D.14 Attachment - Telehealth Program VAPIHCS.pdf

DEPARTMENT OF VETERANS AFFAIRS

PACIFIC ISLANDS HEALTH CARE SYSTEM

HONOLULU, HAWAII 96819-1522

FACILITY POLICY MEMORANDUM

NO.118-16-222

August 11,2016

VAPIHCS TELEHEALTH PROGRAM

1. PURPOSE:

To establish safe and effective clinical, business and technical guidelines for the implementation and maintenance of all Telehealth programs at VA Pacific Islands Health Care System, and all associated outlying clinics. This policy encompasses Home Telehealth (HT), Clinical Video Telehealth (CVT) Store and Forward Telehealth (SFT), as well as the My Health°Vet (MHV) and Secure Messaging (SM) programs.

Telehealth in VHA is defined as "the wider application of care and case management principles to the delivery of health care services using health informatics, disease management and telehealth technologies to facilitate access to care and improve the health of designated individuals and populations". Furthermore, Telehealth involves the use of telehealth technologies to provide clinical care in circumstances where distance separates those receiving services and those providing services. The value VA derives from Telehealth is not in implementing telehealth technologies alone, but also improving the health of Veterans by facilitating effective, cost-effective access to care in the right place at the right time. Telehealth services aim to:

a) Increase access to healthcare, including primary care, specialty care, and patient education;

b) Improve continuity and coordination of care, across the continuum of care;

c) Reduce wait times for access and treatment; and

d) Provide alternatives to long-term institutional care.

2. POLICY:

It is the policy of the VA Pacific Islands Health Care System (VAPIHCS) to integrate the use of Telehealth modalities into the care delivery strategy where appropriate, in order to increase timely, efficient access to healthcare, enhance clinical outcomes, improve patient satisfaction, and reduce health care costs. Telehealth programming at VAPIHCS shall comply with the VHA Telehealth Service Conditions of Participation (COP) and the VISN 21 Telehealth Program policy. Programming is supported by a collaborative network and facility level infrastructure that combines clinical, technical, and business expertise to facilitate standardization, promote growth, and provide oversight for the purpose of achieving and sustaining Telehealth services that improve healthcare provided to veterans and to their caregivers.

DEPARTMENT OF VETERANS AFFAIRS FACILITY POLICY MEMORANDUM'

PACIFIC ISLANDS HEALTH CARE SYSTEM NO.118-16-222

HONOLULU, HAWAII 96819-1522 August 11, 2016

3. EFFECTIVE DATE:

August 19, 2016

4. DEFINITIONS:

a. Conditions of Participation (COP): Reflect program processes (clinical, business, and technical) that are essential to the safe and effective provision of care. These standards are required for all Telehealth programs operating within VHA.

b. Telehealth Technoloqies: Information technology-based tools that collect clinical indices in the form of vital signs, disease management data, still images and live video from an originating site where the patient is located. These data are sent via secure telecommunications networks to a remote site where they are received, reviewed and assessed by clinicians. Telehealth technologies enable a range of healthcare services to be provided that cross the usual constraining boundaries of geographic distance, time, and social and/or cultural borders.

c. Telemedicine: The provision of care by a licensed independent health care provider that directs, diagnoses, or otherwise provides clinical treatment delivered using electronic communications and information technology when distance separates the provider and the patient.

d. Tele-Consultation: The provision of advice on a diagnosis, prognosis, and/or therapy from a licensed independent provider to another licensed independent provider using electronic communications and information technology to support the care provided when distance separates the participants, and where hands on care is delivered at the site of the patient by a licensed independent health care provider. When consultation is between facilities at different stations, the inter-facility consult is used for documentation of recommendations and findings. The responsibility for implementing and evaluating the plan of care as well as writing of any orders is done by the requesting provider.

e. Inter-facility Consult (IFC): A request generated within the CPRS system for care, usually specialty care, to be delivered by a provider who is privileged to practice at a different facility or health care system within the VHA. The consult request and the subsequent results of the request "travel" acrOss facility VistA/CPRS record system boundaries.

f. Local/lntra-facility Consult: A request generated within the CPRS system for care, usually specialty care, to be delivered by a provider who is privileged to practice at the facility or health care system at which the Veteran patient receives his/her primary care. The consult request and the subsequent results of the request remain with the facility VistA/CPRS record system boundaries

g. Telehealth Modalities: Telehealth activities can be facilitated through three different modalities. These include:

i. Home Telehealth (HT): A process whereby the ongoing condition of

'DEPARTMENT OF VETERANS AFFAIRS

HONOLULU, HAWAII 96819-1522

FACILITY POLICY MEMORANDUM

NO.118-16-222

August 11,2016 selected patients is assessed and monitored using Home Telehealth technologies in order to intervene early and prevent adverse clinical outcomes. Home Telehealth uses nationally recognized disease protocol algorithms to assure the delivery of appropriate, effective and efficient clinical care to the patient.

ii. Store and Forward Telehealth (SFT): A Telehealth application in which a trained imager at an originating site takes digital images and downloads them through a computer into VistA Imaging or the tele-reader software.

These are then interpreted by a consulting provider at a distant site in a timeframe that is understood by both parties.

iii. Clinical Video Telehealth (CVT): A Telehealth application that allows the patient to be examined and interviewed by a provider at one site with live interactive audio and video images seen by a consulting provider at a distant site. Clinic Video Telehealth provides an immediate evaluation of a patient's problem since the patient and consulting provider can interact.

The consultant answers questions and provides feedback and recommendations. Video to Home is a form of CVT in which secure CVT technology is used to allow the veteran to receive treatment in the home.

h. E-consult: E-Consult is an approach to provide clinical support from provider to provider. Through a formal consult request, processed and documented in the Computerized Patient Record System (CPRS), a provider requests a specialist to address a clinical problem or answer a clinical question for a specific patient.

Utilizing information provided in the consult request and/or review of the patient's electronic health record, the consultant provides a documented response that addresses the request without a face-to-face visit.

i. Telehealth Locations: Clinic Based Telehealth (CBT) refers to those Telehealth activities, Clinical Video Telehealth (CVT) and Store Forward Telehealth (SFT), which occur between institutional settings, such as medical centers, Community Based Outpatient Clinics (CBOCs), Outreach Clinics, Vet Centers, etc. The location of CBT is broken down by site:

i. Distant/Remote Site (DS)/"Provider Site"/"Provider Side": Location of the health care provider in a Telehealth setting. This term may be applied to the facility/health care system from which a provider delivers care or a Telehealth endpoint from which a provider delivers care; may be within the boundaries of one facility or health care system or cross facility/health care system boundaries as defined by VistA/CPRS record system access.

ii. Local/Originating Site (0S)/"Patient Site"/"Patient Side": Location of the Veteran patient in a Telehealth setting. This term may be applied to the facility/health care system at which the Veteran patient receives primary care or a Telehealth endpoint at which a Veteran patient receives care.

Telehealth Service Agreement (TSA): Agreement between two or more clinical

HONOLULU, HAWAII 96819-1522 August 11, 2016 endpoints that specifies and governs the clinical, business, and technical details of operations of the Telehealth services between receiving and providing facilities and/or community based outpatient clinics. The agreements may exist within one facility or between two or more facilities. They are developed by consensus; signed by service chiefs from involved services; reviewed or updated as changes are needed. The Telehealth Service Agreement outlines:

i. Roles and responsibilities of all participants

ii. Specific clinical, business, and technical operating procedures

iii. Adequate resources, including staffing, space, equipment and connectivity which are identified/ established at all sites

k. My HealtheVet (MHV) and Secure Messaging (SM):

i. My HealtheVet: a personal health record (PHR) secure, web-based portal with easy access to information, tools, and resources for use by the Veteran. The Veteran "owns" this information which includes: Self-entered information, incremental addition of data extracts copied from the EHR for authenticated VA patients as well as Prescription Refills, Secure Messaging, and the VA Blue Button. The intent of this tool is to increase consumer empowerment. Access is set up via a 3-Tier Access Model:

Visitors, Registrants, In-Person Authenticated (IPA).

ii. Blue Button: Information extracted from the VA Electronic Health Record that is available for patients to view, download or print. This includes:

clinical notes (progress notes); admissions and discharges; active problem list; vitals and readings; laboratory results including microbiology;

pathology reports; radiology reports; electrocardiogram (EKG list);

demographics (past three years); VA continuity of care document (CCD), a summary of clinical information that can be exchanged between health care providers to improve patient care coordination. VA CCD can be viewed by providers with the capability to read a CCD file, or the file can be imported elsewhere (e.g., Microsoft Health Vault).

iii. Secure Messaging: Secure Messaging is a secure web-based mail system that allows communication of a non-urgent, non-emergency health-related nature between patients and VA staff. Patients may participate in Secure Messaging if they are a registered My HealtheVet account user and have completed the My HealtheVet In-Person Authentication (IPA) process.

Veterans can request appointments, prescription renewals, ask health and/or other clinical or administrative questions. Patients utilizing this option need to agree to specific terms and conditions regarding this function.

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5. PROCEDURES:

VAPIHCS incorporates the required clinical, business, and technical structure needed to promote, manage, and sustain successful Telehealth Programs.

a. General Telehealth Procedures:

I. Telehealth is included in the VISN strategic plan.

Telehealth Providers must comply with VAPIHCS mandatory security requirements, as well as adhere to VAPIHCS patient confidentiality and privacy policies.

Hi. This policy as well as Patient Care Service level Standard Operating Procedures address the following:

1. Criteria for admission or clinical application;

2. Criteria for discharge or discontinuation of clinical application;

3. Confidentiality;

4. Cleaning/decontamination of Telehealth equipment between patients;

5. Equipment storage, inspection and maintenance;

6. Equipment quality control;

7. Troubleshooting faulty equipment;

8. Emergency plans for clinical and technical disruption of services;

9. Standard Operating Procedures for scheduling and coding; and

10.Competency training.

iv. Collaboration among the Facility Telehealth Coordinator, the facility OIT contact and the facility Biomed contact is essential to insure the compatibility of Telehealth equipment prior to purchase. Specific responsibilities regarding installation, troubleshooting and equipment maintenance are delineated in the VISN 21 OIT/ Biomed Service Level Agreement.

v. It is imperative that VHA Handbook 1730.1 and applicable VA Acquisition Regulations (VAAR) or Federal Acquisition Regulations (FAR) are followed when procuring equipment for individual patients and various medical devices. As appropriate, National Prosthetic Clinical Management Program (PCMP) contracts and/or blanket purchase agreements must be utilized.

vi. The Telehealth Program follows established emergency contingency

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August 11, 2016 plans for Patient Care Service that includes drills to monitor effectiveness of plan and staff responses conducted at routine intervals. Plans include both technology emergencies and patient condition/behavior emergencies.

b. My HealtheVet and Secure Messaging Procedures:

i. The process for enrollment into My HealtheVet and Secure Messaging includes procedures as established by VA Central Office and the MHV National Programming Office, including but not limited to completion of VHA Form 10-5345a-MHV as detailed in VHA Handbook 1907.02, entitled My HealtheVet In-Person Authentication.

ii. Electronic outreach provides information on VA education, programs, and services. Electronic Outreach allows for one-way mass communication with VA Patients with non-personal Pll or PHI information and may be utilized to promote My HealtheVet and Secure Messaging. Electronic Outreach services shall never contain personally identifiable or personal health information and shall not be addressed in the "To" address option to a specific individual, unless using a mail merge option.

iii. Secure Messaging through My HealtheVet is a web-based communication system that allows participating VA patients and VA health care teams the ability to communicate non-urgent, non-emergent health-related information in a secure online environment.

Staff may only utilize Secure Messaging to communicate Personal Health Information (PHI) between VA Patients and Staff. Staff as designated by VA Central Office is to participate in Secure Messaging.

iv. Staff participating in Secure Messaging shall follow established protocols for receiving and responding to Secure Messages within the SM application.

c. Consent:

i. Informed Consent is required for all clinical treatments and procedures, including those delivered via Telehealth. As such, the Telehealth program complies with VAPIHCS FPM 136-14-20, Informed Consent for Treatment and Procedures.

ii. Verbal Consent: Signature consent is not required when the treatment or procedure to be delivered via Telehealth is low-risk and within commonly accepted standards of practice. Verbal consent for Telehealth services need only to be obtained at the commencement of treatment and/or care program and is not required for each individual Telehealth session. The provider must obtain informed consent and document this verbal consent within CPRS at the commencement.

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iii. Signature Consent: Signature consent is required for Telehealth if the care can reasonably be expected to produce significant patient discomfort or the patient is at risk for complications.

iv. A consent/release for Use of Picture or Voice (VA form 10-3203) must be signed if a permanent photograph or video recording is being disclosed to an entity covered by VA. It is not necessary if the photo or recording remains within the patient file and is not released. This form that must be signed by the patient is a document that serves as a release of picture and/or voice information. As such, it is not a document of informed consent.

v. In the event the Telehealth session is part of a research study, written consent must also be obtained per VHA research guidelines.

d. Credentialing and Privileging:

i. All Telehealth providers who are Licensed Independent Practitioners (LIPs) are credentialed and privileged to provide the clinical services offered through the Telehealth modality in accordance with VAPIHCS Credentialing and Privileging Facility Policy Memorandum No. ECMS- 11-16-090, dated April 6, 2016.

ii. Consistent with current Joint Commission standards related to credentialing and privileging and VHA Directive Handbook 1100.19 Credentialing and Privileging, all VHA clinical practitioners involved in the provision of clinical Telehealth services are subject to all existing requirements for credentialing and must be privileged at their home facility for the service they are providing.

iii, For Telehealth consultation between facilities at different stations, the medical provider must be credentialed and privileged at the distant site location and a copy of the credentials must be available to the originating site using either VetPro or a Credentials Transfer Brief.

iv. For telemedicine between facilities at different stations, when services are being provided by a practitioner who directs, diagnoses, documents orders or otherwise provides clinical treatment to a patient using a telemedicine link, the practitioner must be appointed, credentialed and privileged at the facility where the practitioner is located and a copy of the credentials must be available to the originating site using either VetPro or a Credentials Transfer Brief. A signed Memorandum of Understanding between the facilities must be obtained.

v. VAPIHCS abides by the VISN21 Telehealth MOU for Credentialing and Privileging when developing Telehealth services between VAPIHCS and other sites within VISN 21. For services between

HONOLULU, HAWAII 96819-1522 August 11,2016

VAPIHCS and sites outside of VISN 21, a signed Telehealth MOU will be in place.

e. Telehealth Service Agreements (TSA):

I. Telehealth Service Agreements must be in place to detail the clinical, business, and technical operations of all Clinical Video Telehealth (CVT) and Store and Forward Telehealth (SFT) services.

ii. All staff involved in the delivery of CVT and SFT services shall follow the procedures outlined in their service specific TSA.

TSAs are signed and approved by Service Chiefs and are reviewed and updated annually as needed, or as changes occur.

iv. Inter-facility TSAs are presented to the Clinical Executive Board for Approval.

f. Continuous Process Improvement:

i. Telehealth has various core quality and performance measures with continuous monitors. The VAPIHCS Facility Telehealth Coordinator is responsible for submitting data for analysis to the VISN 21 Telehealth Program Manager, on an as needed basis. The Facility Telehealth Steering Committee, under guidance of the committee chair, reviews and monitors various workload measures on a monthly basis, and monitors data to initiate changes for improvement.

ii. Core clinical, business and satisfaction data are collected and reviewed on an ongoing basis. Opportunities for improvement are identified, and recommendations made, by the VAPIHCS Telehealth Steering Committee.

g. Clinic Based Telehealth Procedures:

i. Standard Operating Procedures:

1. Patient Care Service level Standard Operating Procedures (SOPs) and applicable TSAs are followed by all staff involved in the delivery of Clinical Video Telehealth (CVT) and Store and Forward Telehealth (SFT) services.

ii. Planning and Implementation:

1. VAPIHCS serves a 2.3 million square mile area of the Pacific with remote island locations separated by great distances of ocean. Additionally, the region is designated by VHA as rural in the majority of the catchment area. As such, VAPIHCS acknowledges the "need" for Telehealth services, and it is the policy of VAPIHCS to prioritize the use of Telehealth modalities for clinical care, consultation and coordination of care where

'DEPARTMENT OF VETERANS AFFAIRS FACILITY POLICY MEMORANDUM

HONOLULU, HAWAII 96819-1522 August 11,2016 such use is deemed appropriate.

iii. Clinical Pathways: VAPIHCS Telehealth programs utilize a clinical pathway that includes registration of patients on remote Vista systems, scheduling, coding, consults, workload capture and documentation of care.

iv. Scheduling:

1. The scheduling system for CVT visits does not differ from the system already in place for in-person visits in terms of telephone access number, personnel, etc. TCTs and/or other administrative clinic personnel coordinate scheduling of CVT encounters as outlined in the Telehealth Service Agreements.

2. Scheduling for SFT is coordinated by the TCTs and/or other administrative personnel as outlined in the Telehealth Service

Agreements and in the applicable SOPs.

v. Clinic Environment and Space:

1. Standard requirements for all clinical spaces such as an adequate space for special needs patients and/or employees to navigate using wheelchairs must be re-assessed with the addition of Telehealth equipment to ensure it still meets accessibility standards;

2. For gender-specific procedures and examinations, clinics must ensure that the clinical environment and spacing of the examination rooms, equipment, and female chaperones are considered (See VHA Handbook 1330.01 Health Care Services for Women Veterans);

3. CVT space for groups is dependent on the size of the group and the clinical application.

vi. Documentation of Clinic Based Telehealth visits:

1. Encounter forms for each clinic include the location title for all provider-side visits (e.g. Smoking Cessation CVT, MOVE CVT, Diabetes Education CVT, etc.)

2. Encounter forms are populated with the appropriate Telehealth encounter codes and modifiers.

3. Encounter forms will be completed in accordance within 7 calendar days in accordance with VAPIHCS Medical Records Management Facility Policy Memorandum No. 136-13-001, dated May 03,2013

4. Encounter forms must be completed for the provider-side and

HONOLULU, HAWAII 96819-1522 August 11,2016 the patient side of every Telehealth visit:

a. For CVT visits, the patient-side encounter forms shall be completed using the Q3014 CPT code, and the provider-side encounter form shall include the GT modifier.

b. For SFT visits, the GQ modifier (asynchronous communication) should be attached to the provider-side encounter form.

i. In the event that VistA does not allow you to append GQ to the CPT code, the encounter must occur in a clinic with stop codes identifying Telehealth.

vii. Infection Control:

1. All Clinic Based Telehealth equipment must be cleaned according to the manufacturer's recommendation and VAPIHCS FPM# 11-15-032, Cleaning and Disinfection of Non- Critical Reusable Medical Equipment, as outlined in the Patient Care Service SOP entitled Cleaning of Clinic-Based Telehealth Equipment.

viii. Workload Capture and Data Management: It is critical that all activity for Telehealth be coded correctly in order to monitor clinical activity and to undertake routine outcome measurements that ensure clinical quality:

1. Matching CVT and SFT patient and provider side clinics will have the same primary stop codes.

2. The secondary credit stop for CVT and SFT is determined by the location of the patient and the provider, and follows the Office of Telehealth Services' business rules outlined in the Clinic Based Telehealth Operations Manual.

3. CVT patient and provider side encounters occur on the same day and are closed out according to the terms agreed upon in the specific Telehealth Service Agreement.

ix. Equipment Management: Telehealth equipment and technical support requires collaboration between the Telehealth program, Biomedical Section of FMS and the Office of Information & Technology (01T).

1. Central Enterprise Video Network: All CVT equipment is to be registered with the Clinical Enterprise Videoconferencing Network (CEVN) by OIT and is to be tracked in the facility's Telehealth Equipment Inventory List

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2. Troubleshooting Pathways and Infrastructure: A technical support pathway ensures that adequate planning and technical supports are in place and available in the event technical difficulties occur while conducting Telehealth encounters.

x. Patient Education: Patients should be oriented to the Telehealth program environment and understand their rights, responsibilities and Telehealth policies. The orientation and education includes information on the mission and vision of the VAPIHCS Telehealth Program.

xi. Staff Training & Competencies: All clinical staff responsible for the delivery of care to patients using CVT, SFT or HT must possess a minimum level of technical competency to deliver the level of consultation, care and treatment involved. Training is role specific, and staff must comply with the mandatory training requirements outlined on the VHA Telehealth Services website located at:

http://vaww.telehealth.va.gov/roles/prvdr/index.asp

h. Home Telehealth Procedures:

i. Any VAPIHCS patient may be assessed for enrollment in the Home Telehealth program through a consult request entered into CPRS.

ii. Patients meeting Non-Institutional Care criteria are given priority

iii. Lead Care Coordinator or other designated personnel will review all consults to ensure patients are appropriate for the program.

iv. Upon enrollment, patients will be placed in the appropriate category of care based on a formal assessment and individual patient health status

v. Each patient and/or Caregiver accepted for Home Telehealth will demonstrate competency in equipment use and maintenance

vi. Patient/Caregiver will be instructed on Home Telehealth patient rights and responsibilities, the disease process, medication management, behavioral lifestyle modifications and the Home Telehealth emergency plan.

vii. Data from the Telehealth device will be checked by the Home Telehealth Care Coordinator. Monitoring will be done at a frequency established by the individual program and consistent with the clinical needs of the patient.

viii. Interventions and responses to treatment as required will be documented in CPRS progress note per medical center policy.

ix. The patient's primary care provider / RN will be notified of any change

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x. Workload will be captured in accordance with VISN and national coding guidelines for Home Telehealth.

xi. Patients will be discharged from the Home Telehealth program upon:

1. Admission to a nursing home or other long term care facility

2. Relocation outside of the VAPIHCS catchment area

3. Achievement of his/her clinical goals

4. Non response for 30 consecutive days or a desire to no longer participate in the program

5. Expiration

6. RESPONSIBILITY:

a. The VAPIHCS Director is responsible for the planning, coordination, implementation and evaluation of clinical and administrative applications of the Telehealth Program.

b. Associate Director Patient Care Service/ Nurse Executive (ADPCS/NE) is responsible for the overall coordination and operation of the Telehealth program to include, but not limited to:

i. Approving the procedures to identify the appropriate Telehealth population, utilizing proven needs assessment tools which assist in identifying and stratifying patients by risk and need.

ii. Ensuring VAPIHCS complies with all laws, regulations, IT, Information Security, and VHA privacy mandates applicable to Telehealth and Telehealth technologies.

Hi. Ensuring the documentation of services complies with VHA and health care system policies.

iv. Verifying that Telehealth Providers have the required skills and training to provide Telehealth services in their respective health care setting.

v. Identifying and providing the appropriate staff to deliver Telehealth and My HealtheVet services, Staff includes the Facility Telehealth Coordinator, Telehealth RN, Lead Home Telehealth Care Coordinator, Home Telehealth Care Coordinators, My HealtheVet Coordinator, and Telehealth Clinical Technicians at sites where Telehealth activities are taking place, as appropriate for the Telehealth application.

vi. Acquiring the appropriate Telehealth and MyHealtheVet equipment and telecommunication platforms.

HONOLULU, HAWAII 96819-1522 August 11, 2016

vii. Establishing and utilizing appropriate VHA and VISN workload reporting and data management systems and performing systematic audits of Telehealth and MyHealtheVet workload reporting systems, processes and data.

viii. Ensuring that core clinical, business and satisfaction quality and performance measure monitors related to Telehealth programming are tracked and improvement processes are implemented.

ix. Ensuring that VISN Telehealth/Biomed and OIT service level agreement is maintained.

x. Verifying emergency contingency plans for technical and behavioral emergencies are documented and in accordance with other health care system emergency policies.

xi. Ensuring all Patient Care Service staff are aware of and in compliance with this policy, have the required competencies; and for updating this policy. The ADPCS ensures that Quality Assurance measures are developed and implemented for the Telehealth Program to assure the highest level of patient outcomes and satisfaction.

c. Chief of Staff (COS) is responsible to ensure that medical staff working in Telehealth modality has the appropriate training/competencies.

d. Service Chiefs are responsible to ensure that any of the staff participating in Telehealth modalities are aware of and in compliance with applicable TSAs.

e. Chief, Biomed Section of FMS, is responsible for ensuring the telehealth equipment is maintained according to manufacturers' specifications.

f. Chairperson(s), Telehealth Steering Committee is responsible to provide oversight and coordination of VAPIHCS's Telehealth Program; report to the ECMS and to include VAPIHCS leadership representatives along with additional clinical, business, and technical expertise in order to:

I. Develop policies, procedures, and standards for the development, deployment, operation, and management of Telehealth initiatives specific to VAPIHCS.

ii. Facilitate communication and dissemination of information regarding VISN and VHA Telehealth Services initiatives, and ensure that Telehealth services are integrated throughout the facility.

iii. Assist in the development of facility level Telehealth strategic planning, develop recommendations for facility level Telehealth initiatives, and act as a consultative body for VAPIHCS program staff and initiatives.

iv. Monitor core clinical, business, satisfaction, and quality performance

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August 11,2016 monitors related to Telehealth programming at VAPIHCS, ensuring compliance with the VHA Office of Telehealth Services Conditions of Participation, the Privacy Act, Health Information Portability and Accountability Act (HIPAA) and relevant VANHA regulations and VISN Directives and guidance.

g. Facility Telehealth Coordinator (FTC): works closely with the ADPCS/NE and ensures the specifics of the Telehealth Program are administered and operationalized. The FTC:

i. Chairs the VAPIHCS Telehealth Steering Committee;

ii. Participates as a member of the VISN 21 Telehealth Workgroup;

iii. Establishes the core requirements of the facility Telehealth programs, including development and implementation of guiding processes, principles and policies for the development, operations, staffing roles and responsibilities and oversight of Telehealth processes within the facility;

iv. Provides technical and/or administrative support for Telehealth applications;

v. Ensures the use of resources (rooms, equ'ipment, bandwidth, etc.)

and patients for the Telehealth program is planned and coordinated;

vi. Serves as a liaison between image reviewers, primary care providers, specialty care providers, patients and other VA personnel;

vii. Coordinates activities between originating and distant sites as needed;

viii. Provides general oversight of the VAPIHCS Telehealth program, serving as a resource for the business, technology and clinical aspects of the program;

ix. Ensures that VAPIHCS strategic plans include sustainment and expansion of Telehealth programs based on clinical and business needs assessment;

x. Ensures that VAPIHCS Telehealth programs establish and utilize appropriate VHA coding, workload reporting and data management systems and works with VISN Telehealth lead, data analyst and/or appropriate staff to set up systems for appropriate workload tracking and reporting; and

xi. Ensures that Telehealth Service Agreements are developed for all Telehealth programs and services within VAPIHCS

h. Lead Home Telehealth Care Coordinator is responsible for oversight of Home Telehealth activities within VAPIHCS; serves as a point of contact for

HONOLULU, HAWAII 96819-1522 August 11,2016 information, assists with program development and growth, participate in facility strategic planning, and manage program activities to ensure consistency of care and adherence to the Conditions of Participation;

collaborates closely with the FTC.

i. Home Telehealth Care Coordinator is a Licensed Professional who is responsible for providing Home Telehealth. He/she has specific training and competency in the use of disease management protocols, healthcare informatics and HT technologies with complex Veteran patients, and is responsible for:

i. Coordinating care for a panel of patients across the continuum of care.

ii. Assuring care is timely, appropriate, of high quality and cost effective

iii. Serving as a case manager/ clinical HT coordinator while collaborating with primary care and specialty providers to optimize the veteran's health status.

Telehealth Clinical Technician (TCT) is the VAPIHCS staff member who facilitates Telehealth services by operating within one or more of the TOT roles described below:

i. Tele-presenter

1. The Tele-presenter arranges the environment for an optimal teleconferencing experience, attends to any clinical needs for the visit (e.g. manipulating a digital stethoscope, exam camera, or other Telehealth peripheral device), checks the Veteran out of the patient side clinic at the conclusion of the visit, and documents their part of the visit activity in CPRS.

2. The Tele-presenter role falls, by default, to the patient site Telehealth Clinical Technician. If the nature of the clinical visit requires a wider scope of practice or another discipline (e.g.

RN), this need is specified in advance in the Telehealth Service Agreement, as completed by the participating clinicians at the time the service is implemented.

ii. Imager

1 The imager has the skills to image a portion of a patient's anatomy for purposes of patient care only, enter the image into VISTA imaging, and alert a provider who reads/assesses the image later. This individual has been educated in the special skills necessary to effectively capture, store, and forward images. The imager follows national guidelines and is responsible for the quality of the image that is provided to the

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2. The imager uses VistA to check the Veteran out at the conclusion of the visit, documents their part of the visit in CPRS, and closes the "patient side" encounter. The imager role falls, by default, to the patient-site Telehealth Clinical Technician. If the nature of the clinical visit requires a wider scope of practice or another discipline (e.g. RN), this need is specified in advance in the Telehealth Service Agreement, as completed by the participating clinicians at the time the service is implemented.

Telehealth Scheduler

1. The scheduler is the member of the Telehealth team that schedules the provider, patient, and Tele-presenter as needed by communicating to clinic support staff or using scheduling software (i.e. VISTA, Outlook, or SharePoint). The scheduler manages appointment rescheduling and cancellations as needed.

2. The scheduler role may fall to a local facility or a consulting facility's Telehealth Clinical Technician. This individual has been educated in the special skills to use the VistA appointment management system and has knowledge of the clinical program requirements for equipment and the Tele-presenters necessary for a visit.

iv. Technical Support

1. The Technical Support staff is the member of the Telehealth Team that verifies and assures the optimal performance of, and the appropriate cleaning of, the technical equipment involved in the visit. This individual has been educated in the special skills to operate the Telehealth equipment and associated peripheral equipment and troubleshoots problems that may occur with the equipment during the course of the visit.

2. Ensures that Telehealth technology standards are specified and available for operation of the Telehealth program. This includes both provider and patient sites

v. Administrative Support This role addresses office organization and flow of Telehealth work processes, examination of reports and outcomes for quality improvement purposes, and is shared by all TCTs in VAPIHCS

k. The Reader in Store and Forward Telehealth applications is the person located at the distant site that is responsible for responding to a consult

DEPARTMENT OF VETERANS AFFAIRS FACILITY POLICY MEMORANDUM

HONOLULU, HAWAII 96819-1522 August 11,2016 request by viewing and interpreting digital images acquired at the originating site. National standardized training and certification is required of this position for tele-retinal readers.

I. The Consulting Provider in clinic video telehealth applications is located at the distant site and is responsible for responding to a consult request from the originating site by engaging in clinic video telehealth clinics with patients and/or clinical staff located at the originating site.

m. The Referring Provider is located at the originating site and is responsible for initiating a patient consult and following up on consultant recommendations.

n. The Facility MHV Coordinator leads VAPIHCS' efforts to integrate MHV and SM among health care providers and patients and is responsible for:

i. Formulating/implementing marketing strategies to include the development of campaign materials and presentations to inform targeted audiences about MHV and its capabilities.

ii. Scheduling and conducting SM training sessions for staff that prior to using SM and managing the SM Administrative Portal.

iii. Providing medical center leadership with MHV program progress reports and making recommendations to improve the operations and goals of the program.

iv. Providing MHV related content to the Public Affairs Office for use in the facility's web and social media sites.

v. Assisting patients and staff in troubleshooting problems with MHV or

SM.

vi. Tracking integration of MHV and SM within the facility, growth of the number of patients who have completed the In-Person Authentication (IPA) process within the facility and the number of patients who have selected to Opt-in for SM.

7. REFERENCES:

a. The Joint Commission Comprehensive Accreditation Manual, 2013

b. VAPIHCS FPM# 136-14-20, Informed Consent for Treatment and Procedures, dated May 1, 2014

c. VAPIHCS FPM# ECMS-11-16-090, Credentialing and Privileging of Medical Staff and Licensed Independent Practitioners, dated April 06, 2016.

d. VAPIHCS FPM# 136-13-001, Medical Records Management dated May 03,2013

DEPARTMENT OF VETERANS AFFAIRS FACILITY POLICY MEMORANDUM

HONOLULU, HAWAII 96819-1522 August 11, 2016

e. VAPIHCS FPM# 11-15-032, Cleaning and Disinfection of Non-Critical Reusable Medical Equipment, dated March 25,2015

f. VAPIHCS Patient Care Service SOP for Consult Management: Telehealth Services.

g. VAPIHCS Patient Care Service SOP for Clinical Video Telehealth

h. VAPIHCS Patient Care Service SOP for Teledermatology

i. VAPIHCS Patient Care Service SOP for Cleaning of Clinic Based Telehealth Equipment

j. VHA Handbook 1004.01, Informed Consent for Clinical Treatments and Procedures, dated August 14, 2009.

k. VHA Handbook 1004.05, iMED Consent, dated March 19, 2009.

I. VHA Handbook 1100.19, Credentialing and Privileging, dated November, 14, 2008.

m. VHA Directive 2008-056, VHA Consult Policy, September 16, 2008.

n. Department of Veterans Affairs. My Health eVet Product Homepage.

http://vaww.va.qov/MYHEALTHEVET/index.asp

o. Department of Veterans Affairs. VHA Secure Messaging SharePoint.

http://vawmoed.portal.va.qov/development/target/veteran health/myhealthev et/SMChampions/default.aspx

p. VHA Handbook 1907.02, My HealtheVet In-person Authentication, dated June 27, 2008.

q. VISN 21 Telehealth Program Policy Statement No. 10N21-21, August 4,

8. RESCISSION: Facility Policy Memorandum 118-12-222 Home Telehealth Program, dated: June 13, 2012.

9. ATTACHMENTS: None

10. REVIEW DATES: August 2017, August 2018, August 2019, August 2020

11.REISSUE DATE: August 2021

HONOLULU, HAWAII 96819-1522

FACILITY POLICY MEMORANDUM

NO.118-16-222

August 11,2016

12 .FOLLOW-UP RESPONSIBILITY: Facility Telehealth Coordinator

Tonle J. Bagby, PsyD Date:

Acting Director