Chronic conditions do not pause during a pandemic. When faced with delaying the care of over 1,000 patients with neurological conditions, University of Utah Health Neurology Vice Chairs Susan Baggaley and Vivek Reddy rapidly developed a new virtual visit workflow.

1. From a Crisis Rises an Opportunity
Ambulatory Clinics in a Virtual Model
April 7, 2020
Susan Baggaley and Vivek Reddy

2. WHY NOT JUST WAIT THIS OUT…
Long access times will get even worse in the recovery phase
Need a model that will withstand the
wave of uncertainty ahead
Our existing relationships can be helpful for patients
Neurological diseases do not pause for a pandemic

3. GUIDING PRINCIPLES
A Video visit can/should create a true personal connection
Design a familiar, reliable, and comprehensive solution
Accept that a video visit may not be the same, but can still add value
Avoid over-filtering of patients – may miss opportunities to help

4. OUR APPROACH
Move with urgency to stem the tide of postponements
Create a pilot group of providers and staff to do rapid change cycles
Test platforms and workflows with patients
Engage entire clinical team in the new workflows
Go-Live and continue to refine

5. Virtual Clinic
Workflows

6. TRADITIONAL CLINIC WORKFLOW
Scheduling
(Schedulers)
Before visit
(days to weeks)
Arrival/Rooming
(Schedulers/MA)
(Start of the visit)
Exam and
Evaluation
(Provider/
Patient)
Check Out (MA/
Schedulers)
(Immediately
after visit)
VIRTUAL CLINIC WORKFLOW
Scheduling
(Schedulers)
(1-2 weeks
prior)
Pre-Visit
Evaluation
(MA’s) (1-2 days
before)
Exam and
Evaluation
(Provider/
Patient/Family)
Check Out
(MA/
Schedulers)
(Days after visit)

7. SCHEDULING WORKFLOW
Offer patient video option
preferentially
Send patient links to video
visit
Create simple electronic
message to provider with
links
Offer test run of technology
Scheduling
(Schedulers)
(1-2 weeks prior)
Pre-Visit
Evaluation
(MA’s) (1-2 days
before)
Exam and
Evaluation
(Provider/
Patient)
Check Out
(MA/
Schedulers)
(Days after visit)

8. PRE-VISIT WORKFLOW
MA reviews key
clinical information
Ensures outside
records are present
Answers questions
about video visits
Documents all pieces
of Pre-visit evaluation
Scheduling
(Schedulers)
(1-2 weeks prior)
Pre-Visit
Evaluation
(MA’s) (1-2 days
before)
Exam and
Evaluation
(Provider/
Patient)
Check Out
(MA/
Schedulers)
(Days after visit)

9. EXAM AND EVALUATION WORKFLOW
Click on link to start video visit
Evaluate/Examine patient with family and
caregivers
Document note (using Smartphrases)
Orders/Wrap Up in normal fashion
Use Workspace CC and send to scheduler
and assigned MA
Level of Service
• Use normal E&M for video visits
• Use telephone codes for telephone visits
Scheduling
(Schedulers)
(1-2 weeks prior)
Pre-Visit
Evaluation
(MA’s) (1-2 days
before)
Exam and
Evaluation
(Provider/
Patient)
Check Out
(MA/
Schedulers)
(Days after visit)

10. CHECK OUT WORKFLOW
MA/RN receives
electronic
notification
Provider contacts
MA/RN for urgent
need via phone
Patient receives a
call post visit to help
arrange follow up
Scheduling
(Schedulers)
(1-2 weeks prior)
Pre-Visit
Evaluation
(MA’s) (1-2 days
before)
Exam and
Evaluation
(Provider/
Patient)
Check Out
(MA/
Schedulers)
(Days after visit)

11. Video Exam Tips

12. HOME SETUP CONSIDERATIONS
Background
• Plain or virtual
backgrounds, do
not have moving
items
Lighting
• Brightly lit in front,
no backlighting
Sound
• Headset is ideal, if
feedback, turn
down speaker,
don’t move away
further

13. PATIENT CONSIDERATIONS
Rest phone/
camera on a
solid surface
Well-lit room is
best,
encourage
one person to
talk at a time
Use family to
help with
exam

14. BEING PRESENT ON VIDEO
Look at the
camera
Explain multi-
tasking
Use names,
not body
language to
direct
questions

15. What’s Next

16. FUTURE STEPS AND OPTIMIZATION
Evaluate ideal referrals for video and cross
divisional work queues to improve access
Design more efficient and coordinated
evaluations
Optimize templates for virtual visits

17. THANK YOU