When the COVID-19 pandemic hit, providers were forced to rethink how they would deliver care to their patients. With stay at home orders, hospitals at capacity, and patients fearing for their safety, in-person visits were largely out of the question.
Virtual visits quickly become a key pillar of care delivery. For some, virtual visits were a new strategy. For others, virtual visits had always been an essential component of their care delivery model.
During the Vision to Virtual Conference, Kim Putnam, Telehealth Supervisor at ProMedica Home Care, and Mandy Johnson, Care Coordination Post Acute Senior Manager at Banner Health, spoke about how their organizations are leveraging virtual visits to achieve the ultimate goals of patient engagement and behavioral modification. Both programs offered telehealth and virtual visits much before the pandemic rocked the nation, but with the added pressures caused by the pandemic, were forced to double down on their virtual visit strategy to ensure their patients were able to receive robust, quality care at home during the public health emergency (PHE).
Putnam and Johnson focused mostly on actionable best practices, six of which are highlighted below.
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Lessons from the Session: 6 Virtual Visit Best Practices to Consider
1. Set Up a Telehealth Hub
Putnam recommends setting up a “telehealth hub,” or a central location in the office specifically devoted to virtual visits. This approach helps ensure video visits occur in a private and professional space, while minimizing background noise and allowing the telehealth nurse to focus solely on the patient and the virtual visit. At one ProMedica location, the telehealth hub is located in a back area that is walled off from the main office - a determined quiet zone. 
2. Educate the Virtual Visit Team
Putnam emphasized the importance of educating the telehealth team. Clinicians new to telehealth should set aside time to practice using the telehealth equipment. Putnam’s team completes mock visits “over and over,” to ensure that once on a virtual visit with a patient, everything goes smoothly, and the nurse feels comfortable and confident. Putnam has found that her staff is often intimidated at first, fumbling with the equipment, but that once they get comfortable with the process, the anxiety fades.
Johnson expanded on the topic, discussing how her team at Banner uses telehealth champions to educate the larger team - “I work with a few individuals who were very eager to try the video visits. What we do is we take those champions, we get them comfortable, they do their first visit, then they teach their peers.” This model has worked well for Johnson’s team. The champions learn what works, what doesn’t, the barriers, and shares those insights with their peers.
3. Focus on Webside Manner
Putnam stressed the importance of calling the patient by their name, of focusing on webside manner. During the virtual visit, the clinician should treat the patient as they would if they were with the patient in person (look the patient in the eyes, ensure there's no disruptions, talk slowly and confidently). The nurse must give the patient their undivided attention, listen actively, and allow the patient to voice their concerns fully. According to Putnam, the most important goal of the virtual visit must be that the patient voices all of their concerns and gets all of their questions answered - what needs to be reviewed from the providers’ side should be second priority.
4. Use a Scripted Outline During the First Visit
During the first virtual visit, Putnam’s team uses a scripted outline that covers essential “housekeeping” items and essential components for the telehealth program. This includes a welcome message, an explanation of how the equipment works, as well as an encouraging conversation about having patience with the technology - to the patient, Putnam says “let me tell you please don’t let [the equipment] intimate you, give yourself 3-5 days of getting into a routine, of utilizing the equipment. I assure them they can’t hurt the equipment, they can’t break it, unless they throw it out the window...this usually gets a little bit of a smile or a grin and puts them at ease.”
Putting the patient at ease during the initial virtual visit is essential. They are often intimidated by the technology, “a dear in headlights,” but by emphasizing the importance of patience and that acknowledging that there is a learning curve, patients feel more at ease.
5. Leverage Patient Education Tools
ProMedica puts a large focus on patient education during virtual visits. During the first virtual visit, the telehealth nurse reviews with the patient their discharge criteria, as well as the zone tools and what each zone means. The telehealth nurse reviews with the patient how ProMedica can help with each zone to ensure the patient’s symptoms are controlled and they do not return to the hospital.
At Banner Home Care, education during virtual visits is equally as important. Johnson discusses how her team leverages virtual visits after in-person visits to follow up on what was discussed in person. Patients undergoing physical therapy for example, are able to review their exercises with their clinician via virtual visits, ask questions, and troubleshoot any issues that have arisen.
6. Schedule the Virtual Visit into the Plan of Care
Banner Home Care has found success in scheduling virtual visits into the patient’s plan of care. This helps Banner provide best practices and see if they’re making a difference with the virtual visits. Patients appreciate knowing when a visit is occurring and being able to plan accordingly. Additionally, staff can plan accordingly and prepare in advance for each visit, and ensure they’re in a private, secure, setting for the virtual visit.
The 6 best practices above are essential to consider when standing up or expanding a virtual visit strategy. Throughout the session, both Putnam and Johnson focused on the value of virtual visits for patient engagement and ultimately behavioral modification. The goal behind virtual visits should be to equip patients with the tools they need to self manage their condition - to feel comfortable and safe managing their condition at home. The role of the provider is to support the patient, to help them feel at ease with the technology, and to be a sounding board and trusted resource for any concerns.
Putnam ends the session with a challenge - “I'm going to challenge ourselves, our leadership, in redefining healthcare by focusing on healthy aging and wellbeing. How do our patients, especially those with chronic disease, how do they want to manage that end of life care? The real key is making sure we’re giving patients the right care, at the right time, in the right setting.”
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