Video Conferencing Tips for All Platforms
· Setting the stage for the telemedicine visit. The key components to be mindful of during a telemedicine visit include: privacy, good internet connection, minimal
distraction, participant comfort, see and be seen, and hear and be heard.
o Make sure the room you are in is close to your Wi-Fi router.
o Remove all distractions.
o Make sure your device is fully charged or near a power source.
o Plug into it with an ethernet cable whenever possible.
o Wall colors can affect the camera, so use of muted pale tones are easier for the camera to transmit than a busy distracting background.
o Maintain professional dress and appearance.
o Select a landscape versus regular view on your device
o Tablets are superior to mobile devices as the patient image is larger for better visualization of patient exam
o Ask that patients prop their device rather than hold it to minimize shaking movements.
· Framing - Position yourself so that your eyes are located in the top 1/3 of the screen. This will create a natural framing that you typically see of news anchors on television. The camera should be at eye level. Look into the camera and not at the screen when speaking with the patient. Avoid falling “out of frame” and periodically check that your full face is in view.
· Lighting - Avoid sitting directly under a light source as it will cause deep facial shadows. Avoid setting up your computer/mobile screen with a window behind you as your face will then appear dark. A light source or window two feet directly opposite you will provide the most even, flattering lighting, reducing glare on your screen. Consider obtaining a “selfie ring light” that clips to your computer or phone to provide even
lighting of your face (available on Amazon for $15).
Common pitfalls
· Echoes: If you hear an echo or feedback, there may be a speaker system connected to a computer, tablet or phone. Disconnect any external speakers. Echoes also occur with Bluetooth or Airplay connected speakers.
· Ambient noises: Microphones can easily pick up distracting sounds such as paper shuffling, typing on a keyboard, or finger tapping. Consider using a quiet keyboard as you type to dampen the sounds as you use the electronic medical record.
· Facial expression: Be aware that when you stare at a screen or are listening
intently, you can develop a vacant stare or a furrowed brow. As the patient has limited non-verbal cues, they may misread your facial expressions. Remember to nod and smile every few minutes to maintain rapport.32
Remember to:
· Verbally confirm consent and document who is on the video call, the location of the provider and the location of the patient, and the duration of the visit.
· Disconnect and complete charting and E/M coding.
· Attest to the presence and/or role of residents/fellows/other trainees or a scribe
· Patients cannot simultaneously use apps or a flashlight on their mobile phone if the patient is utilizing their phone to videoconference with the provider. As a result, we recommend that the patient will ideally need two devices: one device (a mobile phone or laptop) to communicate with the provider and a second device (e.g. tablet) available to utilize ophthalmic phone apps.
· If possible, it is helpful for the patient to have a family member or friend present to assist (e.g., collateral medical history, to hold phone during gait testing). Just remember to document who was present during the visit and if they assisted during the
telemedicine visit.
Supplementary Inclusions:
· Examples of note templates for neuro-ophthalmology virtual visits that include necessary documentation and feasible examination components are included as online supplemental content (Courtesy of Harold Weinberg, MD; Neil Busis, MD; and Rachel Calix, MD at New York University Langone Health). Epic smart phrases, abbreviations, and attestations will vary by institution/practice. These can be adapted and made into Epic Smart Phrases as appropriate.
