Phone Visits

Leverage existing landline and cellular phones. You may want to consider functionality such as transferring calls to physicians from reception and placing patients on hold until the physician is ready. Conference call technology could be useful depending on your practice.

Video Visits

Video visits will require hardware and a video app or software.

Hardware

• Consider the device you will use to video chat: a computer, tablet or smartphone? Does it require a separate webcam, microphone and/​or speaker?
• Consider your clinic’s internet capacity to have multiple physicians provide video visits at the same time.
  
• Disable cameras when not in use by disconnecting them or using a lens cover.

Video Apps

• A variety of apps and software are available for video calls, and it is important that physicians endeavor to find a solution that offers privacy and works for their patients.
• Shared Health’s Digital Health recommends the use of Microsoft Teams (formerly Skype for Business) and Zoom for Health, but recognizes the need for flexibility to rapidly introduce video visits during the pandemic.

View our one-page overview of video app options and choose one that is right for your practice.

Consider the following when deciding where you will conduct phone or video visits:

• Privacy: just like an in-patient visit, patient confidentiality should be maintained. The volume should be set at an appropriate level in a private room.
• EMR/​chart access: where possible, have access to edit the patient’s EMR/​chart during or immediately following the visit.
• Professional appearance: for video visits, ensure the patient sees a professional space around you, such as a clinic exam room or tidy office.

Conducting virtual visits from home?

If the considerations above can be met at home in a secure and private manner that meets standards, virtual visits can be done at home. In fact, as social distancing advice from public health officials evolves, it may be preferable for you to offer virtual visits from home.

Note: Both the physician and patient must be in Manitoba.

If you’re not already collecting email addresses and mobile phone numbers, get set up to start obtaining this information from patients. It can likely be stored in your EMR.

You may consider using a mail application to send notifications to patients, such as Mail Chimp or Office 365 Business.

Consider the types of health concerns that are generally suitable for phone and video visits. Then consider whether a virtual medicine visit is appropriate and in your patient’s best interest. Reflect on your practice and the types of concerns you see and treatments you offer. You could review patient visits over the last week or two and review which could have been offered virtually. Determine what is safe and appropriate for your practice.

Consider limitations of virtual visits: you can’t feel a lump or administer a vaccine over the phone or video. But patients may have home blood pressure monitors and can give you a blood pressure reading.

For family medicine practices, clinical considerations have been offered by Dr. Jose Francois, the Head of the Department of Family Medicine at the University of Manitoba and Provincial Specialty Lead — Family Medicine with Shared Health. Examples of the types of concerns or conditions that may be suitable for virtual visits include:

• Follow-up care for chronic conditions
• Follow-up to in-person visit within last 2 weeks
• Cold/​flu symptoms (ensure you review COVID-19 screening protocols)
• Conjunctivitis
• Nausea/​vomiting/​diarrhea
• Minor injuries/​aches and pains
• Skin conditions like a rash or bug bites
• Urinary issues.
• Sleep or mood problems
• Medication questions
• Contraception advice
• Mental Health

Whether patients call in to book or schedule appointments online, you will need to introduce a process change to offer virtual visits when appropriate.

Work with reception on modifying your clinic scheduling process. This includes screening patients for clinical suitability, informing patients about virtual visits, and obtaining patient consent. Email confirmation messages are particularly useful for video visits.

As a team, consider your daily workflow. It may be appropriate, during the pandemic, to stagger in-person and virtual visits to help reduce and spread out patient traffic to your clinic, rather than doing all virtual visits as a block.

Like in-person visits, virtual appointments must comply with CPSM standards and applicable legislation, such as PHIA. Doctors Manitoba has incorporated virtual care standards into this guide, but physicians are encouraged to review the extensive CPSM materials on virtual care here.

Your virtual care to patients is generally protected by CMPA. However, if you intend to provide care to patients across provincial borders, you should consult with CMPA to make sure you are protected. You can find useful resources from CMPA here.

Professional and legal obligations include considering the risks to privacy and security and taking steps to mitigate those risks. During the coronavirus public health emergency, it is reasonable to approach privacy compliance in a streamlined manner to avoid delays in decreasing the risk of exposure to COVID-19.

The basics still apply. Take precautions to ensure both and the patient are in a private setting. Patients should be encouraged to use their own device in a private location, rather than at work or in a public place. For video visits, inform patients of the inherent risks of using a third-party video app and obtain their consent.

Before conducting virtual visits with patients, especially using new technology, test your set-up first. This is also an opportunity to help you get comfortable with the new format.