Hospital staff access "Impression" within their EHR system, and select the desired Pre-Registration eForms to send to the patient.
A Best Practice Guide to Implement Virtual Care
Your walk-through guide to best practices for implementing hospital telemedicine.
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.
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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
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.
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.
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.
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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.
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.
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.
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.”
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.
As mentioned in Part 2 Step-by-Step Business Case & Grant Funding, HHS created immediate flexibility for telehealth? for providers? 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.
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.
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.
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.
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.
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.”
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
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.
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
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
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:
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.
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
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.
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.
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?
Common Training Methods
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 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.
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.
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.
To build familiarity with telehealth tools, have experts regularly demonstrate for your team how the auxiliary equipment works
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.
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.
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.
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:
Below are a few examples of how to introduce telehealth as an option within patient workflow.
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.
Credit Center for Connected Health Policy https://www.cchpca.org
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.
Submit to Download All Telehealth Sample Consents
Download Full Version General Telehealth Patient Consent
Download Full Version Consent to Treatment & Release
Download Full Version Sample Informed Consent for Telemedicine Services
Download Full Version Authorization and Consent to Participate in Telemedicine Consultation
Download Full Version Telemedicine Satisfaction Survey Form
In speaking about a post-pandemic approach to healthcare IT, Randy Davis, Vice President and CIO of CGH Medical Center, says,
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.
Are patients required to print and scan in the consent form, or can they access it through their mobile device?
Is the consent simple, quick, intuitive, and fully informing?
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?
Does your HIM staff have to manually retrieve and archive the form into the EHR patient chart?
Are there any delays caused by manual processes such as scanning and archiving?
Can staff easily access, update, and send forms to recipients? Can clinicians easily customize the form with relevant content?
“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.
“With the outbreak of COVID-19, Norman Regional Health System needed a turnkey e-form solution to pre-register patients for our outpatient clinics and for virtual visits. By creating an on-line registration process we will reduce patient time spent in clinic waiting rooms, increase efficiency for clinic healers, and help flatten the curve by decreasing potential exposures for our patients and healers. Access E-Forms was able to assist us in creating a new patient packet that can be sent to patients prior to their visit, completed by the patient in their home, and routed securely back to the appropriate clinic prior to the clinic or virtual visit.”
*Zoom for Healthcare is primarily focused on teleconferencing features
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.
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.
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.”
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.”
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:
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.
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 640x480 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
Top 5 Telehealth Compatible Cameras
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.
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