Due to COVID 19,CARES has relaxed the rules for telemedicine. As of now, you can use publicly available audio/video and store/forward technologies to tend to these unusual circumstances. Noted exceptions are public facing audio/video platforms like Facebook live, Twitch etc.
Limitations and restrictions around HIPAA are also somewhat relaxed during these times. However, the following are general guidelines that can be followed even after we get back to the “normal”.
The technologies you need would depend on the telehealth services you plan to launch and the type of care you intend to provide.
At a bare minimum, you are going to need:
- For eConsults – A HIPAA compliant video conferencing platform. The ability to call 1 or more people at the same time (for consulting physicians or triage reasons) – that includes at a minimum, you the provider and the patient. For video conferencing, you obviously need a secure high speed internet connection and you should be able to access the same from your desktop/laptop, tablets (ipad, android, whatever you choose) and /or a smartphone (iphone, android etc).
- For store and forward / Asynchronous telehealth services, you need a HIPAA-compliant software that allows you, the originating site, to be able to transfer patient’s images to the consulting physician. The consulting specialist should also have access to the same software so they can download/review the media you sent and can revert back with a diagnosis, interpretation and a care plan.
- If you are venturing into remote patient monitoring, you are going to need the same technologies as above in ADDITION to additional technologies (bluetooth enabled) that include (but are not limited to) Digital stethoscopes, otoscopes, ophthalmoscopes, digital scales and blood pressure cuffs etc. Your chosen HIPAA compliant technology needs to enable the patient and the clinician to be able see and hear each other during the consultation. In most cases, nurses or other medical staff would need access to the same platform as well because they will assist the physician in performing the exam (on the physician’s behalf), and would be using the digital instruments listed above.
In all cases, your technology of choice should allow you to document your visits – even if that means that you are going to, later on, document the same (copy/paste) in the patient’s medical record. This is needed for you (or another clinician) to support continuity of care.
Once the technology or platform is selected, the practice is faced with many decisions surrounding the specific guidelines that will govern the deployment of these visits. A decision needs to be made whether telehealth visits are to be provided by all physicians or only a select team of physicians and whether advanced providers participate in the provision of these visits. Is the practice going to make telehealth visits available to all patients or reserved for patients with certain diagnoses? If only certain diagnoses are selected, the practice will need to determine how this triage will occur, and by whom.
It is helpful to determine if the practice or the health plan requires a certain length of time to be spent for each visit, and what specific documentation templates or billing codes they require. It is extremely important to decide whether all schedule time slots are eligible for telemedicine visits or whether providers should assign dedicated blocks of time for these visits, allowing more predictable allocation of support staff who may not play as central a role in these type of visits, since patients do not need to be “roomed” in the traditional sense.
It is necessary to plan for training staff, providers and patients on the use of the telehealth tools. This is an area that is significantly impacted by choosing a highly usable, mature, purpose-built, EHR-integrated telehealth platform, as doing so will reduce the time and effort of implementation, training, and adoption of this new modality.
The following list is not exhaustive, but here are some options.
For telehealth (video calls), a few options are:
Often, you are going to need peripheral devices. A few options are:
For remote patient monitoring, you can consider:
Some of these vendors also sell mobile carts/kits as well. You’d be well advised to pursue an vendor that combines as many of these options together as possible (rather than having to integrate multiple systems).
Let’s look at billing for telemedicine services.