Tip-top telehealth: Medical providers offer guidance for smoother virtual visits

Nearly 10 months into a pandemic, telehealth is one medical pathway that adapted and advanced into more of a norm for routine wellness visits. Also during that span, health care providers are doing more to offer guidance so the virtual encounters can be more efficient and less intimidating.

Dr. Caitlin Allen, a Spokane primary care physician, estimates about 50% of her patient visits weekly still are secured telehealth video appointments. It was about 80% of total patient visits in the spring. Allen is a clinic director for telemedicine and based at the Spokane Teaching Health Clinic operated by Providence.

“Before the pandemic, medicine was headed toward telehealth and trying to increase telehealth access not only for rural communities but also certain specialties,” said Allen, describing how COVID-19-related precautions accelerated virtual options in the medical world. “This has pushed the train forward a lot faster.”

As such, more dollars came from Medicare to pay providers for telehealth visits and boost secured technology, she said. Many of her patients have preferred continuing with telehealth doctor appointments, either for convenience because a medical need is routine, or they have a high-risk for COVID-19 complications, so it’s better to stay home.

Overall, she agreed there are several tips for smoother virtual encounters, and various health organizations often offer a list of telehealth how-to’s. Topping her list, Allen said people should spend time ahead of a virtual appointment making sure their technology and ability to access links or apps are working.

For some who need extra support, she said clinic staff are trained to walk people through the steps. “What I think has helped my patients be successful is if they’re prepared with their technology ahead of time,” Allen said. “I know for Providence, they have to download the applications, one of which is Zoom, and know how to access appropriate links … and to access some things through their portal, MyChart, which is what we use for them to view lab or imaging results.”

Here’s a roundup of other virtual preparations:

Review the technology. You will need a stable internet connection. Use Wi-Fi at home or a secure connection. Don’t use public Wi-Fi. Another suggestion Allen has is to make sure another household member isn’t streaming at the same time as an appointment if you share Wi-Fi.

Use a device with camera, microphone and speakers. If you use a desktop computer or laptop, you’ll need a built-in camera and microphone. You can use a web camera plug-in and headphones. Download any apps in advance.

“For some patients who perhaps haven’t had a ton of experience with technology or Zoom, it might help to have a friend or family member who can help them set that up well ahead of the appointment time,” Allen said.

Optimize audio. Using headphones or earbuds will help you hear more clearly, plus it provides privacy if others are around you. “We even suggest practicing and making sure your mic is working,” Allen added. “We encourage using a headset or some kind of earbuds only because it helps with privacy, and then also it helps with sound quality so the provider and patient can hear more clearly.”

Check with insurance. Although many private insurers have broadened coverage for telehealth appointments, it’s recommended to check with your providers beforehand to see what is allowed. Medicare also has expanded its coverage for telehealth visits.

Choose a quiet, well-lit location. This will help your health care provider to see your face and any physical issues you want to bring up. Allen suggested that people sit in a quiet room with a door closed to minimize distractions or interruptions.

Prepare questions and priorities. As you might do for an in-person appointment, make a list ahead of time of questions or issues you want to discuss. Think of what is your main priority for the visit.

Have your records and history ready. Have handy a list of medications and supplements you take and any health history needed during the appointment. If relevant, take your temperature, blood pressure or blood glucose level so you can discuss your latest reading. Record those numbers and weight before the meeting. Have note paper so you can write down the provider’s recommendations.

Allen said her medical assistant calls ahead of telehealth appointments to gather data. As another advantage of telehealth, she said patients sometimes show her their medicine bottles. “When they’re at home, I’m happy because they can often say, ‘Hold on, let me go get that medicine out of the cabinet,’ and then I can look at the bottle. That’s a huge advantage from when they’re here at the clinic and we’re just guessing.”

Understand security. Providers use secured portals with patients. Providence has a dedicated, secure portal for patient visits through Zoom. Enhanced security steps include encryption, meeting IDs and visit “verification” to ensure a telehealth visit is private and secure. Providers are assigned passwords and waiting rooms that admit only the provider and patient.

Consider wider telehealth uses. Health care providers are doing more with telehealth, ranging from support for anxiety to checking on a rash. “I do an amazing amount of diabetic care, high blood pressure care, medication management, support for anxiety, depression and mental health,” Allen said. “I can’t reach through the screen and listen to a heart or lungs,” so patients with a severe cough or shortness of breath are encouraged to go to an emergency room, she added.

She also does much follow-up care via telehealth, along with visits for ear aches, colds and sinus symptoms. “Even just through discussing their symptoms, we can provide a fairly accurate diagnosis or direct to care if needed for further evaluation.”

For a quick guide on the overall process, Providence also offers an introductory video.