Hello. My name's Helen Hughes and I'm the assistant medical director for the Johns Hopkins Office of telemedicine and the medical director of pediatric telemedicine for the Johns Hopkins Children's Center. I'll be speaking with you today about support workflow processes for ambulatory telemedicine. We think of telemedicine support really as ways in which our staff can support our patients and providers in facilitating telemedicine visits. In our institution, there are four main phases of telemedicine workflows that include support, which are scheduling, visit preparation, visits, during the visits and checkout process. You can see here that there are a few different tasks within each phase. In the scheduling phase, there's the appointment scheduling and MyChart or portal activation. In the visit preparation phase, there's ensuring that patients are set up with MyChart video instructions, as well as a e-check in confirmation. In the visit phase, there is a phase where a task or some clinics are calling patients to remind them into start the visit. We need obtaining of telemedicine and billing consents or acknowledgment if patients are not able to complete this electronically. There's a medication review process and a reason for visit confirmation that's usually completed by medical staff. After visits, patients need to have follow-up visit scheduling, as well as referral and test scheduling that they would have done in person. I'm going to go through a few examples of a typical clinic workflow at our institution. In our EMR, a support staff member may white dot a patient or turn the dot white in the schedule to indicate their working with that patient on preparation. Some clinics are calling patients 15-30 minutes before their appointment to make sure they have everything set up. Support staff may document the patient's telephone number and their address at the time of the visit in case of an emergency and perform medication review and allergy review. They may verify the type of device that the patient is using and if the patient's not able to access the visit through MyChart or electronic portal, then they may use smart phrases in our health record to indicate a verbal consent for the patient's visit for both billing consent and telemedicine medicine consent. If the patient is able to login themselves into MyChart and use our video visit platform, we may have them stay logged in after the support set members helped them and inform them their provider will connect. Then our support staff member often chat in our secure chat function, the provider to let know that the patient's waiting for them and turns the green dot on the schedule to indicate that the patient is ready. If the patient wants to have someone else at a different location join them, they have instructions in their MyChart account to share their visit with that person. If the patient's not able to join the appointment, some clinics use Zoom as a backup and they may indicate to the provider that the patient was not able to use the atypical MyChart workflow, although we do now have the ability to text message video link to patients to our embedded platform in Epic. This is just another way to say that same information, the main phases of a visit being scheduling, before the visit prep, and after the visit. At scheduling,, patients will determine whether visit is in-person or by video and then receive instructions. Then in this pre-visit, 30 minutes before the visit time-frame, what our staff does depends on the patient's ability to access their MyChart or portal account and whether or not the patient can complete e-check in. If they cannot complete electronic check-in, then they need to be manually checked in by our clinic staff and you can see the steps here on the left of the screen. On the right, if they can complete e-check in, then it is less burdensome for our front-line clinic staff in terms of the amount of work to get the patient into the visit. After the visit, often asynchronously clinic staff members will call patients to have develop scheduling done and referral scheduling, although we are working through processes to do this electronically. This is an example of some of the MyChart video visit instructions that patients receive. This is read to them by our scheduling staff and they may also receive it as a message in their MyChart account. This just goes into steps on how to login on the day of the visit, and some basic guidelines around lighting and privacy for their visit, as well as a little bit of instructions about if their visit needs to be conducted by telephone. This is an example of our visual visit instruction web-page which you can see on our website, which has these types of instructions, as well as links to tips for successful video visit, including leaving some time before your appointment to login, conducting the visit in a well lit room, making sure the space is private, dressing in a way that you're comfortable with your provider seeing you, writing down any questions you have in advance, and some technical recommendations around device and browser. This is an example of some of the tips and tricks documents that are available on our website for patients. Then we also have a video, a YouTube video that's linked to our website, which walks through all of the steps for patients, as well as some welcome videos on what to expect for a telemedicine visit.
