1. Conducting a Telehealth Session

2. On the day Make sure in advance that:  All appointments have been confirmed  All written material and test results are collated and ready  A “do not disturb sign” at hand  The patient has received information on Telehealth consultation  The patient has given consent (verbal or written)  The room and equipment are set up – enough chairs, camera angle and sound tested  You know how you will take notes 2

3. You need an appropriate field of view: wide enough to show all the people and close enough so the view can see faces clearly  Chair placement  Camera placement  Zoom  Ensure people fill the screen not the surrounding room The View through the Camera 3

4. Lighting and Contrast  The room needs to be well lit. Normal room lighting will often do.  If extra light is needed, bounce light off the wall onto the patient and clinician.  Don’t shine it in their faces. Good lighting Too dark due to back light Too bright Uneven lighting 4

5. Lighting and Contrast (continued)  Contrast between a patient’s complexion and clothing colour might affect the clarity of pictures.  White clothes/dark skin or black clothes white skin - might be difficult to see facial features. Sit the patient closer to the camera.  Simple backgrounds and plain clothes require less bandwidth to transmit. Three good examples of plain backgrounds and clothing 5

6. Sound  Microphones aren’t good at filtering out sounds (fan, air conditioning, traffic)  Don’t rustle papers near the microphone  Speak clearly and at reasonable volume and ask the person at the other end if the volume is right  Remember the need for privacy 6

7. Getting organised for the consultation Have the patient in the room and ready 10 minutes early Check:  The camera angle and chair placement – consider if eye contact is appropriate for your patient – make sure the specialist knows what is appropriate  Any patient worries related to the room or screen image (address these)  Any other worries - discuss and address  The video quality and lighting 7

8. Doing the consultation The technology  The technology is working nicely – all checked at the beginning  Picture of patient and clinician on screen? Check view occasionally The people  Confirm you have the right person on the other end. They need to confirm that you are the right person  Introductions  One person at a time – proceed as usual  Short time delay  Body language – less obvious over video 8

9. Doing the consultation (continued) Physical examination  The clinician with the patient will need to do this – best discussed before the session begins  Develop protocols for particular types of consultations  Around 10% of Telehealth consultations need an a follow up due to the limitations of ability to do physical examinations Finishing up  Make sure you both know who is doing what – tests, scripts, follow-up 9

10. Doing the consultation (continued) Feeling awkward  May feel quite “intense” due to extra concentration required  Might be disconcerting seeing yourself on-screen. (Also for the patient.)  Practice with friends/family/colleagues on Skype to begin with Remember that patients are generally very positive about their Telehealth consultations (higher than clinicians). The patient is probably feeling better than you about it. 10

11. After the consultation Patient evaluation  It is important to find out how the patient felt about the session – use a standard form to allow comparison between responses over time and to compare to other patient’s experiences. 11

12. 12 After the consultation (continued) Billing and follow-up  Bill the patient in the same way as for any other service  Next appointment?  Prescriptions?  Tests?

13. Trouble shooting Two common problems are: 1. Failure to get started 2.Poor quality picture or sound or call failure Solutions:  Check everything is plugged in – cables connected  Try restarting  Use a speaker phone for the sound to improve overall picture and sound quality  Adjust the frame rate down to about 12 per second 13

14. http://www.rrmeo.com/misc_files/acrrm/acrrm_video /morayfield_consult.mp4 14 An example of a video consultation

15. Questions and discussion 15