There’s a whole lotta talk about why you should use telehealth in your physical therapy practice right now (e.g., scheduling flexibility, financial stability, and reduced no-shows). But what about how to use it? After all, any new technique or technology is bound to come with a learning curve—and if you’re implementing it in your practice on a tight schedule, you need that curve to be a short one. To that end, we’ve created this resource that PTs can use to guide themselves through a typical telehealth visit. Here’s what you need to know:
Knock out your logistical to-dos.
First, make sure you have everything you need before sitting down in front of your computer or mobile device. Specifically, be sure you’ve:
- collected the patient’s intake information prior to the appointment;
- acquired a signed patient consent form;
- reached out to your patient on the day of the appointment to remind him or her about the service and go over expectations, technology requirements, and best practices; and
- notified the patient when the appointment has started.
Ensure you have the proper video setup.
Prior to conducting a telehealth visit, be sure your treatment area is set up and ready to go. You’ll want to make sure you’re working in a well-lit room that’s far away from any noise and has minimal distractions. In fact, you may want to come up with a system to ensure your team knows when you’re on a telehealth call and thus, cannot be interrupted.
Next, double-check your audio device and camera to make sure everything’s working as intended. You don’t want to start your telehealth session only to keep the patient waiting while you troubleshoot technical difficulties. However, technology snafus can—and do—happen, so be sure you have a phone handy to dial-in if necessary. If you’re conducting virtual visits from your home, take all of the necessary precautions to protect your patient’s privacy by conducting the visit in a room that’s out of view of spouses, children, or roommates.
Launch your telehealth video application.
Assuming you notified your patient ahead of time, he or she should already be waiting for you in the virtual session. If your telehealth platform has a waiting room function, admit the patient into the session and greet him or her upon arrival.
Get the patient set up for the session.
Before you get down to business—er, treatment—there are a few preliminary items to get out of the way first. If this is your first telehealth session with the patient, ask him or her whether he or she has:
- had a telehealth, or virtual visit before, and
- used this particular telehealth platform.
Then, show the patient around and point out any tools he or she may need to use throughout the visit. Additionally:
- Confirm that the patient can see and hear you well enough—and that there are no connectivity issues.
- Ensure the patient is comfortable, and give him or her an opportunity to ask any questions before getting started.
- Make sure the patient has adequate space to perform all the movements.
- Ask the patient to verify his or her:
- full name,
- date of birth, and
- current geographic location.
You may also want to confirm the type of device the patient is using, as this may influence the type of treatment you provide. For example, if you’re planning to assess general mobility of a joint or a common orthopedic condition, then a laptop is the preferred device. It’s easier to position a laptop’s camera to get a full field of view when necessary, and it’s generally a less-clunky experience. Mobile devices are also an option—and can be particularly helpful for getting close-up shots of specific areas—but they require a little more creativity when it comes to positioning the camera.
Load the SOAP note.
Now, you’ll start your visit just as you would in the clinic: by opening up your documentation software and loading a SOAP note. (You’ll want to make sure you can still see the patient while you have your note open).
In terms of documenting the assessment, some aspects will be similar to what you’re used to for in-person visits, while others will be a bit different. For the subjective portion, the only real difference between completing this portion during a telehealth visit versus an in-person visit is that you’re connecting over a video screen.
Things get a little tricker with the objective portion. This will require some practice to perfect, and it’ll definitely challenge your creativity and problem-solving skills. This portion will differ from patient to patient depending on the condition being treated. However, functional assessments are incredibly helpful.
Help your patient with camera placement so you can get the full field of view. Then, watch movement patterns and estimate limitations in range of motion or strength based on functional deficits with common activities. Verbal cueing during assessments is more important than ever. Also, don’t forget about your patient-reported outcomes. These measurement tools are your friends during remote treatment sessions—even more so than during in-person visits.
While the assessment portion of a virtual visit will be pretty similar to that of an in-person visit, one additional attribute of your assessment will be deciding whether this patient is appropriate for telehealth. If you feel as though you’re not equipped to properly manage this patient’s condition via telehealth, you should discontinue virtual treatment. For example, if the patient requires manual interventions or cannot safely receive telehealth treatment, he or she would not be a good candidate for telehealth. However, this is ideally something you’ve already taken into consideration before scheduling the visit.
In the plan section, your creativity and problem-solving skills will again be critical to your success. You’ve likely treated patients who’ve shifted to self-management of their condition for a period of time—whether that’s due to them going on vacation mid-treatment or transitioning to self-managed care—and you’re equipped to give patients the tools they need to be successful outside of your treatment sessions.
Home Exercise Program
Home exercise programs are always a crucial component of rehab therapy treatment—whether or not that treatment occurs virtually. For telehealth patients, though, one great trick is to use your telehealth platform’s screen-sharing tool to review the HEP during a live treatment session. That way, you can show patients exactly what you see on your screen—which is exactly what they’ll see when you send the HEP to them after the appointment. Walk the patient through all of the exercises to make sure he or she is crystal clear on how to properly complete them. Of course, when you share your screen, make sure you don’t have any other patient charts or PHI pulled up.
Follow up with the patient.
Your entire virtual visit is important, but it’s absolutely crucial that you stick the landing. After all, there’s no warm transfer to a friendly face at the front desk to check the patient out or schedule future appointments. Using a secure patient portal or online HEP, send the patient his or her at-home exercises, along with a satisfaction survey. (We suggest using the Net Promoter Score® survey, but any satisfaction survey will do.) You should also notify the front office staff so they can reach out to the patient immediately to schedule his or her next appointment while it’s top of mind.
So, there you have it: a step-by-step guide to conducting a physical therapy visit via telehealth. To see an example of this process in action, check out this demo with WebPT’s Director of Product Management, Scott Hebert, DPT:
And, as always, feel free to leave any questions you have in the comment section below!