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The Telehealth model I would select would be the video conferencing. Store & Forward might be another option if our patient population signs up with the portal and/or tech savvy with access to a smart phone. The video conferencing option would be the best and even for those patients that lack a smart phone in our community. They are also able to access video conferencing at our main campus, which is convenient if their appointment is at one of our other satellite campuses and they do not have transportation. In addition, our population faces increasing COVID incidence rates and low COVID vaccination rates. The use of video conferencing may make those both, fully vaccinated or unvaccinated, feel more comfortable seeking care using this medium, but this is just conjecture.
My role as a provider is to utilize this technology to better serve the community and increase access to care. For example, I would reach out to my patient panel for their care needs with these visits if they miss face to face appointments. If combined with the Store & Forward model we can also consult with specialists and the patient as a shared decision making framework in handling the patients care. I would evaluate this program to see if our population would use this technology by comparing the number of annual tele visits and also whether or not the patient satisfaction with quality of care was comparable to previous face to face visits.
Legally, according to Center for Connected Health Policy (CCHP), Hawaii has consent requirements, but the specific language may differ for each organization and length of consent being in general 1 year, but this may change. I also need to check with legal about prescribing controlled substances (CS) with telehealth visits and found that the Governor has temporarily allowed prescribing CS (opioids and benzo’s) via telephone consultation without in person consultation every 90 days (Section 329-38(d)). [https://governor.hawaii.gov/wp-content/uploads/2021/06/2106080-ATG_21st-Emergency-Proclamation-for-COVID-19-distribution-signed.pdf]
Whether or not we use telehealth or face to face there is always going to be ongoing collaboration with specialist such as PT, MD specialists (ie Cardiologist, Podiatry, Endocrine, Behavioral Health, etc). The protocol I would develop in consultation with our EMR working group would to add language in the visit template that the provider will go through prior to the visit and at the end of visit survey the patient for patient satisfaction and likelihood of utilizing more telehealth visits in the future. Was it cost effective in terms of not missing work for the patient or the patient feeling like the quality was the same as face to face visits.
The language I would add in the visit template include confidentiality of the visit, technology glitches may occur during the visit, expectations of both provider and patient to use a private and free from distractions setting, finally that I am not recording this visit. I would also ask about emergency contacts and confirmation of patients phone number and if applicable address if the visit is interrupted or if the patient needs emergency assistance.
I would also let the patient know that anytime if the tele visit isn’t helping and that they can tell me to stop and make an in office visit. However, I would note depending on the schedule that this may not be right away. This of course is absent of emergencies, which I would then contact the emergency contact or call 911. In case I am treating a patient that isn’t in my State, the 911 dispatcher from the patient’s State hopefully would be able to locate the patient with the information I gathered in the beginning of the visit.
Telehealth Program Proposal
One program that I would be very interested in introducing to this author’s current work force is the Community Resiliency Model (CRM) created by the Trauma Resource Institute (Trauma Resources Institute, 2021). These models have been developed to help individuals, in this case frontline health care workers, who have served during the COVID-19 pandemic, understand the biology of traumatic stress reactions, and gain valuable skill and resources in learning how to return the body, mind, and spirit back to a state of balance. This program teaches wellness skills that allow an individual to exercise resiliency muscles to help an individual feel better in mind body and spirit. Some of the skills taught are tracking, resourcing, learning about resilient zone scales, grounding, gesturing, help shift and stay (Trauma Resources Institute, 2021).
Telehealth Model Video Conferencing (synchronous)
Telehealth Equipment Computer/Laptop/iPad/Mobile Device – i.e. ZOOM or Amwell
Population/Healthcare Issue Frontline Health Care Workers COVID-19 Pandemic
Role in the Program Coordinator/Philanthropist
Evaluation Nursing Burnout/Fatigue/Engagement/Employee Satisfaction/Turnover
Legal Considerations HIPAA/Consent
Other Professions CRM trained moderators, Nursing Health Care/ PMHNP, Social Worker, Provider: either midlevel or primary/ Chaplain Services
Protocols Intake, Screening, Surveys related to current perception, pre intervention, post intervention, encouragement to utilize the iChill app and guide sponsored by the trauma
resource institute, Emergency Plan
Consent Written upon agreement to participate and verbal with each interaction documented by provider.
Reference: Trauma Resource Institute. (2021). The Models. Trauma Resources Institute. https://www.traumaresourceinstitute.com/home
For my telehealth program I would like to develop a remote patient monitoring program for people in need of support tracking their medication adherence. I would utilize the Athelas PillTrack system. These devices come SIM connected. The patient data is securely encrypted and stored on Atelas servers in accordance with HIPPA compliance regulations. Our health care practice would need a Business Associates Agreement. Working with Athelas we would be able to tracking our patients with complex medication regimens using the PillTrack Dashboard. They would bill the insurance provider with the CPT codes and we would be paid. We would pilot the program with 10 older adults in our practice to begin. We know that not all RPM is billable, this would allow for us to identify if Medicaid, Medicare and Commercial insurance would pay for this type of remote patient monitoring. We would also gather information on patient and family ease of use. Two consents would likely need to be signed, one from our practice and one from Athelas. We would work collaboratively with our local Visiting Nurses Association who visits the 10 homebound adults that we are evaluating. They would assist with filling the PillTrack system. We would collect a Qualtrics evaluation for the VNA, our practice RNs/providers and the patient/family. We would also collect qualitative responses. Protocols would need to be developed for the practice to check the dashboard over designated intervals of time. The PillTrack system would need to be monitored and refilled by the VNA. Patient education would need to be done to teach the individual how to use the system.
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