To ensure video consultations are conducted in high quality, there are some simple tips that can prepare you, as the healthcare professional, for a good video consultation.
There are several things that you can do to improve your and the citizen’s (patient’s) experience. These tips will touch upon the physical environment as well as the planning, duration and ending of a video consultation.
Physical environment and appearance
Make sure there is good lighting in the room so the image is sharp and don’t wear narrow stripes. These are just two among a range of usable tips for a better video consultation experience.
Physical environment:
- Avoid sitting in an open office environment. Noise and traffic in the background (within the camera angle) distracts the conversation.
- Use of headphones with a microphone gives significantly better sound quality than without and may prevent unauthorized persons listening to the conversation.
- If you have a dedicated office/room for the video consultations, put an ‘occupied’ sign on the door to the room where the video consultation takes place. Also put a sign on the wall in the background that shows which organization you belong to.
- Make sure there is good lighting in the room so the image is sharp. Be aware of direct sunlight, because it affects the quality of the video image. Test the lighting effect in different types of weather. Turn the camera/monitor away from direct sunlight or draw the curtains.
- If you are demonstrating use of equipment, make sure to keep the equipment within reach, and make sure that the camera can be adjusted to a full view of the equipment.
Physical appearance and movement:
- How is your appearance on the screen? Check what is shown to your conversational partner via the small picture of yourself.
- Sit still. If you gesticulate with your hands to emphasize a point, lift them and make sure they can be seen on the screen.
- Remember that body language is minimized in video consultations. To compensate it is possible to exaggerate hand gestures and use facial expressions.
- Avoid sudden movements as they may cause ”image noise”. Also make sure you have the documents and equipment you wish to demonstrate right at hand before the consultation begins. This will minimize your need for moving during the consultation.
- Also avoid clothes with narrow stripes. This makes the screen flicker. If possible wear a uniform or medical gown.
Source / References
- The British Medical Journal: https://www.bmj.com/content/371/bmj.m3945.full
- https://www.who.int/ WHO guideline Recommendations on digital interventions for health system strengthening
- www.rm.dk Center for Digital Psykiatri Vejledning om videosamtaler
Working from home
Think about the appearance of the room and background. If it’s messy or there are many personal items in the image, it may seem distracting and unprofessional.
If that is not possible, use a virtual background with the logo of the organization. That can make the appearance feel more professional.
Inform the citizen (patient) and assure them that you have access to their electronic health records and all other resources needed; and that should the need arise, you will be able to arrange a face-to-face consultation in the clinic.
If there are other people in your home, consider making them aware, that you are unavailable and shouldn’t be disturbed.
Planning the video consultation
Planning the video consultation in detail will help you navigate if something should go wrong or cause obstacles during the video. Once you get used to having video consultations through training, you will find yourself at ease with these type of consultations.
Expectations
- Be clear on the potential outcomes of the consultation. Sometimes it is not possible to cover the same topics in a video consultation compared to a physical consultation. Make that the citizen (patient) is aware of this to ensure a reconciliation of expectations.
- Brief the citizen (patient) if they have to prepare something for the consultation – either if they must prepare some measurements, or if they need some equipment ready at hand.
- If your organization has a leaflet, make sure that the citizen (patient) has received it (Box 2: https://www.bmj.com/content/371/bmj.m3945.full)
- Obtain the citizen’s (patient’s) telephone number so you can call them if the video consultation gets interrupted or video quality deteriorates.
- Inform the citizen (patient) about the expected duration of the video consultation to make sure the citizen (patient) has allocated enough time for the consultation.
Technical aspects
- Make sure you have opened the EHR or other relevant clinical systems. The ideal setup is two screens; the first screen is with the view of the citizen (patient). The other is used for the clinical system.
- Close all programs and apps that are not necessary for the video consultation. This limits the hardware usage and internet connection.
- Make sure that all of the necessary equipment is fully charged or has enough battery to finish the video consultation.
- If technical problems occur and you are not capable of solving the problem by yourself, it is a good idea to have the telephone number to the first line of support ready.
Tips for conversation
Speak clearly and remember breaks in your flow of speech as the video connection can cause a small delay.
Make short breaks. With breaks you also give the citizen (patient), relatives or colleagues the opportunity to ask questions. It is an advantage if you vary your tone of voice and emphasize essential words.
If there are more participants in the video consultation, it is important that you do not interrupt each other. Agree on some communication rules, for example, on how to make yourself heard during the consultation. This is particularly important if a third party is in another location than you.
Rehearse — test the video consultation equipment in a call with a member of the team before using it with a citizen (patient).
During the consultation
Smile, mimics, eye contact and gestures – these are some of the essentails for building the relations in video consultations.
Establish confidentiality
Ask the citizen (patient) how they feel about meeting through the screen right now. This will allow you to make sure that the citizen (patient) is ready for the consultation. If needed, tell the citizen (patient) that you are alone in the room—the citizen (patient) can’t see that on the screen.
Ask the right questions
During video consultations you can’t use the same senses as during physical meetings. Normally, you would gain a lot of insights by observing the citizen’s (patient’s) behavior or the environment in the citizen’s (patient’s) home. This is not possible during video consultations. Therefore, it is extremely important to ask the right questions, so that you are provided with the necessary knowledge about your citizen (patient) in another way. In case of a citizen (patient) with COPD, you could for example ask, how fast they get out of breath, when being active.
A window into the life of your citizen (patient)
Video consultations can offer a window into a citizen’s (patient’s) home or work environment similar to that of a home visit. This can enable functional assessments and assist in clinical decision making. For example, the citizen (patient) could be invited to show where they keep their medication. With a citizen (patient) with a history of falls, seeing a cluttered room may highlight falls risks, in a way that wouldn’t be apparent in a consultation in a hospital or GP setting. Factors contributing to mental health or respiratory problems may be apparent from the home environment (e.g. damp in the home or evidence of hoarding).
Body language
Look for non-verbal signs and body language. It may be harder to read the citizen’s (patient’s) signals through video. Therefore, look for non-verbal signs and try to read the body language. How are the citizen’s (patient’s) eyes: is the citizen (patient) avoiding your gaze? Happy or worried? How is the body posture? Is the citizen (patient) pale, ruddy etc.
Eye contact
Be aware on how to make eye contact over video. Give the citizen (patient) the experience of eye contact by looking directly into the camera. It may take some practice to look into the camera and observe the citizen (patient) simultaneously.
If needed, tell the citizen (patient) that, ”when we are having eye contact like this, I am looking into the camera. When you see me looking down it is not because I am unfocused, but I am looking at you on my screen.”
Greet the citizen!
When both the practitioner and citizen are logged into the video consultation, welcome the citizen and introduce yourself.
Citizen identification
Start by making sure that it is the right citizen (name and social security number) in the same way as when having a physical meeting.
Check the connection
Ask the citizen if the sound and video quality is okay. Also ask if the citizen is sitting in a suitable place.
Agenda for the consultation
As with physical consultation, it is a good idea to align expectations and create a common agenda with the citizen at the start of the consultation.
Keep track of time!
Tell the citizen that he or she can always ask for a break during the consultation. You can ask if the citizen needs a break or a glass of water if you have a feeling, that there is a need for this.
Summaries, when needed
Regularly check whether the citizen hears and understands you, offer short intermittent summaries of the information shared, and check their understanding.
Ending the consultation
Ending the video consultation in a good way is important. Here are four steps to make sure the citizen’s (patient’s) needs have been met and it is clear what is to be expected.
Making sure the citizen’s needs have been met
The citizen might have prepared some topics or questions they want to discuss during the video consultation. Ask if the citizen has any questions left that they want to be answered.
Agree on the next steps
Before ending the conversation, it is a good idea to agree on the next steps of the treatment. Agreements on treatment methods or changes in treatment made during a video consultations are documented in the healthcare records in the same way that you would do in connection with a physical consultation.
Ask about the experience of using video call
By the end of the video consultation, ask how the citizen experienced having a consultation using the computer, and how he or she experienced the contact. This will also allow you to make adjustments if needed.
Set a date for a new appointment
If the video consultation is a part of a regular check up or treatment, it is possible to agree on the date and time for a new appointment.
Ending on a good note
The end of the video call is different from physical attendance. The ending of a video consultation can feel a bit abrupt, since there is no (physical) room for small talk. It is therefore important to ensure that there is time for the conversation to end well. An advice is to communicate clearly that the video consultation is ending.
A good way is to tell the citizen (patient) to disconnect first. This ensures that the citizen (patient) isn’t in doubt of whether the video consultation has ended due to a technical issue, and that the consultation ends on their terms.
Fresh in mind
Remember to document/journalize while the video consultation is still fresh in mind. In some cases, it is not possible to take notes during the video consultations, since there are other things that take priority (eye contact, noise from keyboard, etc.).
Understanding data in a healthcare setting
With the huge amount of raw data being gathered across the entire healthcare sector, it is important to keep in mind, that data is nothing if it is not being used.
A data-driven healthcare system harnesses the data and makes it actionable. While a range of healthcare entities collect data, the data does not necessarily flow freely among these entities in a cohesive or standardized way. For example general practitioners might not be able to see citizen data from the hospital, or the citizen may not be able to access their own data. That is one of the main barriers in many countries, in particular due to the sectorial division of healthcare services. In many cases, this is addressed on a cross-sectorial level or on a national level. (SAM:BO, MedCom, Sundhed.dk).
European Health Data Space
In order to unleash the full potential of health data, the European Commission has presented the European Health Data Space (EHDS).
The European Health Data Space (EHDS) is the first common EU data space. It is a framework that covers a wide range of topics and aims to make data exchanges safe and secure between member states, as well as making it easier to use and reuse health data.
In order to unleash the full potential of health data, the European Commission has presented the European Health Data Space, which is the first common EU data space. It is a framework that covers a wide range of topics and aims to make data exchanges safe and secure between member states, as well as making it easier to use and reuse health data.
Data protection and information security
When using a digital platform it is important that it is compliant with data protection and ehealth regulations.
Telehealth or eHealth regulations, such as the European Union’s General Data Protection Regulation guidelines, are setting the country and organization’s compliance regarding data protection.
With the emergence of video consultations, it is also possible for healthcare professionals to work from home. There are clear privacy and data protection considerations that need to be addressed. Therefore, it is important to provide clear guidelines on how to behave appropriately in a secure way – for example not leaving a computer unattended or not logging out.
Source / References
- https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/abs/model-for-assessing-the-value-of-artificial-intelligence-in-medical-imaging-masai/4C9377D1BB58A0E8DDEACDCCBBCEBA4C
- https://www.rbccm.com/en/gib/healthcare/episode/the_healthcare_data_explosion
- https://health.ec.europa.eu/ehealth-digital-health-and-care/european-health-data-space_en
- https://gdpr.eu/
- https://gotz.web.unc.edu/wp-content/uploads/sites/5664/2019/04/gotz_data_driven_health_2016.pdf
- https://www.ahrq.gov/research/findings/final-reports/iomracereport/reldata5.html
Artificial intelligence – harnessing the data
The use of artificial intelligence (AI) in healthcare is considered very promising and has the potential to disrupt the future healthcare system. A strength of AI is the ability to process huge amounts of data and based on different defined parameters develop algorithms that can discover patterns in data. Algorithms in the healthcare system are not limited to clinical use, but can also be used to predict administrative processes like patient turnout. At the forefront of the emerging AI-technology are radiology. Algorithms have been developed so they can process x-ray scans to detect, for example cancer tumors and bone fractures. However, the implementation of AI in a clinical settings is not without it’s barriers and demands a multi-disciplinary approach. For inspiration, check out MAS-AI, which is a health technology assessment-based framework to support the introduction of AI technologies into healthcare in medical imaging. Check it out here https://cimt.dk/gb/mas-ai/.
