[Steven Gray]

Model: As a CRNA, one way that I could use telehealth would be to conduct preoperative and postoperative screenings and assessments. I would use a combination of models, including remote patient monitoring (RPM), videoconferencing, and store-and-forward telehealth. This would allow the patient to remain in their home and eliminate the burden of traveling to the hospital for a preoperative assessment. Including RPM could aid in my assessment with data such as ECG, blood pressure, SpO2, and average glucose levels. Store and forward could be useful if they had any previous adverse reactions to anesthesia or a history of a difficult airway.
Equipment: For this combination, I would need a computer with videoconferencing capabilities with a reliable and secure internet connection. I would also need all the monitors used for RPM.
Issues: Reliable internet access can always be an issue when using telehealth. Another issue would be the monitors used for RPM. Would those be patient-supplied, or would they need to be rented out to the patient?
Role: My role would be to perform the pre- and post-anesthetic assessments for the patient, determine if any additional testing is needed, determine if they are suitable for anesthesia, provide education about preparing for their operation, and answer any questions that they may have.
Legal consideration: HIPAA compliance and informed consent would be major legal considerations as well as any practice laws in the state where I practice.
Other professions: Other specialists, such as cardiology or pulmonology, as needed by the patient.
Protocols and consent: Consent could be obtained with an email to the patient when setting up the meeting. Another option would be to utilize a “break the glass” consent that appears before the patient is able to begin their telehealth assessment.

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