With the federal government recently expanding Medicare-subsidised telehealth services to all Australians in light of the COVID-19 pandemic, most health consultations will inevitably move online for the time being. Therefore, healthcare providers should be able to provide effective and high-quality care through video consultations (DoH 2020).
Your organisation should know which technology, equipment and software to use, how to set it up and how to ensure video and audio are high-quality.
What is Telehealth?
Telehealth is the remote delivery of healthcare using information and communication technologies. Telehealth services may include virtual consultations, remote patient monitoring and maintenance of electronic patient health records (Mayo Clinic 2017).
In the past, virtual consultations delivered through video conferencing have often been used for patients who live in rural and remote areas so that they can receive care without travelling (RACGP 2019).
However, with the recent changes implemented by the federal government in order to avoid unnecessary exposure of patients and healthcare professionals to COVID-19, video conferencing is likely to become the primary means of delivering care for the foreseeable future.
Therefore, it is of utmost importance that healthcare professionals and staff are familiar with the technology and equipment required, and have the knowledge and skills necessary to utilise it effectively for the delivery of high-quality remote care.
What is Required for a Video Consultation Set-Up?
In order to deliver virtual consultations through video-conferencing, your organisation should have:
An appropriate consultation space that includes:
Arrangements for privacy protection (e.g. screens, doors);
Plain decor that will not be distracting;
Access to medical equipment that may be required;
Measures to prevent disruption (e.g. ‘do not disturb’ signs); and
Access to a phone as a back-up.
Appropriate hardware (i.e. computer);
Appropriate video software;
A high-quality webcam;
A high-quality microphone (built-in or external) with echo-cancelling properties; and
Access to technical support and troubleshooting guides.
What is a Video Consultation Like?
Video consultations should generally be delivered similarly to any other consultation, in-line with the current best-practice models of care. Recommendations for assessment, clarification of diagnosis and recommendations for treatment and review should be effectively communicated as per usual (RACP n.d.).
The limitations of telehealth mean that advanced communication skills are necessary so that health professionals can compensate for the lack of visual cues (Morony et al. 2018).
Maintaining Patient Privacy
Privacy is an important consideration in telehealth, and the confidentiality and privacy of patients should be protected at all times. Video consultations are subject to the same standards and government legislation as regular consultations in regards to privacy, consent and confidentiality (RACGP 2020).
The following measures should be taken to ensure patient privacy:
A dedicated, undisturbed space for consultations should be established. Other people should not be able to hear or view the consultation.
Technology should be fit for clinical purposes and facilitate safety and privacy.
Consultations should be recorded and stored securely.
(RACGP 2020; RACP n.d.)
In general, the technology and equipment used during virtual consultations should be reliable, compatible with the patient’s technology, high-quality and secure to ensure privacy and confidentiality (RACP n.d.).
Poor sound and visuals can be distracting, annoying and may hinder the consultation (RACGP 2019).
Below are some tips from the RACGP (2019) for maximising video and audio quality during virtual consultations:
Ensure lighting is good enough for faces to be clearly visible;
Ask participants to move in or out of frame when necessary;
The camera angle should be adjusted so that the healthcare professional and patient can make eye-contact;
Ensure all parties avoid bright or reflective clothing, as this may affect camera focus;
Ensure the camera is able to focus in on different areas if needed; and
Ensure you are able to share screens to display relevant information or records if necessary.
Participants using an external microphone should place it close to themselves on a firm, flat surface close to minimise background noise and ensure good-quality audio;
Participants should speak clearly at a normal volume;
Participants should switch mobile phones off or to silent;
Microphones should be muted when not speaking so that the other party can be heard clearly; and
Participants should try to minimise unnecessary background noises (e.g. typing on a keyboard).
Conducting a Video Consultation
The following is a general guide from the RACGP (2020) for conducting a video consultation.
Before the Consultation:
Ensure the consultation room is appropriately set up, keeping in mind privacy and audio and visual quality.
Test your technology.
Bring up the patient’s health record and phone number (in case the connection fails).
Starting and Conducting the Consultation:
Commence the consultation by calling/inviting the patient.
Confirm visual and audio quality is satisfactory.
Ask the patient for verbal informed consent for the consultation.
Ask if the patient is happy to proceed, addressing any privacy concerns they may have. The patient should also be in a private space.
Begin the consultation.
Closing the Consultation:
Summarise the key points from the consultation, including any agreed follow-ups such as future appointments, prescriptions and referrals.
Ask the patient if they have any further questions or need any clarification.
Advise the patient that you are ending the consultation.
Once the consultation is over, complete any necessary follow-ups (e.g. sending referrals or writing prescriptions).
Update the patient’s health records.
Note any technical issues and report them to the designated technical support person.
Video Conference Software
The software used for video conferences should be safe, secure and effective. There is specialised telehealth software available, but you may alternatively choose to use general (non-medical) video conferencing software such as Skype, WhatsApp or FaceTime (RACGP 2020).
According to the RACGP (2020), there is currently no evidence to suggest that the video software listed above is unsuitable for clinical use. The Australasian College of Rural & Remote Medicine (2020) has advised that it is ‘reasonably safe at the present time’ to use general video conferencing software for calls. As most video conferencing software uses encryption during transmission, the risk of interception is minimal if there is a direct connection between both ends of the call (ACRRM 2020).
However, the ACRRM recommends that providers do not use the file transfer or text chat features of software such as Skype, WhatsApp or Facetime for clinical purposes because they are much more vulnerable to security breaches than video calls (ACRRM 2020).
It is important to use your own judgment when choosing software. Any potential privacy risks to the patient should be evaluated when necessary.
The Australian Psychological Society (2017) provides three principles to guide the selection of appropriate video conferencing software for telehealth. These are:
When selecting software, providers should take a client-centered approach.
There is minimal or no set-up cost to the client.
The software is accessible through a variety of internet browsers and devices.
The software can successfully operate and provide high-quality video and audio in consideration of the bandwidth available in rural and remote areas.
The software is simple for clients to install, access and operate.
The software should be fit for purpose.
Minimises interruptions and dropouts.
Audio and video transfer is high-quality and reliable.
Compatible between platforms (e.g. Windows and OS X).
Includes instant messaging.
Provides for group-based services.
Consider how often updates are needed, and if they will cause disruption.
Technical support is available.
Consider whether training is required in order for staff to use the software.
The software should facilitate the security and privacy of clients.
Strong passwords, two-factor authentication and an audit trail can be implemented.
Security measures can be regularly updated to protect against malware, viruses, intrusions etc.
The following is an overview of some popular software that you may choose to use, including general and telehealth-specific software. Please note this is not an exhaustive list. Use your own discretion when choosing which software is most appropriate for your own organisation.