A VAHoV is a “Virtual, At-Home Visit.” Anytime you see (and hear) your patient through a remote (virtual) connection, they are not in your office and you are discussing their optometric care, you are performing a VAHoV. These types of visits were virtually non-existent prior to the COVID-19 national emergency, but quickly adopted as a device to help us stay in touch with patients during the crisis.
How to Do It Right
Recognize that it is a different way to see your patients. It’s not designed to be comprehensive eye care and has its limits — although in many ways, it is better than seeing the patient in the office. While you can’t see the various layers of the cornea, you can see the patient in their natural environment.
Have a defined system that your team operates so that you seem to know what you are doing. Walk through a typical visit with a trial patient or two. Define how you will connect, communicate with your patient and deal with misunderstandings. There are a variety of connection tools like EyExam Virtual, Eye Care Live, Doxy.me and Zoom for Healthcare. Pick one and learn how it works.
Treat it like a doctor’s visit, not a phone call. It is important to work out details like insurance, billing and demographics before these visits, just like in-office visits. We recommend a “check-in” with a staff member who confirms or collects any needed data, including credit card information. (They won’t be mad if you talk about money.)
Define how this visit will be documented. We recommend that the staff-person who checked in the patient become the scribe while the doctor is talking to the patient. She can simply turn off her camera, open the patient’s record in the cloud-based EHR and enter the findings. Doctor can turn it back over to her for orders or scheduling, while the doctor logs into the record to review the entries and sign off. Done!
Don’t be late. When a patient is in your office, you have to make them wait a pretty long time before they give up on you. When they are at home, it’s not unheard of for them to go get a sandwich if the wait exceeds a few minutes. Keep up, but have a really good plan for communicating with the patient if time gets away from you.
Moving Forward
Prior to the national shutdown, VAHoV’s were being successfully incorporated into a few practices and we expect it will remain a part of practices as we return to “normal.” The hardest part is actually working it into your normal scheduling techniques.
Under normal circumstances VAHOV’s can be the first visit for any after hours call. Currently, we receive a call from the emergency line and we call to speak to the patient for free. On that call, we decide to see the patient now or later and sometimes we treat the patient by calling in a drop. Utilizing TheTeleOp.com, that same patient can complete a form that identifies several factors about their condition, direct the patient to a VAHoV and once connected – you have performed a VAHoV (a legitimate service).
VAHoV’s are great for Contact Lens Progress Exams (CLPE). Today’s contacts are really safe and easy to fit yet we still like to see them after they have been in a week before we prescribe them. Consider just how inconvenient this is for your patients when you really just need to know if they can see good, they feel good and if the eye looks ok. All of this can be done with a VAHoV. Today’s cell phone cameras give a really good few of contact lens movement and even toric lens rotation.
Dry Eye Follow-up’s are great with a VAHoV. Same as with CLPE’s, the biggest part of the visit is the conversation with the patient about symptoms and compliance and a general look at the eyes. Tear meniscuses can be seen in a VAHoV, if the lighting is right. Dr. Brittany J McMurren is developing a technique to visualize staining through a VAHoV.
There are other follow-ups that can be done through teleoptometry, depending on a variety of factors surrounding the patient’s condition and your comfort level seeing it remotely. Consider allergic conjunctivitis, contact dermatitis, corneal abrasions (little ones), chalazions, headaches, trouble with these progressives …
You can do a lot with virtual visits with your patients, but you also can take it too far, like this guy. Remember that your liability remains the same and you have to do what is best for the patient.
While VAHoV’s don’t keep people away from utilizing us, it keeps us in touch with them and helps us take better care of them than we ever did Before COVID (BC).