Video Consultation Tips
Planning
Ensure your practice staff have all relevant phone numbers (noting that if there is a significant problem with audio on a videoconference, audio via a separate phone line on speaker can be used as a back up). Similarly, for video, consider having a second system as a back up (e.g. Skype or Facetime). As noted already, these are not considered of sufficient quality for a complex videoconsultation, but in the event that a back up is required due to the failure of the initial video link, they can allow a consultation to be completed. Again, it is important that both your practice and that of the referring doctor have all the relevant contact details ahead of the scheduled videoconsultation.
The experience of our members who have been doing videoconsultations is that doing a test run of:
- Initiating, ending and receiving a call
- Muting
- Setting up the consulting room to maximise the quality of the videoconsultation
- Screen Sharing
- Sending and receiving the required documents (within the videoconferencing software or via secure email)
- A contingency plan
will minimise potential problems when you are actually doing "live" videoconsultations.
It is also suggested that a practice checklist be developed as this will streamline planning and reduce the amount of time required to prepare for a videoconsultation.
Patient records and test results
It is important to have the necessary patient records, test reports and the written referral before your consultation and with sufficient time for review before seeing the patient. This will require coordination between your practice and the referring doctors to establish an effective and secure means of transmitting the necessary documents ahead of the consultation time.
Scheduling videoconsultations
Again, feedback from our members who have already been conducting videoconsultations has suggested that scheduling is probably the most difficult aspect of the process of providing consultations via a video link. Suggestions for successful videoconsultations include "batching" these consultations – i.e. doing three or four in a row so you only have to set up your video system once, or scheduling them at the beginning or end of the consulting day, or scheduling outside your normal consulting times. Obviously none of these arrangements may work for you, but some of our members have said this is the way they have made the system work for them.
It is suggested that your practice staff commence the call about five minutes prior to the start of the videoconsultation, which helps to ensure everyone is connected before the actual starting time and to allow some time to iron out the "glitches" that invariably occur from time to time. Keeping to a fixed starting time is important.
Technical considerations
Minimise background noise
All of you will have participated in a teleconference where the background noise made it difficult to hear the conversation or concentrate on the content of the discussions.
The same applies for videoconferencing and the fact that you are participating in a consultation with a patient makes it particularly important to minimise background noise that may have an impact on the quality of the consultation. This includes closing windows and doors, turning down air conditioner fans, turning your mobile phone and beepers to silent mode (or off, depending on your normal practice during patient consultations), lowering the volume on the office telephone (if it can be heard in your consulting room) and computer alert sounds for incoming mail. Microphones can intensify normal sounds, so wearing "noisy" jewellery, for example, can disrupt the signal. It is also worth remembering that you may need to ask the far end participants to mute their microphones when they are not speaking.
Consider the location of your microphone and remember not to put papers or other objects on the microphone, or shuffle papers on your desk.
Maximise audio quality
Remember to speak clearly and towards the microphone and to remind the far end participants to do the same if you have difficulty hearing them. It is important to wait until others have finished speaking before responding to avoid break-up of the audio signal.
Maximise video quality
Camera Position
It is important to position your camera and seating so that you are directly in front of the camera; try to maintain eye contact with participants and whenever possible, look into the lens rather than focusing on the monitor while you are speaking.
It is worth remembering that some colours and patterns are better than others for video, just as they are for television. It is helpful to avoid intense colours, red (which "bleeds" on the screen), white (which may glare) and black (which will absorb the light) and complex patterns, particularly stripes, which affect the camera's ability to focus and may reduce the quality of the transmission.
Lighting
If possible, arrange your consulting room to have lighting that minimises shadows and significant contrasts in lighting. Where possible, place lighting facing you rather than behind, which will minimise shadows and avoid sitting in front of outside windows and visible lights which affect the white balance of the camera and cause you to appear dark.
Remember that a darker room takes more bandwidth to transmit than a lighter room – this is particularly important if your broadband speed is less than optimal.
Running a videoconsultation
Videoconsultations already have their own set of complexities so it is particularly important to avoid interruptions, including phone calls about other patients. Your practice staff will be aware that you are undertaking a videoconsultation and therefore if the call "drops out" or needs to be reconnected because of other technical issues, they should have the contact information to enable them to reconnect the call.
It is important to ensure:
- all participants are introduced – this may just be yourself, plus two (referring doctor or other health professional and patient) at the far site. However, for patient confidentiality this formality is required
- all relevant documentation (patient records, test reports and referral letter) have been received and reviewed
- that at the conclusion of the videoconsultation, the call is ended.
Other useful information on conducting a videoconsultation
The Australian Medical Council's "Guidelines for Technology-based patient consultations"
www.medicalboard.gov.au/Codes-Guidelines-Policies
MDA National's "Risk Management for Telemedicine Providers", which includes some background information and tips for risk management:
www.mdanational.com.au/media/144805/telemedicine_providers.pdf
The MIGA Bulletin (December 2012) also provides some useful advice in relation to record keeping. MIGA advises that both the CPP/specialist and the GP who are participants in a patient consultation via videoconference should keep contemporaneous notes of the consultation, including documenting that the consultation was conducted by videoconference. The records should also note the time of the videoconference and the names of all participants. MIGA notes that this information accords with good medico-legal practice.
Download the AACP Videoconference Checklist