Planning your telehealth workflow
Delivering care using telehealth requires changes to your workflow for delivering care in person. Several processes may be impacted, including scheduling, billing, check-in, appointment structure, triage, consent, and documentation. Establishing a telehealth workflow will increase efficiency and satisfaction for you and your patients.
Changes to your workflow will depend on the telehealth vendor you choose, your practice size and setting, your patient population, and the services you provide. Electronic health records (EHR) should be easy to merge with your telehealth workflow.
Preparing for telehealth visits
Before offering telehealth services, the following factors should be considered:
- Will you need additional staff or new roles, such as a telehealth coordinator and IT lead?
- How will staff roles change, such as with front desk personnel and patient intake?
- Are staff comfortable using technology?
- Are staff ready and committed to providing care with telehealth?
- How will you prepare and train your current health care team?
- Is your technology platform easy to use? Does it integrate with the EHR?
- Does the technology platform provide any training for providers?
- What are some challenges that should be considered in advance?
- How will patients access a telehealth appointment (for example, through a patient portal)? Will they receive an email or text reminder?
- What are some of the technology barriers patients are likely to encounter? How will you assist them?
- When will you offer telehealth appointments (for example, specific days of the week or daily)?
- Will patients schedule online or by calling your office?
- How will you determine if a telehealth appointment is appropriate?
- How and when will you send appointment reminders?
Meeting patient needs
- How will you determine what accommodations the patient might need?
- How and when will you send appointment reminders to patients?
- How will you support patients who do not speak fluent English?
- How will you support patients with disabilities, such as hearing loss or visual impairment?
- How will you support a caregiver, translator, or other people who will assist a patient during the telehealth visit?
Telehealth can improve equity and access for underserved patients.
Tip: Do a telehealth practice run with a co-worker first.
Conducting telehealth visits
A telehealth visit may feel very different to a patient, especially patients with limited experience using technology. The following steps will improve the experience for both you and the patient.
Before the Visit
- Reminder: Send your patient an appointment reminder (for example, email, text, phone call).
- Information: Provide the patient with guidance on how to use the technology (for example, handout or pre-recorded video link).
- Paperwork: Ask the patient to fill out forms online (for example, the reason for the visit, insurance information, symptoms, medical history).
Note: if the patient is not comfortable entering this information electronically, a staff member can collect this information before the visit starts.
- Technology: Have a staff member walk the patient through the technology and logistics (for example, speakers and audio volume, camera, lighting).
- Troubleshooting: Make sure the patient has information on how to address possible technical issues and what to do if the technology issues continue (for example, using audio only).
- Legal Considerations: Make sure the patient consents to have a telehealth visit and answer any questions about the privacy and security of their data including HIPAA.
- Accommodations: If the patient requires accommodations such as a translator, or other supports like closed captioning, make sure these features are operational and the patient feels comfortable.
- Privacy: Ask the patient to find a place that is quiet and private.
Conducting the Visit
- Confirmation: Verify the patient’s identity and the reason for the visit.
- Intake: Have a staff member review and collect information, such as identity verification, symptoms, medical history, and vitals (if appropriate).
- Engage the patient: Keep the visit similar to an in-person visit using friendly body language, interactive dialogue, and eye contact.
- View the patient and information at the same time: Consider using a split screen with a view of the patient on one side and medical information on the other side.
Follow up after telehealth visits
- Documentation: Document that this was a telehealth visit. Use telehealth-specific billing codes or a modifier to the billing code when submitting for reimbursement.
- Evaluation: Collect information from the patient on their experience using telehealth and suggestions for improving future telehealth visits.
Telehealth can be used as a bridge between in-person appointments. Some care requires an in person visit; however, integrating in-office visits with telehealth can support care management.
Tips for expanding your telehealth program
As you increase your use of telehealth, consider other ways that technology can be used help improve the care you provide.
- Remote patient monitoring
- Additional services offered through telehealth
- Improvements based on an evaluation of your telehealth services
- Plan Your Telehealth Workflow: a tip sheet to make telehealth part of your practice (PDF) — from the Health Resources and Services Administration (HRSA)
- Digital Health Implementation Playbook Step 7: Designing the Workflow (PDF) — from the American Medical Association
- Telehealth Workflow Flowchart — from the National Consortium of Telehealth Resource Centers
- Sample Consent to Participate in a Telemedicine Consultation – from the Upper Midwest Telehealth Resource Center