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As a DPT, the primary telehealth model I would be using would be videoconferencing which would be particularly valuable in an outpatient setting. The mHEALTH application could also be used as a supplement. Peripheral devices, such as a pulse oximeter and blood pressure cuff, would be very appropriate when working with cardiac patients. These peripheral devices would allow us, as a clinician, to monitor patient response in real time. We could obtain the consent for these services though a written (prior) as well as verbal during the telehealth visit. As we saw in 2020 the type of population that would be appropriate for telehealth range anywhere from those who are immunocompromised to individuals who lack the transportation to arrive on time to an appointment.
It would be extremely important to evaluate how often we would use the service first and foremost, especially if we do not have the need or want for it. Another aspect to evaluate would be the patient satisfaction behind the service. The legal considerations would encompass further researching the Virginia state requirements (rapid changes could occur), as well as how the company I would work for would obtain informed consent (officially) as well as document. Other professionals I would like to involve would be registered dieticians as well as mental health specialists in order to address all other biopsychosocial aspects of the patients care, in order to maximize their rehabilitation. In order to keep aspects running as smoothly as possible, certain protocols would need to be put in place. These protocols would include emergency procedures, instructional pamphlets for the patient as well as staff, and a strong “help” feature to address any questions/concerns.
In the physical therapy world, I would love to implement a synchronous videoconferencing system to interact with patients. Equipment could include robots to provide assistance to patients in long-term care facilities/nursing homes. Other devices such as blood pressure monitors and pulse oximeters can be utilized for patients with cardiopulmonary pathologies. The beauty of telehealth is that the patient can be in a multitude of originating sites for their visit, including work place and home. As direct access expands and physical therapists have the potential to order imaging, I would love to implement a store and forward method to gain access to patient’s X-rays, MRI’s, or CT scans and communicate with the patient regarding their results appropriately.
I would enjoy working with the orthopedic populations over telehealth systems. I also enjoy the neurologically involved population, but feel as if it is more difficult to provide adequate safety to patients in the neurologic population when performing evaluations and treatments. There may be some populations within the physical therapy realm where telehealth is only appropriate for home assessment and patient education scenarios.
My role in the development of this program would be an organizer as I feel this is my personal strong-suit. I would evaluate the program via verbal feedback received from the patient at the end of every session and then reported via the treating therapist. It is important that both the patients and providers can give feedback about the equipment, programs, and process to ensure the telehealth visits are effective, safe, and enjoyable for all parties involved. Legal considerations to address include consent in accordance with VA laws and HIPAA compliance through our technologies. Ideally, it is best to get written consent just to have something “written in stone” in the event something were to go awry. It is crucial that the telehealth visits mirror an in-person visit as much as is feasibly possible.
I would love to work with occupational therapists, social workers/case managers, registered dietitians, and the physician’s associates/nurse practitioners/doctors prescribing patient care. Protocols would be implemented for patient safety/privacy, co-treatments, reimbursement, and emergency procedures. It is best that the patient is educated on the nature of these protocols prior to initiating a telehealth session.
As a PT it would be of great value to implement telehealth services. The primary telehealth model I would consider using would be synchronous videoconferencing. It would be beneficial to see our patients if we were to have to teach them certain evaluation techniques to try and get more information on what is going on. Mobile health could also be of benefit to allow around the clock monitoring as well as use it for patient education. One other beneficial mode of telehealth would be store and forward. Being able to have access to imaging such as x-rays, MRI, CT, etc. could be beneficial.
Equipment to be used can include robots to help provide assistance to those in SNF, long term care facilities, as well as blood pressure monitors, pulse oximeters, smart watches to detect heart rate. Depending on what patients we are working with and what conditions they have, something like the Kardia Mobile personal EKG could be useful. As therapists we could address a variety of populations such as those with orthopedic injuries or neuromuscular pathologies.
When I become a licensed clinician, my role could entail multiple things: scheduling – I could directly help my patients schedule their telehealth visits; a provider – provide my patients the best care possible; education – patient education is a huge part of our profession. It would be important to evaluate the need for the service to make sure there is a need/want. It’s also important to evaluate patient satisfaction and get feedback. What went well? What could have been better? Feedback is always good in order to be sure improvements are being made. Legally, it would be important to do further research into the Virginia requirements as this is where I would be practicing, as well as any other state that I may have a patient in that is not Virginia. As always, it would be necessary to follow all HIPAA guidelines. Getting both written and oral consent would be of the most benefit as well. Lastly, it is really important to try and mirror telehealth visits with in-person visits as they are just as important.
Personally, I would like to work with OT’s, SLP’s, social workers, case managers, nutritionists and RD’s, psychologists, and physicians who are also providing the care. It is important to treat the patient as a whole and include all who may be beneficial to the patient’s care. Lastly, protocols would be necessary to keep things running as safe and effectively as possible.
As a future physical therapist, I would choose to implement synchronous videoconferencing into my practice. Equipment I could use to assist in synchronous videoconferencing could include computers, tablets, or smartphones, depending on which piece of technology the patient has access to for videoconferencing, as well as blood pressure monitors and pulse oximeters for vitals management. In addition to synchronous videoconferencing, another type of technology I would choose to implement would be store and forward in order to review a patient’s imaging and test results to assist me in my evaluation or treatment of a patient.
Telehealth can assist several different types of patient populations, not limited to those in rural or underprivileged communities who may not have access to transportation to in-person sessions, those who are immunocompromised or non ambulatory who would find it much too fatiguing and challenging to come to an in-person session, and patients with responsibilities they cannot walk away from, such as children.
My role in the program would include coordinator, scheduler, presenter, provider, and educator! As a physical therapist, I would like to be with my patient every step of the way by helping my patient prepare for their first visit, guiding them through their visit, and asking about their experience afterwards so that I can evaluate the visit’s success. Things I would evaluate following a telehealth visit would include the effectiveness of the equipment used during the session, patient satisfaction, and patient safety and privacy. In regards to privacy, I would have to ensure that I am practicing in accordance with state laws as well as HIPAA rules while using technology for telehealth. To aid in this, I would acquire written consent for telehealth from my patient before starting a session.
Telehealth provides a great opportunity to work alongside other healthcare professionals due to the access to records afforded by store and forward and use of secure apps such as mHEALTH. Telehealth would allow me to work alongside social workers, case managers, PA’s, NP’s, SLP’s, and OT’s. Protocols I could develop would include patient safety, emergency, and reimbursement.
If I were to become involved in telehealth physical therapy, it would likely be a combination of videoconferencing and mHealth. Videoconferencing allows me to visualize my patients, ensure that they are completing exercises with proper form, and potentially pick up on any nonverbal cues that may impact their rehabilitation. I plan to work in outpatient sports medicine setting, and utilizing mHealth would allow me to better treat this patient population. For example, I could have my patient utilize an app that tracks their activity level so that I could make sure they are following their prescribed exercise progression. This information could be beneficial to analyze if my patient complains of a new onset of fatigue or soreness beyond their baseline, and to provide them with a measure of accountability.
My most prevalent roles during this telehealth interaction include being both the provider and the educator. I imagine that the office administrators would take care of the coordinating and scheduling needs for this appointment. I would seek feedback from the patient regarding aspects of our visit that went well and ideas for change in order to evaluate the effectiveness of the program. I would also evaluate whether this patient would be better served in person in the clinic. In the case of higher-level athletes, they would potentially need more challenging equipment or heavier weights that they may not have access to in their home. I could also implement standardized outcome measures for objective evaluation of my patient’s improvement. In terms of legal obligations, I would have to abide by Virginia state law regarding how, and how frequently, I need to obtain informed consent. It would be beneficial to review state and federal legislation concerning billing, coding and software requirements. Certain protocols need to be in place prior to the telehealth session, including emergency action plans, patient/provider safety and confidentiality maintenance.
It may be beneficial to involve the athlete’s orthopedic surgeon if the patient is post-surgical, or their athletic trainer due to their inherent familiarity with the patient and sport-specific requirements necessary for return to sport. I would obtain both verbal and written consent prior to our first telehealth appointment, and provide them with directions on accessing the telehealth platform prior to our visit.
As a future physical therapist, implementing telehealth services into my practice would be a valuable asset to expand the reach and cost effectiveness of care. The telehealth model I would use would be videoconferencing due to the fact that the patient would be able to get immediate feedback for questions or barriers they encounter. Coupled with the use of the mHealth app, peripheral devices such as pulse oximeter, blood pressure cuff, and smart watches would give the PT the ability to monitor and analyze, in real time, the health status and changes that the patient presents with. This would be beneficial for a wide range of populations including patients from rural areas, those who are immunocompromised, or facing other barriers that cannot attend face to face visits.
As an entry level PT, there are many roles I would be able to fill regarding telehealth visits including scheduling, providing care, and providing patient education. It would be most important to evaluate the need for such services in order be able to provide patients with the best care possible. This requires the need for visit evaluations to determine the wants and needs of patients, patient satisfaction, and feedback of how to improve such conferences to improve quality of care. Also, further research would be needed to assess legal considerations that would accompany telehealth visits. Being aware of the Virginia state requirements and changes that do or will occur, consent requirements, and documentation standards will ensure that HIPPA guidelines will be followed.
Involved with my interprofessional telehealth healthcare team would likely be physicians, psychologists, registered dietitians, OT’s, SLP’s, social workers, and case managers. This would ensure that the biopsychosocial aspect of patient care would be represented and would be able to handle any situation that may arise. With having many moving parts, protocols would need to be implemented to ensure operations run smoothly and effectively.
I am a physical therapy student and would like to use video conferencing to do telehealth appointments. I think this would be a beneficial medium to use for patients who don’t require as much hands-on care and don’t want to come into the clinic every session. I think video conferencing would be a great way for us to reach patients who don’t want to come into a busy clinic during COVID, and also it would be good for patients who have to drive long ways to get to a clinic.
I would use telehealth to address the pediatric population. This would work well because a lot of pediatrics is educating parents on what they can do at home and how they can do it. I would use telehealth to make therapy easier to get to for parents. Parents are busy with their own work, other kids, and other activities so by doing telehealth, hopefully, it can make their lives a little easier. My role in the program would be to actually deliver the care via videoconference. Some legal considerations we would need to be aware of are to maintain HIPPA while videoconferencing and making sure we have consent before each visit. I would also need to be up to date on Virginia State guidelines for telehealth billing. After each visit, I would evaluate the program and visits by asking the parent how they thought the visit went, and what kind of things they might want to work on next time. I could also use objective measures to track progress for the patients each visit to see if they are actually improving.
Some protocols we would need to have in place would be an emergency action plan in case something goes wrong. I would need to make sure I had the address and know who to call if an emergency occurred. Other professions I could work with would be OT and SLP, since any kids receive those therapies as well. It would work great if we could even co-treat on the same videoconference session. In order to obtain consent, I would have a written document and have the parents sign it before conducting the appointment.
I have had experience using telehealth in physical therapy practice, which showed me the benefits of meeting with patients in their home setting and providing an alternative to coming into a clinic for care. For physical therapy, real-time videoconferencing would be most beneficial for the evaluation and treatment portions of the session, but mHealth would be good to use in conjunction. Synchronous videoconferencing would allow for immediate feedback and correction of technique, ease of obtaining measurements and data, and acknowledgment of patient understanding of the interventions and HEP. mHealth would allow me to get telehealth consent more easily/quickly, monitor patient vitals and activity, and receive and share clinical information for the patient via an app.
Population-wise, I would use this with a younger athletic population as they typically have busy sports schedules. Telehealth would fit in with those schedules, allow them to receive therapy while traveling with a team, and limit extra travel time to get to the clinic. Likely this population would also be proficient with technology use. I would incorporate the athletic trainer, coach, and orthopedic surgeon (if there is one) into their care and maintain contact with those people regarding the athlete’s care, ensuring HIPAA privacy is maintained. I would abide by Virginia telehealth laws with this patient, such as obtaining consent, identifying myself and my credentials, and having the patient confirm their identity and location each visit. I would get verbal consent each visit to ensure the patient agrees to receiving care via the telehealth platform. I could also use the mHealth app to get written consent from the patient.
During therapy sessions, I would be the provider of care and the educator. Since telehealth is less hands-on, education will be important to improve effectiveness of the telehealth platform and ensure carry-over of what is being taught. For outcomes, I would look at the effectiveness of the program- did the patient make progress and return to sport? I would also ask about their experience during the therapy sessions, if the quality was sufficient and if they thought their treatment was beneficial.
As a future Physical Therapist I think that the most viable and successful version of telehealth would likely involve teleconferencing. Since a lot of what we do as therapists involves observation it is important that we see the patient in general. This would also allow for an open conversation with the patient about their medical history and the reason for them requiring therapy overall. Although vitals or other outcome measures may be important for therapy at times the majority of patient will need observation if actual hands-on measurements are not available.
I think this might be important to reach persons who may have social determinants of health that keep them from getting to consistent therapy appointments or do not live in a heavily medically populated areas. This would benefit persons who may need basic exercise programs or who have injuries that don’t need a lot of hands on work that could complete therapy with verbal guidance. However, this would also assume that these patient have access to the internet in general.
As a therapist I would likely be involved in such a program as a provider to my patients who would qualify or require telehealth. However, I would also be willing to create a program that involves other healthcare providers that allows for a more holistic treatment approach that each patient may qualify for as necessary. This may include nursing, MD, mental health, etc to address what the patient needs and cannot receive at in person appointments. After gaining consent prior to and during appointment we would be able to address whatever the patient needs.
I think that physical therapy services and evaluation lends itself to a videoconferencing and RPM model due to the nature of some of the conditions that we address. This model would be appropriate in the outpatient environment where a decent percentage of patients have musculoskeletal impairments. Those with neurological impairments or multisystem impairments that require hands-on attention should seek out care at a traditional clinic. This part of the model would require a laptop, tablet, or smart phone in order to have a successful visit. The use of RPM could be beneficial as patients have the capability to objectively measure their response to exercise. This is important for PT in the outpatient setting because we often manage patients with other comorbidities that are affected by exercise. The type of equipment that would assist PTs is blood pressure, oxygen saturation, heart rate, and respiration rate monitoring. This equipment would effectively allow the PT to monitor a patient’s response to exercise and to effectively evaluate if the response was appropriate considering their current health condition.
My role in the program would be provider and educator. I would be the clinician providing care to the patient for their specific impairment. Education would be provided about their activity behaviors and other behaviors related to their condition.
I would involve MDs, RDs, NPs, OTs, and ATs in the care of patients. Having communication with these professions allows for multiple components of the patient’s care to be addressed.
I would evaluate the access to care to ensure my patients were able to meet with me in an environment where they have adequate privacy and space to perform parts of the evaluation, examination, and treatment. Evaluation of the financial impact of the program would be crucial to the success of the program from a business standpoint. The experience should feel similar to an in-person visit, so the patient and provider experience is important.
Legally I would ensure that telehealth was approved in my state’s practice act. I would also adhere to HIPAA and that the operating system we use for telehealth allows for the maintenance of HIPAA regulations.
I would like to have written consent to have physical record of the agreement. There would also be protocols in place for emergencies, reimbursement, and for help navigating the user interface.
As a future physical therapist, I would select a Combination Telehealth Model. I would want to implement synchronous videoconferencing into my practice because I feel it would be the most beneficial model to ensure that I am able to observe my patient performing the exercises correctly and it would allow me to give feedback and provide cues in real-time. I feel that mHealth could also be beneficial to use in the PT practice to allow for 24/7 monitoring to check physical activity levels. Store and Forward would be beneficial to view patients’ MRIs, X-rays, and CT scans in order to be sure to incorporate all of the findings into the patient’s treatment and education.
I feel that my role during a telehealth program would be the coordinator, scheduler, provider, presenter, and educator. As a physical therapist, I would want to be with my patient from the beginning to the end…from preparing for a session, scheduling sessions, providing the physical therapy care during the session and providing any education needed following our session. As the coordinator, I would want to evaluate what was successful and what could have gone better during the session. I would check with the patient to ensure that he/she felt that it was beneficial and that he/she got a lot out of the session, that the equipment worked correctly, and that the patient felt that his / her privacy was maintained. Legal considerations that would need to be considered would be consent, VA laws/requirements, and HIPAA compliance with the technology used. I would want to get oral and written consent before the start of our first session. Lastly, it’s important to mirror in-person visits as much as you can to ensure the best quality of care.
I feel that Telehealth provides the opportunity to work with other medical professionals that you may not typically have access to in your clinic. I would want to work alongside OTs, SLPs, nutritionists or RDs, psychologists, physicians, NP’s, social workers, and case managers. It would be important to create protocols such as patient safety, emergency, and reimbursement.
For physical therapy I would like to use a combination of video conferencing and mHealth. I think this would be great for a more independent population that is able to consistently complete a HEP. I can remotely assign the patient a HEP and then have them utilize a wearable device to track exercise time, HR, number of steps per day, millage, etc. This would be great for introducing patients for return to running programs or for starting a walking program. I could then schedule virtual check-ins as needed to check on progress and adjust programming. In a sense it allows for me to continue to check on and work with patients even after they no longer need formal physical therapy activities and instead need more guidance for higher end training. This would also allow me to save the patient some PT visits for future use in case they relapse or have another injury down the road. From a legal standpoint I would make sure patients know of any out of pocket costs they may incur as well as having sufficient emergency protocols in place. HIPPA policies would also be in place as well as a BAA with whatever platform I was using to meet with.
As a PT, I would most likely prefer a combination of videoconferencing and mHealth. I see this mostly as a way to work with active adults and athletes whose primary needs are education, exercise prescription, and accountability. It could be more convenient and and cost effective for the patient and provider if the patient does not require hands on care. programming the patients movement schedule and checking for progression, education, and assessment would be beneficial as well as create more autonomy for the patient. Patients could track their heart rate, steps, exercise intensity, duration and frequency with wearable devices, and report their subjective perception of the exercise periodically. We would have to make sure that all our communication and programming platforms were HIPAA compliant and that the patient gave consent for this form of treatment. One limitation could be the ability of the patient to acquire and properly use all technology and equipment to adequately track their status/progress.
As a future physical therapy clinician I would most likely be using synchronous video conferencing and mHealth to offer patients a unique experience that would benefit patient who may not be able to easily access a healthcare provider. I would implement using smartphones, tablets, or computers that the patient is familiar with and I like the idea of easily accessing patient records and images with store and forward. This will only further enhance my ability to provide excellent patient care and form potential differential diagnoses.
Telehealth has the ability to reach patients from all populations and not just rural communities. I have seen telehealth used for a variety of musculoskeletal conditions ranging from sprained ankle to TKA. I imagine that as my comfort level grows with telehealth so will my ability to manage different diagnoses. My role in the program would mostly be provider and educator to my patients.
Other professions I would like to involve would be the orthopedic, nurses, social worker, and case manager into my care with the patient. Working with a variety of healthcare professionals allows optimal care and any issues that arise to be resolved quickly. To ensure security and privacy I would follow HIPAA and obtain patient consent prior to any videoconferencing.
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