I just attended our first in-person Medical Director Summit for our medical group in October. It had been more than three years since we came together as a medical group in person. It was a truly magical experience. No matter how many times I interact with colleagues virtually, it is simply not the same as meeting them in person; giving them a hug; smiling in their face; and interacting with them in the flesh. It was so good to see my colleagues from across the country and network and learn together with them in person. No screen could substitute that personal interaction.

Interacting with other people on a screen is deficient in almost every way. It is nearly impossible to read body language, true tone of voice, and personability through a screen. It is very difficult to garner trust between individuals through a screen. When we implemented a telemedicine program, we struggled early on to build trust between the physicians on one end of the screen, and the nurses on the other end. It was only when I visited on-site that this process of trust was able to develop. The few hours I spent interacting with the on-site clinical team were truly invaluable, even though I interacted with them multiple times virtually in the past. 

This speaks greatly about the nature of us as human beings. We are nothing if not social creatures. The disruptions in social gatherings, while I still understand why we did that early on in the pandemic, was truly disruptive to our nature as human beings. We need to be together as families, colleagues, communities, and peoples. It is in our very DNA.

What’s more, I think this also has to do with our spiritual natures. I believe each of us is infused with the spark of the Divine (all the while not having any sort of Divinity whatsoever). It was breathed into us when we came into being. Those sparks grow into burning flames when brought together, and those flames give off light and warmth and healing. That is further why it is so fulfilling to get together with friends and family. 

I do not criticize the decision to shut down everything and social distance early on in the pandemic. We had no idea what this virus was, or what it was capable of doing. We did the best we could with the information we had at the time. Looking back, whether continued lockdown had a net positive effect is debatable, and we should study every aspect of those decisions. That way, we know better, when the next in evitable pandemic strikes us.

In addition, sometimes, there is no other choice but to interact with someone on a screen: think a critical access hospital that has no Neurology or Critical Care and can only get this via Telemedicine. The pandemic has caused Telemedicine to grow exponentially, and it is going to be, in my estimation, a permanent fixture of clinical care in the future. One hopes and prays that policymakers do not get in the way of this inevitable trend. It is not a substitute for a real-live bedside clinician, but sometimes a clinician on a screen is better than no clinician at all.

That said, my experience during our Summit taught me one unshakable truth: a screen is absolutely no substitute for the real thing. We were made to be together.

The post A Screen Is No Substitute appeared first on Medika Life.

The COVID-19 pandemic is accelerating digital innovations in healthcare delivery that have been moving at a slow, but steady pace for decades. Hospital healthcare use to be primarily analog and standardized – a physical experience centered on a health system’s actions. Now, providing care is becoming more digital and personal where empowered and informed patient-consumers can do more to impact their care. How did we get here, what does it mean, and what’s next?

From first-hand experience, I understand that hospital administrators and executives are very reluctant and slow to change. ‘Why do we have to change the way we do things?’ ‘Why would I ever pay for this stuff?’ These were often the remarks I heard from colleagues for decades while hospital costs in America continued to increase and the health of Americans declined. 2020 has made two things clear: something must change, and that change needs to be big.

The Chronic Issue

Take chronic conditions, which dominate healthcare, as the leading example. Six out of 10 US adults have at least one chronic condition and 75% of the US $3.5 trillion in annual healthcare spending is attributed to the management of chronic conditions.

America is not unique in facing the dilemma of rising costs and declining health due to chronic conditions. The UN estimates 41 million people worldwide die prematurely every year from preventable chronic illnesses. Between 2000 and 2017, health spending in real terms grew by 3.9% a year worldwide while the global economy only grew 3% a year.

Improving the same inputs, i.e. more money, more physicians and nurses, and better medicines – is simply not enough to balance the equation. That approach has been tried for decades and has proven unsuccessful. We cannot train physicians and nurses, develop new therapies, or increase budgets fast enough. We must change the inputs and stop trying to force analog solutions in an increasingly digital world. The integration of technology has been staring us in the face for a long time and we must do things differently so we can achieve a lot more by using fewer hospital resources.

With that being said, the healthcare industry and policymakers are responding. For example, the US Chronic Care Act of 2017 expanded Medicare reimbursement for remote solutions for chronic care management. This provided cohesive coverage for patients that needed it and supported the integration of technology on a larger scale, propelling the necessary momentum needed for change.

COVID – 19: A digital catalyst

While the forces that shape healthcare were steering in the right direction and gaining speed, the global health crisis is an even greater catalyst for change. As a result, the industry-wide preference for incrementalism will hopefully come to an end and move more toward truly transformative change.

Why? Not because hospital administrators and physicians had a collective epiphany that virtual health solutions like e-visits and remote patient monitoring are game-changers. Rather, because the current circumstance is forcing health systems to do more remote engagement with patients and patients have more power than ever before.

Before the pandemic, very few patients had experienced an “e-visit” with their physician or understood that something like that was even an option. As the world continues to evolve and younger more digitally native patients begin managing their own healthcare, it is hard to imagine “e-visits” not being a preference. Patient expectations are rightfully adjusting with the times and it’s important that medical professionals along with the systems they work in adapt too. If the medical industry doesn’t continue to leverage new innovative technology in their practices, the very people they’ve devoted their careers to heal will suffer the most.

Benefits of Virtual Care Solutions

The benefits of virtual care solutions are manifold, but the largest is the ability to positively modify patient behavior. Most chronic disease patients do not adhere to their doctor’s treatment plan, with fifty percent of patients not following their prescribed treatment plan, and with the biggest drop-off occurring in the first month.

Hospital administrators cannot prescribe habits, and that is often why patients fail to follow their orders. However, a virtual care solution— a PC, phone or tablet with biometric devices and a digital assistant — can engage patients daily to support treatment plans and report data back to the primary care team. According to a recent study by KLAS research, remote patient monitoring to track vitals between office visits to adjust medications help avoid ER visits and hospital readmissions.

A digital solution like this can also help include a patient’s family members and impact social determinants of health (SDoH). ‘Dad I see your glucose levels are a bit high and you haven’t exercised much this month. What can we do about that to help you?’ Such a platform, supported with physician care, helps build healthy habits, reduce adverse events, and extend life.

Because it can improve patient behavior and delivers better outcomes, virtual care solutions help enable value-based healthcare, a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. With value-based care models, providers are rewarded for helping patients improve their health, reduce the impact of chronic disease, and live healthier lives.

Patient-consumers wear smartwatches to monitor their health and are increasingly accustomed to e-visits with care providers. How long will they wait for their hospital healthcare teams to put these connections together and start offering smarter solutions? Provider behavior must follow patient-consumer behavior. Health systems and physicians that are slow to adopt could find themselves quickly falling behind in the healthcare marketplace in the years to come.

The post The Journey from Analog Patient to Virtual Health Consumer appeared first on Medika Life.

For many clinicians, service providers, therapists, and counselors, virtual counselling and care is a new venture that takes quite a bit of adjusting to – especially if technology has not been a strong skill set in your toolbox.

Not to fear – starting slow and steady can help you build more confidence as you learn to navigate these waters. While you may need some help from colleagues or other supports for your initial set up, what may once have felt very scary to you may become the norm as you gain more practice and experience using virtual tools and learn how to support your clients in a new way.

Keep reading on for some tips that might help you along in your journey.

Optimize your camera and lighting

Make sure your client can see your face clearly – use good lighting and a good quality camera. Try to complete your session near a light source – use an overhead light or a lamp to brighten up the area so your client can see you better.

If you are working from a desktop, use the best quality webcam you can find to help your client view you as clearly as possible. If you are using a laptop, it usually has a camera built-in but you can attach an external one if you feel an upgrade is necessary.

Build therapeutic rapport

Consider your facial expressions, vocal tone, and body language. Extra effort is needed on your part to convey engagement, empathy, and understanding from behind a screen! Building a therapeutic connection is often more challenging with clients virtually due to the significant physical space and distance between you.

You may find that you need to work even harder to achieve the same impact that you otherwise would have with an in-person session. You may need to be a bit more expressive to help clients feel a greater rapport with you, whether that involves using more relevant facial expressions, reflecting back frequently what the patient has said and confirming you understand correctly, sharing empathic statements more regularly, using more warmth and humour (when appropriate), and checking in with your client to verify if you are on the right track.

Take the “Do Not Disturb” motto seriously

Hold your session in a space where you are the least likely to be disturbed, interrupted, or distracted.

Maintaining privacy and confidentiality is crucial during virtual counseling or care – regardless of whether services are offered in-person or virtually. Use a private space or room and put a sign on the door indicating you are ‘in-session’ to make sure others are aware, particularly if online services are being provided in your home setting and you live with others.

Manage competing responsibilities

If you have a child or children and/or a pet, try to make arrangements so that they are well cared for while you are occupied.

If you have a partner or a family member who can support your child or children and/or pet, as applicable, that can help you stay focused and attentive during your session.

Increase familiarity with your virtual platform

Make sure you are familiar with your virtual care platform so you know how to navigate it well. Watch tutorials, read Frequently Asked Questions (FAQ), reach out to customer service, and practice using the application features so you can build your confidence using it. If the platform has a chatbox function, use that for quick tech support if needed!

Learning how to troubleshoot issues will not only help you but may also possibly allow you to help your client if they run into challenges, too.

Share information about your virtual counseling platform with your client so they have a chance to get familiar with it as well before their first session. If your client has to create an account to login to the virtual care platform, give them the website details in advance so they can get comfortable before they actually have to use it.

Having your client understand the virtual platform is also important if they are entering credit card information securely into the platform for session payment purposes.

Doublecheck your settings – “Testing, testing, check, one, two three….”

Make sure your camera and microphone are working well before the session and ask your client to do the same. This will help you start your session smoothly without glitches.

Have a back-up plan

Be sure to have an alternative set up ready in the wings (e.g. phone counseling) in case you have technical issues that cannot be addressed quickly at the start of the session.

Despite your best efforts, technical issues can sometimes still happen. If this does occur, have your phone charged and ready to go in case you need to switch to this format for your virtual session.

Furthermore, if you find phone counseling to be easiest for you and your client, discuss this with them and see if they would like to pursue this option instead.

Take care of all of the important paperwork

Obtain your client’s completed intake form before their first session so you have their full contact information and emergency contact person’s information in case a crisis occurs in-session. The completed intake form will also help you understand what their specific goals are and what they would like you to help them within your work together.

Similarly, obtain your client’s signed consent form for virtual care services prior to their first session and answer any questions your client has at the start of the session so that they can begin knowing they have made a fully informed decision.

Review the limits of confidentiality

When providing any form of counseling and care services, it is essential to review the limits of confidentiality prior to starting services.

Explain to your client that the information and content discussed in the session will remain confidential except for circumstances involving a risk of harm to themselves, others, or you – or other extremely serious situations. It may help to include a general overview in your virtual care consent form of possible scenarios where confidentiality may have to be broken.

Answer any questions your client may have in regard to the limits of confidentiality before you begin.

Develop virtual care policies, as appropriate, to explain your services – and their limitations

The same professional boundaries and limitations in terms of in-person services are also applicable for virtual counseling and care. For example, your virtual counseling policy may require a section outlining when clients can expect to hear back from you in regards to phone and email messages (e.g. 24–28 hours, business days and hours, etc.).

Your fees policy – if you are providing private fee-based services – will need to include the session rate as well as if there is a late cancellation fee for short notice cancellations that occur within 24 hours of the appointment (mention whether that cancellation fee is the full session cost or 50% of the cost of a session).

You may also wish to create a social media policy that highlights you will not accept ‘friend requests’ or messages from clients on any social media accounts in order to maintain professional boundaries.

It may also be helpful to establish a complaints policy that directs clients on the next steps if they wish to express concern about your services. It would be helpful to include the contact information for your regulatory college as well.

These are just examples of potential virtual care policies. Write up those that are relevant to you and your services. Ensure you have a section at the bottom where your client has to provide their signature and date to confirm in writing that they understand your policies.

You may wish to combine your virtual counseling consent form and virtual care policies into one document or keep them separate – this is a matter of personal preference. If they are separate documents, include a client signature and date section for both forms.

Reach out to your regulatory body and/or a lawyer if you would like some guidance on important things to consider when creating your policies and consent forms.

Keep excellent documentation

Keeping clear and detailed records from every client session is vital to ensure all major themes, issues, plans, and next steps are noted. If your virtual platform offers electronic documentation, make use of that feature if you are comfortable using it. Otherwise, you can determine a documentation system that works best for you, and that meets your regulatory college requirements.

Best wishes as you continue to provide valuable virtual care to your clients and to the community in general!

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