A physician shares his best tips for a successful telehealth practice

Ophthalmology might not be the first specialty that comes to mind when envisioning a telehealth practice, but Dr. Rahul Bhola, medical director of ophthalmology at CHOC, has seamlessly integrated the service in his practice, completing more than 900 telehealth visits since March.

In this Q & A, Dr. Bhola outlines his team’s success in transitioning to telehealth, and shares best practices that physicians in a variety of specialties can put into practice: 

What does an ophthalmology telehealth appointment look like?

A synchronous (live audio-video) CHOC ophthalmology telehealth appointment is divided into four components. I call them the four C’s: contact, connect, consult and care.

  1. Contact
    Our front desk reaches out to the family to confirm contact information. We send a Zoom link to the families, along with information about how to connect to Zoom and download the visual acuity app to check vision before the appointment. 
  2. Connect
    As the appointment day approaches, our technician connects with the family to discuss any technical issues that should be resolved prior to the physician consultation. The technician also goes over the at-home visual acuity check and evaluates basic medical history. 
  3. Consult
    On the actual day of the appointment, the physician connects with the families on Zoom to go over the pertinent history and visual acuity, and performs a focused examination including an external and ocular motility exam. If needed, pictures and videos from the family are requested for further evaluation. This enables us to diagnose a majority of anterior segment ocular issues as well as visual acuity concerns like amblyopia, refractive errors and ocular motility disorders.
  4. Care
    We discuss the treatment care plan and review any medical issues or concerns the patient is experiencing. Throughout this process, we can fulfill their needs ranging from prescription refills for medication or broken glasses without them having to step outside the comfort of their home.

Our office will then schedule a follow-up visit depending on the medical necessity.

Dr. Rahul Bhola offers his best tips for telehealth practices
Dr. Rahul Bhola, medical director of ophthalmology at CHOC , has completed more than 900 telehealth visits since March.

How do your patients and families feel about telehealth?

While some physicians may have been wary of telehealth care, I was pleasantly surprised that patients love telehealth.

Telehealth helped our patients and families feel secure, supported and assured that there would be no interruption in the patient’s care plan during COVID-19.  Our families are so grateful that during this time of emergency, their physician was able to connect with them to address any urgent issues and follow them in clinic on a need-to basis.

Due to the positive response we have received from our families, we will continue to offer telehealth visits for our families, when appropriate.

 Does telehealth compromise quality of care?

Not at all. Providers are often able to spend more time with patients during a telehealth visit. Children are more comfortable in their home setting and you can engage more with them and spend more time on-screen with them.

If we felt the urgency to see our patients face-to-face after the initial exam, we schedule in-person appointments.

What makes your telehealth visits successful?

The expression “Necessity is the mother of invention” really is true when it comes to telehealth.  Telemedicine has been around for a while, but it took a pandemic to make it universal and successful. As soon as the stay-at-home orders were announced we knew we had to connect with our patients to prevent any disruption of their care. Our team was not afraid of change and we realized the urgency to adapt to the circumstances right away to provide uninterrupted care to our patients and their families. We reallocated our resources to maximize our outreach; our goal was to connect with each and every patient scheduled to be seen in the clinic.

What advice and tips do you have for other providers to do telehealth successfully?

Being open minded, adaptable to the changing circumstances and embracing technology were a few things that helped us during this unprecedented time. We created a vigorous team of both technical and non-technical staff in a short span of time to enable successful initiation of a robust tele-ophthalmology program. The key was strategizing dynamically in this constantly changing environment and having frequent huddles with the team to address any issues.

Very quickly we realized that telehealth was amazing to address the four-part aim of healthcare: access, cost-effectiveness, patient satisfaction and physician satisfaction.

There will be nuances for specific specialties. In our case the American Academy of Ophthalmology right away provided resources and tools to help us initiate an effective synchronous telehealth portal.

Technological innovations like visual acuity apps and the ocular motility app were phenomenal tools developed to assist effective consultations.

Find other resources to grow your telehealth practice.

Avoiding burnout: A physician shares self-compassion strategies for provider wellness

By Dr. Rishikesh S. Chavan, pediatric oncologist and medical director of the blood and bone marrow transplant program at the Hyundai Cancer Institute at CHOC

Navigating the COVID-19 pandemic and a rapidly evolving medical landscape has put added pressure and stress on the healthcare workers braving the front lines. This is why it’s more important than ever to recognize signs of burnout in yourself and your colleagues, and essential that we as physicians practice self-compassion.

As physicians juggle their position as a healthcare provider, possibly the head of their household, and many other roles, it can be almost unnatural for physicians to think of themselves and their own needs.

But as the saying goes, you cannot pour from an empty cup. Physicians can’t do their best to care for patients and their own children at home unless they’re supporting their own comfort. I liken it to the safety instructions on an airplane – put your oxygen mask on before assisting others.

Self-compassion tactics

To avoid self-sabotage or self-destructive tendencies, one needs to feel a deep sense of love and acceptance of themselves. That’s why practicing self-compassion is so important. Here are some ways to get started:    

  • Make your own checklist Similar to a checklist one uses at the end of a shift to transition cases, make a personal one to end or begin your day. Everyone’s checklist will look different. We each classify different habits or rituals as essential. Do you need your morning coffee to function best? If you have exercised are you then your best self? For your checklist, consider elements such as:
    1. Acknowledge something that was difficult during your shift. After the feelings come up, let them go.
    2. Name three things that went well.
    3. Did you notice anyone else have a particularly hard shift? Check on them.
    4. Check in with yourself. Are you OK?
    5. Rest and recharge.
  • Relax – Identify your strategy for relaxation to help you take your mind away from the daily grind. Be aware of self-compassion versus self-indulgence. For example, watching an episode of your favorite TV show is one thing but binge watching an entire season is another. For several people, activities like bike riding, working in the garden, reading a book, practicing a musical instrument, or taking a yoga class may help establish a state of flow and provide an opportunity to go deeper.
  • Meditate – By definition, meditation means to focus on something. As you gently have a subtle focus on your heart, you can be a silent observer of your thoughts without reacting to them. An assumption that you are not your thoughts allows you to ignore intrusive thoughts and achieve a sense of peace. Sitting quietly with a guided meditation via apps such as Heartfulness, Headspace or Calm may help you get started. Studies have shown that peace and tranquility rank among the most common feelings people report after meditating, in whatever modality suits them.
  • Check in with your colleagues –Not only should we check in with ourselves, but we should check on our colleagues as well. If you see signs of burnout in a colleague, gently bring them into a conversation, or bring them a cup of coffee, and ask, “Is everything OK? Is there something that you want to talk about? Can I help you with anything?”

Interventions for physician burnout

A 2017 JAMA study found that the strongest evidence for effectiveness in combating physician burnout was organization-directed interventions, but the study noted such programs were rare. Most interventions for physician burnout put the onus back on the physician, with a focus on incentivizing physicians to participate. More effective intervention models are engrained across an entire hospital or healthcare system.

In January 2018, CHOC convened a Physician Wellness Subcommittee, composed of a group of physicians dedicated to help CHOC continue to be proactive and supportive of physicians. Its mission is “To promote physician wellness to benefit ourselves and others.”

Additionally, at CHOC, the spiritual care team offers regular “Tea for the Soul” sessions where chaplains are available to clinicians and provide a compassionate, non-anxious, non-judgmental presence to help them cope with added stressors.

CHOC leadership has taken other steps to provide additional support for its physicians and staff, recognizing the additional stressors placed upon CHOC staff during COVID-19. CHOC’s on-site daycare was set up within 72 hours, giving clinicians peace of mind that their children are safe and happy while they work. Recognizing that shopping for groceries and sundries might be challenging for staff, CHOC has set up in-house shopping resources, as well as a grab-and-go meal program and farmers market.

What referring providers should know about safety at CHOC during COVID-19

At CHOC, we know you want to provide your patients the very best care every day, especially during these uncertain times. CHOC has been in close contact with local, state and federal authorities to stay up to date with the latest outbreak information and ensure we’re following the best practices to limit the spread of COVID-19.

For the safety of our patients and families, here are just a few of the following procedures and measures currently in place:

  • Developed workflows to triage patients presenting with possible symptoms and best practices for treating suspected cases.
  • Increased screening at all CHOC entrances. All visitors, patients, physicians and staff members are screened for COVID-19 symptoms.
  • Everyone is required to wear a mask at all CHOC locations. For those who don’t have masks, we will provide our donated cloth masks at screening.
  • Visitor guidelines have been strengthened to help protect our patients, families, physicians and staff. For full details, please see our visitor guidelines.
  • Clinical areas are cleaned multiple times per day, in addition to the medical grade sanitization we have always provided. We will continue to thoroughly sanitize to the most rigorous standards.
  • We have established an Incident Command Center composed of a multidisciplinary team of leaders. The Command Center centralizes operational decisions, and coordinates CHOC’s response with local authorities and neighboring facilities.

As CHOC and other healthcare facilities adapt to the fluid environment created by the COVID-19 pandemic, and national, state and local recommendations and guidelines changing, we want you to know that we are open and have the following resources to help provide the safest care:

Telehealth appointments are available. To refer a patient, please call the Patient Access Center at 888-770-2462.

• Our 24/7 Nurse line, 1-844-GET-CHOC, is available for parents who have questions about their child’s health.

• If your patients’ families have recently lost or do not have medical insurance, they can call CHOC Family Financial Resource Center at 714-509-8600.

Please visit our website for the latest information about visiting our locations.