From: Proactive integrated virtual healthcare resource use in primary care
 | Pre-appointment | Check-in/Check-out | Medical Encounter | Post-appointment | Ongoing Health Management |
---|---|---|---|---|---|
Veteran Activities | • Schedule medical visit (2, 14, 16) • List problems to be discussed at appointment (3, 4, 14, 16) • Complete Healthy Living Assessment (6) • Identify symptoms and current treatments (3, 14, 16, 22) | • Review and update personal information (16, 20) • Review and update insurance information (16, 20) • Check-in (20) • Check-out (20) • Schedule follow-up visit (2, 14, 15, 16) | • Measure health indices (9, 15, 22) • Learn about condition (4, 10, 11, 14, 15, 16, 17, 19) | • Seeking information about condition and treatment plan (3, 6, 8, 10, 11, 14, 15,16, 17, 19) • Follow-up with providers (2, 14, 15, 16) | • Self-management activities (1, 6, 8, 10, 11,12, 22, 23) • Monitoring health indices (1, 6, 8, 15, 16, 22) • Managing personal health information (3, 8) • Identifying need for additional medical visits (2, 8, 14, 22, 23) • Communicating with health care team (1, 3, 14, 15, 16) • Labs and test (9) |
Primary Care Team Member Activities | • Schedule medical visit (14, 15, 16) • Prepare Veteran for appointment (e.g., fast for labs, list concerns to be discussed) (14, 15, 16) • Stratify hospitalization risk (4) • Coordinate with staff in preparation for appointment (5, 13, 16, 18, 21, 23) | • Schedule follow-up visit (14, 15, 16) | • Measure and document health indices (5, 9, 14, 15, 16, 22) • Obtain medical history (3, 5, 7, 14, 15, 16, 21, 22) • Physical examination (15, 16) • Documentation of assessment and plan (5, 21) • Coordinate care with other providers and services (3, 5, 13, 18, 21) • Educate patient on plan and conditions (4, 10, 11, 14, 15, 16, 17, 19, 23) • Prescribe medication (5) | • Send Veteran to Travel for reimbursement on appointment travel (13, 16) • Staff create registered nurse follow-up messages (1, 13, 14, 18) • Home health assessment for personal care needs and follow-up on resources (5, 14, 15, 16) | • Communicating with health care team (5, 13, 14, 15, 16, 21) • Labs and test (5, 9) • Medication reconciliation (5, 12, 14, 15, 16, 17) • Patient data reporting (4, 5, 21, 22) • Educate patient (10, 11, 14, 15, 16, 17, 19, 23) |
Collaborative Activities | • Discuss Advanced Directives (5, 16) • Prioritize discussion points (14, 15, 16) | • Assist with review and update personal information (16, 20) • Assist with review and update insurance information (16, 20) • Assist with Check-in (20) • Assist with Check-out (20) | • Measure health indices (5, 9, 14, 15, 16, 22) • Discuss concerns/symptoms/current treatment (6, 8, 14, 15, 16) • Labs and tests (5, 9) • Complete required forms (5, 21) • Consenting for procedures (5, 21) • Collect data from journaling, Fitbit, etc. (1, 3, 6, 8, 10, 11, 14, 15, 16, 22) | • Implement treatment plan (1, 5, 8, 10, 11, 19, 22, 23) | • Revise treatment plan (1, 5, 8, 10, 11, 22, 23) |