There is very little we can take for granted these days. In the spirit of planning for the worst and hoping for the best, let’s review the workflow for a completely virtual medical practice. The goal is to avoid sacrificing anything but co-location and in-person interaction. Admittedly, that’s a lot to sacrifice, but we’ve learned the necessity of being prepared to make this sacrifice.
By now, most practices agree that it's a good idea to embrace virtual visits (COVID-19). Let’s get to work on a solution for your practice.
What are the key aspects of the workflow we need to address?A virtual medical practice should include the following:
- Allow patients to schedule themselves
- Check patients in
- "Room" the patient, get their vitals
- Conduct the provider-patient visit
- Conduct post-visit work, check-out
- Perform ongoing care coordination and care management
Let’s look at each of these in more detail.
Schedule appointments in the virtual world
The first thing to address is how patients will schedule their appointments. Most patients know the reason for their visit, but they don’t know how to categorize the visit from a clinical perspective. Nor do they know which visits you are encouraging to be seen virtually. Is it a complete physical, an annual wellness visit, or a regular old office visit? This problem can be solved with a basic decision tree built in the front end of the patient self-scheduling solution.
With a link to "Schedule Your Visit" directly from your website, you can open up your scheduling book to patients (to some that's scary—I get it) and allow them to select the virtual visit appointment that works best for them. But just in case, if patients need help to navigate questions in the decision tree or they have an urgent issue, it's best to have your schedulers field patient calls from the safety of their homes.
The patient self-scheduling solution is not a novel idea. You may already be doing this to some extent with your telecom provider. Some practices schedule hundreds of visits a month this way – others do thousands (upwards of 10,000 per month). This is one solution you can lean on heavily in your all virtual clinic.
Virtual check-inOnce the visit is scheduled in the practice management system, the patient can join either through a link in their email or a text message. They proceed through the pre-visit flow in the virtual visits application and enter the waiting room. At this time, your front desk staff can log into the telemedicine application as a support user and join the virtual visit.
Note that support users can see and access multiple providers’ visits from one login. This flexibility allows one front desk staff member to cover all providers in the practice or just a subset based on how you want to divide up responsibilities.
Virtual face-to-face interaction between your front desk and the patient can include updating demographic and insurance information or casually talking as they would in an in-office visit. Your front desk staff can help assuage concerns and be a comfort to the patients. There’s also an opportunity to bring in an interpreter if necessary. In addition to language assistance, interpreters can help address a patient’s apprehension regarding a virtual visit.
Once the front desk staff has what they need, they can change the visit status on their own or contact the next resource in the line, such as a medical assistant or nurse.
Room the patient, get their vitalsAfter completion of the administrative work, it's time to get clinical. Because support users can access any provider schedule, one medical assistant can cover one provider or all the providers. Once they begin the virtual visit, clinical staff can review and confirm patient responses to built-in pre-visit questionnaires or clinical intake forms provided through an online instant medical history. This step offers the opportunity to record vitals taken independently by the patient or other relevant information.
Once the clinical resource has the information they need, it's time to signal the next resource in the line through message, text, email, or change the visit's status to "Ready for Provider."
Conduct the provider/patient visit
The provider joins the virtual visit. The note has been started, the pre-visit prep completed, and the patient interacts with their provider, who can upload files, send a link to patient education materials, or share screens.
With the EHR mobile app workflow, providers can see key clinical content, view schedules, capture images, and write e-prescriptions. Additionally, providers know when the patient has entered the virtual visit, can see the patient virtually, dictate their clinical note, and then get ready to see the next patient.
Post-visit and check-outOnce the provider updates the visit status to "Ready to Check-out" or "Ready for Care Manager," the last step of the visit process begins. This may be an opportunity to collect payment (if not done during check-in) or thank the patient. The rest of the work is completed practice management (PM) system or the electronic health record (EHR).
How do you get started?This workflow is basic and works well. It's essential to keep in mind that most practices are just a couple of steps away from flipping to an all virtual workflow.
It’s as simple as putting a patient self-scheduling solution in place, one that integrates with the PM system and virtual visits. Look for a virtual visit solution that allows you to leverage licenses for all of your staff—not just your providers—and leverage your mobile EHR app.