Thank you for joining us for today’s telehealth training. This post contains links to the various resources that I discussed via screen share
Disclosures
The webinar represents a partnership between Allina Health (my employer) and the Center for Practice Transformation. Please review my disclosures, especially that bit about seeking counsel from an experienced health lawyer. I’m a medical doctor, not a juris doctor
in partnership with
Platform/Vendor Selection
I use a number of telehealth platforms including Vidyo, Epic Warp Drive and Zoom for Healthcare. I recommend Zoom for Healthcare if you need to get up fast and don’t have an IT department supporting you. It’s literally purchase and practice. Patients just need the Zoom app, which is device and operating system agnostic (and free!)
Solo practitioners and small groups are able to purchase Zoom for Healthcare licenses on a onesie-twosie basis though resellers like LuxSci, which brings the cost down
Make sure you get a Business Associate Agreement to achieve HIPAA compliance (although a safe harbor [waiver] exists during the current public health emergency; please see below)
Scheduling
Use security features. These include meeting passwords and waiting room features [Update: Please see new post for an illustrated explainer]
Conducting Sessions
Socialize individuals and groups to expectations including
- Physical safety, e.g., no sessions while driving
- Privacy, especially in shared spaces. Think: Headsets or earbuds on both ends
- Minimizing environmental distractions (sound, light, motion)
- Deferring personal activities to personal time: smoking, vaping, eating, toileting, et cetera
- Video on (especially for groups); audio toggled on/off
Looking & Sounding Professional
Try at all times to exceed the standards of creepy basement YouTubers. The following are small touches that make a big difference
- Use good lighting. Cheap solutions are readily available on Amazon
- Place your camera at eye level. Options include putting your laptop on a few reams of paper
- Use a headset microphone. I like Sennheiser gaming headsets with noise-cancelling microphones
- Select a bland background. If none is readily available, blow in a virtual background
- Minimize environmental distractions. Under the current circumstances, that might include your kids and dog
- Look into your camera often. That’s where your patient is, not elsewhere on your screen (even if that’s where they appear to be)
- Keep your camera clean (and keyboard, too — wink, wink!). Optical wipes are available through Target and other retailers
Documentation
Payment for telehealth requires that certain elements appear in your visit documentation. The following is the header of my charting templates, where *** are elements that are populated for each encounter
- Date of Service: ***
- Start Time: ***
- End Time: ***
- Type of Service: Evaluation and management (E/M)
- Type of Encounter: Telehealth [or: Virtual health]
- Mode of Transmission: Secure, synchronous, real-time audio and video communication via Vidyo [or: Zoom for Healthcare, et cetera]
- Originating Site: *** [patient location — city and state]
- Distant Site: Minneapolis, Minn.
- Basis for Service: Virtual health, in my judgment, is an appropriate and effective means for providing this service secondary to the current COVID-19 pandemic and the need for social distancing. I have previously seen the patient for traditional in-office care and consider their mental status, including the absence of imminent danger, amenable to virtual care [the final sentence can be edited or deleted]
Collecting Clinical Data
I love scales, measures and patient self-rating forms. The same instruments that I administer in my office can also be administered via telehealth through
- HIPAA-complaint custom forms (shout out to Zach Miller at LuxSci)
- Testing vendors with secure portals, e.g., Pearson’s Q-global
- Document cameras
I’m also okay with home drug testing provided the panel includes sample validity assays and GC/MS confirmations
Notable Waivers & Exceptions
All sorts of regulatory waivers and exceptions have been granted because of the Covid-19 pandemic. Those most relevant to mental health and addiction include
- Enforcement discretion and waived penalties for HIPAA violations
- Exceptions to the Ryan Haight Act
- Medicare waivers
- Waivers and modifications granted by the Minnesota Department of Human Services
Good luck!
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Update: Here’s a link to a recording of the webinar.
