Say cheese!’ The rehab camera is rolling
Here’s sensible advice for tele-visits’
New technology creates not only its own language, but also its own rules of etiquette — a whole new spin to the phrase "bedside manner." After four years and more than 1,500 "tele-visits," Shepherd Center, a 100-bed specialty center in Atlanta, offers the following advice for successful remote patient/provider interactions:
- Obtain informed consent. "We obtain a separate informed consent form for telerehab. We treat telerehab like alternative medicine and use a special consent form for those services," says Michael L. Jones, PhD, founding director of the Virginia C. Crawford Research Institute at Shepherd Center in Atlanta.
- Set mutually agreed-upon goals with the patient. "Before you begin remote communication with a patient, set clear goals for how
the technology will be used and what the goals of remote communication are," Jones suggests. "Make sure you explain the limitations of
the technology as well as the limitations of telerehabilitation."
Jones adds that it helps to explain the limitations of the technology to providers, too. "A physician may come in for a remote consultation, see a bad image, and storm out in the middle of a tele-visit," he says. "Paint the worse-case scenario. Then, if the image is decent, the physician will be pleasantly surprised and more supportive of the program."
- Set rules for beginning and ending transmissions. "If you’re using a speaker phone, it’s very easy for one party to cut the other off," he explains. "Set some rules for the communication. For example, tell the patient that you’re going to say Roger out’ when you are finished speaking and that they should do the same. Tell the patient that when the session is over, you will say, We’re finished. You may turn the machine off.’"
- Establish adequate lighting. Through a process of trial and error, Shepherd has found that halogen lights create the best light source for tele-visits. "Tall standing lamps are the best. You want to create a bright, overall light that’s nonglaring for the best possible image," says Jones. "Natural daylight works for some situations. If you do use daylight, make sure that the source of daylight is behind the camera. You want diffuse lighting rather than spotlighting directly on the individual."
- Remove distractions from the room. "Excess movement in the camera is a real challenge. It causes the image to break up, and then the patient and provider have to wait for the image to clear before continuing the tele-visit," he says.
He suggests that children and pets be removed from the room. In addition, ceiling fans should be turned off, as well as radios and televisions. "The wonderful thing about tele-visits is that we can get a snapshot of how the patient is functioning in the home. The problem is the average home has many distractions that interfere with the technology."
Providers also must make an effort to remove distractions, he says. "You have to avoid nervous habits like tapping a pencil for the same reasons. That simple movement can slow down the image and cause it to distort or break up."
- Maintain a comfortable personal space. "Some patients love seeing themselves on camera, and some don’t," Jones says. "Keep your image and the patient’s image life-size. Try to frame the speaker in the screen."
- Maintain eye contact. "Just as you would during a face-to-face interview, keep eye contact during remote visits," he suggests. "Keep a true camera angle so that the provider and the patient are looking directly into the camera while it’s taking the picture."
- Speak clearly and concisely. "Providers can’t run on and on," he notes. "They have to plan the visit in advance and be succinct."
As for the best audio quality, Jones says Shepherd Center has found that headsets create the best sound quality. "Speaker phones are fine, too, but headsets are best."
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