What I Wish I Knew: Telehealth: Tips, Pearls and Challenges

One of the most crucial elements for a successful telework experience is maintaining and strengthening relationships with your Mental Health team. The nurses, PA’s, social workers, therapists, psychiatrists, technicians, as well as pharmacists who work in the same area as you can be valuable resources and instrumental when challenges arise. It is important to continue fostering those relationships even when working in telehealth settings. Participating actively in virtual meetings and huddles is a simple yet effective way to stay involved. If you have a camera then be sure to turn it on so that your team is able to see you. Doing this helps foster a sense of approachability and familiarity. If it is you’re new to a meeting, taking a moment to introduce yourself and share what it is that you do and how you can support the team. It will be easier to work through future patient issues with collogues if a foundation has already been laid of an interdisciplinary team approach. Working with the team will be exceptionally helpful if dealing with a patient in a crisis or emergency, which we’ll explore in the next tip.

What to do in a crisis or emergency

Dealing with someone in crisis or with an emergency is always a challenge and may be even more so when utilizing telehealth. For this reason, it is always best to be prepared with the following:

1. Know the Patient’s home address as well as their emergency contact
2. If the patient attends the meeting from a different address, ask for their location at the very start of the appointment and whether anyone else is in the home
3. Have the patient’s emergency numbers on hand as well as contacts for other emergency services at your facility such as: suicide prevention team, crisis line, etc.
4. Be ready to use your team! When dealing with a crisis, it would be prudent to remain in contact with the patient while sending a message to your team explaining the situation. You may then provide the team with contact numbers and additional information so that they can reach out to the appropriate party(s) while you remain in contact with the patient.

Additional challenges of telehealth services and how to overcome them

• Technology failure – Unfortunately, this is inevitable. Technology will fail whether it be an issue with the system being used, internet/connectivity, servers, or the cosmic aligning that day. Therefore, there should always be a backup plan. Most of my telehealth appointments are either by video from home or video from one of our distant clinic sites while I work out of our main facility in the city or home. In case of video malfunction, I will try one of two things: 1. Another video option (the VA has classic VVC, or VVC NOW which I use as a backup) or 2. Switch to phone. If facility phones are not working, then can consider using other programs if appropriate such as Doximity.
• Testing, such as AIMS exam – Even through Telehealth I will continue doing the screenings necessary for patient care. For things such as the AIMS, have the patient prop their phone/device up and move their seat back so that you may have a better view of them. Then continue with the exam as you would were they then in person. When documenting this in the chart I usually add an * stating that the exam was limited due to being conducted virtually through telehealth. Alternatively, some sites may have additional resources such a nursing staff that can perform an AIMS if the patient is scheduled and able to attend an in-person appointment.
• I am just starting out and do not know where to start! – Chances are there is someone at your facility or location who is already involved in some facet of telehealth. Start by reaching out to those collogues or ask your supervisor if they can connect you with someone who has experience in this area. Those who have already stepped into the deep pools of telehealth can be a great resource when learning how to swim past obstacles as they come. Chances are when things go awry, seasoned telehealth users may have already dealt with similar issues and can help provide guidance as you maneuver the waters.
• You are only as strong as your lowest denominator- Our patients come with various experiences when it comes to telehealth or technology use. It is important to understand our patient’s experience and comfort with technology. You may need to allot time to help troubleshoot if it is a first-time telehealth appointment. If the patient is not seen in a scheduled video appointment, then reach out by phone for they may be having technology issues. Also reach out to your facility to understand tools you may have to access to in order to better assist the patient. For example, my facility has consults that can be placed to telehealth technicians who will help patients troubleshoot telehealth appointments prior to their actual appointment date.

A positive impact in patient care

How can one provide adequate care when you are not actually with the patient? I’d like to end on a positive note with some ways telehealth could impact patient care for the better.

• A glimpse into their world – A colleague had worked with a patient who was originally diagnosed with depression and started on an antidepressant. Over the course of a month the clinician witnessed the patient’s immaculate home/surroundings become disheveled and for lack of better terms, a mess. Slightly pressured speech from an appointment could not fully portray the impact of their home life, which was evident by the video appointments from home. This in turn facilitated in that patient’s diagnostic re-evaluation.
•  Building Rapport – With some, bonds of trust seem to be built quicker through video appointments. The patient sees you over video in their home, an environment where they mainly see friends or family members enter. Telehealth offers a unique opportunity to meet patients where they are, both physically and emotionally.
• Access –Telehealth breaks down common barriers to care. Whether patients live in rural settings, struggle finding time and money for frequent visits to the clinic, face inclement weather, or experience anxiety or other stressors about visiting a clinic in person, virtual appointments provide a flexible, safe alternative. By offering telehealth as an option, we ensure more patients can access the support and care they need.