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Virtual Care

Thank you to the Doctors of BC for developing the valuable DTO Virtual Care Toolkit and permitting us to adapt it to meet our needs in Alberta.
Updates to this page will be made as new resources and information become available.

The below step by step approach and links to additional resources are intended to provide at the very least, minimal information to enable clinic teams to get up and running with offering virtual care services within a relatively short time frame. Please also refer to the AMA Virtual Care and AMA COVID-19 webpages for important news and updates for Alberta Physicians.

1. Team Engagement
2. Selecting Technology
3. Communicating with Patients
4. Clinic Processes for Decreasing the Spread of COVID-19
5. Triaging Patients and Booking Appointments
6. Preparing for Virtual Visits
7. Starting a Virtual Visit
8. Conducting a Virtual Visit
9. Sending and Receiving Documents
10. Billing
11. Follow-Up Visits
12. Presumed/Confirmed COVID-19 Positive Primary Care Pathway

1. Team Engagement

Consider scheduling regular team meetings with your clinic team to discuss changes, workflows, and responsibilities. Please see the below resources to help make the most of these meetings and engage your clinic team.

2. Selecting Technology

Please see the AMA Virtual Care webpage for a list of available virtual care tools.

When selecting virtual care tools, consider the following:

  • How the tool will fit into the clinic environment
  • Most visits do not require video conferencing and phone visits are easier to implement
  • It is easier to use tools that are integrated within the EMR (e.g. patient portal, video conferencing)
  • Look to peers and social networks for support
  • Ease of use of the tool for physicians, staff and patients
  • Ability to quickly implement the tool
  • Cost of the tool and any required contracts (e.g. do you have to commit to the tool for an extended period of time?)
  • Physicians with access to the AHS Insights platform have access to AHS Zoom which is a regulated tool in Alberta
  • The security of the tool - see page 4 of the Alberta Virtual Care Toolkit for a list of virtual tools that use encryption and have servers in Canada
  • The availability of support (e.g. is it in AB, Canada, or the US?)

3. Communicating with Patients

Obtaining and Recording Patient Contact Information

When a patient calls the clinic, verify that you have their current email address and mobile number on file:

  • Email addresses can be used for communicating new virtual care services to groups of patients, as well as sending the virtual care visit link/URL to an individual patient
  • Mobile numbers are useful for communicating with a patient if there are any issues with the virtual visit, or to ensure they are ready for the visit
Consider storing this information in both the demographic section of the patient's chart and an email software solution.

Promoting Virtual Care in Your Clinic

Inform patients of changes to clinic processes and available virtual care option through one or more of these options:
  • Information on Your Website
    • Consider outlining the process for signing up for virtual care, along with a list of conditions that are eligible and excluded
  • Email
    • Consider using an email software solution, which will enable you to email groups of patients with information about the new virtual care services.
    • See pages 12 & 13 of  the Doctors of BC Virtual Care Toolkit for example email templates
  • Posters in Your Clinic
  • In-Person Communication
  • Over-the-Phone Communication

Patient FAQs

Consider using the Newfoundland and Labrador Medical Association's (NLMA) Patient FAQ as a template

Electronic Communication with Patients

  • Email Communication
    • Physicians should consider setting up a new email address to allow patients to send emails to the clinic but not to their personal email
    • Let patients know that no personal health information should be included in the email. Section 3 of the Office of the Information and Privacy Commissioner (OIPC) of Alberta Practical Guide to the Health Information Act defines personal health information as both:
      • Diagnostic, treatment and care information, and
      • Registration information (e.g. name, signature, gender, photograph, personal healthcare number (PHN), residency, telecommunications information, health service eligibility information, billing information)
  • EMR-Integrated Secure Messaging

4. Clinic Processes for Decreasing Exposure to COVID-19

Scheduling Time for Virtual Visits

Consider specific days and time slots for virtual visits and how this will work with existing in-person appointments. For example:
  • Mornings are reserved for virtual visits only
  • Early afternoons are reserved for in-person appointments with patients who have been screened and deemed at low-risk for COVID-19
  • Break for wash and sanitization period
  • Late afternoons/evenings are reserved for in-person appointments with patients who have been screened and deemed at high-risk for COVID-19

Physical Setup of the Clinic

Consider the following when deciding how to use the physical space in your clinic:

  • Where in-person patient care will be provided. For example, will only certain exam rooms be used for high-risk patients?
  • Reduce the number of chairs in the waiting room and increase the distance between them to allow for social distancing
  • Place lines on the floor indicating where patients should stand when waiting to talk to a receptionist
  • Designate a space (e.g. lunch room) that is used solely by staff who never come in contact with patients

Other Considerations

Consider other processes that could be implemented to protect clinic staff, providers, and patients from exposure to COVID-19. Example processes include:

  • Screen all patients who have an upcoming appointment or call to book an appointment over the phone. Some EMRs have a built-in screening tool that staff can use to guide them through this screening process.
  • Divide the clinic staff and providers into two teams so that if one team is infected, the clinic can remain open
  • Establish a standard process for in-person appointments with high-risk patients. For example:
    • The patient parks in the parking lot and stays in their car while they phone the clinic to notify them of their arrival
    • The physician goes out to the patient’s car in full PPE
    • The physician gives the patient hand sanitizer, a mask, and gloves, which the patient uses/puts on before entering the clinic
    • When the visit is complete, the patient is provided with hand sanitizer and a new set of gloves before leaving the clinic
    • The exam room is fully sanitized

5. Triaging Patients and Booking Appointments

Triaging Patients by Type of Visit

Consider which patients or visit types are suitable for virtual visits. Reviewing your schedule over the last week could help with identifying potential patients and visit types.

Screening Patients for COVID-19 Symptoms and Exposure

Booking Virtual Visits

  • Consider how patients can book virtual visits. Will your solution allow for online booking or are all appointments triggered by staff, or otherwise go through staff?
  • Consider the role of the MOA. Will they contact the patient ahead of time? Will they set up the visit for the physician on the computer?
  • Depending on the tool chosen, you will either be sending the patient a link to a virtual waiting room or a link for a specific appointment time

Obtaining Patient Consent for Video Sessions

Physicians providing health care services via video sessions should obtain patient consent for this specific purpose. This does not need to be collected with every session with that patient.

  • CMPA recommends the use of a signed informed consent form: WordPDF
  • In some situations, obtaining a written consent might be difficult – verbal consent documented in patient’s chart is also acceptable as long as it covers the details

The following CMPA-approved statement should be used to initiate a Virtual Care patient encounter:

“Just like online shopping or email, Virtual Care has some inherent privacy and security risks that your health information may be intercepted or unintentionally disclosed. We want to make sure you understand this before we proceed. In order to improve privacy and confidentiality, you should also take steps to participate in this virtual care encounter in a private setting and should not use an employer’s or someone else’s computer/device as they may be able to access your information.
If you want more information, please check the link on our [website/confirmation email/etc.]. If it is determined you require a physical exam you may still need to be assessed in person. You should also understand that virtual care is not a substitute for attending the Emergency Department if urgent care is needed. Are you ok to continue?”

Recording Patient Consent for Video Sessions

Consider where to record the patients consent in the EMR.

  • Clinics should develop a standard process for collecting consent, documenting in the patient chart, and keeping track
  • EMR users can consider creating a macro for recording consent

To record verbal consent in a patient’s chart you may copy and paste the following into the chart:

"Informed verbal consent was obtained from this patient to communicate and provide care using virtual and other telecommunications tools. This patient has been explained the risks related to unauthorized disclosure or interception of personal health information and steps they can take to help protect their information. We have discussed that care provided through video or audio communication cannot replace the need for physical examination or an in person visit for some disorders or urgent problems and patient understands the need to seek urgent care in an Emergency Department as necessary."

EMR tip sheets for recording Patient Consent in the EMR: Wolf; Med Access; Healthquest; Accuro; PS Suite

6. Preparing for Virtual Visits

Setting Up the Room

Consider placement of EMR screen vs. placement of video screen. Can both be displayed on the same screen, or are two screens needed?
Essential items include: webcam, microphone and speaker

Testing Equipment

For a video-based virtual visit the computer, laptop, tablet, or smart phone you are using needs to have:

  • Webcam
  • Microphone
  • Speaker
  • Headsets are recommended

It is important to test the hardware to ensure your webcam, microphone and speaker are all working and it also helps to be familiar with how to adjust the settings as well.

Run an online speed test from the room you would use for video consults to find out the internet speed. Use the equipment you are planning to use for the most accurate test. You can use the site (https://www.speedtest.net/).

Setting Up the EMR

See the following EMR tip sheets for suggestions on how to set-up your EMR to capture virtual visit appointments: WolfMed AccessHealthquestAccuroPS Suite

Virtual Visit Etiquette

Consider the following when space that the patient will view during a virtual visit. Consider clarifying your actions to the patient if you are not looking at them (e.g. typing up notes on the EMR).

7. Starting a Virtual Visit

Patient "Check-In" Process

Does the patient need to call and ‘check in’?
Does the virtual tool have a virtual waiting room?

Troubleshooting Technical Issues with Patients

Ensure that staff know how to troubleshoot the most common technical issues related to virtual care so they can assist patient over the phone. The Newfoundland and Labrador Medical Association's (NLMA) Patient FAQ provides some helpful tips and tricks

8. Conducting a Virtual Visit

Consider having a standard method for recording that the visit was conducted over video. Charting the patient encounter for video consults is the same as for an in-person visit.

Resources

EMR Processes

Ensure that the following information is recorded in the EMR:

  • The type of virtual visit
  • Patient consent has been obtained (for video visits)
  • The patient disclaimer for virtual visits was read to the patient
  • Start and stop times of patient contact
EMR Virtual Visit Process Tip Sheets: Wolf; Med Access; Healthquest; Accuro; PS Suite

Virtual Assessments

Resources coming soon!

9. Sending and Receiving Documents

If working away from the clinic office, consider how to transfer documents (e.g. prescriptions, lab and imaging requisitions). Could an MOA send this from the clinic? Consider testing the EMR from home to see what is possible.

Does the patient need access to a printer? If yes, consider including this in your patient scripts.

10. Billing

Available service codes are published on the AMA Virtual Care webpage.

11. Follow-Up Visits

Consider the workflow for arranging a follow-up visit for the patient. What are the instructions for the patient?

12. Presumed/Confirmed COVID-19 Positive Primary Care Pathway

The Calgary Zone PCNs and AHS created a primary care pathway for patients who have been presumed/confirmed positive for COVID-19 which can be found here.