Hospital Telehealth Toolkit
Best Practice Guide to Implement Virtual Care
Including:
- Downloadable Telehealth Consent EXAMPLES & Creation Strategy
- Top 10 eVisit Challenges & Solutions
- Telehealth Room Design Best Practices from Lighting to Placement Strategy
- Virtual Care Team Structure & Training Resources
- Hospital Business Case Guidance & Grant Funding Quick Access Links
- Top EHR Integrated, HIPAA Complaint Technology Solutions for Workflow Optimization
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Hospital
Telehealth
Toolkit
A Best Practice Guide to Implement Virtual Care
Your walk-through guide to best practices for implementing hospital telemedicine.
Before You Begin | How to Use This Guide
Patient care preference, dictated by necessary safety measures, has obligated hospital leaders to completely recalibrate how they approach healthcare visits, pushing mobile-based solutions such as Telehealth, Home Monitoring, Virtual Waiting Rooms and Virtual Visits; the list goes on and on. We here at Access wish to help by providing useful information that can guide healthcare strategies and efforts in this new era.
How to read this guide
1. Comprehensive Analysis | With a hospital approach, this guide provides in depth analysis of launching a virtual care program to equip you with the knowledge to decide if telemedicine is a good fit. Backed by research from top critics and advocates, we’ll provide answers to questions like, “Why should hospitals invest in telehealth NOW?” and, “How are Medicare, Medicaid and government regulations changing to increase telemedicine options for hospitals?”
2. Resource Guidance | We’ll present research based, best practice guidance honed from the best telehealth resources available including the American Telemedicine Association, Telemedicine Journal and e-Health studies, Telehealth Resource Centers and many others. We will include and array of answers to question such as, “Which specific teleconference cameras meet ATA’s requirements?” and, “What are the Top 5 EHR Compatible, HIPAA Compliant Teleconference Software Solutions?” We’ll provide structured outlines to help build your telehealth business case, form your virtual care teams and set up the best telehealth room design for your clinicians.
Quick Access Contents
(click sections below or continue scrolling)
Part 1 – Introduction to Hospital Enabled Telehealth
What is Telehealth NOW?
Top 10 Telehealth Challenges and Solutions Concerning Hospitals
Part 2 – Creating your Telehealth Business Case
Why Should Hospitals Invest in Virtual Care NOW? 10 Key Benefits
Patient Satisfaction & Future ROI Potential
Steps to Create your Business Case
Where to Find Funding and Grants for Telehealth?
Part 3 – Building and Training your Telehealth Team
Who is your Telehealth Champion?
Champion Key Roles and Responsibilities
Care Team Structure, Roles and Responsibilities
Implementation Team Structure, Roles and Responsibilities
Part 4 – Workflow and Program Design Strategy
Patient Workflow
Why is Telehealth Informed Consent Necessary?
What should your Informed Consent Include? EXAMPLES
Why should you prioritize EHR Integration Workflow?
Impression Integrated eConsent Solution
EHR Integrated HIPAA Compliant Teleconference Recommendations
Where will our clinicians perform an eVisit?
Virtual Care Room Design
Room Lighting Recommendations
Video Conferencing Cameras and Recommendations
Part 5 – Close
Part – 6 Helpful Resource List
Part 1 |
Introduction to Hospital Enabled Telehealth
As the health care industry faces historic financial losses and a recession due to the COVID-19 pandemic, hospital leaders must quickly identify value-focused initiatives and seek out the financial resources to fund them.
Looking back at the recession of 2007, shrinking household incomes were a key factor that contributed greatly to the strain on the healthcare system. Data suggests that many patients did not seek medically necessary care due to financial hardship. With a 13% unemployment rate and COVID-19, patients are not only affected financially, but also fearful of seeking care in the current hospital environment. The answer is increased access to care, and virtual care has proven to be the solution patients and hospitals are looking for.
What is Telehealth NOW?
Since its inception in 1897, “tele” health has been considered an avenue to offer care to avoid unnecessary office visits. In the early 1970s, NASA in partnership with the Papago Indians, further laid the foundation by developing remote healthcare techniques that are still used today. Since then, telehealth has found its stronghold primarily in rural settings to increase health and mental health access for patients.
Now, due to the pandemic, the barriers to telehealth have all but collapsed. CMS temporarily expanded Medicare reimbursement and applicable services to broaden telemedicine options for all Americans. This expansion now allows for Medicare to pay for visits regardless of location, including within a patient’s home, and allows for a wider range of providers to offer virtual visits. Congress also appropriated $200 million in funding to healthcare providers to rapidly develop and implement virtual care programs within their hospitals.
Telehealth, virtual care, and virtual waiting rooms have quickly become a win-win for both patients and hospitals due to the low cost for patients and increased market for hospitals. Hospitals have seen incredible transformations around virtual visits, with reports of over 1,000% growth. Carrot Health’s white paper Combating COVID-19 with Virtual Care and Predictive Analytics documents a leading telehealth platform that experienced a 3,600% increase in use over the first 11 days of the COVID-19 pandemic and over 400K total visits in March 2020 alone.
Top 10 Telehealth Challenges and Solutions Concerning Hospitals
As telehealth proves to be a cost-effective and safe beacon of hope for the patient that would otherwise not receive care, it is also a solution for hospitals to deliver care amidst overwhelming public concern due to the COVID-19 pandemic. Increasing access to care through telehealth seems to be a promising option for hospitals, according to an analysis from Advisory Board,
“as many as 20 percent of virtual care patients would theoretically convert to being full-service patients of a hospital or health system at an estimated annual revenue increase of approximately $3,000 per patient.”
Despite this benefit, however, there are still several concerns with the efficacy and implementation of a hospital telehealth or virtual care program.
Top 10 Concerns & Solutions Challenging Hospital Telehealth
(Click to Expand Contents)
1. Patient Satisfaction, Adoption, & Retention Concerns
A common myth among critics is the concern of an impersonal patient experience due to the virtual environment of a telehealth visit. It is often assumed that because patients and providers are communicating through a video screen and that visits are briefer than your traditional in-person visit, a virtual visit will lack a feeling of human connection and cause issues with patient satisfaction. This is a myth; patients often have lesser feelings of human connection during an in-person visit than during a telehealth visit.
According to GlobalMed’s Virtual Care vs. In-Person Visits: Which is Higher Quality?, during an in-person visit, 64% of primary care physicians did not ask why a patient came in, and when they did, patients were interrupted within 11 seconds. American Telemedicine Association CEO Ann Mond Johnson in ATA’s Johnson Looks to Dispel The 7 Myths of Telehealth Adoption, explains a different perspective “virtual visits – especially those used in telamental health – often compel patient and provider to look each other in the eye. As well, the telemedicine platform can improve interactions for patients who aren’t comfortable seeing a doctor in person.”
While there is certainly a distance barrier and looking at a monitor can feel less human, there are a few practices that will help your patients feel as though they are speaking with a person and not a computer. According to Best Practices for Patient Engagement with Telehealth, providers can build rapport with their patients by interacting with them. A simple, “How are you doing?” can go a long way in building a human connection through a computer. Asking patient-centered questions about their goals for care in the beginning of the visit can open a healthy discussion between provider and patient. If the patient is new to the virtual visit experience, providers can educate them by discussing the aspects of the visit and virtual care, so they know what to expect and feel more comfortable. Making direct eye contact, actively listening, and not interrupting when the patient is speaking can all improve the patient experience during a virtual visit. In addition, creating a welcoming virtual care environment with quality telehealth-appropriate cameras, natural lighting, and room aesthetics as outlined in Part 4 Strategic Location, Environment & Hardware Considerations, can also improve the patient experience. If the patient less familiar with initiating a telehealth visit, which is a common barrier for elderly individuals, providers should take extra care to create an inviting environment and anticipate their needs, especially for individuals who lack experience with technology. By following these practices, you will make a considerable positive impact on patient engagement and the success of your virtual care program.
2. Diagnosis & Exam Challenges
While telehealth is suitable for a wide array of care needs-from treating the common cold, flu, UTI, insect bites, sore throats, post-op check ins, remote monitoring and more –there are situations which require an in-person examination. According to a Telemedicine Journal and e-Health study examining the effectiveness of consumer electronics within a telehealth exam, “Elements of the physical examination that are easily observed show high concordance, but posterior structures and elements that are difficult to observe using consumer communications technology limit the utility” of the telehealth exam.
Providers should use their best judgement and follow protocol to determine when and how to schedule an in-person exam. The clear advantage of a hospital- or clinic-implemented telehealth strategy is the readiness to schedule an in-person visit when necessary. To lessen the impact on patients, providers should be prepared to schedule the exam during the telehealth visit. Hospital- and clinic-based telehealth programs should develop protocol for in-person exams, including scheduling, coordination, payment, and a contactless check-in. Providers will need to describe the aspects of the exam that will take place, follow-up considerations, and other preparations. For example, if a patient is coming in for a urinalysis to test for UTI, the provider might collect payment and any other information ahead of time to expedite the visit. Other considerations include informing them of the test that will be administered and roughly how long the visit will take, giving them an estimate of the time it will take to get the test results, and providing instructions for follow-up and prescription procedures. Considering COVID-19 and other HAI exposure risk, clinics should also advise patients to bring a mask and wait in their vehicles if their room is not available upon arrival. While translating a telemedicine visit to an in-person examination is not always ideal from a patient perspective, full communication about the scope of care and easing the check-in process will drastically minimize any negative impact.
3. Quality of Care & Continuity Concerns
According to Beckers Hospital Review, a top patient concern for telehealth is low quality of care. There is not adequate evidence to suggest that the quality of care given is lower for telehealth other than what may be derived from limitations of care, such as visits that require an in-person exam. Given that telehealth increases access to care through lower costs and by “meeting patients where they are,” virtual care improves health care outcomes. Individuals who might not seek care in a timely manner or address medical care at all benefit from the option of telemedicine as a less invasive, less intimidating care option.
However, lack of data for care continuity has the potential to introduce risk as patient records may not reflect outcomes, treatment plans, and diagnoses from outside telehealth providers. This lack of platform integration between providers is common; however, introducing telehealth options within hospitals and clinics where patients receive primary care can eliminate this risk through interconnectivity within the EHR. According to Arizona Telemedicine, “By using a platform that integrates with your EHR, you can record your established workflow and ensure your patients’ e-visits are properly documented and updated for future visits.” In cases where this circumstance is unavoidable, the best solution is to request details of your patient’s last visit and attempt to access their medical records to eliminate misdiagnosis and treatment risks.
4. Clinician Burnout
With packed days, high demand, and increasing burdens and complications caused by COVID-19, clinician burnout is certainly a huge concern for healthcare systems and physicians. However, according to Chief Medical Officer for Greenway Health, Geeta Nayyar, MD, MBA, in Telemedicine Offers New Hope For Burnout Reduction During COVID-19, the incidence of burnout is primarily a result of workflow inefficiencies. Dr. Nayyar says, “When we say digital health and burnout, I think the two things that come to mind are just EHR—it’s a burnout associated with the EHR—and the second one, sort of as the dovetail to that, is the clicks. The number of clicks and the excess of inefficiencies created by many of the EHR software out there.” Regarding positive experiences with telehealth, Dr. Nayyar states, “I think those that have had positive experiences have workflows that have been really customized or well thought out for their specialty or per their vendor of choice.”
Telehealth can create greater flexibility and day-to-day variety through telehealth days. “On telemedicine days, I can see patients from an office in my own home,” says David Shprecher, DO, Movement Disorders Director at Banner Sun Health Research Institute in Phoenix. “This allows me to telecommute and save about an hour of total travel time. This can be a nice break from the rat race.”
5. Medicare & Medicaid Reimbursement Concerns
Cited as a top challenge for telemedicine programs, the applicability of telehealth has been suppressed for years due to state and federal reimbursement restrictions.
Prior to the COVID-19 pandemic, federally run Medicare coverage had many restrictions on how coverage could be applied. With the onset of the COVID-19 pandemic, CMS temporarily expanded Medicare reimbursement and applicable services to broaden telemedicine options for all Americans.
This expansion now allows for Medicare to pay for visits regardless of location, including within a patient’s home, and allows for a wider range of providers to offer virtual visits. To learn about Medicare reimbursement rates for your area, use this CMS PHYSICIAN FEE SCHEDULE SEARCH tool.
Medicaid has been less restrictive. While most states do reimburse for live telehealth, relatively few states will cover store-and-forward or remote patient monitoring telehealth. It is a good idea to check your specific state laws and policies. Use the CCHP Current State Laws & Reimbursement Policies state search tool to stay informed on your state’s laws, regulations and Medicaid programs.
6. Telehealth Restrictions & Regulations
As mentioned in Part 2 Step-by-Step Business Case & Grant Funding, HHS created immediate flexibility for telehealth providers and hospitals during the COVID-19 pandemic. Now, according to HHS.gov, “HIPAA-covered health care providers may, in good faith, provide telehealth services to patients using remote communication technologies, such as commonly used apps – including FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype – for telehealth services, even if the application does not fully comply with HIPAA rules.” Furthermore, the “established patient with a physician” requirement is no longer enforced, which means a physician can see a new patient and still receive Medicare reimbursement during this public health emergency.
7. Privacy & Security Concerns
As telehealth is a virtual two-way communication between providers and patients sharing health information, there is an understandable concern regarding potential privacy breaches. Providers should ensure patient provider trust by maintaining strict standards in safeguarding patient privacy and security. When communicating electronic Protected Health Information (ePHI), it is critical to use a system to monitor these communications and prevent breaches.
Providers should seek a HIPAA-compliant communication platform that has encrypted data transmission and allows only authorized users to access ePHI. It is important to consider all potential threats to the integrity of ePHI, particularly virtual environment changes or end user risks. For example, if a provider or third-party contractor is working from home, connected to a hospital network, ensure that they are fully protected against potential cyber-attacks. According to HEALTH IT SECURITY, “VPNs are one of the most common, secure methods for connecting remotely to an enterprise network. However, organizations have been failing to patch core vulnerabilities found in some of the most popular VPNs, despite repeat warnings and available patches.”
For patient end protection, consider implementing a two-factor authentication to add more protection against cyber-attacks and have a detailed plan to address security and privacy concerns and take measures to protect patient security and ease potential apprehension.
8. Program Awareness Concerns, Sustainability, & Growth
Growing pains and sustainability are both top concerns for any new hospital venture; however, there are some strategic practices to consider prior to launching a successful telehealth initiative. In Part 4 Strategic Location, Environment & Hardware Considerations, we detail the best methods to establish a virtual care program in an existing hospital, including placement within a specific area if the building, such as near the ER or out-patient check in, to positively impact the promotion of the virtual care program through physical exposure. In Part 3 Best Practices for Building a Telehealth Team Now, we specifically address shared responsibilities among the providers, care managers, nurses, front desk staff, and schedulers in actively promoting telehealth as an option to current patients.
9. Technical Training & Restructuring Responsibilities
Restructuring and learning new systems and processes in preparation to implement telemedicine within a hospital is a labor-intensive endeavor, which is why we have devoted an entire blog to give you the insight and outside resources necessary to help you achieve your mission.
In Part 3, Clinician Champions, Team Structure & Training, we outline the characteristics and roles of a clinical telehealth champion who pushes the implementation and virtual care program forward. We detail the four distinct core components and roles of each telemedicine team: Core, Leadership, Advisory and Implementation. Within Telehealth Staff & Care Team Roles & Responsibilities, we outline the five cross-compatible roles among existing clinical staff to structure your new virtual care team. We reveal six training methods to prepare your team and evaluate your program to ensure a smooth patient experience.
10. Hospital Integration & Implementation Challenges
Implementing and integrating a virtual care option within a hospital may seem daunting; however, proper structure, planning, and alignment with the organization’s mission will facilitate implementation within a tighter timeline. Providers can start by creating a business plan, as exhibited in Part 2 Step-by-Step Business Case & Grant Funding, that outlines the scope of the project, helps determine its efficacy, and steers next steps; including key stakeholder buy-in.
During implementation, it’s critical to keep workflow and security in mind by choosing an EHR compatible teleconference software solution so visits are kept within a patient’s chart. Consider compliance and risk, as guided in Part 1 Pre-registration & Telehealth Consent Strategy, by choosing an EHR integrated eConsent solution like, Impression.
Part 2 |
Creating your Telehealth Business Case
Why Should Hospitals Invest in Virtual Care NOW?
According to a white paper from Fair Health, telehealth surged from 2016 to 2017 by a drastic 53%. Beckers Hospital Review echoes this finding in an article The business case for investing in virtual care by posing the question,
“What if someone told you that if your health system leveraged the right type of virtual care platform you could add 2,000 new patients by offering a virtual care service line?”
The article further states, “an analysis from the Advisory Board estimated that as many as 20 percent of virtual care patients would theoretically convert to being full-service patients of a hospital or health system at an estimated annual revenue increase of approximately $3,000 per patient.”
10 Key Benefits of Telehealth & Virtual Care
- Improves clinical efficiency
- Reduces patient and provider cost
- Increases revenue
- Reduces barriers to treatment
- Improves health outcomes
- Improves patient satisfaction
- Reduces risk of Hospital Acquired Infections (HAI)
- Increases provider market
- Improves provider satisfaction
- Minimizes risk to healthcare workers
Despite telehealth’s growing popularity, expansion was stifled by limits in coverage, payment, policy issues, and Medicare dictating geographic use and practice settings. However, with onset of the COVID-19 national public health emergency, immediate flexibility was created around telehealth to supply patients with safe access to care, thus boosting virtual care in 2020. Carrot Health’s white paper Combating COVID-19 with Virtual Care and Predictive Analytics documents a leading telehealth platform that experienced a 3,600% increase in use over the first 11 days of the COVID-19 pandemic and over 400K total visits in March 2020 alone.
Telehealth flexibility during COVID-19
Patient Satisfaction & Future ROI Potential
The recent pandemic has undoubtedly placed historic financial strain on America’s hospitals, affecting both supply-side and demand-side as we head into a recession. According to the American Hospital Association (AHA), COVID-19 caused an estimated $202.6 billion in losses for America’s hospitals and healthcare systems in just a 4-month period. HealthAffairs, who analyzed the 2007 recession and its impact on the hospital finances in Hospital Financial Performance In The Recent Recession And Implications For Institutions That Remain Financially Weak, stated, “hospitals need financial resources now to implement changes in the delivery of health care so that they can start restructuring organizational programs and activities.” Hospitals need revenue to support projects for new types of care, such as virtual care, telehealth, and virtual waiting rooms. The upcoming financial struggles will certainly affect a hospital’s delivery system reform and value focused purchasing initiatives, so the question is…
“Where should hospitals invest for the best ROI amid a recession?“
Virtual care is a good place to be. According to Brookings, a large reason healthcare funding shrinks during a recession is due to declining household incomes. Evidence shows a segment of the population simply avoids or puts off health care altogether, leading to lower health spending and obvious health risks for patients. With virtual health, doctors can meet patients where they are, increasing access to care. Furthermore, the lower cost of a virtual visit encourages patients to get the care they need, when they need it, and offsetting some of the negative financial and health impacts caused by a recession.
Steps to Create your Business Case
As the new norm for health care shifts, virtual visits, virtual waiting rooms, and telehealth have become the “meet patients where they are” solution hospitals need. This abrupt demand, however, has left many hospitals wondering where to begin. Fortunately, The National Consortium of Telehealth Resource Centers has provided a step-by-step guide with questions to consider as you plan , as well as a sample business proposal that you can view HERE.
15 Key Steps to Create a Business Proposal to Implement Telemedicine
Where to Find Funding and Grants for Telehealth?
There are several grants available for virtual care programs as well as various resources surrounding COVID-19, which you can explore by clicking the links below. When you search these databases, be sure to include various phrases such as “telehealth” or “COVID” to maximize your opportunity for funding
Current Telehealth Grants and Funding Opportunities
- COVID-19 Telehealth Program – In April 2020, the FCC released $200 million in emergency funding for the COVID-19 Telehealth Program for eligible nonprofit and public health care providers to help offer connected care services to patients at their homes or mobile locations in response to the COVID-19 pandemic. At present, there is still $90 million in funding available.
- Health Resources and Services Administration Telehealth Programs – The Office for the Advancement of Telehealth (OAT), provides a list of active and inactive grants.
- Telehealth Resource Centers – Choose your state to contact your telehealth resource center for state-specific funding opportunities.
- Nonprofits, Foundations, and other funding opportunities:
- Patient-Centered Outcomes Research Institute
- The Leona M. and Harry B. Helmsley Charitable Trust
- Robert Wood Johnson Foundation
- Hearst Foundations
- Novartis US COVID-19 Initiatives
- USDA Rural Development Community Facilities Direct Loan & Grant Program
- American Academy of Pediatrics Grants
- HRSA Federal Grant List
- National Institute of Health Grants
- National Science Foundation
- GRANTS.GOV Database Search
Part 3 |
Building and Training your Telehealth Team
As your hospital considers telemedicine as a means to deliver expanded and convenient healthcare, it is important to gain an understanding of the key players in a virtual care program and the optimal team structure for successful implementation before moving forward.
In the following section, we will address the importance of a clinical champion for your virtual care program and provide the key qualities and roles of a successful telehealth champion. Guided by research from AMA, we will also explore telehealth team structure, as well as the roles and responsibilities within a virtual care implementation team and telemedicine staff and care teams. We will conclude with a definitive array of best practices and training resources, answering questions such as:
- What should telehealth training include?
- What are the best telehealth training methods for implementation, or continued education?
- What educational resources, schools and programs are available telemedicine training?
Who is your Telehealth Champion?
A telehealth or virtual care champion, sometimes known as the clinician champion, is the rudder that steers as well as the sail that propels virtual care implementation and improvement operations. Champions are enthusiastic individuals who promote and support your virtual care program. They wholeheartedly believe that a virtual care program will benefit the organization, improve patient care, and increase healthcare access for those who would otherwise not receive care.
In a whitepaper by Northwest Regional Telehealth Resource Center, comprised of hospital surveys addressing identification and development of telehealth champions, one respondent commented,
“My experience has been that the clinical champion believes in the value of telemedicine for health care delivery. Having said that, the secret is to convince clinical staff that this is a win/win situation for both the patient and provider. Administration is ultimately responsible for thoughtful development and implementation of telemedicine services. If done properly, the clinical staff is engaged in an efficient and effective healthcare delivery model that benefits patients, providers and the organization as a whole.”
A champion will often reveal themselves during the initial phase of telehealth considerations by consistently pushing the need for a telehealth strategy. Sometimes telehealth champions develop over time, as Eugene Somphone, MD, says in the Healthcare IT News article, Telehealth heroes: meet the physician champions of video visits,
“I was initially drawn into telemedicine, not by choice, but because our health plan decided to offer the service as an embedded benefit,” he said. “However, once I learned more, I immediately recognized the tremendous potential in terms of convenience, access and cost. I wanted to be on the forefront of this revolution in healthcare.“
In either case, key champion characteristics are essentially the same, and a consistent theme that consistently draws in champions is seeing the immense value in improving patient health care delivery virtually.
7 Key Roles of a Virtual Care Champion
- Works with key decision-makers to gain buy-in for virtual care initiatives
- Develops and maintains the virtual care program in alignment with the organizational strategy
- Upholds and educates staff on the core values of the telehealth program for the organization
- Networks with hospitals, clinics, other virtual care champions and telehealth support organizations to gain and share industry knowledge and resources
- Implements ongoing training sessions to empower staff and maximize program efficiency
- Regularly facilitates continuous improvement through discussions and feedback sessions with telehealth staff
- Analyzes performance and defines virtual care success metrics
9 Key Components of a Virtual Care Champion
- Energetic proponent for virtual care
- Persistent, forward thinker
- Respected leader with an ability to effectively engage clinical staff and executive team members
- Non-stop learner who is excited to educate others
- Driver of adoption and/or growth
- Driver of virtual care success metrics
- Mentor to staff and users
- Coordinator and communicator of virtual care needs between departments, including clinical staff, IT and management
- Wholehearted believer in the benefits of virtual care to patients and the organization
Care Team Structure, Roles and Responsibilities
During the implementation phase, you will want to carefully select the members of your care team. Though it is completely dependent on your hospital’s needs, according to AMA, care team and staff members for telehealth often include the following Telehealth Clinical Roles and Responsibilities.
Telehealth Staff & Care Team Roles & Responsibilities
Physician / Provider
- Navigates and conducts telehealth visits
- Is familiar with telehealth and suggests virtual care as an option to patients when appropriate
- Performs, documents, and bills for eVisits
- Conducts necessary follow-up care
Nurse/Care Manager
- Is aware of the conditions that warrant a telehealth visit
- Educates and informs patients when an eVisit is an option
- Supports care management such as outreach, follow-ups, and coordination
- Coordinates with physician/provider when an eVisit patient is checked in
Medical Assistant / Patient Care Tech
- Supports patient troubleshooting pre-visit and during visit
- Supports nurse/care manager in setting telehealth visit expectations
- Supports nurse/care manager by coordinating with physician/provider when an eVisit patient is checked in
Front Desk Staff / Scheduler
- Is familiar with telehealth and provides the option to patients when appropriate
- Schedules eVisit appointments on the physician/provider calendar per the appropriate protocol
- Sets financial expectations with the patient at the time of scheduling
Practice Manager
- Creates and runs KPI reports
- Monitors feedback
- Knowledgeable in all aspects of revenue
- Submits and reconciles explanation of benefits
- Intermediary between care team and administrative team
Implementation Team Structure, Roles and Responsibilities
According to the AMA’s Telehealth Implementation Playbook, which includes a vast amount of helpful resources such as worksheets, guidance on team engagement, kickoff meeting agendas and more, telehealth strategies should organize their stakeholders into four distinct teams for implementation: core, leadership, advisory, and implementation.
Why is training important?
In Becker’s Health IT article, 10 Best Practices for Implementing Telemedicine in Hospitals, Shelley Palumbo, Chief Administrative Officer of the Center for Health and Technology at UC Davis Health System, says, “Training is a key component of a successful program.” Ms. Palumbo expands on this further by saying,
“Telehealth technology isn’t that difficult to integrate, but it doesn’t eliminate the need for training. Each of our practitioners goes through a hands-on program to learn how to use the equipment prior to seeing patients via telehealth. This enables practitioners to become comfortable with the video and audio components and discuss any remaining questions or concerns.”
Training is essential for your staff and, more importantly, for the safety and satisfaction of your patients. Training should be provided to all staff members who are expected to participate in virtual visits, telehealth, or virtual waiting room engagements, including the telehealth coordinator, care team members, and technical, billing, coding, and compliance staff. Whether you are just getting started with implementing telehealth or virtual waiting rooms, or you are looking for resources to further educate and train your staff, there are a variety of resources available to help.
Common Training Methods & Frequency
Training is a critical component to the health of your eVisit program. The frequency completely depends on your hospital’s needs, and it is the responsibility of the telehealth administration to decide the best schedule for training. If your program is experiencing a high turnover rate, frequent training may be necessary, perhaps weekly or even monthly. If you have a well-established, stable telemedicine program, quarterly or annual training may be suitable.
According to the NRTRC, in their extensive white paper Telehealth Network Training, there are a variety of methods hospitals and clinics use to train their staff. Care facilities are encouraged explore several options and ultimately choose a method the staff is most responsive to and that proves to be most effective.
What Should Telehealth Training Include?
According to Exploring Critical Success for Telehealth Implementation, training should include a variety of the following:
- Referral protocols
- Equipment usage and troubleshooting
- Patient presentation techniques
- Coding and billing
- Medical records
- Patient consent
- Process flow
Common Training Methods
Connection Trials
Site-to-site testing to ensure all staff is comfortable with the connection process, as well as ensuring the functional readiness of your network
Staff Introductions
Staff members should make test connections regularly, particularly with remote employees. This will allow the opportunity for staff to become acquainted with each other and to set expectations to ensure smooth encounters.
Mock Encounters
Staff should perform mock patient sessions, supervised by trainers and administrative staff, to evaluate efficacy. These trial runs provide administrators an opportunity to witness key elements of a virtual visit so they can revise or implement new protocols.
Play Days
Periods where staff can test and utilize new virtual care equipment. This relaxed environment builds familiarity with new products and can assist with identifying necessary process improvements prior to practice use.
Auxiliary Equipment Testing
To build familiarity with telehealth tools, have experts regularly demonstrate for your team how the auxiliary equipment works
Site Visits
If you have remote staff, consider site visits to see their operating conditions, share news, discuss and address environmental challenges, and strengthen communication. This is also a great opportunity to identify other training needs.
Formal Training Programs for Staff and Continued Education
Listed below are a few recommended options for telehealth training. You should also connect with your regional telehealth resource center HERE, who can help you identify training programs or find specific resources to suit your needs.
The University of Arizona Telemedicine Training Program –
In these one-day fast track courses accredited by the American Telemedicine Association and taught by national experts in virtual care and business of telemedicine, you will learn about developing a telemedicine program and telemedicine clinical applications.
+ Utilize telemedicine applications
+ Create work plans for patients
+ Create interdisciplinary teams
+ Determine clinical settings
+ Apply telemedicine in various clinical scenarios
+ Implement payment policies for reimbursement
+ Facilitate telehealth training for staff
Thomas Jefferson University Telehealth Facilitator Certificate
In this five-week online program designed by the National Academic Center for Telehealth at Thomas Jefferson University, you’ll be prepared in the role as a telehealth facilitator.
You will learn how to:
Part 4 |
Workflow and Program Design Strategy
Patient Workflow
Below are a few examples of how to introduce telehealth as an option within patient workflow.
Why is Telehealth Informed Consent Necessary?
Simply put, a virtual visit informed consent form obtains consent, explains what telehealth is, lays out expectations, benefits, and patient rights; and addresses security measures and risks for the patient. Some variations also include more detail on as billing, trainee observation, prescribing policies, scope of service, communication, and follow-up. 
Surprisingly, virtual visit consents have largely been a “scan in and manual archive paper process” due to widespread use in smaller clinics and rural communities; however, necessity and technological advances have paved the way for electronic EHR integrated telehealth consent forms to quickly become the preferred method of consent.
While informed consent is not always required by law for telehealth or virtual visits, from a security and compliance standpoint, it is ALWAYS a best practice to require consent for your telehealth and “virtual waiting room” visits. According to Elizabeth Krupinski, Ph.D., Associate Director of Evaluation for the Arizona Telemedicine Program and Director of the SWTRC,
“even if your state doesn’t have specific rules on informed consent for telemedicine, keep in mind that informed consent not only informs and protects the patient, but also, according the MedPro Group, protects the provider from the risk of facing consent-based negligence claims.”
Legal requirements vary from state to state. Some states do not require consent, while others require written or even verbal consent. Consent requirements could also be a condition of payment, depending on the payer.
So where do I go to find out? Center of Health Connect Policy has created an easy to use Telehealth Policy Resource Map to help identify current state laws and reimbursement policies, which you can access below.
Simply click the link and choose your state. You can further filter by category, topic, and keyword.
Credit Center for Connected Health Policy https://www.cchpca.org
What Should your Informed Consent Include?
First and foremost, you should check current laws and policies for telemedicine through ATA, your regional Telehealth Resource Center, or CCHP for specific guidance on what MUST be included. These organizations can also be a valuable resource in providing sample telehealth informed consent forms. Also, keep in mind to include any additional billing or scheduling policies that your hospital may have regarding telehealth visits.
Southwest Telehealth Resource Center suggests following these guidelines:
1. Inform patients of their rights, including the right to stop or refuse treatment
2. Inform them of their own responsibilities for the Virtual Visit
3. Include a formal complaint process to resolve potential issues that might come up
4. Describe potential benefits, constraints, and risks, including privacy and security
5. Inform patients of what will happen in the event of a technology or equipment failure during the virtual visit, and state a contingency plan
6. Inform and obtain their consent when students or trainees are present
7. Obtain consent before recording a virtual visit; make it known that any recording made will be available upon request and that the recording release will require written patient authorization or court order
8. Adhere to all applicable laws and regional and local practices as to Patient Informed Consents & Disclaimers
9. Set appropriate expectations regarding Virtual Visit to include proscribing procedures, communication, follow-up, and scope of service.
10. Have a process in place for those who refuse to sign the consent forms or receive virtual care
Downloadable Telehealth Consent Examples
View previews below, or click to download complete consent sample.
General Patient Consent
Download Full Version General Telehealth Patient Consent
Consent to Treatment & Release (Kentucky Telecare)
Download Full Version Consent to Treatment & Release
Sample Informed Consent for Telemedicine Services
Download Full Version Sample Informed Consent for Telemedicine Services
Authorization and Consent to Participate in Telemedicine Consultation
Download Full Version Authorization and Consent to Participate in Telemedicine Consultation
Telemedicine Satisfaction Survey Form
Download Full Version Telemedicine Satisfaction Survey Form
Why should you prioritize EHR Integration Workflow for Consents?
In speaking about a post-pandemic approach to healthcare IT, Randy Davis, Vice President and CIO of CGH Medical Center, says,
“The need for access to records has now been 100 percent verified.”
At present, the virtual visit sector is dominated by paper forms that must be scanned in by the patient from home or dropped off at the hospital. This completely defeats the purpose of any total telehealth or virtual visit narrative, causing unease and dissatisfaction for patients. In addition, hospital staff then must scan a re-printed form or manually archive the form into the corresponding patient record within the EHR, delaying access and increasing unnecessary workload, not to mention wasting paper.
No matter how you slice it, paper-based consents stand in stark contrast to the priorities of a proper Telehealth strategy. A complete telehealth strategy for hospitals must include EHR-integrated solutions, like Access eForms Impression, which paves the way for a paperless and contactless check-in process as part of a “virtual waiting room” experience for patients who must visit the hospital.
Checklist Considerations
Patient Convenience
Are patients required to print and scan in the consent form, or can they access it through their mobile device?
Patient Experience
Is the consent simple, quick, intuitive, and fully informing?
Patient Safety
Are patients required to come into the hospital to fill out the initial consents or drop them off? Do they have to spend an extended period of time in the waiting room?
Automatic EHR Integration Workflow
Does your HIM staff have to manually retrieve and archive the form into the EHR patient chart?
Immediate Access to Patient Records
Are there any delays caused by manual processes such as scanning and archiving?
Clinician Ease of Use
Can staff easily access, update, and send forms to recipients? Can clinicians easily customize the form with relevant content?
Integrated eConsent Solution
Allow your patients to electronically complete and sign forms at-home for a contactless check-in as part of your pre-registration or complete telehealth strategy
What is 
“Impression” is part of the Passport offering by Access that converts existing paper-based processes into EHR integrated paperless solutions. We have designed “Impression” to complement your telehealth strategy by enabling your hospital to extend electronic Pre-Registration forms to your patient in advance of their visit. Patients can electronically sign all Pre-Registration forms in the comfort of their own home in advance of their appointment. When patients arrive to your hospital, they are met with a contactless check-in process that is safer and faster. Not only does this facilitate a complete telehealth strategy for your hospital, it also provides the first “Impression” you want your patients to experience.
Contactless Check-In in 3 Easy Steps
send
Hospital staff access “Impression” within their EHR system, and select the desired Pre-Registration eForms to send to the patient.
SIGN
The patient receives a secure email and SMS text message for dual-authentication purposes. They then electronically sign and complete the eForms.
COMPLETE
The completed electronic Pre-Registration forms are automatically indexed directly into the patient’s chart within the hospitals ECM system.
EHR Integrated Teleconference Software Recommendations
Top 5 EHR Compatible & HIPAA Compliant
Teleconference Software Solutions
Price per month: $200 for up to 10 hosts
Purchase site: CLICK HERE
Key Notes:
- Epic integrated
- Transcripts of recordings
- Medical device integrations
- Workflow features – Patient waiting room, in-app file sharing, collaboration features
- Revenue cycle features – None
- Marketing features – None
- Security features – Follows HIPAA and PIPEDA regulations; offers signed BAA compliance for protected health information
*Zoom for Healthcare is primarily focused on teleconferencing features
Price per month: $49 for basic plan
Purchase site: CLICK HERE
Key Notes:
- EHR integrated
- File transfer
- Guest invite link
- e-Prescription
- Workflow features – Invite patients via email and SMS, patient self-scheduling, triage secure webchat, cancel Appointments (patient), intake chief complaint, post-visit survey, patient visit summary notes, patient portal access, provider scheduling, file / document upload to patient portal
- Revenue cycle features – Pay online with credit card pre-authorization,
- Marketing features – Custom subdomain, professional landing page, logo branding
- Security features – BAA for HIPAA compliance, military grade 256-bit AES encryption
- Support – Dedicated telehealth consultant, live provider training, live support
Price per month: $49 for basic plan
Purchase site: CLICK HERE
Key Notes:
- EHR integrated
- Mobile supported
- Workflow features – Third party workflows, scheduling, advanced notification settings, custom appointment types and routing, PredictiveIQ AI, patient self-scheduling, on-demand queue
- Revenue cycle features – Payments
- Marketing features – Post visit surveys, advanced reporting
- Security features – HIPAA compliant
- Support – Account manager white glove setup, live training
Price per month: $150 per provider basic plan
Purchase site: CLICK HERE
Key Notes:
- EHR integrated
- Workflow features – Unlimited live video visits, scheduling, automated appointment reminders, practice branded web application and communications, patient mobile apps
- Revenue cycle features – Telemedicine eligibility verification, fee schedule customization, patient payment collection
- Marketing features – Patient marketing, custom web page, marketing materials
- Security features – Business associate agreement for HIPAA compliance
- Support – Online training and help center access, live support, custom onboarding and implementation
Price per month: $349
Purchase site: CLICK HERE
Key Notes:
- EHR Integrated through CareCloud
- Mobile Patient Portal App
- Mobile supported
- Workflow features – Automated email/text reminders
- Revenue cycle features – Add on solution
- Security features – HIPAA-compliant, secure cloud-based network
- Support – Live onboarding and training
Where will our clinicians perform an eVisit?
Telehealth consultation locations for hospitals vary based on convenience for clinicians, department priority, space availability, and considerations for future expansion. Some providers may also have the option of delivering virtual care from their homes due to stay-at-home orders or flexible working arrangements, while others may work offsite, at a central location within the hospital, or within a specific department for convenient access. 
In any case, environmental factors such as space needed and the types of consultation to occur–which all effect room design and location–must be outlined prior to choosing a workplace.
Use What is Available
According to Telemedicine Workplace Environments: Designing for Success, hospitals implementing a virtual care solution should consider converting existing spaces, rather than building a new space, for telemedicine. Unused office space, previous clinical exam rooms, or even a repurposed storage room, can be potential locations. In any scenario, if the potential telehealth location meets the requirements for space, lighting, ambiance, ventilation, and has good proximity to clinical staff and hardware requirements, it should be suitable for virtual visits.
Location Strategy
Choosing strategic locations for telehealth positively impacts a virtual care program. For example, if you are implementing pediatric telehealth, consider visible locations within that department so that patients and clinical staff are consistently aware that virtual care is an option. You may also consider placing a telehealth consultation room near out-patient check-in to gain the most exposure. If your hospital has an overloaded ER, consider placing your telehealth within its vicinity so that patients know they can schedule an eVisit to check-in. This may to deter unnecessary ER admissions and give clinicians the opportunity to direct patients to more appropriate services. In any case, make sure your virtual care examination rooms are near clinical staff.
Offsite Locations
According to former AMA President Robert Wah in 2014,
“Whether a patient is seeing his or her physician in person or via telemedicine, the same standards of care must be maintained.”
For telehealth outside of the clinical environment, including those services administered from a provider’s home, many of the same best practices apply. ATA’s Core Operational Guidelines for Telehealth Services Involving Provider-patient Interaction further states,
“Healthcare professionals providing telehealth services should (always) ensure? that workspaces are secure, private, reasonably soundproof, and have a lockable door to prevent unexpected entry. Efforts shall be made to ensure privacy so provider discussion cannot be overheard by others outside of the room where the service is provided.”
Virtual Care Room Design
10 Key Telehealth Room Design Considerations
- Acoustics & ambience
- Privacy & security
- Lighting options
- Furniture & equipment needs
- Equipment access & installation
- Heating, venting, & air conditioning
- Furniture and equipment layout
- Cleanliness
- Organization for obstacle avoidance
- Patient accessibility
Whether you are building a new telehealth space or repurposing an existing room within your hospital, it is a good idea to create a floor plan to help determine your workable space. You will want to configure elements such as office furniture and different types of equipment needed to ensure it is optimal for your eVisit needs.
If patients will be entering the room at any point, you will need to make sure there is ample space to navigate, especially in the event they have specific accessibility needs or are accompanied by medical equipment. You will want to provide adequate ventilation, filtering and heat control. Telemedical equipment, including lights, computers, and docking stations, all generate heat and can be damaged by dust particles. In addition, the space should be free of any distracting outside noise and the room acoustics should facilitate clear sound and two-way communication. Visually, a background with a brightly painted wall may not show well on camera and can be distracting, so be sure to paint the room in neutral, soothing tones or use a greenscreen. According to Vantage Technology Consulting Group in Healthcare Design Question – What’s the Impact of Telehealth on the Design of Exam Rooms,
“We implemented green screen technology on a project for the Mayo Clinic where the doctors were in a different country and time zone but didn’t want to emphasize that fact to the patient. Essentially, this turns the telehealth room into a mini-production studio.”
Room Lighting Recommendations
Lighting and Placement
According to American Telemedicine Association’s publication, Let there be Light: A Quick Guide to Telemedicine Lighting, which is a go-to resource for virtual care lighting and techniques, appropriate lighting is linked to patient satisfaction, which contributes to clinical engagement and reimbursement.
Incorporating a natural look and feel through lighting and room design “humanizes” a virtual visit, which is important in promoting an overall positive experience, particularly for new or less familiar patients. ATA suggests the following:
Lighting
- Natural light – This is preferred; however, it is often impractical in a clinical environment.
- Natural artificial light – This is recommended as it is an alternative to daylight, as it is a warm white light. 3200K-4000K lumens are optimal. Avoid lighting the space with colored lightbulbs or LED lighting, — the blue hue causes an unnatural appearance.
- Fluorescent – This is preferred if done properly. Use cool white to reduce heating. Use 3500K lumens at home or 5000K lumens in a commercial setting. Use lighting fixtures specifically designed for videoconferencing if possible.
- Lamps – Useful to compensate for poor lighting or task lights.
- Suggested color temperature options:
- Shade 6500K
- Sunlight 6000K Fluorescent 5500K – 4000K
- Twilight 4000K
- Incandescent (tungsten) 3500K – 3000K
Lighting Angle
100% indirect lighting is recommended as it allows light to be more evenly distributed without creating hotspots. Multiple frontal light sources placed for vertical illumination at 35-40% above eye-level to create a 3D effect is recommended. Fill lighting can remove shadows and balance color. You will want to void downlighting, as it can create facial shadows. The graphic below provides an appropriate lighting design for a telehealth provider’s space.
Video Conferencing Cameras and Recommendations
According to American Telehealth Association, “internet-based video conferencing software programs should provide such services at a bandwidth of at least 384 Kbps in each of the downlink and uplink directions. Such services should provide a minimum of 640×480 resolution at 30 frames per second.” While there is a vast array of cameras that can be used for hospital telehealth, we will focus on a few video conferencing camera options outside the camera native to your laptop or tablet.
Preferred Camera Requirements
- Frame rate between 25-30 per second
- Resolution minimum 1280×720 pixels, preferably full HD at 1920×1080 pixels
- Accurate colorimetry
Top 5 Telehealth Compatible Cameras
Logitech BCC950 Conference Cam
Logitech C925E Business Webcam
TEVO-HD30S HD 30x Zoom Telehealth Camera
+ 1920×1080 2.38 mega pixel
+ 30X optical zoom
+ Pan: 0-340° Tilt :0°~120°
+ IR remote control
Part 5 |
Close
As hospitals look towards the “post COVID-19” future, and shift focus to increase operational efficiencies and improve patient safety measures, the old proverb “necessity is the mother of invention” holds true more than ever.
Patient care preference, dictated by necessary safety measures, has obligated hospital leaders to completely recalibrate how they approach healthcare visits, pushing mobile-based solutions such as Telehealth, Home Monitoring, Virtual Waiting Rooms and Virtual Visits; the list goes on and on…
We here at Access hope this information has been helpful by providing useful information that can guide your healthcare strategies and efforts in this new era.
Part 6 |
Helpful Hospital Telehealth Resource List
TTAC Resources
National Telehealth Technology Assessment Resource Center
COVID-19 Telehealth Toolkit
A special document released to assist organizations implement telehealth during the COVID-19 outbreak
American Telemedicine Association
Practice Guidelines & Resources
U.S. Department of Health & Human Services
Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency
U.S. National Institutes of Health's National Library of Medicine
Telemedicine Workplace Environments: Designing for Success
Thomas Jefferson University 5-Week Online Telehealth Facilitator Certificate Program
Telehealth a Major Resource During a Crisis
University of Arizona 1 Day Training: Developing a Telemedicine Program
Developing a Telemedicine Program
Telehealth 101 the Basics
Telehealth Resource Center
Telemedicine General Forms
Collection of general forms used in delivery of telemedicine services
COVID-19 Telehealth Program
The COVID-19 Telehealth Program provides $200 million in funding
Federal Funding for Telehealth
Federal agencies invest millions of dollars each year to support better access to quality health care for rural and other underserved areas and populations
Rural Telehealth Toolkit
Grant Funding for Telehealth Programs
Telehealth Grant Funding Sources and Applications
tips on how to begin the telehealth grant search and application process
Many Telehealth Funding Opportunities Available – Grantwriting Tips Added As Well!
list of grant and other funding opportunities with potential for telehealth applications that have been recently announced or whose deadlines have been extended
AMA quick guide to telemedicine in practice
The American Medical Association has designed resources to support physicians and practices in expediting the implementation of telemedicine, so care can continue to be provided to those who need it most
15 Key Steps for Creating a Business Proposal to Implement Telemedicine
Telehealth Resources at Your Fingertips
The CTRC Telehealth Program Developer Kit
A Roadmap For Successful Telehealth Program Development
TELEMEDICINE & INFORMED PATIENT CONSENT: DONE THE RIGHT WAY
Not only is getting informed patient consent a recommended best practice by the American Telemedicine Association (ATA), it’s actually a requirement in many states.
Resources Needed for Implementing Telehealth Programs
Rural programs may require several different kinds of resources, such as physical space, staffing, technology, and partnerships, to implement and expand telehealth services
Core Operational Guidelines for Telehealth Services Involving Provider-Patient Interaction
The following guidelines are fundamental requirements to be followed when providing medical and other healthcare services using telecommunications technologies
HIPAA Guidelines on Telemedicine
Communicating ePHI at Distance
