Download: Viva Care MD Telehealth Consultation Guide

Introduction

Traditional delivery of primary care takes place in a face-to-face transaction between provider and patient. In telehealth, however, the transaction is ‘filtered’ by the distance and technology. The potential problem of filtered communication in a telehealth encounter was examined from a human factors perspective. Patients with and without experience of telehealth, and providers who had experience of telehealth, were asked about patient-provider relationships in interviews and focus groups.

Seven themes emerged: initial impressions, style of questions, field of view, physical interaction, social talk, control of encounter and ancillary services.

This suggests that communication can be improved and better patient-provider relationships can be developed in a primary care telehealth encounter if attention is paid to four areas of the interaction:

  • Verbal,
  • Non-verbal,
  • Relational and actions/transactional.
  • The human factors dimension of telehealth is an important element in delivery of health care at a distance – and is one of few factors over which the provider has direct control.

Every Physician has their own style of delivering patient care, though with Telehealth there are few factors to consider. Please follow the suggested communication guide for you Telehealth consultations.

Visit Encounters

The below are recommendations on how to conduct a telehealth visit.

  1. Suggestions to Begin Consultation (MOA)
  2. Ask patient to clearly say their:
  3. Name
  4. Date of Birth
  5. Ask patient for reason of visit
  6. During Consultation (Physician)
  7. Physicians behavior should encourage patient participation
  8. Ask open ended questions, ensuring and confirming patient comprehension
  9. Request patient’s opinion
  10. Make statement of concern agreement and approval

These practices will give patient peace of mind and a sense of welcome and encouragement to come back for a Telehealth visit.

CMPA Telehealth Challenges and Obligations

Telehealth is becoming increasingly common as a healthcare delivery vehicle. For at least some aspects of patient care, physicians and patients need not be at the same location any more.

Canada is among the world leaders in telehealth. Canada Health Infoway reports that, in 2010, there were approximately 260,000 telehealth events in Canada.1

  1. Privacy and information security

Physicians have both an ethical and legal obligation to keep their patients’ personal health information confidential. The Canadian Medical Association’s Code of Ethics requires physicians to “protect the personal health information of their patients.” In addition, privacy legislation applicable in every province and territory generally stipulates that personal information cannot be collected, used, or disclosed unless the individual has provided consent or the activity is otherwise permitted by law. When providing telehealth services across provinces and territories, physicians will want to take appropriate steps to comply with the privacy legislation applicable in each jurisdiction.

Physicians would be prudent to confirm to the extent possible, that both the patient and the physician are in physical settings that are appropriate for the encounter and permit the patient to share personal information in a reasonably private manner.

Physicians should be satisfied that reasonable security protocols are in place to adequately protect patient information being transmitted via electronic means, such as electronic messaging or video conferencing platforms. Most reputable telehealth service providers recognize the importance of information security and employ a variety of protection mechanisms such as passwords, firewalls, and encryption to minimize the risk of unauthorized access to patient data. Physicians should confirm that the telehealth service provider has appropriate security measures in place before engaging a particular company.

Physicians who want to record telehealth encounters should obtain the patient’s consent to record, and confirm whether the patient understands the intended use of the recording. The consent discussion should be noted in the patient’s medical record. Like all patient information, the recording must be stored in a secure manner.

  1. Patient Consent in Telehealth

As with any medical care, patients must receive adequate information about the benefits and risks of the proposed treatment so they may provide their informed consent. Telehealth may present additional challenges in this regard. Consequently, it may be prudent to also request that the patient read and accept standard terms and conditions for the telehealth service. Regardless of the mode used to communicate this information the consent and any related discussions with the patent should be noted in the patient’s medical record.

 

III. Practices on Prescriptions and Renewals  

  1. Exercise caution when providing prescriptions or other treatment recommendations to patients whom they have not personally examined.
  2. Not to prescribe narcotic or other controlled medications to patients whom they have not personally examined or with whom they do not have a longitudinal treating relationship unless they are in direct communication with another licensed healthcare practitioner who has examined the patient.

 

  1. Protocol for Prescription or Requisitions:
  2. Physician is done with consultation
  3. Complete patient chart
  4. Physician prints out prescription or requisition and signs
  5. MOA faxes or emails prescription or requisition to designated location

 

 

  1. Telehealth Service with Direct Interactive Video Link with the Patient Fee Codes

 

P13036 Telehealth GP in-office Consultation …………………………………………………….. 80.37

 

P13037 Telehealth GP in-office Visit ………………………………………………………………… 33.56

 

P13038 Telehealth GP in-office individual counseling for a prolonged visit for

(Minimum time per visit – 20 minutes) ……………………………………………………………. 57.42

 

Note: MSP will pay for up to four (4) such visits per patient per year

(see Preamble D. 3. 3.)

 

Telehealth GP in-office Group Counseling

 

For groups of two or more patients

P13041 – First full hour ………………………………………………………………………………… 84.75

 

P13042 – Second hour, per . hour or major portion thereof ……………………………… 42.41

 

P13016 Telehealth GP out-of-office Consultation …………………………………………. 106.92

 

P13017 Telehealth GP out-of-office Visit ……………………………………………………….. 40.31

 

P13018 Telehealth GP out-of-office Individual counseling for a prolonged visit for

counseling (minimum time per visit – 20 minutes) …………………………………………. 73.87

 

Note: MSP will pay for up to four (4) such visits per patient per year

(see Preamble D. 3. 3.)

 

Telehealth GP out-of-office Group Counseling

 

For groups of two or more patients

P13021 – First full hour ………………………………………………………………………………… 85.77

 

P13022 – Second hour, per. hour or major portion thereof ………………………………. 42.92

 

13020 Telehealth General Practitioner Assistant – Physical Assessment as requested by receiving specialist:

for each 15 minutes or major portion thereof ………………………………………………… 30.15

 

Notes:

 

  1. i) Applicable only if general practitioner is required at the referring end to assist with essential physical assessment, without which the specialist service would be ineffective.

 

  1. ii) Applies only to period spent during consultation with specialist.