Communication. Often there's the communication during the visit. What I often inform and tell a lot of our providers who are new to a service like telemedicine is to make sure we're ensuring accurate next step communication. For newer providers we mitigate some of this by making sure a lot of the patient-facing materials have from a technology standpoint but from a web portal or from an app portal, communication about what those next steps will look like. But providers play an important role in guiding that. We have a number of different support staff for our program but everyone plays a role in making sure there's consistency of expectation and experience. Just ensuring what that next step communication should be and when there are challenges to that, when you get feedback either from patients, providers, or administrators that something is not quite happening as it should in an efficient way or in a follow-up way, that's the way to further enhance maybe some of those materials or provide patient education to make sure everyone is on the same page. You want to really make sure that you communicate I think another pillar of telemedicine which is that this care is complimentary, it's not a replacement. I think the language of saying that telemedicine is a space that can do everything like in-person account is just not realistic. But I think it helps build a more organic and friendly telemedicine encounter for a health system, for a patient, and for a provider so that there's no miscommunication around what can be done in this space. That the limits of that space are understood and communicated clearly. For those who are newer to building a program or getting some pushback about what the space should be in their institution using this type of language and creating this intent for why this product is coming along or the service line is coming along goes a long way to building the relationships needed in a clinical care space to have the team necessary for the before, after, and follow-up that will be critical for advancing this patient's care needs. It's really essential to talk about teams of care and real-time support. In any type of program you may be thinking about, often we think about the provider meeting with the patient and the IT framework supporting it. But all the teams of care that we have within our typical conventional brick and mortar hospital systems, we need to have in a similar way in this virtual space. Institutions can often think the work is just getting done because things are just moving through this clinical virtual space. In reality it requires a lot of logistical support and real-time support to make sure these care pathways, workflows, and just clinical care general is provided to such a high extent and that nothing is getting dropped. Integrating new ideas and expectations while we emerge in this health care transformation, I will say that the best way we have evolved as a health system and as a program here at UC Davis Health is just listening, listening to feedback and incorporating it when it's possible. Often patients and the providers have the keys needed to tell us how to evolve this product in a way that meets the expectations of that clinic space. Regulatory considerations are really important in telemedicine over the past couple of years things that are completely pushed now were not pushed a few years ago. There's a few aspects of this that I think are important and note worthy. First-off, HIPAA. HIPAA, we should achieve the same HIPAA standards in this clinical space as in any other clinical space. That's why it's really important in the beginning of an encounter for providers to really talk through making sure patients in a private space make sure that they have a space to talk and that what they're saying is not being overheard both on the side of the patient and also on the side of the provider hence the need for a safe, secure space for the provider also to be obviously engaging in this and having an office or a separate space in their hospital where they can have that private and secure conversation. Medical licensure. The current standards have shifted somewhat over the past couple of years. But as a safety way to look at this, you as the provider do not need to be in the state where the patient is receiving services but the patient needs to be in a state where you have licensure. I could be providing care to a patient and I could be in Nevada if the patient is in California because I have a California medical license. But inversely, if I was in California and that patient was in Nevada, I do not have a Nevada license, I could not provide that clinical care. Often programs do a lot of work in ensuring that the patients have to say where they're at at the time of the visit. In our program we specify where are you when the patient is calling so they have to confirm they are in California. Occasionally people click through these things and they're not often paying attention as closely as they need to. If a provider finds out in the course of that care that they're not where they said they were, I always say that the best practice is to say listen, we can't through just this mechanism provide home care, I can't provide additional prescriptions or any type but do the right thing as a provider. Help educate that patient as to where they need to go next to get the care they need if that's not the right space for them from a regulatory standpoint. Provider credentialing and privileges. Oftentimes as you're starting up programs or even within these programs there may be unique aspects of provider credentialing and privileging that you want to think through ahead of time and it can take a little time or extra time in an on-boarding process. There might be expectations that, oh, we have 80 providers interested, let's start. That time may lack a provider coming on by a month or two sometimes so, and that's even when they're internal to the system already. Just considerations to make sure that that is achieved and that you have the time lag you need to get your program up and running. From a CMS standpoint, I think it's really important to just have a regulatory expert that is monitoring and tracking these changes as they come. I greatly expect the next couple of years we continue to see evolution of what is allowed and not allowed in the space. I just think it's important as providers that in a brick and mortar set-up we may be very familiar with a lot of those expectations. You may be a lot less familiar with the expectations that are there. As a provider be informed, ask questions about what your program is doing to keep you safe from that standpoint. With that being said there are definitely some other considerations to think about EHR and documentation. I know that this is in the language that we all speak in health care today. But taking time to think through if there's unique considerations or attributes you want in that documentation to create consistency across your service and to be able to better understand what's occurring in those encounters is very important. Interpreting services, we want to create a telemedicine space that parallels any other space both from HIPAA and compliance standpoint but also from the expectations we have in translation services, patients should be able to speak their preferred language so they feel comfortable in this space. We have worked hard to achieve that in our program and every program has to be doing that. But it takes a lot of work up front to think through some of the IT logistics of making that occur. I really encourage you to make sure you have those conversations early on. A multiparty video if there are other parties coming in, obviously the rule of the road is making sure that they should be there and that the patient wants them there. The patient really directs traffic if you will about who should be there and why they're there. Then from a workflow development standpoint, oftentimes some of the feedback that comes back to you as a program manager or as administrator or even as a telemedicine provider that you're providing feedback, sometimes there's other ways to do this job apart from the patient just seeing a provider. I know early in COVID for example we worked hard to establish a workflow whereby patients who were asymptomatic to that desire testing for COVID didn't need to see a telemedicine provider. There was a different workflow for that patient. Improving both patient workflows and then just from the standpoint of patient experience, so they could get the care they needed. There's a lot of ways in which we all play a role in enhancing that patient provider experience. I really hope that some of these aspects today help to bring up some ideas and maybe some new tools in your ideas about what telemedicine is and what it can be. To review, we went through understanding best practice for a provider during telehealth visit and highlighted a few aspects that we can also help the patient before they start that visit. We talked about communication and hand-offs and the importance of that. Then we talked about HIPAA and regulation and both providers, patients, and health systems, really need to be thinking thoughtfully about this moving space and making sure we're keeping both safe and effective care in this clinical new paradigm. Thank you so much for your attention today. As always, please reach out by email for any follow-up questions you may have. Thank you for your attention.
