How do I conduct a telehealth encounter in eClinicalWorks (ECW), including patient consent, scheduling, identity verification, connection testing, virtual assessment, documentation, billing, and follow‑up?

Conducting a Telehealth Visit in eClinicalWorks (ECW)

To conduct a telehealth encounter in ECW, you must systematically address consent, identity verification, environment setup, connection testing, virtual assessment, documentation with specific telehealth disclaimers, and appropriate billing with telehealth modifiers—following a structured workflow that prioritizes patient safety and regulatory compliance.

Pre-Visit Preparation and Scheduling

Patient Consent

• Obtain explicit consent specific to the telemedicine encounter before initiating the visit 1
• Document in the consent process an explanation of potential uses of any electronic medical record or video recording and who will have access to it 1
• Include a disclaimer in your documentation such as "teleconsultation is provided with the consent of the patient" 1, 2

Verify Patient and Provider Location

• Document the patient's physical location at the time of the visit, as medical practice legally occurs where the patient is located 1
• Confirm you are licensed in the state where the patient is physically present during the encounter 1
• Document your own location as the provider 1

Beginning the Telehealth Encounter

Identity Verification

• Start each telemedicine encounter with confirmation of identity of both provider and patient 1
• Consider displaying photo identification for mutual verification 1
• Have the patient introduce themselves and any family members participating in the visit 1

Environment and Technology Setup

• Ensure both you and the patient are in a private setting with a closed door 1
• Verify the patient is preferably alone or with a relative who may help with technical issues 2
• Use laptops or desktop computers rather than cell phones when possible 2
• Ensure adequate lighting with the camera positioned at eye level 1, 2
• Wear professional attire as you would for an in-person visit 1, 2

Connection Testing

• Ensure adequate audio/visual transmission at the beginning of the call 1
• Be prepared to pivot to an alternate method (such as telephone) if the connection is broken or unreliable 1
• Test that secure, encrypted transmission is functioning properly 1

Conducting the Virtual Assessment

Establishing Rapport

• Begin with an introduction of yourself and your expertise 1
• Explain how the visit will proceed and establish goals upfront 1, 3
• Address both the limitations and advantages of telemedicine visits 1
• Maintain deliberate eye contact with the camera and use intentional body language to convey empathy 1, 3

Physical Examination Limitations and Alternatives

• Recognize that conventional physical examination is not possible during video visits 2, 4
• Direct the patient through a self-examination as a reasonable alternative 2
• Request patient-reported vital signs (temperature, heart rate, blood pressure) if home equipment is available 2
• Document that physical examination is limited by the telehealth modality 2
• Convert to an in-person visit when hands-on examination is clinically necessary 4, 5

Clinical Assessment

• Use active listening throughout the visit 3
• Implement pre-visit questionnaires via secure messaging to gather information efficiently 1
• Document all clinical participants' roles and actions 1
• List any other individuals present at the visit 1

Documentation Requirements

Essential Documentation Elements

Your telehealth note must include the following specific components 1:

• Patient consent to telemedicine
• Method of telemedicine (secure 2-way interactive video connection or phone call)
• Patient location
• Provider location
• Listing of all clinical participants' roles and actions
• Other individuals present at the visit
• A telehealth disclaimer 1

Additional Documentation

• Document all clinical data as you would for a face-to-face consultation 2
• Note any limitations of the examination due to the telehealth modality 2
• Verify whether a specific teaching statement is needed if trainees are involved 1

Ordering Tests and Follow-Up

Complementary Diagnostic Exams

• Send laboratory or imaging requisitions via secure encrypted email when the patient is in another geographical area 1
• Use secure applications like those integrated into your EHR system for safe file transmission 1
• Request tests rationally, considering the patient's clinical urgency, age, health status, and local healthcare capacity 1

Follow-Up Planning

• Ensure results of requested tests are available before the follow-up visit 1
• Send reports to the patient after results are available, or ensure they are visible in the patient's electronic record 1
• Send post-visit instructions via secure portal or mail 1
• Schedule follow-up visits as clinically appropriate 1

Billing and Coding

Proper Billing Procedures

• Bill using the same CPT codes as in-person visits (99202-99205 for new patients, 99211-99215 for established patients) 1
• Include the appropriate Place of Service code for telehealth 1
• Add the telehealth CPT modifier (such as modifier 95, GQ, or GT depending on payer requirements) 1
• Bill based on complexity with appropriate modifiers for audiovisual encounters 1
• Bill based on time for telephone-only visits 1

Critical Pitfalls to Avoid

Common Errors

• Do not switch frequently between in-person and telemedicine visits during a single clinic session, as this reduces efficiency 1
• Never use unsecured platforms that lack end-to-end encryption for patient encounters 1
• Do not proceed with telehealth when hands-on examination is clinically necessary—convert to in-person care 4, 5
• Avoid relying solely on telehealth for conditions requiring physical examination, as this can compromise patient care 4

Security and Privacy

• Use only secure, HIPAA-compliant platforms integrated with your EHR system 1
• Inform patients about the significance of secure versus unsecure networks 1
• Ensure secure transmission and storage of electronic data at your end of the network 1
• Check with clinical administrators about current local regulations before adopting specific technologies 1

Provider Considerations

• Be cognizant of provider isolation and burnout related to telemedicine 1
• Maintain the same quality assurance protocols for telehealth as for in-person encounters to avoid a two-tiered system of care 4
• Establish best practices to integrate multidisciplinary care into your telehealth workflow 1