Add video visits to your practice

Video visits can be a valuable addition to your practice alongside telephone and in-person visits. Each physician needs to determine how video visits best fit into their practice and to choose the steps and actions from this toolkit that address their needs. 

See "Assess your practice needs" under Start to determine if your practice is ready for implementing video technology. Contact FPSC's practice support program for coaching and customized support.

Choose a video visit platform

Allocate time for your practice champion to test the functionality of the video platform to determine how it meets the needs of your practice. Avoid using free products in a clinical setting without considering privacy protection. However, trialing a free version with colleagues might be a good way to become familiar with a video platform before making a decision. Test the following workflows:

Goal:

• Your practice team has tested and selected a video visit platform to use with patients.

Actions: 

Discuss with your team:

• Identify a practice champion who will research and test video platforms, and work with the vendor to provide instruction and support to the rest of the practice team.

• Prioritize the features your practice needs in a video platform such as virtual waiting room, ability to include additional attendees in the visit, workflow for sending a link to patients, etc.

Select a video visit tool. 

• Check with your EMR vendor and ask if they offer integrated video platforms. Features will vary and there might be an additional fee. However, using an EMR-integrated platform could simplify your workflow.

• Zoom for Healthcare is a free option that's available until August 2024. Patients do not need a special account for their video visits.

• Ask your regional health authority if they can provide an account for the platform they use.

• Consider whether a non EMR-integrated video platform would be suitable for your practice.

• Contact 2-3 vendors to discuss your needs and their video solution in detail. Also, speak with your peers or get connected to a peer mentor at View Email Addresspeermentors@doctorsofbc.ca through the practice support program.

Questions to ask vendors:

• Cost—Ask for a personalized quote as well as any additional costs related to customization, training, or data analytics. Discuss the number of accounts you're likely to need for physicians and staff. Ask for a demo, free trial period, or free version of their tool. Compare free and paid version features.

• Device compatibility and supported browsers—Can the video platform be integrated with your EMR? Will it work with your current booking system? Does the physician or a patient need to download any software or apps? What web browsers are supported (e.g., Google Chrome, Safari, Firefox)? Is the tool compatible with both iOS and Android? Does it work on your devices; e.g., mobile phone, laptop, or tablet?

• Privacy and security—Request detailed information/documentation from vendors about the privacy and security safeguards built into their tool. Confirm if sharing documents with patients is secure—is the transmission of data encrypted? Is any information being stored and what security measures are in place?

• Support—Does the vendor offer support for physicians, clinic staff, or patients? How do they communicate when there is an issue (e.g., email, phone, live chat)? What is their typical response time? Ask for references whom you can contact for feedback and personal experience.

Allocate time for your practice champion to test the functionality of the video platform to determine how it meets the needs of your practice:

• Avoid using free products in a clinical setting without considering privacy protection. However, trialing a free version with colleagues might be a good way to become familiar with a video platform before making a decision. Test the following workflows:

• Patient preparation—Send the invitation to a video visit by email and/or by text. Can you customize the invitation format?

• Booking/scheduling—Mark video appointments in the physician's schedule in the EMR or online booking platform (whichever applies). How does this impact your current workflow?

• Waiting room—Place patient in the waiting room. Send the patient a message in the waiting room. Can you share a resource with a waiting patient? Can you customize the tool; e.g., display clinic/ physician name, post information, etc.

• Video visit—Start and end the visit. Move from patient to patient. Return patient back to the waiting room. Share documents or links with the patient. Share screen during a visit to display results, forms, and educational resources. Try using a second screen or additional device to access your EMR during the video appointment. Review the patient record, search for information (e.g. patient consent), and make a visit note. Provide group visits to support multiple parties in visit; e.g., consulting provider, family members, etc.

• Troubleshooting—Find a way to connect with a patient if the video call drops; e.g., connect with the medical office assistant (MOA) to start over, and have patient phone number ready to complete the visit by telephone call if needed.

Delegate tasks to a designated practice champion.

• Create user accounts for your team.

• Test and establish workflow adjustments.

• If you need assistance using your video platform on the Private Physician Network (PPN), contact PHSA for support at View Email Addressppnadmin@phsa.ca.

• Provide training for your practice team members.

• Prepare instructions on how patients can use key features during their video visits.

Read more:

• Zoom for Healthcare video tutorials

• Doxy.me video tutorial

Add video visits to your clinic's booking process

Your practice will need a process for identifying which patients could be booked for video, in-person, and phone visits. 

If you use a video platform integrated with your EMR, then work with your vendor to make changes to your current booking process. Also, consider setting up online booking. It can automate some tasks like emailing a virtual visit invitation to patients. However, if online booking isn't integrated with your EMR, then it might require double entry. Refer to the Boost section of this toolkit for more information about online booking options. 

Ensure your practice team is trained on the updated booking process and familiar with the patient resources that your practice has chosen to use.

Goals:

• Your practice team is booking in-person, video, and phone appointments.

• Your practice team has an updated booking process for video visits and supporting resources.

Actions:

Define booking criteria for different appointment types and train the practice team.

• With your team, define when to book in-person, video, or telephone visits.

Update and document changes in the booking process.

• Ask your team to test the video platform and to update their current booking process accordingly. Consider how you will collect patient consent. Create templates to send video visit links to patients. Click here to see examples.

• Find a method to clearly indicate in the patient cart if a virtual visit is, or is not, appropriate, considering the patient's access to technology, impairments, cognitive abilities, etc.

• Update your practice policies to incorporate changes. For example, if you have a "no show" policy for in-person visits, ensure it includes video visits.

• Train your practice team members to promote video visits and to inform patients about new options.

Prepare your patients for the first video visit.

• Explain the process and what to expect; e.g., giving consent, how they will receive the visit link, possible waiting to connect with the physician, or resources they will receive, etc.

• Ask your patients if they would benefit from additional support during the video visit such as the presence of a caregiver or family member, or the use of interpretation services. Here are templates for your practice.

• Share technical support information with your patients:

  • Patients can call the Patient Virtual Healthcare Tech Support at 1-844-442-4433 from Monday to Friday, 7:00 a.m. -- 5:00 p.m. and Saturday, 10:00 a.m. - 2:00 p.m.

  • Before their visit with Zoom for Healthcare, patients can run a test at https://zoom.us.test.

  • Before their visit with Doxy.me, patients can run a test at doxy.me/precall-test. They can learn how to check in with different browsers (Firefox, Chrome, Safari), and do troubleshooting if their microphone isn't working.

• Online booking can be set to send handouts and information to patients automatically when booking the video visit. See the Boost section for more detail.

Consider patients with diverse needs.

• You can book interpreting services in more than 200 languages, 24 hours a day, seven days a week, from the Provincial Health Services Authority. Visit their website for more information.

• You can book Deaf, Deaf-Blind, and Hard of Hearing interpreting services through the Provincial Health Services Authority.Visit their website for more information.

Set up your workspace for video visits

Physicians can do video visits from their clinics, offices, or a remote setting like home. In each setting, it's critical to protect patient privacy. If you're new to a video platform, allow time to try it with your team and family before offering video visits to your patients. 

Goal:

You and your practice team are ready to provide video visits in the office and/or remotely.

Actions:

Review your current technology necessary to provide video visits.

• Equipment—Have a camera and microphone for all workstations used for video calls. Consider using two screens: one for the video, and one for the EMR so you can easily access the patient's record. Test how to share the screen with the patient. Consider using a headset for a more private conversation with your patient. If you need to insert scanned signatures into your EMR, consider purchasing a signing pad for a relatively low one-time cost.

• Internet connectivity—Check the speed at each location where a video call will be held. You can use an online service such as speedtest.net to get an instant report. Download speeds of 30 Mbps or higher are acceptable for video visits. If your upload speed is 5 Mbps or under, you might need to contact your internet service provider to discuss options for upgrading your plan to 10-30 Mbps upload speed or higher. If possible, use a hard-wired (ethernet) connection to your router or modem instead of Wi-Fi. If you're using Wi-Fi, try to be in the same room as the router or use a Wi-Fi extender device to boost the signal. Check the settings in your videoconferencing software if you experience connectivity issues. For example, high definition (HD) streaming can be turned off. 

• View Email AddressContact DTO to learn more about setting up privacy and security safeguards for conducting video visits.

Arrange the physical space.

• When using video, test the equipment you need (e.g., camera, microphone, headset, etc.) for quality and comfort. 

• Hold video and phone visits in a dedicated space that's private and free from distractions and background noise. Be aware of your surroundings and what your patient will see on your video. Ensure your backdrop is not too busy and that it makes a welcoming impression.

• Set up the camera at eye level and check what part of your surroundings will be displayed to your patients.

• If possible, prop your device horizontally instead of vertically to provide a good view of yourself.

• Select a space with plenty of light so that your image is not fuzzy or dark. Try to face a window or light source.

• Decide how to access the patient's record during the video visit. Arrange your workstation so you can easily access your EMR while being able to visually connect with your patient. 

• If you decide to use your smartphone for video, be aware that it will use a significant amount of data if you aren't connected to Wi-Fi.

• Consider ergonomics as the effects of uncomfortable sitting will accumulate over time.

Establish a work flow and start conducting video visits

Implementing virtual care affects clinical workflows and office procedures, especially when your team is working remotely, or delivering video visits remotely from locations outside the clinic. The Royal College of Physicians and Surgeons of Canada published a virtual care playbook that provides high level guidance for fitting virtual care and related technology into practice workflows. 

If you don't have experience conducting video visits with patients, then watch this one-minute video from the Canadian Medical Association on best practices during video visits: "How to achieve a 'webside' manner".

Goals:

• Your practice provides regular video visits in addition to phone calls and in-person visits as appropriate.

• You, your team, and your patients share positive opinions about the video visit experience.

Actions:

Create a workflow.

• Involve your medical office assistant (MOA) in the process of creating your practice workflow for video visits. When you're working remotely, quick communication with a waiting patient might not always be possible, so ensure your practice staff knows what steps are required for various scenarios such as:

  • Managing an online waiting room

  • Incomplete appointments due to connection failure, or another reason

  • Booking follow up appointments and referrals

  • Completing lab tests and other diagnostic requisitions

  • Providing patients with documents or other information

• Have a backup plan. You, your patient, and your team should have clear instructions on what to do to complete the visit when the connection fails; for example, how to have a phone number ready for quick contact.

• Consider how your practice team can troubleshoot the most common technical issues to assist patients over the phone.

• If working remotely, have a way to send prescriptions, lab requisitions, notes, forms, etc. 

• Create a template to capture notes in the EMR for phone and video visits.

Prepare yourself for the visit.

• Charge your devices. Have power cables ready in case your devices run out of power.

• Turn off other devices and close unnecessary programs to prevent straining your computer memory and reducing the quality of your video.

• Test your camera and audio system.

• Set the volume on your side to an appropriate but discreet level or utilize headsets with a microphone to protect privacy.

• Ensure you are in a private space with no possibility for others to see or hear your interaction with a patient.

Conduct the visit.

• When appropriate, start the video session with clear introductions and confirm the patient's identity. If needed, document patient consent (see the sample templates).

• Identify the reason for the visit. Be aware of who is in the room with the patient.

• Ensure the patient is not in a public space, not driving, and not occupied so you can get their full attention.

• Ask if the patient can see and hear you clearly. Difficulty can impact your ability to diagnose the patient. Suggest adjustments; e.g., to turn toward the window, or go to another room.

• Make eye contact with the patient, nod along to show you are listening.

• Provide explanations for your actions when necessary; for example, when looking away to take notes.

• If necessary, instruct patient how to perform self-measurements or other tasks needed as part of the examination.

• Share your screen to support the conversation.

End the visit.

• Explain to a patient how to proceed with a prescription, lab requisition, or a follow-up appointment or referral if necessary.

• Consider how to communicate the end of the video visit; e.g., "We're nearing the end of the visit. Is there anything I can clarify for you?" "Do you have any questions before we sign off?".

• If this is the first video visit with this patient, ask for feedback to evaluate their experience so you can consider improvements to ensure virtual care is a positive experience for you and your patients.

• Once the session is over, all participants are expected to disconnect from the call immediately.

Evaluate and improve.

Develop a method for measuring the effectiveness of using video visits. Consider using the practice support program's patient experience tool with the support of a coach. Learn more about the patient experience tool.

Inform patients about video visits

Once you've established a workflow for scheduling and conducting video visits, you and your practice team can more actively promote virtual care options to your patients.

Introducing video technology might be intimidating to some patients at first. Patients might not realize that a video call with their doctor is not very different from connecting via video with family or friends. Patients who are already familiar with video calls are natural candidates for video visits. 

Inform your patients about changes in your practice in your practice using various communication channels. Tell patients when a virtual visit is appropriate and how to book it. See the Boost section of this toolkit to learn more about different options for sending broadcast messages to your patient panel.

Goal: 

Your practice team regularly informs patients about the available options for virtual visits, including video visits.

Actions:

Notify your patients about the options for virtual visits.

• In all your communications, identify yourself clearly with your name and the clinic's name so patients know the message is coming from their doctor.

• Create message templates for your practice team to ensure clarity and consistency in your communications.

• Define your key messages and decide how to sequence your announcements—both the amount of detail, timing, and frequency.

Consider listing your practice on the Pathways Medical Care Directory.

Pathways is a one-stop online directory to easily find information about doctors and medical clinics in British Columbia. Listing your clinic on Pathways helps patients find details of how to connect with their provider for virtual care by phone or video, and also provides latest clinic updates. Register here to create your free physician profile. Pathways is a registered non-profit that grew out of the Fraser Northwest Division of Family Practice and is funded by the Family Practice Services Committee.

Physician's voice:

"I can still receive an income by doing virtual visits if I am ill or travelling within the province. Recently, I was able to visit my daughter and newborn grandchild and still maintain a few hours of work each day."

"The diagnosis is in the history. Examination and investigation alone are not enough. My observation and listening skills have much improved with practicing virtual care."

"We often engage patient's family members to assist their patients with the first visit. This initial time investment pays off with strengthening longitudinal care and benefits the most vulnerable and complex patients."

"Once I started to provide video visits regularly, I noticed the battery on my cell phone was running out quickly. So I propped a plugged-in tablet and use my laptop with a camera to access the EMR."

The Doctors Technology Office is an FPSC-initiative.