Information governance and safety in remote consultations

Data security, patient safety and risk assessments
Remote balance assessment with carer support

I have a degree of concern that what we are doing remotely needs a new governance framework and we are all at a degree of medico-legal risk

Physiotherapist, Musculoskeletal/Rheumatology

This quote highlights an area of concern for some practitioners. We give some general guidance on the main issues here, but due to the fast pace of remote technology, this is an evolving situation so individuals need to keep up to date with current governance regulations.

Local governance requirements will vary so check your own organisational guidance – speak to your manager or information governance department if there is anything you are unsure of.

General guidance

Security and confidentiality

  • For video consultations, to ensure you comply with the latest GDPR advice, you should use technology that has been approved for clinical use and is permitted by your organisation. Make sure you use a secure platform, secure internet access and password-protected, encrypted devices – see our section on technology for video consultations and assessments.
  • It may seem obvious but make sure you are speaking to the right person! You should always check the patient’s identity at the beginning of a telephone or online appointment.
  • Ensure the patient is ready for the consultation and in a private space if possible, or has consented to others being present.
  • Make sure you are also in a private space.
  • During the consultation, clear your computer desktop and take care with screen sharing. Try to ensure that the only programs or browser tabs open are those that are necessary for the consultation. If you will be seeing a lot of patients virtually, remember to check this between appointments.
  • Check your cloud settings – disable automatic uploads and sharing across devices.
  • If you are carrying out the consultation from home, turn off virtual assistants.
  • Do not record the consultation without the patient’s consent – make sure default recording settings are turned off.

Consent

  • Ensure the patient has provided informed consent for participating in the assessment (i.e. that you have explained what and how it will happen, how data is stored and what the next step will be) and that this is clearly documented.
  • Consent should be an ongoing process, not just something that is done at the start of a consultation. Consent should be sought for each new action of the intervention and as part of a collaborative process.
  • If you will be using audio or video recordings or images for your assessment, you should take specific consent for these in advance.
  • If additional practitioners are present during the consultation, check that the patient is happy with this.
  • Ensure you can assess the patient's capacity. If a patient lacks capacity, consider whether a remote consultation is appropriate and that mental capacity law can be adhered to.

Record-keeping

Always ensure you follow the NHS Digital code of practice, GMC guidance on managing and protecting personal information and GDPR / Data Protection law.

Document how the consultation was carried out (i.e. phone or online), why it was done remotely and who was present (both with you and the patient). Include a risk assessment and follow your usual recording guidance, ensuring that notes are recorded within 24 to 48 hours. 

Note any limitations of the remote consultation and planned follow-up, for example:

“Image of seating received from daughter, showing a Configura comfort chair with waterfall cushions and standard integral pressure relief base. However, as patient was not sitting in chair, as requested, posture was unable to be assessed. OT to request image/video of client sitting in designated seat to assess if any unmet postural needs are present and review.”

For further information:

Use of video recordings and images

Making use of video recordings and images can be very helpful for remote physical assessments. If you are considering doing this, here are some tips:

  • Obtain (and document) consent from the patient in advance.
  • Explain (and document) how the recording will be used and how long it will be stored for and where, following local guidance policy. For a good example, see the University Hospitals Plymouth NHS Trust’s policy on audio and visual recordings.
  • If the patient will be taking the recording or image, make sure they have a secure means of transferring it to you (e.g. sending to your encrypted work e-mail address). When you receive the file, you should upload it to the electronic patient record or use it to make notes and then delete it and the original e-mail.
  • If you will be sharing images or videos with other practitioners, consider whether this is really necessary. If so, make sure you have the patient’s consent for this, that the files are transferred securely and that everyone is aware of the security risks.
  • If the patient wants to record a consultation for their own use, they should be permitted to do this – but encourage them to be open about this.
  • Further guidance from the GMC on making visual and audio recordings of patients

Case study: Transfers and video recording

             Q&A

What should I do if I am working remotely and can only access part of the patient’s information, such as electronic records but not previous paper records?

"I would advise that if this problem arose it should be discussed with the service line manager to see if a solution can be found, i.e. having paper medical records at home. Whatever the outcome, for our Trust I would ask that this was placed on our Risk Register, e.g. risk of not having a paper record to refer to or if you do have them the risk of having confidential records off site" Head of Health Records, NHS Trust

Consultant computer assessment

Safety and risk assessment

Among some colleagues I noticed a perceived fear regarding the safety of remote interventions and this dominated so they were reluctant to consider any remote interventions or even reviews.

Physiotherapist, Neurology

In our survey and discussions with practitioners, many reported being more risk averse with telephone and video-based consultations. Safety should be a central consideration when deciding on the suitability of remote consultations and a robust risk assessment should be completed. You should use your clinical judgement to weigh up the pros and cons of different methods of consultation. Consider carefully whether the patient has capacity, and any cognitive, communication or sensory impairments, and what support they have available to determine if a remote method is appropriate. See our guide to video consultations vs. other methods.

When conducting virtual physical assessments or delivering interventions at a distance, be vigilant but try not to be over-cautious:

Remember the patient is functioning in their own home daily so don’t play it too safe. Risk assess well and empower the patient to risk assess and work on rehab.

Physiotherapist, Neurology

Safety tips:

  • Remember that for video consultations, the patient’s attention will be split between listening to you and working the technology (particularly if there is no carer or supporter). Video consultations should only be done with low risk patients, particularly where they are alone.
  • Start at a low level and gradually increase what you are asking the patient to do in terms of movement
  • Gradually increase your own competence in using remote methods by completing low risk assessments first, and only work within your own competencies
  • Take particular care if assessing transfers (e.g. chair, toilet, bed or bath) – in these cases a competent carer or family member should normally be physically with the patient and can provide the footage/access to virtual media to ensure the person is not trying to film themselves or juggle. 

Take particular care if completing higher risk manual handling assessments (such as hoisting) as these need to be thoroughly risk assessed for suitability first.

Community Occupational Therapist


Further information:

Further reading:

Case study: Safety and video recording

Consultation safety checklist

Before the consultation

  • Have you risk assessed carefully and thoroughly?
  • Is this an appropriate and safe way of assessing / consulting with your patient?
  • Do you have access to a telephone (or a second phone in telephone consultations)? In the event of an emergency, this will enable you to call for help while maintaining contact with the patient and/or their family or carers.
  • Do you have emergency contact details for the patient and/or a family member or carer?
  • Are you aware of your organisation’s medical event protocol?

At the start of the consultation

  • Are there any red flags or signs of serious pathology? Have a plan for dealing with these.
  • Does the patient have support from a family member or carer? They can help to steady the patient, watch out for environmental hazards or provide standby assistance.
  • Does the patient (or their family member or carer) have a phone within easy reach?
  • Is the patient aware of their surroundings and the importance of safety?
  • If using a video consultation, have you visually checked the environment for potential obstacles and trip hazards?
  • Is the floor surface safe for exercising / walking on? (e.g. hardwood, vinyl or low pile carpet)
  • Is there sufficient space in the room for safely carrying out the exercises you have planned?
  • Does the patient have access to a firm surface such as a dining chair or sideboard to support themselves during movement or exercises?
  • Is a chair available in case the patient needs to rest in between exercises?
  • Does the patient have their mobility aids with them?
  • Is the patient appropriately dressed, for example are they wearing flat footwear?
  • Is the patient comfortable with the movement or exercises you are asking them to demonstrate?

At the end of the consultation

Is the patient feeling well with no worsening symptoms?
If the answer is No, you should use your clinical judgement to plan an appropriate course of action, following your organisation’s medical event protocol (e.g. arrange an urgent face-to-face assessment or GP referral)

Do you or the patient have any safety concerns?
If yes, these should be discussed and a plan of action formulated.

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