Thank you to the Doctors of BC for developing the valuable DTO Virtual Care Toolkit and permitting us to adapt it to meet our needs in Alberta.Updates to this page will be made as new resources and information become available.
The below step by step approach and links to additional resources are intended to provide at the very least, minimal information to enable clinic teams to get up and running with offering virtual care services within a relatively short time frame. Please also refer to the AMA Virtual Care and AMA COVID-19 webpages for important news and updates for Alberta Physicians.
1. Team Engagement2. Selecting Technology3. Communicating with Patients4. Clinic Processes for Decreasing the Spread of COVID-195. Triaging Patients and Booking Appointments6. Preparing for Virtual Visits7. Starting a Virtual Visit8. Conducting a Virtual Visit9. Sending and Receiving Documents10. Billing11. Follow-Up Visits12. Presumed/Confirmed COVID-19 Positive Primary Care Pathway
Consider scheduling regular team meetings with your clinic team to discuss changes, workflows, and responsibilities. Please see the below resources to help make the most of these meetings and engage your clinic team.
Please see the AMA Virtual Care webpage for a list of available virtual care tools.
When selecting virtual care tools, consider the following:
Obtaining and Recording Patient Contact Information When a patient calls the clinic, verify that you have their current email address and mobile number on file: Email addresses can be used for communicating new virtual care services to groups of patients, as well as sending the virtual care visit link/URL to an individual patient Mobile numbers are useful for communicating with a patient if there are any issues with the virtual visit, or to ensure they are ready for the visit Consider storing this information in both the demographic section of the patient's chart and an email software solution. Promoting Virtual Care in Your Clinic Inform patients of changes to clinic processes and available virtual care option through one or more of these options: Information on Your Website Consider outlining the process for signing up for virtual care, along with a list of conditions that are eligible and excluded Email Consider using an email software solution, which will enable you to email groups of patients with information about the new virtual care services. See pages 12 & 13 of the Doctors of BC Virtual Care Toolkit for example email templates Posters in Your Clinic Consider using the Doctors of BC Patient Notification Poster for Clinics Transitioning to Virtual Care as a template In-Person Communication Over-the-Phone Communication Patient FAQs Consider using the Newfoundland and Labrador Medical Association's (NLMA) Patient FAQ as a template Electronic Communication with Patients Email Communication Physicians should consider setting up a new email address to allow patients to send emails to the clinic but not to their personal email Let patients know that no personal health information should be included in the email. Section 3 of the Office of the Information and Privacy Commissioner (OIPC) of Alberta Practical Guide to the Health Information Act defines personal health information as both: Diagnostic, treatment and care information, and Registration information (e.g. name, signature, gender, photograph, personal healthcare number (PHN), residency, telecommunications information, health service eligibility information, billing information) EMR-Integrated Secure Messaging See the AMA Virtual Care webpage for EMR-integrated secure messaging options
Obtaining and Recording Patient Contact Information
When a patient calls the clinic, verify that you have their current email address and mobile number on file: Email addresses can be used for communicating new virtual care services to groups of patients, as well as sending the virtual care visit link/URL to an individual patient Mobile numbers are useful for communicating with a patient if there are any issues with the virtual visit, or to ensure they are ready for the visit Consider storing this information in both the demographic section of the patient's chart and an email software solution.
When a patient calls the clinic, verify that you have their current email address and mobile number on file:
Promoting Virtual Care in Your Clinic Inform patients of changes to clinic processes and available virtual care option through one or more of these options: Information on Your Website Consider outlining the process for signing up for virtual care, along with a list of conditions that are eligible and excluded Email Consider using an email software solution, which will enable you to email groups of patients with information about the new virtual care services. See pages 12 & 13 of the Doctors of BC Virtual Care Toolkit for example email templates Posters in Your Clinic Consider using the Doctors of BC Patient Notification Poster for Clinics Transitioning to Virtual Care as a template In-Person Communication Over-the-Phone Communication Patient FAQs Consider using the Newfoundland and Labrador Medical Association's (NLMA) Patient FAQ as a template Electronic Communication with Patients Email Communication Physicians should consider setting up a new email address to allow patients to send emails to the clinic but not to their personal email Let patients know that no personal health information should be included in the email. Section 3 of the Office of the Information and Privacy Commissioner (OIPC) of Alberta Practical Guide to the Health Information Act defines personal health information as both: Diagnostic, treatment and care information, and Registration information (e.g. name, signature, gender, photograph, personal healthcare number (PHN), residency, telecommunications information, health service eligibility information, billing information) EMR-Integrated Secure Messaging See the AMA Virtual Care webpage for EMR-integrated secure messaging options
Inform patients of changes to clinic processes and available virtual care option through one or more of these options: Information on Your Website Consider outlining the process for signing up for virtual care, along with a list of conditions that are eligible and excluded Email Consider using an email software solution, which will enable you to email groups of patients with information about the new virtual care services. See pages 12 & 13 of the Doctors of BC Virtual Care Toolkit for example email templates Posters in Your Clinic Consider using the Doctors of BC Patient Notification Poster for Clinics Transitioning to Virtual Care as a template In-Person Communication Over-the-Phone Communication
Consider using the Newfoundland and Labrador Medical Association's (NLMA) Patient FAQ as a template
Email Communication Physicians should consider setting up a new email address to allow patients to send emails to the clinic but not to their personal email Let patients know that no personal health information should be included in the email. Section 3 of the Office of the Information and Privacy Commissioner (OIPC) of Alberta Practical Guide to the Health Information Act defines personal health information as both: Diagnostic, treatment and care information, and Registration information (e.g. name, signature, gender, photograph, personal healthcare number (PHN), residency, telecommunications information, health service eligibility information, billing information) EMR-Integrated Secure Messaging See the AMA Virtual Care webpage for EMR-integrated secure messaging options
Consider the following when deciding how to use the physical space in your clinic:
Consider other processes that could be implemented to protect clinic staff, providers, and patients from exposure to COVID-19. Example processes include:
Triaging Patients by Type of Visit Consider which patients or visit types are suitable for virtual visits. Reviewing your schedule over the last week could help with identifying potential patients and visit types. Screening Patients for COVID-19 Symptoms and Exposure Booking Virtual Visits Consider how patients can book virtual visits. Will your solution allow for online booking or are all appointments triggered by staff, or otherwise go through staff? Consider the role of the MOA. Will they contact the patient ahead of time? Will they set up the visit for the physician on the computer? Depending on the tool chosen, you will either be sending the patient a link to a virtual waiting room or a link for a specific appointment time Obtaining Patient Consent for Video Sessions Physicians providing health care services via video sessions should obtain patient consent for this specific purpose. This does not need to be collected with every session with that patient. CMPA recommends the use of a signed informed consent form: Word; PDF In some situations, obtaining a written consent might be difficult – verbal consent documented in patient’s chart is also acceptable as long as it covers the details The following CMPA-approved statement should be used to initiate a Virtual Care patient encounter: “Just like online shopping or email, Virtual Care has some inherent privacy and security risks that your health information may be intercepted or unintentionally disclosed. We want to make sure you understand this before we proceed. In order to improve privacy and confidentiality, you should also take steps to participate in this virtual care encounter in a private setting and should not use an employer’s or someone else’s computer/device as they may be able to access your information.If you want more information, please check the link on our [website/confirmation email/etc.]. If it is determined you require a physical exam you may still need to be assessed in person. You should also understand that virtual care is not a substitute for attending the Emergency Department if urgent care is needed. Are you ok to continue?” Recording Patient Consent for Video Sessions Consider where to record the patients consent in the EMR. Clinics should develop a standard process for collecting consent, documenting in the patient chart, and keeping track EMR users can consider creating a macro for recording consent To record verbal consent in a patient’s chart you may copy and paste the following into the chart: "Informed verbal consent was obtained from this patient to communicate and provide care using virtual and other telecommunications tools. This patient has been explained the risks related to unauthorized disclosure or interception of personal health information and steps they can take to help protect their information. We have discussed that care provided through video or audio communication cannot replace the need for physical examination or an in person visit for some disorders or urgent problems and patient understands the need to seek urgent care in an Emergency Department as necessary." EMR tip sheets for recording Patient Consent in the EMR: Wolf; Med Access; Healthquest; Accuro; PS Suite
Consider which patients or visit types are suitable for virtual visits. Reviewing your schedule over the last week could help with identifying potential patients and visit types.
Consider how patients can book virtual visits. Will your solution allow for online booking or are all appointments triggered by staff, or otherwise go through staff? Consider the role of the MOA. Will they contact the patient ahead of time? Will they set up the visit for the physician on the computer? Depending on the tool chosen, you will either be sending the patient a link to a virtual waiting room or a link for a specific appointment time
Physicians providing health care services via video sessions should obtain patient consent for this specific purpose. This does not need to be collected with every session with that patient. CMPA recommends the use of a signed informed consent form: Word; PDF In some situations, obtaining a written consent might be difficult – verbal consent documented in patient’s chart is also acceptable as long as it covers the details The following CMPA-approved statement should be used to initiate a Virtual Care patient encounter: “Just like online shopping or email, Virtual Care has some inherent privacy and security risks that your health information may be intercepted or unintentionally disclosed. We want to make sure you understand this before we proceed. In order to improve privacy and confidentiality, you should also take steps to participate in this virtual care encounter in a private setting and should not use an employer’s or someone else’s computer/device as they may be able to access your information.If you want more information, please check the link on our [website/confirmation email/etc.]. If it is determined you require a physical exam you may still need to be assessed in person. You should also understand that virtual care is not a substitute for attending the Emergency Department if urgent care is needed. Are you ok to continue?”
Physicians providing health care services via video sessions should obtain patient consent for this specific purpose. This does not need to be collected with every session with that patient.
The following CMPA-approved statement should be used to initiate a Virtual Care patient encounter:
“Just like online shopping or email, Virtual Care has some inherent privacy and security risks that your health information may be intercepted or unintentionally disclosed. We want to make sure you understand this before we proceed. In order to improve privacy and confidentiality, you should also take steps to participate in this virtual care encounter in a private setting and should not use an employer’s or someone else’s computer/device as they may be able to access your information.If you want more information, please check the link on our [website/confirmation email/etc.]. If it is determined you require a physical exam you may still need to be assessed in person. You should also understand that virtual care is not a substitute for attending the Emergency Department if urgent care is needed. Are you ok to continue?”
Consider where to record the patients consent in the EMR. Clinics should develop a standard process for collecting consent, documenting in the patient chart, and keeping track EMR users can consider creating a macro for recording consent To record verbal consent in a patient’s chart you may copy and paste the following into the chart: "Informed verbal consent was obtained from this patient to communicate and provide care using virtual and other telecommunications tools. This patient has been explained the risks related to unauthorized disclosure or interception of personal health information and steps they can take to help protect their information. We have discussed that care provided through video or audio communication cannot replace the need for physical examination or an in person visit for some disorders or urgent problems and patient understands the need to seek urgent care in an Emergency Department as necessary." EMR tip sheets for recording Patient Consent in the EMR: Wolf; Med Access; Healthquest; Accuro; PS Suite
Consider where to record the patients consent in the EMR.
To record verbal consent in a patient’s chart you may copy and paste the following into the chart:
"Informed verbal consent was obtained from this patient to communicate and provide care using virtual and other telecommunications tools. This patient has been explained the risks related to unauthorized disclosure or interception of personal health information and steps they can take to help protect their information. We have discussed that care provided through video or audio communication cannot replace the need for physical examination or an in person visit for some disorders or urgent problems and patient understands the need to seek urgent care in an Emergency Department as necessary."
EMR tip sheets for recording Patient Consent in the EMR: Wolf; Med Access; Healthquest; Accuro; PS Suite
Setting Up the Room Consider placement of EMR screen vs. placement of video screen. Can both be displayed on the same screen, or are two screens needed?Essential items include: webcam, microphone and speaker Testing Equipment For a video-based virtual visit the computer, laptop, tablet, or smart phone you are using needs to have: Webcam Microphone Speaker Headsets are recommended It is important to test the hardware to ensure your webcam, microphone and speaker are all working and it also helps to be familiar with how to adjust the settings as well.Run an online speed test from the room you would use for video consults to find out the internet speed. Use the equipment you are planning to use for the most accurate test. You can use the site (https://www.speedtest.net/). Setting Up the EMR See the following EMR tip sheets for suggestions on how to set-up your EMR to capture virtual visit appointments: Wolf; Med Access; Healthquest; Accuro; PS Suite Virtual Visit Etiquette Consider the following when space that the patient will view during a virtual visit. Consider clarifying your actions to the patient if you are not looking at them (e.g. typing up notes on the EMR).
Consider placement of EMR screen vs. placement of video screen. Can both be displayed on the same screen, or are two screens needed?Essential items include: webcam, microphone and speaker
For a video-based virtual visit the computer, laptop, tablet, or smart phone you are using needs to have: Webcam Microphone Speaker Headsets are recommended It is important to test the hardware to ensure your webcam, microphone and speaker are all working and it also helps to be familiar with how to adjust the settings as well.Run an online speed test from the room you would use for video consults to find out the internet speed. Use the equipment you are planning to use for the most accurate test. You can use the site (https://www.speedtest.net/).
For a video-based virtual visit the computer, laptop, tablet, or smart phone you are using needs to have:
It is important to test the hardware to ensure your webcam, microphone and speaker are all working and it also helps to be familiar with how to adjust the settings as well.Run an online speed test from the room you would use for video consults to find out the internet speed. Use the equipment you are planning to use for the most accurate test. You can use the site (https://www.speedtest.net/).
See the following EMR tip sheets for suggestions on how to set-up your EMR to capture virtual visit appointments: Wolf; Med Access; Healthquest; Accuro; PS Suite
Consider the following when space that the patient will view during a virtual visit. Consider clarifying your actions to the patient if you are not looking at them (e.g. typing up notes on the EMR).
Patient "Check-In" Process Does the patient need to call and ‘check in’?Does the virtual tool have a virtual waiting room? Troubleshooting Technical Issues with Patients Ensure that staff know how to troubleshoot the most common technical issues related to virtual care so they can assist patient over the phone. The Newfoundland and Labrador Medical Association's (NLMA) Patient FAQ provides some helpful tips and tricks
Does the patient need to call and ‘check in’?Does the virtual tool have a virtual waiting room?
Ensure that staff know how to troubleshoot the most common technical issues related to virtual care so they can assist patient over the phone. The Newfoundland and Labrador Medical Association's (NLMA) Patient FAQ provides some helpful tips and tricks
Consider having a standard method for recording that the visit was conducted over video. Charting the patient encounter for video consults is the same as for an in-person visit.
Resources How to Run a Great Virtual Meeting EMR Processes Ensure that the following information is recorded in the EMR: The type of virtual visit Patient consent has been obtained (for video visits) The patient disclaimer for virtual visits was read to the patient Start and stop times of patient contact EMR Virtual Visit Process Tip Sheets: Wolf; Med Access; Healthquest; Accuro; PS Suite Virtual Assessments Resources coming soon!
How to Run a Great Virtual Meeting
Ensure that the following information is recorded in the EMR: The type of virtual visit Patient consent has been obtained (for video visits) The patient disclaimer for virtual visits was read to the patient Start and stop times of patient contact EMR Virtual Visit Process Tip Sheets: Wolf; Med Access; Healthquest; Accuro; PS Suite
Ensure that the following information is recorded in the EMR:
Resources coming soon!
If working away from the clinic office, consider how to transfer documents (e.g. prescriptions, lab and imaging requisitions). Could an MOA send this from the clinic? Consider testing the EMR from home to see what is possible.Does the patient need access to a printer? If yes, consider including this in your patient scripts.
Available service codes are published on the AMA Virtual Care webpage.
Consider the workflow for arranging a follow-up visit for the patient. What are the instructions for the patient?
The Calgary Zone PCNs and AHS created a primary care pathway for patients who have been presumed/confirmed positive for COVID-19 which can be found here.
