Before you set up Skype you will need to consider a number of factors. Initially you should have discussions internally with IT providers and information governance (IG) services to ensure that they are comfortable with the approach.
Example protocols which can be found on the website www.digitalhealthsot.nhs.uk have satisfied these types of concerns in CCGs and practices and include medical defence organisation considerations - we have also reproduced these here:
You might adopt or adapt some sections or a document for your own purpose – taking your own professional responsibility for the document that must fit with local IG and security procedures.
Promoting the service
The second key aspect will be promoting the service and gaining consent from patients or service users.
You will need to be clear with the patient that this form of consultation does not replace the existing services but enhances them. Patients will need to be selected to ensure that you are not adding to an already stretched workload.
These patients may be ones who are responsible for repeat non-attendance or may be suffering from a long-term condition where accessing GP services is difficult. They may also be using self-monitoring equipment.
There are examples of patient inclusion and exclusion criteria in the practice protocol, which you can download from the link above.
Organising the clinics
Once you have agreed the approach you can begin the process of organising the Skype clinics. This is straightforward and involves the practice or clinic compiling the Skype contact list, messaging the patient to inform them when their consultation will take place and then contacting them at the given time as you would with a telephone consultation.
It is important before commencing any consultation that you again ask the patient to confirm that they are happy using Skype and that they are broadcasting from a private room.
What equipment do you need
The equipment required is straightforward – a laptop or PC and webcam but you will need to check your broadband connection speed beforehand by testing the approach before going live.
All Skype–Skype voice, video or file transfers and instant message interactions are encrypted; but a call from Skype to a mobile or landline phone is not. Then the part of your call involving the ordinary phone network is not encrypted. Skype is on the NHS G-Cloud which contains approved software for use by NHS organisations.
Frequently asked questions
What are the barriers to implementing telemedicine?
Setting up telemedicine needs to happen at scale if it is to be effective. That requires planning, engagement and some upskilling with prior agreements on IG, privacy impact assessment, informed consent, medical defence organisation indemnity, protocols as well as the cost and set-up of equipment (maybe encrypted video link, or webcams) and upskilling (patient or service user, clinicians, administrators).
The book this article is taken from has more advice about addressing many of these issues (see below for details).
Another concern is about the security of Skype – and common FAQs are answered here.
How will the use of video consultation help reduce demand on health services?
There are some excellent examples of where the use of video is beginning to reduce demand on services. For example, in Roundwood Surgery, Forest Town, Mansfield they have created virtual ward rounds within a care home using iPads.
The GP has a one-to-one consultation with their patient using Skype. Virtual ward rounds were completed between a GP from Roundwood Surgery in Mansfield and Stone Cross, a learning disability residential home.
Prior to the introduction of the virtual ward if a client was ill, both transport and carers would be required to take them to the practice. This could be very disruptive for residents with severe learning disabilities. It also reduced the numbers of staff on duty within the home.
The introduction of virtual ward rounds has allowed the staff at Stone Cross to spend more quality time with their clients. The GP has reported that holding regular virtual ward rounds has improved the levels of care delivered to residents and reduced demand.
How do you decide which form of telemedicine should be used?
This is entirely dependent on budgets and support from the IT teams. You may feel that the use of Skype or FaceTime is too risky for your organisation, which would lead you towards an encrypted system such as that provided by v-connect.
If you are happy to adopt or adapt the protocols that are available with this book or perhaps don’t have a budget to install bespoke equipment then low-cost options such as Skype and FaceTime have been tried and tested and are available.
What are the benefits of Skype/video consultations from a patient’s perspective?
- provide convenient and increased accessibility to clinicians (e.g. GP or practice nurse)
- enable patients to discuss any health concerns or worries you might have
- give clinicians an opportunity to treat any health issues in a timely manner
- might help patients avoid visits to your GP practice or A&E.
Marc Schmid is the communications and digital lead for the Pennine Lancashire Health Transformation Board and a member of the Lancashire Digital Board and director of social enterprise Redmoor Communications
This articles is taken from a new book Digital Healthcare: The Essential Guide by Dr Ruth Chambers, Marc Schmid and Jayne Birch-Jones, priced £24.99 and published by Otmoor Publishing.
Medeconomics users can buy the book for the reduced price of £19.99 by emailing firstname.lastname@example.org and quoting ‘Medeconomics offer’.