In the COVID-19 partner Q&A series, we will share knowledge and expertise from HRS partners across the country on how they are leveraging telehealth in response to COVID-19. Below, NVNA & Hospice Telemedicine Clinical Manager, Cheryl Meyer Nelson, shares her insights into enhancing clinical workflow and patient experience using virtual visits.

1. How has the perception of telehealth changed among your staff or among your patients since the outbreak of COVID-19?

Telehealth is receiving more media attention than ever before and with that comes a greater understanding from patients and their family members. Patients and their family are more willing to learn about telehealth and understand the purpose behind it. We’re hoping to take advantage of the captive audience we’re seeing to help patients see how telehealth can not only protect them during this outbreak but can improve their daily lives as we approach the other side of this pandemic.

In addition, our clinicians are having an easier time training patients to use the technology and helping patients troubleshoot any issues that arise because of this heightened awareness.

2. What aspects of the telehealth platform have been most valuable during the

The COVID-19 symptom surveys have been essential to our clinical workflow and patient evaluations during the outbreak. We have enrolled all of our telehealth patients on the COVID Care Plan (even if they do not have a COVID diagnosis) to provide an additional layer of symptom monitoring and to encourage telehealth compliance.

The biometric devices included in patients kits, specifically the blood pressure monitor, pulse oximeter, along with the ability to manually enter and track temperature, have always provided our clinical team with critical information. The COVID symptom survey helps to round out our view of the patient’s daily health. The virtual visits provide an opportunity for bidirectional communication, safety and PPE management.

3. What have been your biggest challenges in managing patients with fewer in-person visits?

We’ve transitioned some visits, including skilled nursing, therapy, and other specialty care visits, from in-home to virtual. We're also using virtual visits to assess risk and triage patients that demonstrate COVID symptoms and support other medical conditions. This improves communication with their physicians and within the clinical care team.

While we know virtual visits are an alternative for in-home visits, there are a lot of other changes that come along with such a dramatic shift in patient care. Changes to clinical workflow are a huge consideration. For example, determining how many virtual visits should we provide each patient per week, or how many per episode of care. We’re trying to crystallize the proper workflow for visits and the correct way to document the visits and next steps so clinicians across NVNA & Hospice are up-to-date on best practices. The integration between our EMR, MatrixCare (Brightree), and the HRS platform has made a huge difference in keeping our entire agency informed.

4. What are your recommendations for virtual visits?

From a technology perspective, connectivity is essential. When our field staff are installing the telehealth system, we recommend connecting to wi-fi if the patient’s cellular reception is lower than two bars in their home. We always perform an initial practice virtual visit during the set up to introduce patients to the platform. This ensures proper technical connection and helps the patient understand the virtual visit process.

We also encourage all our clinicians and field staff to use humor and consider learning styles when teaching patients how to use telehealth equipment and perform virtual visits. For the vast majority of patients, this technology is entirely different from anything they have previously done with their healthcare providers. Taking the time to help patients learn and understand the purpose, encourages greater utilization and adherence with the technology. Humor can reduce anxiety during a stressful time and show patients that it’s ok to make mistakes and to ask questions.

For COVID surveillance and beyond, both biometric readings and symptom surveys provide clinicians with essential information. At NVNA and Hospice, we’ve noticed a strong correlation between a patient’s compliance with daily surveys and biometric recordings with their willingness to participate in virtual visits. It’s so important to educate patients to routinely participate in the surveys and biometrics as well as how important virtual visits are to improving their health.