D.18 36C26126R0014 SOP-HT-03_Remote Patient Monitoring - Home Telehealth.docx

Remote Patient Monitoring - Home Telehealth (RPM-HT) Emergency Preparedness Plan (EOP) & Continuity of Operations Plan

VA Northern California VA Health Care System (VANCHCS) Mather, CA 95655 Signatory Authority:

RPM-HT Nurse Manager Responsible Owner:

Chief Nurse Team Lead Program Director, Home Based Primary Care & Home Telehealth

Service Line(s):

Connected Care/GEC/Remote Patient Monitoring (RPM)-Home Telehealth (HT) Effective Date:

December 04, 2024 Recertification Date:

December 04, 2029

1. SUMMARY OF CONTENT

This document details the Remote Patient Monitoring-Home Telehealth (RPM-HT) program process in the event of an emergency that could result in an interruption of RPM-HT services at VANCHCS.

2. PURPOSE AND AUTHORITY

a. The purpose of this standard operating procedure (SOP) is to establish procedures on optimum care and support enrolled RPM-HT Veterans in the event of an emergency that could result in an interruption of RPM-HT services. This SOP must be followed by RPM-HT staff members who are responsible for caring for enrolled RPM-HT Veterans.

(1) In the event of a disaster or emergency, RPM-HT will make every effort to minimize service disruption, and to account for the Veterans safety and well-being.

(2) Every effort will be made to contact RPM-HT Veterans requiring life support devices and/or those whose health status would be severely jeopardized by an interruption to RPM-HT services.

(3) The VANCHCS Emergency Management Plan for the RPM-HT program is to be conducted in coordination with the NCHCS and facility emergency plans, and consists of four phases: preparedness, response, recovery, and mitigation. All incidents will be reported, documented, assessed, and actions taken to promote emergency preparedness.

b. There is no governing document.

3. PROCEDURES

a. Preparedness. All RPM-HT staff must familiarize themselves with their facility’s Emergency Operation Plan (EOP). This plan identifies which authorities are responsible for responding to emergencies and disasters.

(1) Upon Enrollment. Veterans and Caregivers are mailed emergency preparedness information on the following items, including:

1. Access to VANCHCS, both during RPM-HT Program hours, and after-hours.

2. The Clinical Contact Center number 1-800-382-8387 and the VA Disaster Hotline and Recourses number 1-800-507-4571.

3. Emergency items to have easily accessible, i.e., flashlight, batteries radio (which can operate on batteries, etc.), and are asked to verbalize an escape route from their home in case of fire.

4. How to prepare for an emergency or disaster.

5. Actions that will be taken by RPM-HT staff in the event of a disaster and power failure.

6. Veterans who require life support equipment such as oxygen, CPAP, or routine nebulizer treatments will be given instructions regarding contacting their local power supplier to notify them of the presence of life support or medically necessary equipment.

(2) All RPM-HT Veterans Will be Assessed to Determine the Level of Response by Care Coordination Staff. The following criteria will be utilized to categorize RPM- HT Veterans:

(a) Level 1 (High Priority). Level 1, High Priority Veterans, are Veterans who need Immediate Evaluation within 1 business day, and meet any of the following criteria:

1. Veterans that live alone with cognitive impairment psychological diagnosis with possibility of decompensation related to the disaster and/or unable to access resources.

2. Veterans that are on life support, oxygen, or ventilator dependent.

3. Veterans with caregivers that are low functioning, cognitively impaired, and cannot access resources.

4. Veterans’ dependent for assistance with medication management and/or unable to self-administer insulin or if Veteran is unstable on coumadin.

5. Interruption of health services would severely impact.

6. Veteran's ability to meet basic physiological and safety needs.

(b) Level 2 (Moderate Priority). Level 2, Moderate Priority Veterans, are Veterans who need to be evaluated within three to seven business (3-7) days, and meet any of the following criteria:

1. Veterans who can manage within 3-7 business days without HT intervention.

2. Veterans who are unable to carry out medical plan of care independently for more than 3-7 days.

3. A Phone call required if the Veteran is dependent on HT for medication refills.

(c) Level 3 (Low Priority). Level 3, Low Priority Veterans, are Veterans who can go seven to fourteen (7-14) business days without HT intervention, and meet any of the following criteria:

1. Veterans that have physical, emotional, and local resources, and can access them.

2. Veterans who have caregivers that are not cognitively/physically impaired.

3. Veterans who have friends and/or family able to assist with accessing resources.

b. Response Activities.

(1) Facility Emergency.

(a) The decision to implement the emergency plan can be made by the VISN Telehealth Program Manager, or any member of executive leadership at the VISN, or facility level. The RPM-HT Lead Coordinator should contact the VISN Telehealth Program Manager when criteria are met to activate the plan.

(b) If the emergency plan requires implementation, an email will be sent to the V21 CCHT mail group (V21MACNCHCSCCHT@va.gov) to notify all care coordinators of the event. The Lead HT Coordinator will notify staff by direct contact, phone, email, or instant message (IM).

(c) Each VISN site will maintain a once-a-month list of all Veterans enrolled in RPM- HT.

(d) The VA Northern California RPM-HT list is uploaded on near the first of the month to VISN Emergency Continuity of Operations (COOP) SharePoint site (access limited and granted to appropriate staff only).

(e) The table below documents the established cross coverage for each facility. If additional resources are needed, the VISN Telehealth Program Manager, or any member of executive leadership at the VISN level may assign additional support.

(f) In the case of a FACILITY emergency that affects San Francisco HCS, Northern California HCS will be notified by VISN leaders to enact the COOP plan.

(g) The Nurse Manager or Designee will divide the list by Care Coordinator and add them responsible to a column.

(h) Using the Emergency list, each Care Coordinator will be contacted.

(i) Each Care Coordinator will contact the Veteran listed.

(j) Notification of Disaster Affecting Our “Sister Site”. Upon notification of a disaster affecting our designated “sister” site, NCHCS Care Coordinators will begin notifying:

1. Level 1 patients affected by the disaster within one (1) business.

2. In the event of a continuing disaster or emergency, Level 2 patients within three to seven business (3-7) days as indicated above, and Level 3 patients will be contacted if the situation continues beyond seven to fourteen (7-14) business days.

3. In the event of irreparable damage to the facility infrastructure, the RPM-HT program office(s) will be secured to avoid further damage and the vendors will be notified of the situation.

(k) Notification Information. Notification will consist of:

1. Informing patients their Care Coordination program is unable to monitor their information.

2. If they are experiencing problems due to their chronic health condition, or due to effects of the disaster, they should seek assistance through appropriate local resources.

3. It is not the expectation that the “sister site” will provide monitoring and care coordination.

4. Veterans will be updated on the status of health care delivery and support, and asked questions, including:

(1) Availability of services.

(2) Telephone coverage.

(3) Verify they have numbers of emergency services including ambulance, equipment, and oxygen supplies.

(4) Verify safety and availability of urgent or emergency room services including the Red Cross.

(5) Are you safe?

(6) Do you have media avenues to hear of mandatory evacuations?

(7) Do you have an evacuation plan if needed?

(8) Do you have enough food?

(9) Do you have enough water?

(10) Do you have enough medicine?

(11) Do you have enough oxygen?

(12) Veterans will be provided the non-emergency contacts, based on county as listed on the Emergency.

(13) Plans for resuming HT Program in-home monitoring.

(14) Care Coordinator will document in the designated area per RPM-HT Nurse Manger relevant information for site staff when RPM-HT services resume.

(15) If the VANCHCS cannot provide RPM-HT services due to an emergency, the VISN COOP plan will take effect to manage coverage of the Veterans on RPM-HT and Palo Alto will cover NCHCS RPM-HT Veterans using the same protocol listed above.

(2) Computer Service Disruption.

(a) If computer service is minimally disrupted is less than 24 hours and the interruption is not directly following or before a weekend, Care Coordinators should continue to actively care and case manage the Veterans they know have current problems, receive telephone calls, and act on updates/alerts.

(b) If computer service interruption occurs during the week and disruption is anticipated to be longer than 24 hours, all RPM-HT Veterans will be informed and instructed as to the course of treatment and monitoring plan.

(c) If computer service interruption directly follows a weekend or is immediately prior to a weekend-such that loss of regular Veteran contact is greater than 72 hours, Care Coordinators should contact the Veterans they are actively providing care/case management to and those identified as Level 1 to check on their status.

(d) Depending on the nature of the disaster, Veterans may be told that no one will be monitoring their responses, and they will be reminded to call appropriate numbers (given at time of enrollment) if they require Medical or Emergency services.

c. Recovery Activities.

(1) The Facility Emergency Manager will provide briefings regarding appropriate short- and long-term restoration of the facilities’ operations to include RRM-HT programs. RPM-HT staff will be in regular contact with their supervisor regarding their role and duties associated with the restoration of some or all operations.

(2) RPM-HT staff will establish a reasonable time frame to resume Veteran contact and monitoring if service was disrupted.

(3) If cross coverage of RPM-HT patients was necessary, RPM-HT staff will communicate with their “sister site” RPM-HT staff to obtain a status report of Veterans contacted. Annotations on the Veteran list located on the secure location on the V21 SharePoint site will be reviewed as part of this communication.

d. Mitigation Activities.

(1) RPM- HT staff will meet with appropriate Emergency Management team members for debriefing to determine the vulnerabilities of RPM- HT enrolled Veterans and program. Tabletop drills will be conducted between the facilities at least annually by the VISN to ensure the procedures and processes are functional and understood by the RPM-HT staff.

e. Continuity of Operations Plan (COOP).

(1) RPM-HT program is not intended to replace primary, urgent, or emergency medical care. However, Veterans who are enrolled with RPM-HT do enjoy a clinical relationship with their RPM-HT Care Coordinator. Very often, Veterans contact RPM-HT for medication renewal, appointment changes, and other clinical information.

(2) Veterans are encouraged to transmit physiologic data daily, and to answer DMP questions daily. Veterans, families, and caregivers are educated during enrollment that RPM-HT is not an emergency service, and they are instructed to call 911 for true emergencies.

(3) RPM-HT operates Monday through Friday, during normal business hours. They are closed on weekends, and on every Federal holiday. There are also several times during the year when required training will cause a delay in normal operations. The RPM-HT will send a vendor message detailing any disruption of normal services and the expected return of staff to normal operations.

f. Records Management Requirements. All records regardless of format (e.g., paper, electronic, electronic systems) created or discussed by this SOP shall be managed per the National Archives and Records Administration (NARA) approved records schedules found in VA Records Control Schedule 10-1. Questions regarding any aspect of records management should be addressed to the appropriate Records Manager or Records Liaison.

4. ASSIGNMENT OF RESPONSIBILITIES

a. Chief Nurse Team Lead Program Director, Home Based Primary Care and Home Telehealth, and the RPM-HT Nurse Manger/designee. The Chief Nurse Team Lead Program Director, Home Based Primary Care and Home Telehealth, is responsible for the orientation of all staff members to the emergency preparedness plan and for annual review of the plan with staff.

b. All Remote Patient Monitoring (RPM) Staff. All RPM-HT staff should contact the RPM-HT office as soon as possible in the event of an emergency if they are not located on site. RPM-HT staff should remain at home if instructed to do so by local authorities.

c. Remote Patient Monitoring - Home Telehealth (RPM-HT) Care Coordinators. The Remote Patient Monitoring - Home Telehealth (RPM-HT) Care Coordinators are responsible for the following:

(1) Determining the acuity of their Veterans on their panels at enrollment and provide emergency preparedness information.

(2) Keeping Veterans databases up to date monthly.

(3) Updating their Veteran’s disaster priority level as the Veterans condition changes in the RPM-HT database and vendor site. This includes Veterans experiencing disease exacerbations, those requiring increasing medical management in the home, or new requirements for life support equipment in the home such as oxygen, CPAP, or routine nebulizers. This is done at a minimum of every 180 days if the Veterans condition is stable during their enrollment in the RPM-HT program.

d. Remote Patient Monitoring - Home Telehealth (RPM-HT), Lead Program Support Assistant (PSA), or designee. The Remote Patient Monitoring - Home Telehealth (RPM-HT), Lead Program Support Assistant (PSA), or designee, is responsible for the following:

(1) Uploading the master RPM-HT staff roster to the VISN SharePoint site near the beginning of the month.

(2) Ensuring the accurate and timely upload of the Emergency Veterans list by the 5th working day of every month to a secure location on the NCHCS SharePoint site. The list must also have the month name of when the sheet was reconciled. The VISN’s Telehealth office will sporadically perform spot checks to ensure Veteran’s privacy and policy required information compliance. This list must be inclusive of:

(a) Veteran’s last name.

(b) Veteran’s first name.

(c) Last four of social security number.

(d) Veteran’s phone number/ emergency contact number.

(e) Acuity rank (in accordance with policy).

(f) Life support item such as oxygen, CPAP etc.

5. DEFINITIONS

a. Emergency Preparedness. Emergency preparedness is the plan(s) for the provision of Veteran care coordination in the event of a natural disaster, inclement weather, pandemic, civil disturbance, power outage, communication system failure or damage to organization site.

6. REFERENCES

a. Telehealth, Office of Connected Care, Remote Patient Monitoring Home Telehealth, available at: https://vaww.telehealth.va.gov/pgm/ht/index.asp.

b. VA Telehealth, Remote Patient Monitoring Home Telehealth Manual, dated July 2023, available at: https://alt-612eabb1bae6a.blackboard.com/bbcswebdav/library/LibraryContent/RPM-HT/rpm_ht_manual/rpm-ht.html?source_domain=vaots.blackboard.com.

c. U.S. Department of Homeland Security, Disaster Assistance, Information: Veterans, available at: https://www.disasterassistance.gov/information/veterans.

d. VHA Records Control Schedule 10-1, Item Number 5254.1, Continuity Planning and Related Emergency Planning Files, dated January 2021, available at: https://www.va.gov/vhapublications/rcs10/rcs10-1.pdf.

e. VA Disaster Hotline & Resources.

7. RESCISSION

SOP-HT-03, Emergency Management Plan for the Home Telehealth (HT) Program, dated June 09, 2014, is rescinded.

8. REVIEW

This SOP must be reviewed at minimum at recertification and including when there are changes to the governing document. This review is documented on the VHA Forms and Publications Website (see http://vaww.va.gov/vhapublications/index.cfm).

9. RECERTIFICATION

This SOP is scheduled for recertification on or before the last working day of December 04, 2029. In the event of contradiction with national policy, the national policy supersedes and controls.

10. SIGNATORY AUTHORITY

Blessing Ikpeama, DNP NI-BC RPM-HT Nurse Manager Date Approved: 12/04/2024

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: Emailed to the All-Employee VA Northern California Health Care System Email Distribution List on December 04, 2024. SOPs are available at: https://dvagov.sharepoint.com/sites/VHANCal/sop/SitePages/Home.aspx NOTE: This is an internal VA Web site that is not available to the public.

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