Telemedicine Staffing&

Guidelines

Telemedicine Staffing

• While program structure may vary significantly, the core functions and responsibilities are often very similar.

• One person can serve multiple roles

Key Functions1. Project/Program Management2. Clinical Direction and Oversight3. Clinical Referrals4. Clinical Service Provision5. Program Operation / Site Coordination 6. Site Coordination – Remote 7. Patient Presentation8. Technical Support

Project/Program Manager

• Manages on-going operational aspects of the telehealth activity

• Needs assessment• Policy and Procedures• Workflow and staffing• Planning, designing

• Interacts with other departments• Educates others about telehealth

Technology Coordinator

• A Technical Specialist or Network Analyst serves as the primary contact for equipment issues, particularly:

• Connectivity• Troubleshooting

• Available for immediate response when clinical services are being provided

Clinical Direction and Oversight

• Clinical Director role – Liaison between telehealth and rest of clinical staff

• Often serves as program champion• Provides encouragement, direction and

oversight• May be needed at both patient and provider

sites

Patient Site Clinical Referrals

• Referring clinician determines when a patient needs a specialist that is not available on site and makes referral to a telehealth practitioner.

• Interacts with scheduling staff, remote site coordinator and patient presenters.

• May also assist in planning by identifying community needs

Clinical Service Provision

• Practitioner at specialty site provides service requested by referring practitioner.

• May also request services for patient as part of follow-up care

• Leads and conducts actual patient interaction and directs patient presenters.

Program Operations / Patient Site Coordinator

• Telehealth Operations Manager or Telehealth Coordinator role(s)

• Prime patient contact person• Coordinates use of equip• Advocate/educator within org.• Assures protocols are followed• Data collection and evaluations• Could also be Patient Presenter

Site Coordinator -Remote Site*

• Serves as the main point of contact at the remote location

• The information distribution center for all things telehealth

* Where Provider is located

Patient Presentation(TelePresenter)

• Provides some level clinical or technological assistance with the patient interaction or examination.

• Serves as an extension of the remote clinician• Assists the patient• Operates the equipment• Utilizes peripherals, as needed• Ensures standards of care

Tele-Presenter Role

• Requires ability to operate the telehealth equipment (including, sometimes, the understanding and use of various scopes and other peripheral devices)

• Also involves patient discharge, patient education and coordinating of additional care

Tele-Presenter Role• The role of Patient Presenter can be filled by

many individuals. • Two or more individuals should be trained to

serve as Tele-presenters.• In order to incorporate telehealth as a core

service, some organizations have determined that all nursing staff should be able to present patients as needs arise

Patient Monitoring

• In the case of home health programs, establishing and maintaining a relationship with the patient being monitored is a key function.

• Observing and communicating with the patients involved in the program is the core to home-based telehealth services.

Telemedicine Guidelines

• Quality of health care must be maintained regardless of the mode of delivery.

• Telemedicine sites must comply with HIPAA Privacy Rule guidelines regarding patient information, having proper security measures and appropriate administrative, physical and technical safeguards in place regarding the use of any protected health information (PHI)

Telemedicine Guidelines

• All existing confidentiality protections apply to telemedicine as to all in-person activity.

• The use of videoconferencing technology should be mentioned in advance to patients, if possible, and included on Patient Consent forms.

Telemedicine GuidelinesI understand that I may be participating as a patient via

interactive tele-video (ITV) technology provided by ________. I understand that I or my caregivers may communicate via ITV equipment with my healthcare providers. I further understand that I can request that the telemedicine consultation be discontinued at any time.

I understand that this telemedicine encounter, if recorded, may result in my Protected Health Information (PHI) being retained and used, as described by federal regulations, Health Insurance Portability and Accountability Act (HIPAA), and that various HIPAA regulations pertaining to this PHI may become applicable.

The ITV equipment and telecommunication lines used in the telemedicine consultations are secured to ensure patient confidentiality and privacy.

Telemedicine Guidelines

• Documentation sufficient to meet health insurance provider billing procedures should be maintained at the originating and the distant locations to substantiate the services provided.

• The telemedicine equipment and transmission speed must be technically sufficient to support the services provided.

Telemedicine Guidelines

• The physical environments at both the originating and distant site are clinical environments and the spaces should reflect that.

• Staff involved in the telemedicine visit should be trained in the use of the telemedicine equipment and competent in its operation.

Telemedicine Guidelines

• A back-up plan should be developed in the event that difficulties develop in the video transmission.

(In most cases, the back-up plan is for the provider and patient to connect via telephone.)

Technical Standards• The telemedicine equipment and transmission

speed must be technically sufficient to allow a medical provider to render a real-time, interactive exam or other service to a patient at distant location.

• The audio and visual quality of the transmission from the patient (Originating) site must meet the diagnostic or examination needs of the practitioner located at the Distant (or Remote) site.

Technical Standards

• All telemedicine-related systems and activities are to comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as amended, and all other applicable state and federal laws and regulations.

Technical Standards• Telemedicine equipment should be integrated

into a clinical space so as to – minimize its presence– allow for appropriate patient privacy– maximize the patient’s attention on the

practitioner.

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