Hello. My name is Candace Sadorra, and I'm the telehealth operations manager at the UC Davis Center for Health and Technology. Today, I'll be talking to you about provider and patient preparation. The objectives for this course are to understand the different telehealth modalities, understand the dynamics of a telehealth visit. Before we begin, I'd like to review a few of the definitions of terms that I will be using throughout this presentation. The following are terms as defined by The Centers for Medicare & Medicaid Services. The originating site, is the physical location of the patient at the time of the telehealth visit. The distant site is where the provider who's furnishing the telehealth services is located. Before we dive into how to prepare for telehealth visits, it is important to understand the more common types of telehealth modalities. In the area of synchronous telehealth visits, where there is a live audio and video connection, there are a few different models of care. The first one is demonstrated here, which is the provider to provider consultation. In this model, the patient is with their primary care provider and connects over a live video connection to the specialist. This is typically a consultative model, where the specialists or distant site provider evaluates the patient over video and provides recommendations to the primary care provider, also known as the originating site provider. The primary care provider is then responsible for the patient's treatment plan, and this helps to maintain the patient's medical home with their primary care provider. Direct interaction can happen during this visit where the patient and primary care can ask questions about the recommendations in real-time. Another type of synchronous telehealth visit is usually referred to as a direct to patient model. This is where the patient is located in their home, seeing their primary specialty, or other type of provider over live video. In this case, the telemedicine provider is responsible for the care of the patient and will enter orders, prescriptions, answer any questions, and also be responsible for the follow-up care, if necessary. Lastly, there are the asynchronous models. Here, images or recorded video are taken and sent for review, and interpretation at a later date and time. There are direct to consumer models where the patients can take a photograph or video and send to a provider for evaluation, or in the provider to provider model, the clinicians are able to send electronic communications, such as staff messaging or an E-Consult order. The E-Consult modality is designed to increase access to care, improve communication and collaboration, and ultimately improve outcomes. There are also new models where facilitated recorded consults are sent to a provider for a review and evaluation, and studies are currently evaluating the effectiveness of this model when compared to synchronous consultations. Now for the patient side of things, here are some tips to get started. You and the clinic staff should be prepared to explain the telehealth visit prior to scheduling, such as what is involved? How to connect? What they can expect? What copays or fees may be expected? And the benefits of doing telehealth. Be sure to share available resources with patients like tip sheets, websites, technical support, and who to call if they have any questions or issues. If a copay will be required, explain this ahead of time, and how they can expect to pay, so there aren't any surprises. In the provider-to-provider model, make sure that the room where the patient and clinician will be connecting from is quiet, secure, has adequate lighting, and there is telehealth equipment to conduct the synchronous telehealth consultation. When explaining a telehealth visit, it will be important to review the following, which should, again, be available in the resources described in the previous slide. First, test your equipment, cell phone, tablet, computer. Are they able to navigate to the website? Do they have the right app? Do they know how to log in? And can they connect? They should also have a reliable and strong Wi-Fi connection. They should be in a quiet and secure location , free of distractions. Oftentimes, copays or other fees will be collected prior to the connection, depending on their insurance coverage, so be sure to review this with them. Lastly, like any other visit, be prepared with your list of questions for the provider, and have a clear list of your current medications. Sometimes patients may even have their pill bottles, candy. There are also some important operational considerations. When establishing your program, consider where your documentation will live. Is it going to be in your site's electronic health record? Or will it be in the originating site's electronic health record? And what is the scalability for multiple organizations with different electronic health records? And required training and logins for your providers. Do you have an interpreting program, that can also do telehealth, and easily join visits? Does your platform support multiparty video? That is, what if mom and dad, grandma, or the husband and wife, who are all in different locations, but want to be in the visit, can they join? Radiology and imaging. How will you obtain access to or receive these in advance of the visit? Most important, develop your workflows which incorporates all of the above such as how do patients come into the system? How will documentation for visits be communicated? Insert if and when interpreting is needed and how they'll connect. Does radiology, imaging need to be sent in, in front of the consult? And how will that be done? Also, remember to prepare documentation and tools for both your providers, and the patients on what to expect, how to connect, and whom to contact for any questions. These are just a few of the key items to consider when developing your workflows. In summary, you should be able to, again, understand the different telehealth modalities, understand the dynamics of a telehealth visit. Thank you very much.
