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In my last blog post, I wrote about how COVID-19 affects ambulatory practices in hard-hit regions of the country, including my own practice. One of the most profound changes, with repercussions beyond the current public health crisis, is the emergence of telehealth as the new norm for patient care. 

For many medical providers, myself included, the past few weeks have been a sudden but deep dive into a schedule chock-full of virtual visits. What has this trial by fire taught us?

Pay attention to the platform
In the early days of COVID-19, many doctors used FaceTime, Skype, Zoom,, or whatever video communication tool was readily available to treat patients—making a quick choice as the federal government loosened up regulations. Now physicians have had a bit more time to consider their telehealth platform.

What's become clearer to me are the advantages of a platform that integrates with your appointment schedule and EHR, that collects data such as duration and details of the visit and sends this data to the EHR, and that works with mobile technology. 

Physicians who plunged headlong into virtual care may come to realize that they're likely to be delivering care this way for the rest of their careers. We will be much more efficient if telehealth integrates with our practice workflow.

Assign patient intake and follow-up to staff
Another important consideration is the approach to patient intake and follow-up. During the recent, sudden initiation into virtual care, many doctors logged in to their telehealth applications and conducted the patient intake themselves—an unfamiliar process for many of us. What's more, physicians commonly devoted a good five minutes of the visit to helping the patient connect to the application. 

When the physician conducts the initial intake and takes on the work of the medical assistant, it can erode the therapeutic relationship with the patient. Statements such as, “before I tell you what I think is going on, let’s review your medications and allergies," do not build confidence in a doctor's abilities. Prep work is also a drain on physician time. 

As you expand into virtual care, develop procedures whereby staff prep virtual visits—just as staff members prep office visits in the non-virtual world. Have a staff member call 10 minutes before the visit and make sure the patient can connect to their telehealth application. The staff member then completes the usual intake that practice physicians normally would have them perform. 

Ideally, your telehealth solution should facilitate this role with a specific user type for someone who assists with the visit but doesn't bill for the visit. After the staff member does the initial call, the physician can perform the virtual visit and then hand the visit back to the staff member to schedule a follow-up appointment or help with required activity such as getting laboratory work done.

Prepare patients for their virtual visit
To lessen the risk of COVID-19 exposure, your practice may need to transition patients from scheduled in-person office visits to virtual visits. Communicate with your patients to help them through this change. Consider outreach by phone or email. Be informative, but casual. Don't make a big deal out of going virtual—it isn't. 

Advise the patient to find a quiet place with the best internet connection possible. Encourage them to double check the battery life on their desktop computer, laptop, or mobile phone shortly before the visit. Some telehealth platforms allow the patient to test their device before the visit—encourage your patients to use this feature if it's available. 

Advise patients that they may be asked to complete some paperwork upfront; for example, they may need to fill out a consent form or answer intake questions online. To do so, they may need to join the visit a few minutes early.

Encourage the patient to write down what they’d like to discuss in advance. When appropriate, ask the patient if they have access to devices to monitor their health status such as a scale, thermometer, blood pressure cuff, or blood sugar monitor. If yes, encourage the patient to take readings and write them down before the visit. 

The positive potential of virtual care
Virtual visits can be a great experience for both the physician and patient. In my next blog, I'll talk about how virtual technology can strengthen the physician-patient relationship. 

To read more, please visit the telehealth and virtual visits page on the NextGen Healthcare website. 

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Headshot of Robert L. Murray, PhD, MD, FAAFP
Robert Murry, PhD, MD, FAAFP
Chief Medical Officer
Dr. Robert (Bob) Murry joined NextGen Healthcare in July 2012 and was appointed chief medical officer in December 2021. He brings to this position more than 20 years of extensive clinical experience and background in health IT. Previously, Dr. Murry served as the company’s Chief Medical Information Officer (CMIO) since May 2017. During his time as CMIO, he was the "Voice-of-the-Physician" ac...