and is probably something you can't do yourself these days.
Use a professional - contact xcrania on 0800 XCRANIA (927 2642) or firstname.lastname@example.org, or your IT provider, set up a unique login and be really mindful of keeping this secure.
Video-conferencing software on your mobile phone may seem enough, especially if you have an unlimited data plan, but we need to be careful about security.
The New Zealand standards for health services are complex and legion. The New Zealand telehealth forum has lots of great information to help.
Services like doxy.me, Vsee and Zoom for Healthcare meet US standards for encryption and security, but this level of security is not necessary here. Many DHBs and PHOs are using Zoom "pro" accounts to host meetings and this provides an acceptable common standard, especially when hosted from an otherwise secure a computer system.
(The Clinic and Professional (paid) versions of doxy.me use Stripe as their payment gateway to process credit card transactions. Stripe charges 2.9% + $0.30 per transaction. Here is some further information on the doxy.me payment functionality. This YouTube video really simply explains the Stripe/Doxy set up and integration.)
Your practice management system already has the ability to
link video-conferencing between a patient portal and clinical staff. Get your
PMS to switch this on.
There is so much you can do from home once you are connected it can be tempting to just try and see patients. This is fine, but it may not be the most useful thing you can do to simply replicate the same thing you've always done.
Ask you team how you can be most helpful.
You could reduce demand by doing phone triage, manage need by seeing patients with or without a nurse in support, or free up colleague's time by dealing with inbox messages and tasks.
If you are new to virtual health, start small and review what you do regularly. Being there for your clinic team may be enough. Whilst you are online checking results, having you available for a quick question or debrief can be hugely supportive for your clinic staff.
If you haven't seen the BBC interview where the US diplomat's three-year old daughter interrupts his interview - watch it now! Think about your setup at home and don't let this happen!
When I first thought about virtual health I thought I would be sitting on the beach, or at a café - of course this is totally inappropriate and likely to lead to complaint - not only from your patient, but also anyone who happens to look over your shoulder and realises what you are doing. We have taken huge pride in keeping health information confidential, now is not the time to show open notes with everyone in Starbucks.
You can't assume the patient can see and hear you because you can see and hear them. Have a trial run, ideally see yourself as the patient will see you, if it's unpleasant get the setup right.
You are an expert communicator and know that making eye contact helps connection, facial expression is a vital element of the consultation, for both you and the patient. The ideal is to have the patient record on the same screen as the video.
If you have to look away from the patient to see their records, tell them what you are doing so they know that when the main bit of you they can see is your ear that you are not staring out of the window.
This is an unusual setting for a consultation and it's good to be explicit about the expectations and limitations of the system and check that the patient is OK.
My video consultations usually start with me introducing myself and explaining "I am working from home, I can see your records, but when I look at them I need to look sideways, I can see and hear you clearly - can you see and hear me ok ? I know this is an unusual way of seeing a doctor, I won't be able to examine you myself, but the nurse there will be able to help us. Are you OK with going ahead?"
Make remote working as much like working in your office as possible. You have a pattern to the way your work that keeps you thorough, and the patient safe.
Whilst you can cope with a different look and feel to the PMS on a smaller screen, even small changes can alter the way you use the system, fiddle with the display settings to get this right.
Regulation and case law is going to take a while to catch up with virtual health. Patients are going to remember this interaction and if anything goes wrong they are more likely to raise a complaint or ask for an explanation because it has been an unusual process.
Be diligent in pre consultation - check recent records, past medical history, medication lists and allergies really carefully.
Record everything. When you are dealing with tasks make sure you record in the body of the notes what you have done, why you have done it and what actions are to be taken.
Write complete clinical notes - detail using the patient's own words why they are consulting you, what their fears, ideas and expectations are, who was in the room, what examination took place, how easily you could see, what was agreed as a plan for management or tests, and your agreed safety netting.
If you are actually sick, get well. Just because you can work from home doesn't mean you should! Read a novel, write a poem, plant a few trees, play with your kids, just rest up! Being kind to yourself is essential professional development.
Computers are great tools, but knowing when not to turn them on is a vital part of learning to use them.
Being available to see patients alongside one of the other staff members is a massive opportunity to learn from each other, and for the patient to benefit from an interprofessional shared consultation - they get both the care and the cure.
With virtual health in your skill set you can support people doing home visits, see patients when they are overseas or start to manage multiple clinical sites.
The HCH collaborative are sharing resources to all practices as part of it's response to COVID-19.
Please see our webpage: New Zealand ePrescription service - information for general practices for more details on how to get set up for ePrescribing and signature exempt prescriptions.