Medicolegal Logistics

The last couple of weeks have been monumental for our project. As I wrote in my last post, prior to this week, so many questions remained – what platform could we use to conduct Telehealth appointments that would be compliant with HIPPA? How could we document the appointments without access to the paper charts at the clinic? As our appointments were previously all walk-up, and we did not have a telephone in the clinic, how were we going to contact patients and set up appointments?

This past week, we met with our lead community liaison in Fremont, one of the Chief Compliance Officers for the Duke Health System, and the Clinical Directors of the Duke Telehealth Office to figure out exactly how we could run the Telehealth system so that it would be both compliant with medicolegal requirements, and also accessible to the population we serve. Also, I, along with three other medical students on the leadership team, took a trip to Fremont last weekend to take a look at the supplies in the empty clinic, drop off cleaning materials like hand sanitizer and Clorox wipes, and investigate how we could set up a Telehealth station at the clinic.

For scheduling appointments, we will plan to create a clinic phone number using Jabber, and we will both post the number in the local poster office and ask local pastors to advertise it at services. Patients can leave voicemails at this number requesting appointments, and any one of us leaders will be able to check it. We will also gather patient’s phone numbers from the charts and call to inform them about the new version of the clinic. In order to conduct appointments, we will use a Duke hotspot and purchase two tablets. Patients will come in for 1-hour appointments and log into either Zoom (video calls) or Doximity (phone calls) to be seen by a physician and a group of first- and third-year medical students. We will have one person on-site during any clinic day to let the patient in, take vitals, and open charts to gather information on past medical history. All of our visits going forward will be documented in DukeBox.

One thing I am learning so far is that setting this up takes much more collaboration and work than expected! Since the pandemic began, Telehealth has rapidly become a comfortable format for conducting healthcare appointments. With the widespread use of encrypted Zoom, I could not imagine that there would be too many barriers to setting this up. However, ensuring that we comply with the ethics of conducting healthcare and the medicolegal regulations of a large institution, in combination with making Telehealth an accessible option for people with limited resources, is an enormous task. However, the urgency is palpable, as I suspect it may be a while before many of our patients at the clinic receive their COVID vaccine. As the COVID infection rate and death rate continue to climb, it is critical that we are able to optimize their health. We hope that the new virtual format of the clinic, in addition to providing a bridge to in-person clinic once the pandemic is well-controlled, will allow us to increase our patient population indefinitely to include those who were previously unable to make it to the original clinic every 3rd Saturday of the month.

In addition to setting up the clinic, as we continue to prepare our first-year medical students for success when we officially begin the virtual clinic, we have been hosting educational lectures. Most recently, we had a lecture on Telehealth etiquette, including verifying patient identification, ensuring that the patient is alone in the room or that they feel comfortable speaking about medical matters in front of others who are in the room, and finding creative ways to do a physical exam (ex. having a patient press on their own abdomen to find tenderness). We also brushed up on some chronic management of diabetes and hypertension.