Your Guide to Understanding Telehealth’s Terminology & Best Practices

By Jimmy McKay, PT, DPT

Director of Communications

With a dramatic increase in virtual communications in the last few months, we’re now communicating via our phones’ cameras and microphones regularly. This guide serves as a first step toward improving the communication experience for you and your audience.

Since March 2020, the utilization of telehealth has greatly increased by physical, occupational, and speech therapists. Both as a means to deliver their skilled care to their patients as well as communicating with colleagues, friends, and family.

With this sudden increase in the use of “virtual” environments, it’s a good idea to make sure you’re implementing best practices. Improving the delivery of your communication will offer a better experience for your audience (patients, colleagues, friends, and family). It will also set you up for success to communicate more clearly with less effort for you.

Defining Telehealth Health Terms

Telehealth terminology can often feel like jargon. According to the American Physical Therapy Association, telehealth is the use of electronic information and telecommunication technologies to remotely provide health care information and services.

Two-Way, Real-Time Interactive Communication

If you’ve used Apple FaceTime, Google Meet, or Zoom meetings, you’ve communicated with a two-way real-time communication device. This is the use of some combination of audio or video communication where the parties in the meeting interact in real-time.

E-Visit

An E-Visit is defined as “a patient-initiated online assessment and management services for an established patient … using an online patient portal, not in real-time,” according to the APTA. The provider and patient can exchange information but not in real-time. Information can be shared through messaging apps, photos, patient handouts, etc. This is an asynchronous way of communicating between patients and providers, meaning communication doesn’t happen at the same time.

Virtual Check-In

This type of patient-provider interaction is limited to audio. For example, a telephone conversion could serve a virtual check-in. It is in real-time and involves a direct link between provider and patient but does not allow for video information to be included.

Set Yourself up for Success

While you bring your clinical skills to all of your patient interactions, with telehealth you need to add in some other skills. You now have a medium (audio, video, or text) between you and your patient. Here are some factors to consider when you’re going to use a method of delivering care with Telehealth tools.

Getting the Most Out of Video

Lighting – On Hollywood sets the word “lights” comes before camera and action, so you should start there. Before we position our camera, be aware of the light in the environment that you’ll be in. We want to avoid the side and backlighting. This means we want the brightest light to be originating from in front of your face. This avoids shadowing and a silhouette effect that will make your face appear dark and difficult to see on camera. This can limit many of the great reasons to utilize video in the first place, like eye contact, facial expression, and a smile.

Consider using a portable smartphone tripod. There are many small and affordable models that enable you to prop your device up. Then you can easily make sure your camera remains at eye level. This also frees your hands for patient demonstration or note-taking.

Camera placement – We’ve all seen “selfie videos” where someone is holding their smartphone at arm’s length. Eventually, that person’s arm fatigues and we get a great inferior view of nasal canals. This can be a distraction for the viewer. Optimal placement of a camera for telehealth delivery with video is at your eye level. Much like you were taught, you always want to be on the same level as your patients. Think of a situation where you are treating a patient who utilizes a wheelchair for mobility, you wouldn’t stand in front of them and look straight down at them. You would make every effort to have your eyes at the same level as theirs. Cameras are no different. Avoid looking down or up at the camera lens so that your image appears to look directly at your patient.

Background – Now that we’ve made sure your face comes through in frame. Let’s focus on what is around your face isn’t distracting.

Simple is the gold standard to aim for with what is behind you on video interaction. If your background is too busy, it can become a distraction and take the focus off your information. A plain colored wall is a great way to minimize distraction and increase the clarity of your communication.

Sound – Make sure that you can hear and be heard clearly without interference.

Headphones – Nuance in a patient’s voice can tell a skilled clinician a lot about how that patient is feeling or if they are understanding instructions. Attention to clear sound can improve your interaction greatly.

Headphones reduce feedback as well as bring the sound from your patient closer to your ears so that you can hear better.

Environment – Just as we evaluated our environment for video, we also want to scan our environment for sound. Are there distracting sounds like a TV or other conversations? Are you in an environment where traffic or other noises might appear suddenly? While we might not have the luxury of a completely sound-free environment, giving attention to what sounds could interfere with clear communication is a great way to reduce distractions.

Microphone – Many smart devices like laptops and cell phones have great microphones. But it’s a good idea to test out the quality of your particular device before beginning any patient care with it. Can you be heard clearly? Are there any noises that come along with your voice like buzzing or interference? These should all be addressed before to make sure your audio is clear and noise-free.

Mute Button – If you do have a situation where an unexpected sound begins, knowing where the mute button on your device is can minimize distraction. We’ve heard many stories of how an emergency vehicle driving by can derail a patient interaction. Knowing where your mute button is can help to remove that distraction.

Interacting:

Now that you’re ready for prime time, here are some best practices to follow while delivering and receiving audio/video information during Telehealth.

Be Prepared – It’s the motto of the Boy Scouts of America for a reason. It can also help save your Telehealth session. Are you prepared for your patient interaction? Do you have the information that you will need in front of you or can you access it easily and quickly? Do you have the right amount of time set aside in your schedule to communicate or are you rushing? Is your device powered up or will you need to scramble for a power cord in the middle of your appointment? Or even worse… Will it run out of power, thus disconnecting you completely? All these occurrences are devastating to the patient experience. But the good news is, they can be avoided with preparedness.

Take your time – While you might be interacting with Telehealth as a provider regularly, for many of your patients this could be their first time in this type of environment. Making sure that they are clear and comfortable with how your appointment will go, leaving them time to ask any questions, and setting clear “next step” expectations can all greatly improve your Telehealth appointments. Taking your time also means giving your patient some added time to respond to questions or instructions. Remember there is now a device and an internet connection between you and your patient. Slowing down can reduce anxiety and increase the quality of your communication.

Plan B – If your patient can’t access your communication platform because of a technology failure, internet outage, or lack of knowledge, what will you do? You’re a provider of skilled care and having a backup platform is a great way to save a missed appointment. Can you pivot from a video call to a phone call? Can you utilize another platform? Having a plan B ahead of time can save you from having to delay treatment.

Conclusion

Telehealth was thrust into your vocabulary 2020, and it might be causing some anxiety as you begin to implement it more into your clinical practice. Remember that this is still an interaction between a skilled provider and someone who is in need of your care. While Telehealth and the tools that go with it are important, in the end, it’s a means to build a therapeutic alliance with a patient. There are other resources from professional associations like APTA, AOTA, and ASHA. And always keep in mind that you can talk to your colleagues about their experiences to improve your telehealth delivery.