By now, numerous countries around the world have responded to the current global health crisis by implementing lockdowns in order to prevent disease transmission. (3) As the situation is continuously evolving, healthcare practitioners in the United States and Canada may be looking for guidance on how to prepare their practice for a new reality as healthcare transitions to virtual practice. This article will discuss the implications of a lockdown on healthcare practices, as well as tips for transitioning to a virtual practice.
What is a lockdown?
A lockdown is defined as “an emergency measure or condition in which people are temporarily prevented from entering or leaving a restricted area or building during a threat of danger”. (10) With the current health crisis, local and national governments are implementing lockdown measures, which include shutting down public transportation, closing non-essential businesses and services, and urging individuals to stay at home. (3)
Choosing to maintain a physical practice
The Centers for Disease Control and Prevention (CDC) currently recommends that healthcare providers and health facilities prioritize emergency and urgent visits to accommodate for the increasing demand this health crisis is placing on the healthcare system. This involves postponing elective and non-urgent visits or procedures, as well as routine eyecare and dental appointments. (5) Further, the CDC recommends that healthcare facilities take steps to prepare for a disease outbreak in their community. The CDC’s recommendations include:
- Staying informed by referring to current and reliable sources (e.g., local and national health authorities)
- Creating or updating your emergency plan, including staffing plans
- Developing relationships with stakeholders (e.g., public health partners)
- Creating a list of emergency contacts and making it accessible in your health facility
- Communicating with your patients and staff about updates (6)
Check with your local authorities to determine whether you can or should maintain a physical practice at this time. For practitioners who decide to maintain a physical practice, we’ve outlined some considerations below.
Preparing your team
Supporting your staff during this time is essential as they are managing the frontlines of the situation. Prepare your team by communicating what is known about current conditions, how these conditions may impact the practice, and the emergency plan in place. (6)
For guidelines on handling the exposure of healthcare staff to individuals confirmed or suspected to have the disease, refer to recommendations provided by official health authorities, such as the CDC’s Interim infection prevention and control recommendations. (7)
Several measures can help protect your team from infection and reduce transmission in your health facility. Preventive measures if you are still able to maintain a physical operation include:
- Increasing compliance to respiratory, hand, and surface hygiene practices
- Setting up additional hand washing or sanitizing stations (11)
- Encouraging employees to stay home when ill
- Screening patients for symptoms of respiratory infections
- Ensuring personal protection equipment (PPE) is sufficiently stocked (e.g., respirator, face mask, protective eyewear, gloves, gowns) (6)(7)
- Providing training on infection prevention and control, including PPE use (6)
Additional ways to support your staff include maintaining regular work hours, encouraging breaks, facilitating access to counselling or mental health resources, and encouraging open and cooperative communication between employees and management. (6)
Preparing your patients
In order to provide the best care to your patients, it’s essential to stay up-to-date on the most current information and treatment approaches during a health crisis. Refer to the Technical guidance from the World Health Organization (WHO), Clinical care guidelines developed by the CDC, and the Public health management of cases guidelines from the Public Health Agency of Canada (PHAC) to stay current.
Create a separate waiting area in your health facility for individuals with respiratory symptoms. If possible, use a well-ventilated area. (6) Additionally, the CDC suggests several approaches to redirect patients from visiting your clinic if they can be cared for at home, which include:
- Changing your operating hours to add time for telephone triaging of cases
- Adding or changing messages on your telephone system in order to communicate when patients should visit your health facility or seek emergency care
- Using telehealth technologies to provide virtual care (6)
In general, urge your patients to follow community-based measures to prevent the spread of illness. Current recommendations from the WHO, CDC, and PHAC for personal hygiene include:
- Hand hygiene, which involves frequently washing hands with soap and water or using an alcohol-based hand sanitizer
- Respiratory hygiene, which involves using disposable tissues to cover sneezes and coughs, or sneezing and coughing into the bend of your arm
- Environmental hygiene, which involves regularly cleaning and disinfecting surfaces (e.g., door handles, tables, keyboards, desks, faucets, toilets)
- Social distancing, which involves maintaining at least three feet (one meter) of distance from other individuals, particularly those who are ill
- Facemasks, which are only recommended for individuals with respiratory symptoms (e.g., coughing, sneezing, difficulty breathing)
- Self-isolation at home when showing signs of illness (8)(11)(14)
Alcohol-based personal hygiene products, such as hand sanitizers, and disinfectants, such as household cleaners, should contain at least 60% alcohol and 70% alcohol, respectively. (8)
Overall, keep your communications high-spirited and emphasize caution, not fear. For information on how to talk to your patients about this health crisis, view the Fullscript blog.
Transitioning to a virtual practice
The current global situation is pushing telehealth, also referred to as telemedicine and virtual healthcare, to the forefront.
What is telehealth?
According to the American Medical Association (AMA), telehealth is the practice of medicine using live audio-video communication tools which allow providers to meet with patients virtually, regardless of physical location. A virtual medical practice may utilize video conferencing tools or applications, mobile health applications, and remote monitoring tools, such as wearable devices and blood pressure monitors. (12) It’s important to note that certain definitions of telehealth include any technology that allows medical care to be provided at a distance, (4) while other definitions may exclude certain forms of communication, such as telephone, email, instant messages, and fax. (12)
Examples of telehealth services include:
- Mental health services and emergency psychiatry via interactive audio-video appointments
- Remote management of chronic illnesses, including remote data collection of vitals such as blood pressure and blood sugar levels
- Virtual support services to women with high-risk pregnancies (12)
- Online prescribing platforms for pharmaceuticals and for dietary supplements, such as Fullscript
On March 17th 2020, the United States administration announced that Medicare services are temporarily being expanded to accommodate the rapidly changing healthcare system needs in response to the current disease outbreak. The Centers for Medicare & Medicaid Services (CMS) has identified three primary types of telehealth services that healthcare professionals can provide to Medicare beneficiaries, which include virtual check-ins, e-visits, and Medicare telehealth visits. (9) For more information on insurance coverage for telemedicine, patients should consult the CMS and/or their insurance provider.
Benefits of telehealth
Effective telehealth services may provide numerous benefits for healthcare providers and patients, including:
- Improved patient triaging
- Increased patient and staff safety
- Increased quality of care and operational efficiency
- Reduced barriers to healthcare access (e.g., travel, time restrictions)
- Improved decision support for health conditions
- Increased patient compliance to treatment
- Enhanced coordination among multiple practitioners providing integrative care
- Improved communication between healthcare practitioners and patients (12)
Preparing for virtual practice
We recommend checking with your professional association for specific guidance on the laws and regulations surrounding telemedicine in your practice. The AMA provides the following recommendations for implementing telehealth:
- Designate staff to plan and implement telemedicine services for your practice
- Consult with your insurance provider to ensure your malpractice policy coverage includes telehealth
- Review the payment and policy guidelines that apply to telehealth visits and services (2)
Additional considerations include selecting a telehealth vendor that complies with the Health Insurance Portability and Accountability Act (HIPAA) and familiarizing yourself with managing remote teams. If you use an electronic health record (EHR) system in your practice, check to see if the EHR provides a telehealth function. Otherwise, contact your professional association to inquire about their recommended telehealth platforms. (2) Virtual medical practice management may require you to provide staff with all required equipment for online work from home, train on new processes and software, as well as guide your employees on how to work from home effectively.
Preparing your patients
It’s essential to notify your patients of changes to your clinical practice and receive their consent for telemedicine appointments and communications. You can ensure patients are prepared by having your support staff proactively reach out to patients, sending an email to your patient list, announcing changes in your patient portal and/or clinic website, and posting physical notifications in your health facility. (2)
Establish a process to help patients easily access and navigate the telemedicine services you’re providing. (2) Consider providing resources, such as a list of steps to follow to access online services and contact information for your EHR or telemedicine app support teams. You may also choose to offer alternative methods of communication, such as telephone consultations, to accomodate accessibility issues.
The bottom line
As the current global health crisis evolves, it may necessitate changes to policies and procedures in your health facility. Follow the tips in this article when preparing your health facility, staff, and patients for continuing physical practice and transitioning to telehealth.
- American Association of Naturopathic Physicians. (n.d.). Health crisis resources and clinic guidelines. Retrieved from https://naturopathic.org/
- American Medical Association. (n.d.). AMA quick guide to telemedicine in practice. Retrieved from https://www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice
- BBC News. (2020, March 17). How are virus lockdowns being enforced? Retrieved from https://www.bbc.com/news/world-51911340
- Canadian Medical Protective Association. (2006, March 1). Practising telehealth. Retrieved from https://www.cmpa-acpm.ca/en/membership/protection-for-members/principles-of-assistance/practising-telehealth
- Centers for Disease Control and Prevention. (2020a, February 11). Healthcare facilities. Retrieved from https://www.cdc.gov/
- Centers for Disease Control and Prevention. (2020b, February 11). Steps healthcare facilities can take. Retrieved from https://www.cdc.gov/
- Centers for Disease Control and Prevention. (2020c, February 11). Interim infection prevention and control recommendations for patients in healthcare settings. Retrieved from https://www.cdc.gov/
- Centers for Disease Control and Prevention. (2020d, March 18). Protect yourself. Retrieved from https://www.cdc.gov/
- Centers for Medicare & Medicaid Services. (2020, March 17). Medicare telemedicine health care provider fact sheet. Retrieved from https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
- Lockdown. (n.d.). In Merriam-Webster. Retrieved from https://www.merriam-webster.com/dictionary/lockdown
- Public Health Agency of Canada. (2020, March 12). Community-based measures to mitigate the spread of the virus in Canada. Retrieved from https://www.canada.ca/en/public-health/services/diseases/
- Rheuban, K. S. (2015, October 7). Telemedicine: Connect to specialists and facilitate better access to care for your patients. Retrieved from https://edhub.ama-assn.org/steps-forward/module/2702689
- World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved from https://icd.who.int/browse11/l-m/en
- World Health Organization. (2020a, March 9). Q&A. Retrieved from https://www.who.int/news-room/q-a-detail/
- World Health Organization. (2020b, March 18). Advice for the public. Retrieved from https://www.who.int/emergencies/diseases/en/