Telehealth enables consultations between clinicians and families where there are challenges to 'in person' clinics. Telehealth in rheumatology poses challenges as the physical examination is an integral part of clinical assessment.
Here we provide pdf downloads with the following resources:
Guidance for Telehealth / Remote consultations (for the Clinician Provider) covering technical considerations, administration tasks, suggested examination routine and preparing families.
Information handout about Telehealth / Remote consultations for families.
Electronic Medical Record Dot Phrases for Telehealth / Remote consultations and suggested Consent format.
Recording clinical consultation proforma (in the absence of Electronic Medical Record).
V-pGALS checklist (text) and guide (graphic) - which can be sent to parents in advance of the consultation.
Esentially these are the key considerations:
For the clinician:
- Familiarise yourself with the telehealth platform and functions.
- Troubleshoot technical issues before your first visit. Platform specific issues:
- Some platforms enable you to take stills and include them in the patients record.
- Consider using a virtual background with your hospital logo or design.
- Some platforms allow invite functions to enable multidisciplinary clinics.
- Learn different functions such as locking the visit (to ensure privacy).
- Learn how to record the consultation in the electronic medical record.
- Think through logistics of camera set up how to get the best views of each part of the body.
Preparing the family:
- Send weblink and instructions to the family beforehand.
- Include a copy of the consent which will be taken verbally.
- Include pictures of V-pGALS manouvres.
- Consider where to conduct the consultation if at home.
- Ideally need a quiet room, good internet signal, good lighting and adequate space for the child to walk (at least 5 feet in one direction) and also sit on the floor.
- A sofa or bed or table for the examination with the child lying down.
- Bring medications to the room where they are doing telehealth.
- Have family email pictures ahead of time to a dedicated email.
- Resolution to visualise rashes is much better through pictures than the video screen.
- If family is using a tablet or phone with both a “selfie” and a more traditional view-finder camera, use the selfie side for the history and then switch to the view-finder side for the physical exam.
- Hold the tablet or phone overhead to visualize certain joints (e.g. hands and knees).
- Have someone else present / available for at least part of the visit to hold device during examination. Be sensitive to privacy considerations.
- Creativity can be used for physical examination tools, for example:
- Use a tape measure to assess muscle atrophy and height.
- Use at-home scales to measure current weight.
- Count heart rate and respirations over one minute, or tap out a the child's heart beat for the examiner to hear.
- Smartwatch / smartphone can help assess child's activity level (e.g. number of steps in a day and heart rate data).