Step 4

Set Up Your Video Exam Rooms

Provider’s side

Background

• Limit clutter in the field of view of the camera
• Consider using a solid color backdrop ~1 meter from camera
   

Lighting

• Ensure face is well lit to optimize resolution
  • If light is bothersome cover with a light softener
• Avoid backlighting
• Avoid overexposure
• Avoid excessive shadows
• Some LED lights flicker with certain cameras-try to change lighting (non flicker LED lights), location or camera.
• Consider scheduling televisits during naturally lit times of the day
   

Provider appearance:

• Use picture-in-picture to verify your face is centered and close enough to the camera, while capturing hands for gesturing during communication
• Wear solid-colored clothing; avoid busy patterns
• Wear a white coat if this is your regular dress code.
• Ensure intermittent eye contact with the patient by looking at the camera instead of the screen
• Stand/ sit upright (avoid slouching and swiveling the chair)

Patient’s side

If patient is at home:

• Send your patient a prep sheet with guidelines for the visit, including:
  • Have a second person available for assistance with video
  • Set up a seat 2-3 feet from the webcam
  • Set up a second seat 8-10 feet from the webcam for full body and gait exam; consider also using a hallway for gait exam
  • Close shades, blinds, doors to prevent backlighting, and sit facing a light rather than in front of one
  • Limit background clutter, reflection (pictures, mirrors and windows), and noise (turn off TV, radio)
  • Recommend using picture in picture in your video software (and explain how to do this)
  • A disclaimer if applicable – some institutions recommend having the patient sign a consent acknowledging that they have a choice between telemedicine care and in-office care, and also informs them that visit is not recorded.
     

If patient is at remote healthcare site:

• Consider using a telepresenter. These are trained personnel who can assist in portions of the exam that are difficult to perform remotely (e.g. checking tone, pull-test, reflexes, eye movements, etc).  Providers should consider the cost of training and having telepresenters available.

Step 5:  Conduct a Visit