Lessons learned performing telehealth visits during COVID-19

Female clinician in a white lab coat performs a virtual visit on her laptop.
Physician assistant Barbara Rhodes interacts with a patient during a virtual visit. (Photo by Michael Goderre)

In the midst of the COVID-19 pandemic, one positive development is that many health care providers are finding new ways to use technology to provide patients with care in the comfort and safety of their own homes, from diagnosing hernias and fractures to managing post-operative care to supporting transgender patients.

Expanding our telehealth capacity

With mandates for physical distancing keeping all but essential care from being performed in medical settings, many barriers that previously restricted widespread adoption of telehealth have now been relaxed or suspended, at least during the pandemic. 

“Our staff and clinicians have responded quickly to these challenging times (and the changing situation) by expanding our existing telehealth services to honor physical distancing while ensuring social connectivity,” says Donald Bae, MD, clinical chief of Orthopedic Surgery in the Orthopedic and Sports Medicine Center. 

Tips to improve your telehealth visits

In the past month, our health care providers have learned many important lessons to manage virtual visits effectively. Primary care providers and specialists can apply these findings to strengthen their own telehealth efforts: 

  • Find new ways to connect with families. Bae says that in his department, providers who see patients remotely have to think about smaller steps they can take for patients whose elective surgeries have been put on hold. “I am a big believer that even if you can’t put on a brace or perform an operation right now, you can use telehealth to connect with patients and start the process of helping them build a relationship with your organization,” he says. He also suggests that providers take the time to make genuine connections. “Say ‘hi’ and thank patients and families for their understanding (especially if there are any technical difficulties), and thank them for allowing you into their home,” he adds.
  • Build privacy into the visit for older childrenFrances Grimstad, MD, an attending in the Division of Gynecology, explains that over the past few weeks, she and her colleagues have had to find new ways to make sure they could provide one-on-one time to talk to teens in private.  “In a traditional clinic visit, we have a time when we ask the parents to step out of the room. Initially with telehealth, some patients were taking their calls in the car and everyone could hear the conversation. Recognizing this was a problem for this population, the clinicians have built a private moment into their new process, too. “Now we are asking patients to use headsets or have a private room where they can talk for a part of the call without being overheard,” she says. 
  • Use parents or other caregivers to gather key information. Attending surgeon Alex Cuenca, MD, PhD, says his patient examinations typically require a lot of physical assessments. In the absence of being able to touch patients, he guides parents on how and where to touch the patient and then watch the child’s face to gauge their reaction and level of pain. “As a prescreening tool, if you can get the parents to mimic the motion, you can assess the patient and potentially come up with a treatment plan,” he says. 
  • Manage visits to keep patients comfortable. In the Pediatric Transplant Center, most patient calls involve a multi-disciplinary team including the transplant nurse, nurse practitioner or fellow, attending physician, dietitian, social worker, and pharmacist. JoAnn Morey, MS, RN, CPNP, CCTC, says that initially all of the team members were included on one big Zoom call, but this was not conducive for patients to feel comfortable talking about personal things like symptoms and medication management. As a result, they changed the process to have one provider at a time meet with each patient. The provider texts the next person in line when are almost ready for the next person to take over. This enables calls to run smoothly for patients while making the best use of each clinician’s time. 
  • Designate a department telehealth champion. Thomas Hamilton, MD, assistant program director of the Pediatric Surgery Fellowship, says that having someone designated to be in charge of telehealth for each service line is essential to continue moving forward and to address obstacles that arise in the process. He adds that it’s also important to allocate a space where providers can have privacy to conduct these calls.

Looking ahead

While it’s difficult to anticipate what lies ahead for telehealth appointments in a post COVID-19 world, many clinicians believe that the progress that has been made over the past month or so will continue, providing many patients and families with more convenient access to care.

Get more answers about Boston Children’s response to COVID-19 and learn more about our virtual visits.