As an alternative to in-person visits, physicians and other health professionals are encouraged, where appropriate to consider delivering care through virtual care modalities. Two key options to providing care virtually in this context are phone calls and eVisits (home video visits).
Some general guidelines in transitioning in person appointments to virtual care appointments include:
- Verbal consent should be obtained from patients and documented in their chart (see attached for specific suggestions from the OMA on consenting for eVisits in the attached).
- Virtual appointments should be booked and registered in the applicable HHS scheduling system (Meditech, PatientLink, Mosaic) where possible.
- Documentation of virtual visits should be done in the same way as in-person visits (dictation, note, etc.).
- Consideration should be given to patient education (if required) and support in the event of technical difficulties.
- A plan should be created to ensure tasks after the visit are completed (eg. investigation requisitions and prescriptions are sent, follow-up appointments are booked, etc.)
- Ensure you have the required technology.
What is a virtual visit?
A virtual visit is an appointment with your doctor or health care team that does not involve an in-person meeting.
Instead of coming to the hospital, you speak with your health care team using a regular telephone, smartphone or your computer (for video-visits). Virtual visits minimize in-person meetings, and reduce your risk of contracting COVID-19.
Why is Hamilton Health Sciences offering virtual visits?
We are using virtual visits more often at HHS to reduce how many people come to the hospital. This is to protect our patients, staff and the community from the spread of COVID-19.
Virtual visits are not new. HHS and health care teams across Ontario have been using virtual visits for some time through the Ontario Telemedicine Network (OTN). However, we are offering virtual visits in more clinics now and using a new platform called Zoom Healthcare, as a result of the COVID-19 pandemic. We are doing this so that we can make sure patients have access to care during this time, without exposing patients or staff to unnecessary risk.
What happens during a virtual visit?
Your health care team talks with you about your current health status, any symptoms you are experiencing and your needs. If your health care team feels that an in-person visit would be a better fit for you, they will discuss your options and next steps with you.
HHS recommends the use of the OTN Hub. It is PHIPA compliant and can be accessed at no cost. The steps for physicians to get access to the OTN Hub are in the resources section below. For HHS staff or McMaster administrative staff needing access, please contact Nate VandenDool (firstname.lastname@example.org, ext. 72267). Additional resources to using the OTN Hub can be found here. If the OTN Hub is not an acceptable option for physicians, other options exist for your consideration as outlined on the Ontario MD website. Information on physician billing for eVisits can be found in the attached OMA documents. For users of the OTN Hub, a guideline for billing can be found here.
What equipment do I need?
You will need:
- a personal device (computer, tablet, cellphone) with a web camera and microphone
- high speed internet
- an email address (for video-conferencing)
- private space
- pen and paper to write down any questions or instructions from your health care team
If you don’t have access to these things, your health care team will do everything that they can to make other arrangements for you to access care appropriate to your needs.
How will my virtual visit be booked?
Your health care team may call you to discuss changing your upcoming appointment to a virtual visit.
- They will talk to you about options for virtual care. This may include offering a regular telephone call or a video call using a system called Ontario Telemedicine Network (OTN) or Zoom Healthcare, depending on your provider.
- They will give you instructions on how to prepare.
- They will also ask for your verbal consent for the upcoming appointment.
- They will let you know the day and time of your virtual visit and confirm they have your preferred contact information.
The decision on which type of virtual visit you have will be made based on your care needs and the technology you and the clinic have access to.
What can I expect during my virtual visit?
- Your health care team will call you on the phone at the scheduled time
- A call from HHS will appear as a “blocked” or “unknown” caller. Please make sure that you answer if you are expecting a call from us.
- You and your health care team will talk about how you’re feeling, your questions and next steps in your care plan.
HHS uses two secure video conferencing tools:
- Ontario Telemedicine Network (OTN); and,
- Zoom Healthcare
What to expect using OTN
If you agree to participate in a virtual visit using OTN, HHS will need to provide your name and email address to OTN. Your health care team will schedule your virtual visit with OTN. Before your appointment, you will receive an email from OTN No-Reply < email@example.com>
- Do not reply to the email or send the video conference link or appointment email to anyone.
- This email contains:
- Your care provider’s name
- The date and time of your virtual visit.
- Instructions on using OTN with Help resources
- Links to download the required application (if using a mobile device)
- A link to test if the application works well on your device before your appointment (which we recommend trying before your first appointment)
- A link to access your appointment at the scheduled time
15 minutes prior to your scheduled appointment, you click on the “Start eVisit” link in your email to join the video visit with your health care team on your smartphone of computer using the OTN video system. You will be placed in a waiting room “Waiting for the Host to Join” until your health care provider (“Host”) joins the visit.
- If you have trouble with the video system, your health care team will call your telephone number instead.
- During your appointment, you and your health care team will talk about how you’re feeling, your questions and next steps in your care plan.
- Please call your care provider’s office if you have any questions regarding your OTN appointment or if you do not receive this email from OTN.
What to expect using Zoom
- If you agree to participate in a virtual visit, HHS will need to provide your name and email address to Zoom Healthcare. Your health care team will schedule your virtual visit using the Zoom Healthcare system.
- Before your appointment, you will receive an email from your health care provider or their administrative support with instructions and a link to join a secure video conference with your care team on your smartphone or computer using the Zoom Healthcare video system at the scheduled date and time which is noted in the email. A password will also be included.
- 15 minutes prior to your scheduled appointment, you need to click the link (or copy and paste it into an internet browser window). The system will automatically place you in a virtual waiting room until your health care provider – the “host” – joins the meeting
- If you have trouble with the video system, your care team will call your telephone number instead.
During your appointment, you and your health care team will talk about how you’re feeling, your questions and next steps in your care plan
Please call your health care provider’s office if you have any questions regarding your Zoom appointment or if you do not receive an email confirming the appointment time and providing you with a link.
Is videoconferencing safe and private?
- There is some risk with any virtual care solution. Just like when using e-mail there is always a risk that your information could be intercepted/misdirected. However, the video conferencing platforms that HHS uses are used by many hospitals in Ontario and Canada. These platforms have been reviewed by our Privacy and Information Security teams, and we are taking appropriate precautions to make sure your information is as safe and secure as possible.
- Calls and video are not recorded or kept by OTN or Zoom Healthcare after you appointment finishes.
- However, specific to Zoom Healthcare, it is possible that the live feed of your appointment may be routed outside of Canada, through the United States of America, before it is deleted.
WARNING: Electronic communication, including virtual visits and email, may have some risk. Third parties may take over electronic communication and introduce malware, phishing scams, or other unauthorized access.
HHS is not responsible for the security of patients’ internet service providers, email domains, personal devices or personal computers.
We suggest that you use your personal email when communicating about your health and not a work email address, as your employer may have the right to inspect your work email.
Use a secure internet connection. Do not use a public internet connection such as at the airport internet café, public library or other open area. Other people may be able to use the link to listen in on your appointment without you knowing.
Email consent and safety
- HHS may also send you appointment information and other general information by email if you have consented to receive information in this way. Your health care team may ask you for consent to communicate using email when scheduling your virtual appointment or during the virtual appointment.
- Please do not send emails for urgent symptoms, questions or in an emergency. If you have an urgent medical issue, please call 911 or visit an Emergency Department or Urgent Care Centre.
- Some care areas may send you a follow-up survey after your appointment by email. This will help us improve the quality of our care. They should let you know about this during your appointment, so check with them that they have your preferred contact details.
- If you receive a link to a survey and are not sure if it is coming from your care team, please call them to check before clicking on any links.
Protecting your privacy
Your privacy is very important to us at HHS. We protect your privacy during virtual visits in the same way as we do during a clinic visit.
- Only the people providing care to you will be present during your appointment – unless you are part of a group care sessions, in which case other members of the group session will also be present.
- Our discussion during the visit will be documented in your health record, just like an in-person appointment would be.
We suggest that you take similar steps to protect your own privacy. This means being aware of your surroundings and who may be able to overhear your virtual visit.
What can I do to prepare for my virtual visit?
- Make sure that your technology is set up properly
- Find a quiet spot so that you can easily hear and be heard
- Decide if you would like a family member or caregiver to be with you during the visit
- If you are part of a group session, it is important to be mindful of the privacy of other group members. Try to find a private spot in your home where other members of your family cannot see/hear the session. Use headphones, if you can, and avoid having other distractions (television, music, etc.) on in the background.
- Have all your materials ready prior to the meeting including:
- Health Card
- Pen and paper to write down information and instructions
- List of medications being taken (if applicable)
- Notes of medical history, symptoms
- Questions you would like to ask
Can I decline a virtual visit or change my mind?
Yes, you can decline or withdraw your consent for virtual visits or communication using email or text, at any time by contacting your health care provider. Please know that this may lead to delays in your care during this challenging time, as only urgent in-person appointments are being offered in our clinics right now.
Virtual Care for Long-Term Care
An innovative program will launch today (April 6), using a virtual care model to support the care needs of long term care (LTC) residents in their homes during the COVID-19 pandemic. LTC healthcare teams will gain access to Emergency Physicians and alternate care pathways to reduce the need for transport to an emergency department.
Where can I learn more or provide feedback about virtual visits?
- Ontario Telemedicine Network Website: https://otn.ca
- Zoom Healthcare: https://support.zoom.us/hc/en-us
- Evaluation of Virtual Care https://www.hhscebi.ca/projects/evaluation-of-virtual-care-at-hamilton-health-sciences/
- HHS Patient Experience Office:
- Email: PatientExperience@HHSC.ca
- Phone: 905.521.2100 extension 75240