Virtual Encounters
Virtual care is about all the ways healthcare providers can interact with patients when separated by time or space. Virtual encounters can leverage one or more of text (instant messaging), audio (telephony) or video (video conferencing). "Virtual Health Services" is a broader term that includes considerations of scheduling, queuing, documenting and reporting virtual interactions.
Most physician charting occurs close to in-person interactions when patients are in the ER, are hospitalized or are in clinic. Training covers this well and the knowledge and skills are mostly applicable to virtual encounters. Some considerations, including which encounter type to create and how to mimic check-in and check-out workflows, are unique to virtual care.
Encounter Types
There are many encounter types, each suited to different types of healthcare interaction.
Scheduled Encounters
Scheduled encounters are planned. They are set for a date and time, with visit properties that fit the specialty need. Scheduled encounters can be conducted in-person or virtually. Indeed, encounters originally scheduled for in-person interaction can be converted for virtual care without losing properties or preparations.
Scheduled encounters are preferred for virtual care. They do a better job preserving referral workflows, capturing useful process information, and facilitating resource management. Use scheduled encounters when it is possible to do so.
Ad hoc Encounters
“Ad hoc” (unscheduled) encounters can be created by a prescriber on-the-fly (“Create Encounter” tab within an open chart) as needed. “Telephone” and “Telemedicine” encounters are among the selectable options. These support chart review, problem and medication reconciliation, documentation, ordering, prescribing, communicating (letters) and professional billing.
A Telephone Encounter is used for unscheduled interactions with outpatients, family or other stakeholders in a patient's care.
Telephone encounters can be initiated using the "Create Encounter" activity in a chart that is open outside another encounter. They can also be initiated through the "Telephone Call" activity command found with global (chart) search using "telephone" as a keyword. Finally, In Basket messages specific to a patient usually include a "Telephone Call" button (or optional QuickAction) that will create and open a telephone encounter.
This supports all required documentation and ordering even though the navigator differs from a regular ambulatory visit.
Advanced features, like Express Lanes and specialty customizations, are not easily accessible.
Documenting a telephone interaction (e.g., with family) for an inpatient is best done with a progress note added to the patient's chart opened to the relevant inpatient encounter.
A Telemedicine Encounter is used when videoconferencing is in play.
This has the same navigator as a regular ambulatory visit, and allows use of the specialty-specific tools created for other ambulatory encounters (note templates, bookmark sectioning of progress notes, etc.)
Partial Encounters
Sometimes prescribers may need to interact with the chart outside of patient interaction (in-person or virtual). One may want to place orders that anticipate a future interaction. One may want to document an interaction that occurs where Connect Care has not yet deployed. This can be accomplished with one or niche types.
Documentation and Orders Only encounters are useful for situations Connect Care physicians frequently confront.
Other niche encounter types suit specific situations, including:
Refill – Place Medication Refill for patient
Referral – Document a referral
Patient Message – Send a MyAHS Connect message to a patient
Letter (Out) – Document with sole intent to create a letter
Prep for Procedure – Used by surgeons to complete pre-surgery tasks for OpTime
Addiction and Mental Health
Crisis Encounter – Used for Crisis Calls
Screening Encounter – Used for Intake/Screening
Virtual Encounters
Full virtual care encounters can be scheduled or unscheduled (see above Ad Hoc visit types). A scheduled visit can be converted to a "virtual" encounter.
When scheduled appointments need to occur remotely (patient or prescriber), clinical support staff convert existing (in-person) clinic appointments to either “Telephone Visit” or “Virtual Visit” as appropriate. In some settings, the term “Telehealth Visit” is used instead of “Virtual Visit”.
Ideally, support staff will pre-register and check-in patients either the day prior to or the morning of the previously planned clinic. This allows staff to collect or update demographic information and relevant documents.
Situations may arise where no support staff are available to facilitate patient identification or check-in activities. The prescriber can take care of this and can manage an entire virtual visit independently. In most cases, telephone interaction suffices. Should videoconferencing be required, the AHS Zoom secure solution should be used. This will become automatic when Zoom is fully integrated with Connect Care.