Using telemedicine to provide continuity of care

In response to the COVID-19 outbreak, the Centers for Medicare and Medicaid Services announced an expansion of telemedicine benefits for Medicare beneficiaries this month. Leaders from the federal government and the healthcare industry are promoting an increased use of telemedicine as a way to provide continuity of care without patients visiting a doctor’s office in person.

For healthcare providers, this means a reduction in most of the restrictions previously covering telemedicine practice. At Vital Interaction we’ve seen an immediate uptick from our clients in the use of telemedicine in their practices, including providers moving to all virtual office visits in response to COVID-19. It’s clear to us now that telemedicine will play a critical component in the future of healthcare delivery in the country as the industry continues to evolve at a rapid pace.

We urge you to consider implementing telemedicine now to engage with patients in the short term and to begin building the tools your practice needs to enhance telehealth services in the future. Not only does it offer immediate revenue generation, but telemedicine also provides additional benefits to both providers and patients.

In response to concerns we’ve heard about how to implement telemedicine and begin conducting virtual patient visits today, we offer these tips: 

• Research and select a HIPAA-compliant telehealth platform or video conferencing tool that uses simple technology compatible with any device (computer, phone, tablet). Some available options include: Zoom, Doxy.me and many many others.

• Set up your telehealth services to mirror in-patient visits as closely as possible. For example:

1. 1. Use a unique video link and/or meeting room code for each patient to protect privacy.
   2. Create a standard communications tool to invite people to join the virtual appointment (email or text with link and technology FAQs).
   3. Enable the feature to allow your provider, scribe, medical tech, etc. to control who enters and leaves the meeting room so you don’t have patient overlap. Instead, patients can join a virtual waiting room and you can add or remove them to an appointment room when you are ready.
   4. If you are super busy and use lots of rooms in your practice, consider enabling multiple rooms and allowing your staff to go in and out of the rooms as needed.  This would only be required from groups that can move almost all their appointments to telemedicine.
   5. Enable time tracking on your telemedicine platform so you can report on the time for each visit.
   6. Consider a back-up time tracking solution (outside of the telemedicine platform to ensure billing accuracy) and a virtual phone solution for those customers you need to call directly. We have used Google Voice and Dialpad. Some PBX and Virtual IP solutions may let you set up a phone at home. Doing this allows you to see how long calls last for each phone number called, without sharing a personal phone number.
   7. Understand what you need to collect payment for each telehealth visit and complete the paperwork upfront, even if it means staff calling or texting the patient beforehand.
   8. Include an emergency phone number for patients to call if the technology isn’t working for them and include that information in the appointment invitation.

• Test the technology. More than once. If you haven’t used telemedicine tools before, provide training for all team members and give them an opportunity to practice before your first patient appointment. Include in the training your plan for if the technology fails.  

• As you learn more about what works best for you and telemedicine, compile your best practices for future implementation – including procedures for what visits should always be telemedicine (like a post-op visit) and which should not. (For example, how to describe to a patient post-op what conditions they should look for to ask for an in-person visit rather than telemedicine, i.e. swelling, pain, redness). 

• If all providers aren’t ready for telemedicine in your practice, select a few guinea pigs to try it out and ask them to train the rest of your provider team in the future. Once they see how simple it is, how well patients respond to it and how much revenue it generates — they’ll be all in too.

Communicating with patients about telemedicine visits

If you’re implementing telemedicine for the first time, it’s important to get the patient communication just right. That’s where we can help! Vital Interaction’s platform makes it easy to simplify, automate and set-up patient communications that are specific to telehealth services. 

Here’s what we recommend: 

Message Cadence and Set Up – Send out a pre-appointment message that includes: 

1. 1. Basics on the technology needed to attend a virtual appointment 
   2. The best place to take the video call from your doctor (i.e. quiet, private, good internet connection)
   3. Instructions on testing the technology needed beforehand 
   4. Links to learn more about the telehealth platform or video conferencing tool you are using 

Telehealth Appointment Reminder: Send a text and an email an hour or two before the appointment that includes the link for joining the meeting, as well as the emergency contact number in case it doesn’t work.

Appointment Starting Message: Send a text and an email at the time of the appointment, with the call-in instructions, meeting link, FAQs, and emergency contact number.

Here are some sample messages:

Email (for using Zoom): “Hi {first_name}, This is a friendly reminder about your telehealth appointment scheduled with {doctor_name}. Please confirm your appointment by clicking the button below. {weekday} {month} {mday} at {time} [Cancel Confirm options] Prior to your appointment, download the zoom app on your device (laptop, tablet, or smartphone) for the best experience. Make sure you use a device with a camera, mic and strong connection. Please click the below link at your appointment time. Meeting Link: {doctor_custom_msg_1} 

If you don’t have access to a device with video, use our call-in option: Call-in number: {doctor_custom_msg_2} Meeting ID: {doctor_custom_msg_3} One tap mobile: {doctor_custom_msg_4} Please call our office at {facility_phone_formatted} if you have any questions. We appreciate your time and look forward to speaking with you soon! Sincerely, {group_name}”

Text (for using Zoom): “Hi {first_name}, This is a friendly reminder about your telehealth appointment scheduled with {doctor_name} on {weekday} {month} {mday} at {time}. Prior to your appointment, download the zoom app on your device (laptop, tablet, or smartphone) for the best experience. Make sure you use a device with a camera, mic and strong connection. Please click on the link below at your appointment time and follow prompts. 

Meeting Link: {doctor_custom_msg_1} If you don’t have access to a device with video, use our call in option: Call in number: {doctor_custom_msg_2} Meeting ID: {doctor_custom_msg_3} One tap mobile: {doctor_custom_msg_4} Please call our office at {facility_phone_formatted} if you have any questions. Please reply Y to confirm, or follow this link to cancel {vi_cancel_link}. Reply STOP for no more messages.”

Text / Email: “Hello {first_name}, You have a telehealth appointment scheduled with {doctor_name} at {time} on {small_date}. Please click on the link below AT YOUR APPOINTMENT TIME and follow prompts. {doctor_custom_msg_1} If you lose this link you can go to our website, click About Us, then click on your provider name to see the link on their page.”

Email / text (without link in message): “Tele-medicine is now available at {group_name}! All appointments and services will be Telemed through our website until further notice. Please use a device (laptop, smartphone) with a camera, mic and strong connection to enter our virtual waiting room 5 minutes before your appointment. Stay safe and see you soon!”

Text / Email (phone call appts): “{first_name}, this is a friendly reminder about your telehealth appointment with {doctor_name} at {time} on {small_date}. We will call you for your appointment, you will not need to come to the clinic. We look forward to speaking with you!”

Text/email: “Thank you for using our new telehealth option. At your scheduled appointment time at {time} on {small_date} please click on the link: {doctor_custom_msg_1} to begin your appointment. If you need to cancel your appointment please call us at {facility_phone_formatted}.”

Text / email: “{first_name}, {group name} is confirming your Telemedicine Visit on {small_date} {time} with {doctor_name}. Please use the Link below to access and sign in 1 minute prior to your appointment time. Thank you. {doctor_custom_msg_1}”

Beating Spam Folders in Text and Email

Unfortunately, links in emails and especially text messages are often considered SPAM and may be filtered out before they reach the patient. To help, we recently added new SPAM features for texts using a Short Code. While it doesn’t allow for two-way conversation, it does allow for improved delivery of links. To implement this new feature, contact support.

Provider Custom Message Automation Fields

To allow for automation of messaging, we recommend adding the following provider custom message fields in VI and in your Practice Management System:

1. 1. Unique Provider Meeting Link – www.telehealthcompany/providername/123
   2. Call-In Number
   3. Meeting ID 
   4. One-Touch Call-In Number

Adding these fields gives you the ability to create automated messages regarding telemedicine appointments.

Thinking long term about telemedicine 

The sudden uptick in telemedicine use by our client base has caused us at Vital Interaction to rethink our development roadmap and pivot quickly to adding features and new tools that support telemedicine use now and in the future. For example, we’re working on:

• Message delivery within 1 hour of an appointment – Right now the latest a message can be set for delivery is one hour prior to the appointment. We are working on implementing a real-time feature that allows messages to be delivered in near real-time, up to 5 minutes prior to an appointment.  We feel this is a critical feature to provide patients the information they need at their fingertips for virtual appointment success.

• Improved Calendar invites – This was a feature we planned on tackling this quarter, but we’re adding additional functionality to allow:

1. 1. Meeting links as part of the invite
   2. Instructions on how to call in, join and more
   3. Delivery of invites via text as well as email

• Provider messaging – This was also already under development, but was delayed for more urgent tasks. In the future, we envision being able to communicate with providers in both an automated and non-automated manner and in particular sharing links, calendar invites, call-in numbers and more with providers at or before appointment times.

• Appointment conversion – Our system already allows for automated cancellation and/or rescheduling of appointments. We envision new tools that allow in-patient visits to be converted into telemedicine visits, and vice versa as well. 

As we support the future strength of the healthcare industry and the implementation of new patient-centric technologies like telemedicine to improve outcomes, increase revenues and enhance patient care, we are proud to be on this journey with you.

If you have any questions at all about implementing telehealth in your current practice or suggestions on how we can help now or in the future, please don’t hesitate to reach out. No question is too big (or too small) for our team to tackle with you.