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Best of 2020: A Rheumatologist’s Tips: Telemedicine in 6 Easy Steps

Dec 23, 2020 12:31 pm

Editor's note: This article originally appeared March 18, 2020, and is being shared again as "Best of 2020" for your reading pleasure.

Ready for Telemedicine/Telerheumatology?

Once you and your patient agree on a virtual visit, the following suggestions may help facilitate the interaction.  If you have the ability and the capacity, record the visit. 

Step 1: Get your setup ready. 

Choose a quiet place that affords some privacy and have your computer in front of you with the patient’s chart opened.

Step 2: Connect with your patient. 

Introduce yourself and any staff present, then verify the patient’s name, date of birth.  Ask if they are by themselves and if they would like anyone to be present.

Step 3: Conduct the visit. As with any medical visit, inquire about their health/chief complaints. Ask if they have had any medication changes or new allergies. If they have a blood pressure cuff at home, have them check their own vitals and show you via the phone.  

There are free phone apps that can help to measure blood pressure, pulse, cardiac rhythms. Direct your assessments based on their chief complaint and remember the basics: LOOK (INSPECT) FOR ABNORMALITIES and EVALUATE THE FUNCTION. Unfortunately we cannot palpate or auscultate so identify other clues to help you. Examples: Patient: “Doctor, my hand hurts.” You: “Show me from your phone your hand. Now make a fist (at this time assess the MCPs for swelling and look at range of motion. Pick up a pencil and write a sentence (to assess function)." Document your findings while you assessi your patient.

Step 4: Order labs/imaging. Patients may have access to local labs and imaging centers.  If you choose to, you can have them come into your office for labs; however, these patients need to be scheduled so no one is in the waiting room and patients are spaced far in time to allow for adequate cleaning of the lab space and waiting room in between patients.  Send lab orders electronically or fax the order to the labs yourself. Some labs and imaging centers may take verbal orders, but I would discourage this due to high volume and risk for medical error.

Step 5:  Refill medications. If the patient is doing well, consider sending a 90-day supply of medication. Ask patients if the pharmacies they use deliver to their home or use the mail order option so that they can avoid having to leave home and risk exposure.  

Step 6: Ending the visit and scheduling followup. Reassure patients that they can reach you, and take time to answer their questions.  I find that this step is extremely important and will avoid multiple callbacks. Remember to follow up on any tests you have ordered and let patients know of the results. 

If you have additional hints to help with the virtual visit, please share by commenting below (Rheumatologists: please sign in to comment).

Disclosures
The author has no conflicts of interest to disclose related to this subject

Rheumatologists’ Comments

MANSOOR AHMED

| Dec 24, 2020 10:38 pm

My Suggestions:
Always try to capture a screen shot of patient's face and then patient showing problem areas, like hands, feet or a rash. It will be good for documentation and proof.

Always try to document start and end time of the visit. Some softwares do it automatically.
I always try to reinforce the significance of in- person visit and encourage patients to have the next visit as in-person for more thorough and detailed Evaluation.

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