Emerging Practices in Telehealth: Best Practices in a Rapidly Changing Field

Description:

Emerging Practices in Telehealth: Best Practices in a Rapidly Changing Field is an introduction to telehealth basics, best practices and implementation methods. The book guides the reader from start to finish through the workflow implementation of telehealth technology, including EMRs, clinical workflows, RPM, billing systems, and patient experience. It also explores how telehealth can increase healthcare access and decrease disparities across the globe. Practicing clinicians, medical fellows, allied healthcare professionals, hospital administrators, and hospital IT professionals will all benefit from this practical guidebook.

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Foreword

For many of us, practicing medicine virtually was nothing more than a hightech dream of the future. Perhaps in training we talked of a future time when we could get vital signs and other data remotely and intervene in a patient’s health to improve outcomes.

Fast forward to 2020. A highly contagious virus creates a pandemic with lockdowns in most of the world. All of a sudden, the dream of telehealth became a reality in every corner of the planet. Using adaptations of widely used videoconferencing software and techniques combined with newly created sensor and remote monitoring tools, most of the medical world was thrust into this vast new digital frontier.

What emerged was nothing short of exhilarating. Incredible convenience, fast clinician access, and the avoidance of the drive, traffic parking, and wait time became common. People could access their favorite doctors from the convenience of their phonesdfrom home, work, or even while on a walk. Memories of the long gone “home visit” came rushing back for many of us as we gained insights into our patients’ homes and homelives. We, in some ways, felt more connected even though we were often miles apart.

The world felt like a much smaller place through the magic of technology and widespread internet connectivitydeven in the poorest places on earth. Colleagues could connect virtually and provide consultations while patients in neighboring states were able to get specialty care they were unable to get locally or in a timely fashion.

The good news is that telehealth is here to stay. Through widespread adoption coupled with incredible convenience, virtually all clinics and hospitals continue to support this vital tool which will only become more commonplace as technology and faster wireless access continues to develop. With sensors, batteries, and remote monitoring, listening, and measuring tools improving every day, perhaps the in-person visit will become the rarity. Only time will tell!

As such, this book will serve as your trusty field guide for understanding how best to implement telehealth and will guide you through the technology, billing, legal considerations, global implementations, and the future of wearables. We hope you will keep this near your desk and use it as a practical implementation toolkit and a handy reference. We wish you the best success in your telehealth endeavors!

– Drs. Andrew M. Freeman and Ami B. Bhatt

Table of contents :
Cover
Emerging Practices in Telehealth: Best Practices in a Rapidly Changing Field
Copyright
Foreword
Contributors
1. The basics of telehealth
Introduction
Statistics
Common approaches/types of telehealth
Telemedicine versus telehealth
The benefits of telehealth
Choosing a vendor+platforms
Setting up for telehealth
Tips for success
A short primer on basic billing for telehealth
Welcome to telehealth
References
2. Telehealth technology infrastructure and implementation strategies
Introduction
Universal technical infrastructure requirements of telehealth
Access to broadband internet
Disparities in broadband internet access
Imaging technology (audio-video capabilities)
Technical support staff
Patients
Clinicians
Technical support staff
Staff training
Digital literacy
Evaluating telehealth platforms
Implementation strategies in areas without reliable broadband internet and low digital literacy
Prioritize telephone encounters and consider low broadband options
Implementation strategies for enterprise healthcare organizations
Identify key stakeholders and develop a leadership team for strategy planning and implementation
Pilot small but with scalability in mind
Implementation strategies for individual or group clinician practices
Take advantage of the ability to move quickly and rapidly identify the most reliable, cost-effective solution with least di …
Implementation strategies for virtual-only services
Find a specialized area that is underserved by the current market and create a service for the user that provides exception …
Conclusion
References
3. Telehealth implementation in clinical practice: integration into electronic medical records and clinical workflows
Introduction
Pre-implementation: implementing telehealth into clinical practice
Integration into the EMR
Clinical workflows: focusing on patient centered approach and best practices for telehealth visits
Conclusion
References
4. Billing basics and fundamentals
Key stakeholder payors
Medicare and Medicaid
Private payors
VA’s Veterans Health Administration and Department of Defense (VHA &DOD)
Providing health care for veterans
Coding and billing (Fig. 4.1)
Basic understanding coding systems
Code modifiers
Audio-only specific modifiers
Telehealth place of service (POS)
Communication technology-based (CTB)
Telehealth pre-pandemic (Fig. 4.2)
Medicare
State Medicaid
Private insurers and state telehealth coverage
US Department of Veterans Affairs (VA)
Pandemic Fig. 4.2
Medicare expansion of service
Medicaid
Private insurance
US Department of Veterans Affairs (VA)
So what happens after the end of the PHE? Fig. 4.2
References
5. Optimizing the patient experience for telehealth and remote patient monitoring programs: Best practices and requirements fo …
Introduction
What are the requirements for a positive patient experience?
Set clear goals for telehealth or remote patient monitoring programs
Establish “what’s in it for me” for patients
Invest in patient and provider training
Ensure 24/7 access to care
Collect and give regular feedback
Don’t just treat. Identify gaps in care
Triage patients based on real-time data
Make technology useable
Ensure connectivity
Take a whole-person view
Consumerize healthcare
Measure patient experience and optimize
Conclusion
References
6. Legal considerations
Legal and regulatory compliance in an era of rapid innovation
Telehealth and the practice of medicine
State licensing
Standard of care
Telehealth practice standards
Remote prescribing of drugs and controlled substances
Non-controlled substances
Controlled substances
Tort liability
Malpractice insurance coverage
The corporate practice of medicine
The friendly PC model
Fraud and abuse laws
Federal
State antikickback, fee splitting, and patient brokering laws
Digital health technology
Privacy and security
Online services and federal communications commission rule
Subscription fee models and insurance laws
Hospital telehealth credentialing and privileging
Telehealth payment policy and reimbursement
Medicare coverage of telehealth services
Remote patient monitoring
Medicaid coverage of telehealth services
Commercial health insurance coverage of telehealth services
Telehealth commercial coverage laws
Telehealth payment parity laws
No surprises act and its impact on telemedicine
Conclusion
7. Continuous cardiology: the intersection of telehealth and remote patient monitoring
Introduction
What is remote patient monitoring?
How did we get here?
The current RPM landscape in cardiology
Heart failure
Atrial fibrillation and other arrhythmias
Hypertension
Physical activity and cardiovascular disease prevention
The medicare model for RPM
How can we best combine telehealth and RPM?
Current challenges and future directions
An evolving regulatory landscape
Safety and privacy challenges
The promise of artificial intelligence
Conclusion
References
8. Creating the perfect telehealth product
Introduction
What is the perfect telehealth product?
A brief history, challenges, and opportunities of telehealth products
New product design and development
Telehealth product building blocks and construction
Heartbeat Health, a telehealth product case study
Future directions of telehealth products
Conclusion
References
9. Increasing access and decreasing disparity with telehealth
Introduction
Improving internet access and connectivity to help decrease disparities in telehealth
Training of providers and support staff to help increase digital literacy and improved access to telehealth
Improving budgets to increase access to telehealth and decrease health care disparities
Improved reimbursement to increase access to telehealth and decrease disparities
Conclusion
References
10. The international telemedicine experience: Russia
“Doctor–doctor” telemedical interaction
“Patient–doctor” type of telemedicine
References
11. International telehealth implementation—the Indian experience, project CardioGram
The Indian healthcare system
National digital health mission
Project CardioGram inception
Evolution
PHC characteristics
Staff characteristics
Patient characteristics
Diagnostic capacity
Medicines availability
Staff
Instruments
Timings
Workflow (the patient queue can proceed in the following order)
Lessons from early implementation
References
12. Global telehealth and digital health: how to support programs and infrastructure
Key points
Traditional healthcare models undergoing transformation
Understand the healthcare ecosystem
Who are the stakeholders and how might a potential digital health solution affect them?
Public-public collaboration is growing and important
Evaluate the politics and geopolitical context
Healthcare across borders
Evaluate the potential, specific role of digital health technology
Use principles of design thinking to your advantage
Choosing the right digital health technology
Precision health and broader directions of digital health technology
Evaluate the local development with an eye to scaling
Putting it all together: launching the program
Build stakeholder trust
Create roadmaps of short-term, medium-term, and long-term ROI
Implement with eye toward scrutiny of impact and demonstrating early wins to grow buy-in
Maintenance, growth, and scaling the effort
Conclusion
References
13. The rise of AI in telehealth
Artificial intelligence and its subtypes
Telehealth and its subcategories
Applications of AI in telehealth
AI in telemedicine
AI in remote patient monitoring
AI in mobile health (mHealth)
AI in store-and-forward: imaging and pathology
Challenges of AI in tele-health and future directions
References
14. Pearls of wisdom from the past 5years of working in telehealth
Introduction
Changes that paved the way for telehealth adoption
Technical capabilities
Recognition of telehealth as an element of clinical care
New payment models
Consumer demand
The effects of COVID-19 on telehealth adoption
Early stages of the pandemic
Defining the role of telehealth beyond times of crisis
Consideration 1. categorizing clinical interactions
Consideration 2. ensuring telehealth makes financial sense
Consideration 3. integrating telehealth into provider’s workflow
Consideration 4. improving technology accessibility for patients
Consideration 5. ensuring telehealth care delivery advances health equity
Emerging innovations in telehealth
New technologies
New modes of care delivery
Conclusion
References
Index