[Eboni Fleming]

I participated in the case regarding a hospital follow up for a patient that had a stroke. I was the provider. I was also the patient for a telehealth visit for diabetic foot care education. Professionals to involve in the stroke case include home health, occupational therapy, physical therapy and speech. For the diabetic foot care scenario, other professionals to involve could include a diabetes educator and podiatrist. Additional technology that can be used for diabetes follow up is remote glucose monitoring.

https://zoom.us/rec/play/CTdfoa6JR_La3DyILnI2Ppz4Rqv_r-Of4ddtTkDEv5-agdUE4cuag_eF75DtqbK7HkiysF8u5ZViXTlj.HQB6WMB8kKvLVJIH?canPlayFromShare=true&from=share_recording_detail&continueMode=true&iet=frpfaHEqkvewJk5_GsbeEuYXjD7sGU7By2jl97JXW10.AG.-KrjB2Y3bUkxVdhQO6foQI4vMqX3m38A1vVX34c3TDwOvcmKvKpdaoHtl_XCgFgUGQMlcZn_2vf9wRrMC8tmhfk5j8w0rwQ6reYHELzdw1KOnOAVV4_GeA.rX4dAvjNbwbmrRiyQzVmZg.3w05E6fjmbc2wNIM&componentName=rec-play&originRequestUrl=https%3A%2F%2Fzoom.us%2Frec%2Fshare%2FKcCYQF0-R0hVjrachtjxiX8NtHMdvvzoIOkppq-4rdfANPp9t2R-PRvRKhuiqnUt.m0k_RPlbT7Nd3mNn%3Fiet%3DfrpfaHEqkvewJk5_GsbeEuYXjD7sGU7By2jl97JXW10.AG.-KrjB2Y3bUkxVdhQO6foQI4vMqX3m38A1vVX34c3TDwOvcmKvKpdaoHtl_XCgFgUGQMlcZn_2vf9wRrMC8tmhfk5j8w0rwQ6reYHELzdw1KOnOAVV4_GeA.rX4dAvjNbwbmrRiyQzVmZg.3w05E6fjmbc2wNIM

Telehealth Etiquette Checklist
Group #: 3
Patient Case: Alton Haynes-Stroke

As you view each version of a video consultation, please critique how well the clinicians demonstrate interpersonal skills using this checklist of 12 Critical Behaviors. For each critical behavior, three to five competencies that support the behavior are listed. Indicate the rating from 1 to 5 that you think applies best about the performance of each Critical Behavior using the following response scale:
1 = very poor performance; 2 = poor performance; 3 = fair performance; 4 = good performance; 5 = very good performance.

You can also add Coaching Comments at the end that you might say to the clinician.

Critical Behavior  Competency RATING
1. Orientation
ü Explained expectations for the televisit  Expressed positive views of telecare  Checked for cultural/regional differences  Introduced self
ü Explained role on the health care team 1 2 3 4 5

5
2. Verbal Clarity  Used clear language
 Avoids or explains abbreviations and technical language  Clarified unclear statements as needed 1 2 3 4 5

5
3. Active Listening
ü Used repetition and summarizing to reinforce information  Specifically invited questions
ü Checked for clear understanding of what the patient was saying  Avoided interrupting patient 1 2 3 4 5

5
4. Patient-Focused
ü Explored problem impact in the patient’s life  Allowed the patient to set the pace for the consultation
ü Used adequate open-ended follow up questions to obtain a view of the whole health problem 1 2 3 4 5

5
5. Tone of Voice  Friendly
ü Softened tone when conveying emotional content
ü Used appropriate vocal volume and rate for patient understanding 1 2 3 4 5

5
6. Eye Contact
ü Made eye contact before speaking
ü Appropriate length to enhance patient comfort  Stayed visually attentive 1 2 3 4 5

5
7. Other Body Language
 Open posture- arms uncrossed (neutral/positive)  Appropriate and engaging facial expressions  Kept position facing patient/camera and unobscured  Limited distracting movements or note-taking  Appeared comfortable in the virtual environment 1 2 3 4 5

5
8. Empathy
ü Conveyed empathy nonverbally  Showed openness to patient’s emotions  Showed acceptance of patient’s emotions
ü Responded to patient’s nonverbal indicators of emotional state
ü Used silences to facilitate the patient’s expression of thoughts and feelings 1 2 3 4 5

5
9. Rapport  Created rapport
 Encouraged patient to express self  Showed interest in the patient as a person 1 2 3 4 5

5
10. Respect
ü Acknowledged patient’s coping efforts
ü Accepted legitimacy of patient’s views and feelings; is not judgmental 1 2 3 4 5

5
11. Therapeutic Alliance
ü Responded to patient with emotional vs. informational comments, appropriately  Collaborated with decision-making  Offered partnership
ü Dealt with embarrassing topics sensitively 1 2 3 4 5

5
12. Environment
ü Limited background noise or distractions  Explained role of any others present
ü Explained setting
ü Assured privacy of patient consultation 1 2 3 4 5

5
Overall Rating
Coaching comments:

1 2 3 4 5

5
Please provide your general feedback on using the checklist here.

Telehealth Exam/Education Rubric
Group #: 3
Patient Case: Alton Haynes-Stroke
Check
1. Identifies reason for the visit 1
2. Confirms that patient agrees with the reason for the visit and accepts that it is delivered by telehealth 1
3. Obtains history of symptoms or situation 1
4. Obtains approaches/treatments patient has taken to address the issue 1
5. Conducts an appropriate physical using equipment at home, and/or other individuals to assist or provides telehealth education using appropriate learning style 1
6. Discusses findings/Overview of education 1
7. Develop plan (follow-up, referral, medication, etc.) 1
8. Determines patient’s understanding of plan/education 1
9. Determines how patient will get information on the visit (email, portal, secure text, etc.) 1
Total (1 point each) 9/9

[Eboni Fleming]

Telehealth is an amazing use of technology that allows us to expand access to care, improve the patient’s experience, and better support alternative healthcare delivery options. The model that I would use is a combination of different models. I think that videoconferencing provides a super convenient and safe way to provide care. Most patients have some form of technology appropriate for the visit such as their phone or tablet and are well versed in how to use it. Depending on the setting I work in, I think remote patient monitoring would be great as well. Having the ability to directly access things like blood glucose monitoring, blood pressure readings or EKGs would simplify care and make better use of time. I would factor in costs, ease of use, and reliability when deciding what type of equipment to utilize. I have used HIPAA compliant zoom, doxyme, and Webex in the past for videoconferencing and all were relatively user friendly. The issues I would address using the telehealth platform would be those typically scene in the primary care setting such as: acute illness, appointments for lab reviews, follow up appointments (hospital follow up, blood pressure follow up, medication adjustments), and consultations. I would assume the role of the provder-Family Nurse Practitioner, and ensure my patient is fully prepared to receive services via telehealth. I would let them know that it is available, how it will be conducted, what to expect, and ensure I am obtaining consent. In my opinion, written consent is preferrable. I think we should let our patients know when they establish care that this is a service that is offered and then obtaining consent from the beginning to utilize for subsequent appropriate visits would be the easiest and consistent protocol to develop. The consents would then be renewed on an annual basis. This coordination of care would take buy in from the entire office team to ensure that processes are understood and followed. There are many legal considerations to account for, and as I provider we must be competent in following the established guidelines. We must consider billing, ensure documentation is consist with regulations, privacy and HIPAA compliance is maintained, and the standard of care is not comprised. Other professions I would like to involve include case managers, counselors, therapists, and specialists.

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