A three-phase telehealth workflow

If your behavioral health agency first launched telehealth in response to COVID-19, you may have created a rushed, bare-bones program to meet short-term needs. However, to maintain a successful telehealth program in a post-COVID world, you need a robust plan for your telehealth workflow.

Because telehealth appointments are a little different from normal, in-person visits, they require a different approach to ensure that both staff and clients have the best experience. This may include how the physical workspace is arranged, how appointments are made, and communications between providers and clients. The telehealth workflow should not disrupt the organization’s overall operations.

A telehealth workflow includes three phases:

• Preparing for a telehealth session
• Conducting a telehealth visit
• Following up after the visit

The minute details of your telehealth workflow should be adapted to your telehealth platform and the unique needs of your agency and clients. In general, however, your workflow will include those three steps.

1. Preparing for a telehealth session

The pre-visit period for telehealth includes several components:

• Determining what types of services can be provided via telehealth
• Knowing which clients will benefit the most from telehealth
• When telehealth visits can be scheduled (days and hours)
• How clients can schedule telehealth visits
• Knowing what clinicians and staff need for a successful telehealth visit

Your organization should first document your current clinical and administrative workflow to understand where telehealth fits in. This may include client training, appointment logistics, consent, troubleshooting, and billing.

You may want to get client feedback to better understand their needs and how telehealth could help them. Ask your clients about what times of day would work best for remote appointments, and whether they have any concerns that might prevent them from using telehealth.

Although HIPAA and other standards have been relaxed during the COVID-19 public health emergency, telehealth visits should follow all the same state and federal requirements as onsite visits. This includes fraud and abuse laws, privacy standards, and licensing requirements.

Staff must be adequately trained and prepared to set up telehealth visits. This includes an understanding of: 

• How to access the information needed for each client visit
• How clients will access telehealth sessions, such as a “virtual waiting room”
• Who will greet clients first and perform assessments when the telehealth visit begins, such as a medical assistant
• What resources are needed, such as strong wi-fi connections, internet bandwidth, clear video and microphone equipment, and a quiet or private space
• How to use telehealth equipment and software 

When developing a telehealth workflow, providers should conduct a few practice sessions with coworkers first. It may be a good idea to involve your telehealth solutions vendor so they can help identify and address areas of improvement. Practice runs will help refine the process before it is fully implemented, reducing frustrations and improving the experience for your staff and clients.

2. Conducting a telehealth visit

All clinicians and support staff who interact with clients during a telehealth visit should maintain the same professional standards as they would for in-person care.

Clients should feel that they are getting much the same experience through telehealth as they would onsite. Providers and staff can ensure this by:

• Creating a professional environment using a quiet, private room of the appropriate location, size, and layout
• Maintaining adequate lighting
• Using sufficient equipment, including high-quality sound and video, with a strong Internet connection
• Dressing with the same level of professionalism as an onsite visit
• Reviewing the client’s records and complaints before the start of the visit
• Eliminating distractions (muting phones, turning off notifications, etc.)
• Allowing more time than expected for telehealth calls, at least early in their implementation; this provides a buffer time to troubleshoot any glitches and help providers and clients get comfortable with the format

At the start of the visit, providers or welcome staff should greet clients and identify themselves to the clients, especially if the visit is audio-only. Confirm the client’s identity and ask whether the client’s equipment is working properly.

Because on-screen communication styles may vary from in-person interactions, it is critical that providers follow best communication practices during a telehealth visit. During a telehealth call, make sure that you:

• Adjust the webcam to eye level
• Speak clearly and deliberately
• Pause frequently to accommodate delays in transmission
• Use empathetic, person-centered language
• Include non-verbal language, such as nodding and attentive posture, to indicate that you are listening to your client
• If you have to turn away from the camera during the appointment, narrate these actions to your client (“I’m taking some notes here,” or “I am looking up your previous visit”)
• Inform your client verbally of the next steps, such as making follow-up appointments, adjusting the care plan, or ordering prescriptions

Providers can also ask their telehealth vendors if they provide training or materials on how to conduct a successful telehealth visit.

3. Following up after the visit

The telehealth visit should be documented like an in-person visit. However, the documentation should note that it was a telehealth visit. Be sure to include client consent, which may have been given verbally or signed and submitted electronically.

As you proceed with your telehealth program, be sure to collect data that will help you track any goals you have set for the program. Request feedback from team members and clients about the telehealth experience and how it may be improved. Continue to evaluate the program, identify areas that can be improved or adjusted, and determine what your telehealth program’s future will look like.

Depending on the goals of your telehealth program, it can take at least six months to show clinical results. Before then, it is important to observe other measures of success, such as staff and client satisfaction, client engagement, and reimbursements received.

Four telehealth workflow diagrams and other resources to help with implementation:

• AHRQ’s Easy-to-Understand Telehealth Consent Form
• Telehealth Implementation Playbook (PDF) from the American Medical Association
• Sample Telehealth Workflow (PDF) from the California Telehealth Resource Center
• HHS List of Telehealth Resources

After the COVID-19 public health emergency, many providers and clients will choose to keep and even expand their telehealth programs. The right partner can help ensure your telehealth program’s long-term success. Contact Streamline Healthcare Solutions today to get more information on how you can start implementing telehealth services.