Virtual online healthcare consultations: what’s good practice

Stuart Knowles shares a few pointers for health and care organisations to consider when operating remote video consultations between clinician and patient.

The Covid-19 black swan event has brought into sharp focus the technical and regulatory challenges of practising during a pandemic with healthcare professionals being asked to triage and treat patients by remote consultations where possible to protect staff and patient from the virus. 

Video consultations

A lifeline for clinicians as well as patients. Video consultations can offer a number of advantages to patients and the healthcare system but fears have been expressed that they may be clinically risky and bring significant regulatory concerns.

So, what’s the starting point?

It is always the professional guidelines and requirements which remain in force. That said, we can well understand clinicians feeling a little less than reassured by the GMC and other regulators suggesting they will take into account the current emergency circumstances. We are not entirely sure what that means…

A few pointers

Health providers running sexual health clinics (or where diagnostic imaging might be required)

There is a serious question when you have video diagnostics with medical images of a sensitive nature. If your video delivery of services involves images you might want to give this some thought. It certainly would be a candidate for (yet another) policy.

But there is a real issue about the transfer of images by email particularly the sharing of sensitive images. Less of a problem if your patient is over 18. But for those under 18, a  face-to-face consultation would be most appropriate. If clinicians require an image that may require sharing or uploading for diagnostic purposes, then a face-to-face consultation is preferable.

Keep in mind cyber-security and the steps to take

We are aware that different platforms are being used and those which have NHS approval include end to end encryption. It is important to keep in mind, when conducting video consultations, the need to use a secure system approved for clinical use wherever possible.

Chaperones

Organising chaperones is also one way of managing the risk. How can that be managed remotely and by video?

Care with mental health patients

There are rules for patients with mental health problems or who may lack capacity. It is possible to diagnose a mental health disorder or whether they lack capacity remotely, but the problems are real.  You may want to take a look at some guidance from my colleagues, Jill Mason and Molly Sanghera, in an article entitled: Updated: NHS England/Improvement guidance on the Mental Health Act and supporting systems during the coronavirus pandemic.

There is some guidance and practical tips available – here's a 'how-to' guide produced for local authorities – but well worth considering. This is quite a useful briefing too on the requirements for remote assessments (the MHA requires the patient to be “personally assessed”).

Coronavirus and malpractice: standards of care – standards of record keeping

The golden thread in managing risk, indemnity and malpractice is record keeping – now as never before, record keeping by healthcare professionals will be crucial. Why? Read Stephen King’s article here.

Final thought

Finally, with thirty years of NHS advice behind me, I take the view that clinicians and the NHS should do what is in the best interests of patients and the health of the population as a whole.  Action should be taken to protect people’s lives in the most appropriate way as permitted and deemed necessary by relevant clinicians. These are exceptional circumstances and should be treated as such. I think this is what is meant when the regulators say they will take a pragmatic approach. I would argue that recording a consultation is ‘a clinical note’ subject to the issue above. Courts are already accepting this (in other areas of law). It seems to me GPs and healthcare professionals may put themselves at risk or indeed may themselves become ‘super spreaders’ if pragmatic action is not taken. That is the mischief the altered practice seeks to avoid.