## The Case for Hybrid Practice The proportion of outpatient consultations that can be effectively conducted by video is consistently estimated at 30–50%, depending on specialty. For specialties like psychiatry, dermatology (follow-up), endocrinology (medication review), and physiotherapy (exercise progression), the proportion is even higher. Clinics that offer telemedicine see: - Higher patient convenience and satisfaction for follow-up visits. - Reduced no-show rates for remote consultations (patients are already "there"). - Access to patients in geographic areas not served by physical branches. - Reduced clinic footprint costs per consultation (no room, no consumables). ## Which Consultations Work Well Remotely **Good candidates for telemedicine**: - Medication review and dose titration (hypertension, diabetes, thyroid, psychiatric medications). - Post-procedure follow-up when wound inspection is not required. - Mental health consultations (psychiatry, psychology). - Nutrition counselling. - Physiotherapy exercise progression review. - Dermatology follow-up for known conditions (acne review, rosacea, psoriasis reassessment). - Paediatric developmental review (speech, behaviour) with parent participation. **Poor candidates for telemedicine**: - First presentation of an undifferentiated complaint. - Any situation requiring physical examination (abdominal pain, joint examination, auscultation). - Procedures (injections, dressings, minor surgery). - Emergency presentations. - Patients who are not confident with technology (unless assisted). ## Technical Setup Checklist ### Physician Side - Stable internet connection ≥ 10 Mbps upload and download. - Webcam resolution ≥ 1080p (built-in laptop cameras are often sufficient). - Headset with microphone (reduces echo and background noise). - Neutral, professional background or virtual background. - Adequate lighting (front-facing, not backlit). - Laptop or desktop preferred over mobile for screen real estate. ### Patient Side - No special setup required — most patients use a smartphone. - Provide patients with a step-by-step connection guide in their appointment confirmation message. - Offer a 10-minute "tech check" before the first telemedicine appointment for elderly or less tech-confident patients. ### Platform - Use a platform that is HIPAA/GDPR-compliant and supports end-to-end encryption. - Avoid consumer-grade video tools (WhatsApp Video, FaceTime) for clinical consultations — they do not provide the necessary data processing agreements. - ClinIT integrates with compliant video platforms, generating a secure one-click room link that is included in the patient's appointment reminder. ## Workflow Integration ### Booking Flag the appointment as "Telemedicine" at booking time. The patient receives a confirmation with a video link and instructions. The reminder message 48 hours and 2 hours before the appointment re-includes the link. ### Pre-Visit Send the patient a short pre-visit form (symptoms since last visit, BP reading at home, blood glucose log) through the patient portal. The data is visible to the doctor before the call starts. ### The Consultation Open the video call from within ClinIT. The clinical note template is visible alongside the video window. Document the consultation exactly as you would for an in-person visit — history, assessment, plan. Prescriptions and referral letters generated digitally are sent to the patient portal immediately after the call. ### Billing Telemedicine consultations are billed at a standard consultation rate (or a dedicated telemedicine rate if the clinic differentiates). Invoice generation and payment follow the same flow as in-person visits. ## Consent & Compliance Patients should provide written (or documented verbal) consent for telemedicine on their first virtual consultation. The consent should confirm: - The patient understands the limitations of remote examination. - The patient is in a private location during the consultation. - Data is transmitted over an encrypted connection. - The consultation may be discontinued if clinical needs exceed what telemedicine can safely address. Document the consent in the patient record and set a flag so subsequent telemedicine visits do not require re-consent. ## Measuring Telemedicine Performance Track separately from in-person visits: - Telemedicine appointment completion rate (typically higher than in-person). - Patient satisfaction score for virtual visits. - Technical failure rate (connection drops, audio/video issues). - Escalation rate (consultations that needed to be converted to in-person).