hen the pandemic began, we had to call most of our patients to cancel their appointments because we weren’t set up to see patients virtually. At the time, we didn’t have access to MyChart (Epic’s platform for virtual care), so we had to schedule appointments using Zoom or InTouch. Just like a meeting, Zoom required us to send an email to every patient with an invitation to join the Zoom call. We quickly realized that we needed a clear, manageable process to better serve our patients. 

By relying on our team—Clinical Nurse Coordinator Angie McGuire and our medical assistants—we have transformed into an organized virtual and in-person clinic. Here’s how:

1. Make it easier for patients by anticipating which platform to use

MyChart is now our preferred method of virtual visits, but it’s not a one-size fits all and doesn’t accommodate all patient needs. For example, we use other virtual care platforms, like Zoom and Doximity, for patients living in care centers with non-family support. So to help the patient plan for their appointment, we have to know which platform the provider will use. 

Help patients know what to expect before the appointment. We reach out to patients 24-48 hours in advance of their appointment. We let them know which web platform to expect, and also to “pre-room”—go over the patient’s meds, history, pharmacy, level of pain, all of the same information that would happen if the patient came in person. Importantly, we set the expectation with the patient of which platform (MyChart, Zoom, Doximity, etc.) they’ll use.

Personalize your confirmation. We send patients an email from University of Utah Health Cardiology (instead of our personal emails) with the Zoom instructions and all of the consent forms. We created our own email because we wanted to be mindful that our patients (and all of us) receive a lot of spam. The patient knows we are deliberately communicating with them by using their name, appointment time, date, provider and the Zoom link. If the patient replies, an auto-reply tells the patient how to get in touch with us.

2. Establish clear expectations for clinic support roles

When we first started virtual care, we thought, "Oh, it's all virtual, so the providers won’t need much, they’ll just get on and connect.” We soon discovered that is not true. Providers cannot run a virtual clinic without support. We do a lot of work to get patients connected, which has completely changed how we staff our clinic. We have two staff members assigned to each physician care team every day. One person calls the schedule for the day or two in advance (pre-calling), and one person runs the virtual clinic (point). We’ve created clear expectations around each role. 

One of the main responsibilities of the point person is to assist with connectivity. If the point person notices the patient hasn’t connected within 10 minutes of the appointment time, they call that patient to ask, "Hey, I don't see you logged in for your visit yet. Did you get the link? Are you doing okay?” 

If that provider is also seeing in-person visits, they will take care of the in-person visits at the same time. We have specific follow-up processes for after the patient has been seen to ensure we have followed up on any additional testing or checked in with the patient if we have adjusted any medications or plans of care.

3. Leverage the team’s expertise

This virtual care journey has reminded me not to underestimate the creativity and problem-solving ability of your team. We all want to do a good job.

All of our processes were created jointly, by experimenting and huddling together. In our team huddles we talk about what works and what doesn’t. For example, one of our at-home employees identified the need for the orders role after noticing that we struggled to connect with patients on subsequent tries if we didn’t connect on the first try. The “orders” person answers the phone directly when the patient calls back and finishes rooming the patient. 

Another staff-driven improvement has been to clearly identify roles. At the beginning, whoever was in on that day called patients. We didn’t assign people to particular providers. The result was a lot of frustration, especially as some work was incomplete or done incorrectly. Now, the same individual running clinic makes their own calls in advance. They know what to expect because they set it up themselves.