Telehealth Survey: Pre-Test

Please create a 4 digit unique random numeric ID that you will utilize as your Student ID for this experience using the following guidelines:

_7___ Last Digit in your Phone Number (Cell or Home) – Example: Cell Phone # is 757-123-4567

_6___ Last Digit in your Birth Year –  Example: Birth Year 2016

_4___Last Digit for your Home Street Address –  Example:1234 Anywhere Street

_9___Last Digit in your SSN – Example: 123-45-6789

7649  Unique Participant ID

What is your age?

What is your sex?

Which best describes your racial or ethnic identity?

How would you describe your home’s location?

What profession have you or are you pursuing?

Please select the role that best represents your current status in the healthcare field.

How likely do you feel you will be to use telehealth in your chosen field of practice?

Have you had previous experience with telehealth?

Do you currently work in a clinical site that provides telehealth?

Do you currently work in an educational site that provides telehealth education?

When using telehealth, you follow HIPAA guidelines.

Practice with the equipment is essential for a successful telehealth visit.

It is important that a telehealth visit resemble a face-to-face visit (beginning, middle, and end of the appointment).

I am confident I can use videoconference technology.

I am confident I can select appropriate technology to use in my practice setting.

I am confident I can establish rapport with a patient I meet in a videoconference.

I am confident I can research and determine the kind of telehealth and telehealth equipment that would be appropriate in my practice.

I am confident I can convey empathy with a patient I meet in a videoconference.

I am confident I can present myself/role to patients during a videoconference.

I am confident I can correctly obtain a history with a patient I meet in a videoconference.

I am confident I can select when to conduct a live telehealth visit versus a store-and-forward visit.

I am confident I can correctly perform a psychosocial assessment of a patient I meet in a videoconference.

I am confident I can address the barriers to providing healthcare via telehealth.

I am confident I can correctly diagnose a patient I meet with using telehealth.

I am confident I can promote the benefits of providing healthcare via telehealth.

I am confident I can determine when Telehealth is applicable and when it is not.

I am confident I can manage the patients having an emergency during a telehealth visit.

I am confident I can research equipment and costs.

I am confident I understand the HIPAA guidelines related to a telehealth visit.

I am confident I can influence others within my profession in the use of telehealth.

I am confident I can read the nonverbal cues of a patient I meet in a videoconference.

I am confident I can obtain information regarding rules and regulations regarding telehealth. 

I am confident I can recommend the correct follow-up services for a patient I meet with via telehealth.

I understand the telehealth metrics/measurements needed to analyze success of a telehealth program.

I am confident I can create a holistic treatment plan in collaboration with a patient I treat via telehealth.

I am confident I can select the correct patient populations or diagnosis for a telehealth encounter.

I am confident I can appropriately follow the reimbursement guidelines for telehealth.

I am confident I can correctly assess a patients physical condition using telehealth without peripherals (videoconferencing).

I am confident I can use the appropriate coding or modifiers for a telehealth visit.

I am confident I understand the differences between Medicare, Medicaid, and Private Insurance reimbursement for telehealth. 

I am confident in my ability to assess physical issues using videoconferencing.

I am confident in my ability to implement a Business Associate Agreement (BAA) with a telehealth vendor

I am confident I understand Federal and State restrictions placed on telehealth.