D.24- FACILITY TELEHEALTH EMERGENCY PLAN AND EQUIPMENT AND SOFTWARE FAILURE PROCEDURE.pdf

FACILITY TELEHEALTH EMERGENCY PLAN

SOP 11Tel-001

Syracuse VA Medical Center Syracuse, NY 13210

Signatory Authority:

Facility Telehealth Coordinator

Responsible Owner:

Facility Telehealth Coordinator

Service Line(s):

Telehealth Department

Effective Date:

June 2021

Recertification Date:

June 2026

1. PURPOSE AND AUTHORITY

a. The purpose of this standard operating procedure (SOP) is to establish procedures related to medical and behavioral health emergency response procedures.

This SOP must be followed by all staff providing Telehealth services.

b. There is no governing document.

2. PROCEDURES

a. Emergency Procedures. Emergency procedures are addressed in the Telehealth Service Agreement and facility guidance documents.

(1) It will be necessary for the Facility Telehealth Coordinator to provide the clinician with the Telehealth Service Agreement that contains all the emergency information.

(2) To facilitate communication in emergency situations, a phone must be available in the telehealth room for the provider to support the patient if an emergency arises.

(a) Alternative forms of communication must be available for patient and provider sites to connect immediately.

1. Some of these alert mechanisms may include cell phones, pagers, panic buttons and electronic medical record alerts, etc.

(3) It is also important to proactively provide patients engaging in telehealth care with options to reach the Veterans Crisis Line (i.e., phone, 1-800-273 8255, press 1; text 838255; and chat), so they can receive crisis support at any time.

b. Clinic-Based Clinical Video Telehealth (CVT) Mental Health Emergency.

Before all clinic based CVT visits, the telehealth provider and Tele-Presenter must have readily available the Emergency Plan Contact List, including the key patient and provider site points of contact.

Attachment D.24 RFP 36C24224R0049

June 2021 SOP 11Tel-001

(1) In the event a patient is assessed by a provider and deemed to be in imminent danger to self or others the provider will contact the patient site and initiate the patient site policy for emergency Mental Health response:

(2) Provider will contact the Tele-Presenter via Microsoft Teams Chat, and/or Tele- Presenter emergency phone.

(3) If no response, provider will follow the patient site emergency contact form for the patient site.

(4) The patient site Tele-Presenter/Clinical POC and local staff will collaborate to ensure that an on-site staff member is present in the room with the patient for added support while awaiting transfer or other appropriate clinical disposition.

(5) Telehealth provider will work with patient site staff to ensure appropriate transfer, follow-up care, and notification of appropriate patient site staff members [e.g., Onsite Licensed Independent Practitioner (LIP), Disruptive Behavior Committee, Crisis Team, Veterans Affairs (VA) Police, and/or Suicide Prevention Coordinator].

(6) Patient site Clinical POC (LIP) will complete necessary paperwork and arrange for transfer to local hospital.

(a) If there is not a local LIP available at the patient site, the patient site staff will contact the local emergency personnel.

(7) After the emergency has been resolved, the telehealth provider will document the incident, assessment, and plan in the patient electronic health record (patient side) and will assign appropriate team members as additional signers to the note.

c. Clinic-Based Clinical Video Telehealth (CVT) Medical Emergency. Before all clinic based CVT visits, the telehealth provider and Tele-Presenter must have readily available the Emergency Plan Contact List, including the key patient and provider site points of contact. If the patient is assessed by the provider and deemed to be experiencing a medical emergency, the provider will contact the patient site and initiate the patient site policy for emergency medical response:

(1) Provider will contact the Tele-Presenter via Microsoft Teams Chat or Call, and/or Tele-Presenter emergency phone.

(2) If no response, provider will follow the patient site emergency medical plan.

(3) The telehealth provider will work with patient site staff to ensure appropriate transfer, follow-up care, and notification of patient site staff members.

(4) After the medical emergency has been resolved, the telehealth provider will document the incident, assessment, and follow-up plan in the patient’s electronic.

d. Clinical Video Telehealth (CVT) to Home or Non-VA Location/ VA Video Connect Mental Health or Medical Emergency. To promote safety, all telehealth visits to the home or other non-VA locations require certain information and resources to be obtained/verified at the start of the actual encounter and documented in the medical record, including:

(1) The Veteran’s phone number.

(2) The Veteran’s present location and address.

(3) The Veteran’s emergency contact name and phone number (if available).

(4) Ensuring the Veteran is in a private/confidential location.

(5) Asking if there are other individuals present with the patient, and if so, getting the name and contact information for the individual(s).

(6) Contact information for local emergency services (e911).

(7) If the patient is assessed by the provider and deemed to be in imminent danger to self or others or experiencing a medical emergency, the provider will utilize one of the following as appropriate:

(a) Provider will contact e911: E911 is a service that providers can use to be routed to emergency dispatch services in the Veteran’s area. To use E911, the provider first dials the E911 center also known as the Emergency Call Relay Center at 1-267-908- 6605 and relays the Veteran’s location — including the street address, city, state, and ZIP code.

(b) The telehealth provider will work with patient site staff to ensure appropriate transfer, follow-up care, and notification of patient site staff members.

(c) After the mental health or medical emergency has been resolved, the telehealth provider will document the incident, assessment, and follow-up plan in the patient’s electronic medical record (patient side) and will assign appropriate team members as additional signers to the note as indicated.

(8) If the patient is assessed by the provider to not be in imminent danger to self or others the following steps will be taken:

(a) Ensure patient has a follow-up appointment with an appropriate provider.

(b) Provide the patient with the Veterans Crisis Line number (1-800-273-8255, press 1).

(c) Telehealth provider will document the appointment, assessment, and follow-up plan in the patient’s electronic health record (patient side) and will assign appropriate team members as additional signers to the note.

3. ASSIGNMENT OF RESPONSIBILITIES

a. Staff. Staff are responsible for:

(1) Following a consistent process in arranging for clinically appropriate emergency care for patients presenting to telehealth appointments with a medical or behavioral health emergency.

(a) Patients will be treated with dignity, privacy, and respect, with an emphasis on recovery and building positive relationships.

(2) Providing interventions and services that are consistent with the Veteran’s needs.

(3) Assessing patient risk and coordinate clinically indicated transfer or follow-up care with patient site staff or local services.

(4) Recognizing a medical or behavioral health emergency and initiating the emergency response procedures as defined in this SOP.

(5) Following the patient site/local facility policy for emergency response and crisis intervention.

b. Telehealth Providers. Telehealth Providers are responsible for:

(1) Recognizing a medical or behavioral health emergency and initiating the emergency response procedures as defined in this SOP.

(2) Documenting in accordance with VA policy and notifying their supervisor of any medical or behavioral health emergency that initiated the emergency response procedures.

(3) Following the patient site/local facility policy for emergency response and crisis intervention.

c. Medical Center Leadership. Medical Center Leadership is responsible for:

(1) Ensuring the emergency response procedures are instituted for each patient site that receives telehealth services.

(2) Ensuring that each plan is reviewed and tested at least every year to ensure emergency procedures function properly and are updated as needed.

d. Patient Site Tele-Presenter or Designee. Patient Site Tele-Presenter or Designee at patient site is responsible for:

(1) Answering phones and/or instant messaging or Skype calls and coordinating with the telehealth provider to initiate clinically indicated care for the Veteran, which is consistent with local (patient site) and national policies.

(2) In an urgent situation, the Tele-Presenter is expected to be aware of the emergency plan that dictates the course of action, including what points of contact should be notified according to the situation.

(3) To facilitate, the Tele-Presenter should have access to a phone within or immediately adjacent to the patient room.

e. Patient Site Leadership. Patient Site Leadership is responsible for:

(1) Ensuring an emergency standard operating procedure is outlined at the patient site.

(2) Ensuring patient site staff are aware of these emergency operating procedures and respond to the medical or behavioral health emergency with actions that are clinically appropriate, administratively efficient, and consistent with local and national policies.

f. Facility Telehealth Coordinator. The Facility Telehealth Coordinator is responsible for:

(1) Ensuring that employees are familiar with this Standard Operating Procedure

(SOP).

4. DEFINITIONS

None.

5. REFERENCES

a. VHA Handbook 1160.01 - Uniform Mental Health Services in VA Medical Centers and Clinics, dated September 11, 2008. https://vaww.va.gov/vhapublications/index.cfm

b. Connected Care Telehealth Manual

c. VHA Office of Connected Care, VA Video Connect (VVC) Supplement, dated September 2018. https://dvagov.sharepoint.com/sites/vha-telehealth/docs/vvc-spp.pdf

d. VHA Office of Connected Care, TeleMental Health Supplement, dated August 2017. https://dvagov.sharepoint.com/sites/vha-telehealth/docs/tmh-spp.pdf

e. TMH Emergency Procedures Template https://vaww.infoshare.va.gov/sites/telehealth/docs/tmh-emgproc-tmplt.docx

f. VA Video Connect Provider Guidance – Emergency Procedures https://vaww.infoshare.va.gov/sites/telehealth/docs/vvc-prv-brw.docx

Attachment D.24 RFP 36C24224R0049 https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/index.cfm https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth%20Foundations/th_manual/th_manual/TH-manual.html https://vaww.infoshare.va.gov/sites/telehealth/docs/vvc-spp.pdf https://vaww.infoshare.va.gov/sites/telehealth/docs/vvc-spp.pdf https://vaww.infoshare.va.gov/sites/telehealth/docs/tmh-spp.pdf https://vaww.infoshare.va.gov/sites/telehealth/docs/tmh-spp.pdf https://vaww.infoshare.va.gov/sites/telehealth/docs/tmh-emgproc-tmplt.docx https://vaww.infoshare.va.gov/sites/telehealth/docs/vvc-prv-brw.docx

g. Syracuse Telehealth Department SharePoint site.

https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth%20Founda tions/th_manual/th_manual/TH-manual.html

6. REVIEW

Annually, at minimum at recertification, when there are changes to the governing document (for example, national policy or a health care accreditation body mandate), and any regulatory requirement for more frequent review. Documentation of the review is located within the Syracuse Telehealth Department SharePoint site;

https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth%20Founda tions/th_manual/th_manual/TH-manual.html.

7. RECERTIFICATION

This SOP is scheduled for recertification on or before the last working day of June 2026.

In the event of contradiction with national policy, the national policy supersedes and controls.

8. SIGNATORY AUTHORITY

JOSEPH R. GONZALES

Facility Telehealth Coordinator Date Approved: June 22, 2021

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

DISTRIBUTION: SOPs are available at: Syracuse Medical Center Document Control SharePoint (DCS). https://dvagov.sharepoint.com/sites/VHASYR/svdc.

https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth%20Foundations/th_manual/th_manual/TH-manual.html https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth%20Foundations/th_manual/th_manual/TH-manual.html https://dvagov.sharepoint.com/sites/VHASYR/svdc/ https://dvagov.sharepoint.com/sites/VHASYR/svdc/

FACILITY TELEHEALTH EQUIPMENT AND SOFTWARE FAILURE PROCEDURE

SOP 11Tel-002

Syracuse VA Medical Center Syracuse, NY 13210

Signatory Authority:

Facility Telehealth Coordinator

Responsible Owner:

Facility Telehealth Coordinator

Service Line(s):

Telehealth Department

Effective Date:

June 2021

Recertification Date:

June 2026

1. PURPOSE AND AUTHORITY

a. The purpose of this standard operating procedure (SOP) is to outline the management and process related to equipment and software failure for all staff providing telehealth services. The guidance below is meant to limit the impact of any one technology failure on patient care utilizing the best clinical judgment. This SOP must be followed by all staff that provide health care through virtual means such as VA Video Connect (VVC) and or Clinical Video Technology (CVT).

b. There is no governing document.

2. PROCEDURES

a. Common Equipment and Software Failures. All common equipment and software failures are addressed below. All procedures involve working with Information Technology (IT), hub administrative staff and local support to minimize impact of patient care.

b. CPRS. An interruption in Computerized Patient Record System (CPRS) access should not impact the provider’s ability to see the patient. Below are the alternative access routes and potential scenarios.

(1) CPRS is down nationwide:

(a) Access Joint Legacy Viewer (JLV) to review past history and medications https://jlv.med.va.gov/JLV/.

(b) Or Access Read Only CPRS via https://vistaro.syracuse.med.va.gov/

(c) Document in the usual note template either on paper or electronically.

(d) Enter the note and any associated orders or consults when the system becomes available.

(2) Alternate Site CPRS ICON has disappeared. Options include:

Attachment D.24 RFP 36C24224R0049 https://jlv.med.va.gov/JLV/ https://vistaro.syracuse.med.va.gov/

(a) Go to the shared folder, copy a shortcut of the icon from the CPRS Icon folder onto your desktop.

(b) Open your internet browser and use Citrix Store Front (VA Shortcuts, National, Citrix) https://citrixaccess.va.gov/Citrix/FASStoreWeb/

(3) CPRS is down on the provider side (hub site):

(a) Document on the patient side.

(b) Track which patients were impacted.

(c) Document on the provider side when the system becomes available.

(4) CPRS is down on the patient side (spoke site):

(a) Document on the provider side.

(b) Track which patients are impacted. Inform the patient of any expected delays (entering medications or consults).

(c) Document on the patient side when the system becomes available. Enter appropriate orders or consults at that time.

c. Video Failure.

(1) Main camera is out:

(a) The main camera is generally either a Dx80/Ex90, web camera or a laptop camera.

(b) Each provider should also have a backup camera, which may include a laptop camera (if you have a Dx80), a free-standing webcam, or access to another office or exam room with a working camera.

(c) If the main camera is out, please use the backup camera. The free-standing webcams will require a link via Virtual Care Manager. The link contains an address that a TelePresenter in the clinic can enter to call directly into the appointment.

(2) Both main and backup cameras are out:

(a) Please meet with the Veteran via telephone.

(b) Enter an IT help desk ticket.

(c) Bring your computer to the local IT help desk and inform the Facility Telehealth Coordinator or hub administrative staff.

(3) Both the main and backup cameras are out:

https://citrixaccess.va.gov/Citrix/FASStoreWeb/

(a) Please meet with the Veteran via telephone.

(b) Enter an IT help desk ticket.

(c) Bring your computer to the local IT helpdesk and inform facility telehealth coordinator or hub administrative staff.

d. Audio Failure.

(1) The camera is working, but patient cannot hear:

(a) Attempt to use a back-up camera.

(b) If the local site has a telephone in the room, call the room and use the phone for audio while continuing the video. If the local site does not have a telephone in the room and the Veteran has a phone, ask the Veteran if you can call his/her cell phone for audio while continuing video.

(c) Between sessions, test with a different receiver to determine if the problem was on the provider or patient side.

(d) If the patient side is the problem:

1. Clinic-based Clinical Video Telehealth (CVT):

a. Ask the TelePresenter to contact their Facility Telehealth Coordinator for support.

b. Ask to see additional appointments in another room.

c. Ask for a phone to be placed in the room for audio.

2. CVT to home (via VA Video Connect):

a. Ask the patient to call the Telehealth Help Desk for support (1-866-651-3180).

b. Ask your Facility Telehealth Coordinator (FTC) or designated staff to contact the Veteran for a test call to address connection.

c. If the provider side is the problem, contact FTC and Telehealth Help Desk for support.

3. The camera is working, but provider cannot hear:

a. Instant Message the TelePresenter and ask him/her to assist.

b. Call the clinic room and use the phone for audio.

c. Ask the TelePresenter to contact his/her FTC for support.

d. CVT to home: ask the patient to call the Telehealth Help Desk for support.

e. Telephone Failure.

(1) Teams Message or email hub Medical Support Assistant (MSA) and spoke side TelePresenter to inform them that your telephone is not working and request electronic communication.

(2) If the internet is also out, please use your cell phone to inform hub MSA and ask them to communicate with spoke side staff.

f. Virtual Private Network (VPN) Failure.

(1) Contact the national IT help desk to enter a ticket. State specifically that the problem is causing a work stoppage and impacting clinical care. Follow up with your local IT providing your ticket number and problem (This can potentially speed up the fix).

(2) Inform facility or hub administrative staff.

(3) Attempt to connect using CITRIX to access CPRS and other clinical programs. If you are able to do this and it is clinically appropriate, please continue care via telephone and backup programs.

(4) Relocate to a local Community Based Outpatient Clinic (CBOC) or medical center if the connectivity outage is expected to be longer than a half of the day.

(a) Ask IT or the local Mental Health (MH) lead for an empty office or exam room.

(b) Any active ethernet port will provide connectivity.

1. If there are any barriers, please call your supervisor to help coordinate with facility leadership.

g. VA Video Connect Failure.

(1) Try connecting by both Virtual Care Manager (VCM) and VA Video Connect (VVC) Now.

(2) Meet with the Veteran via telephone.

(3) After that session, contact the Office of Connected Care Help (1-866-651-3180) to enter a help ticket or determine if there is a known fix.

h. Loss of Internet Access.

(1) Inform facility or hub administrative staff and enter an IT ticket.

(a) For in-clinic staff:

1. Call the patient or patient side clinic to inform them of the outage.

2. Meet with the Veteran via telephone. If the needed information is not available to conduct a full session, assess for safety and reschedule.

(b) For virtual/teleworking staff:

1. Relocate to a local CBOC or medical center if the connectivity outage is expected to be longer than half of a day.

a. Ask IT or the local MH lead for an empty office or exam room.

(1) Any active ethernet port will provide connectivity.

2. Call the patient or patient side clinic to inform them of the outage.

3. Meet with the Veteran via telephone. If the needed information is not available to conduct a full session, assess for safety and reschedule.

i. Computer Failure.

(1) Contact the national IT helpdesk to enter a ticket. State specifically that the problem is causing a work stoppage and impacting clinical care. Also call local IT with ticket number and situation.

(2) Inform hub administrative staff.

(3) Local providers, those who can come into the Syracuse VA Medical Center, will come into the hub and use another computer to see patients.

(4) Virtual/Distance Providers: call Hub MSA to coordinate with local MSA, both clinical care and follow-up care.

(5) Note: if you have a personal computer, when you call the National IT Help desk for computer failure issue, at this time you can also request a pin that will allow you to access CITRIX for CPRS from home laptop. Alternatively, using a Personal Identity Verification (PIV) reader you can access CITRIX or CPRS.

(a) Go to the shared folder, copy a shortcut of the icon from the CPRS Icon folder onto your desktop.

(b) If applicable, use the VG launcher app in the VA shortcuts folder on your desktop or in the shared folder.

(c) Open your internet browser and use CITRIX access (VA Shortcuts, National, Citrix) https://citrixaccess.va.gov/Citrix/StoreWeb/.

(6) CPRS is down on the provider side (hub site).

https://citrixaccess.va.gov/Citrix/StoreWeb/

(a) Document on the patient side.

(b) Track which patients were impacted.

(c) Document on the provider side when the system becomes available.

(7) CPRS is down on the patient side (spoke site).

(a) Document on the provider side.

1. Track which patients are impacted. Inform the patient of any expected delays (entering medications or consults).

2. Document on the patient side when the system becomes available. Enter appropriate orders or consults at that time.

3. If applicable, use the VG launcher app in the VA shortcuts folder on your desktop or in the shared.

3. ASSIGNMENT OF RESPONSIBILITIES

None

4. DEFINITIONS

None

5. REFERENCES

a. Connected Care Telehealth Manual https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth Foundations/th_manual/th_manual/TH-manual.html

b. VVC Supplement.

https://dvagov.sharepoint.com/sites/vha-telehealth/docs/vvc-spp.pdf

c. Telemental Health Supplement.

https://dvagov.sharepoint.com/sites/vha-telehealth/docs/tmh-spp.pdf

d. TMH Emergency Procedures Template

e. VA Video Connect Provider Guidance – Emergency Procedures.

https://dvagov.sharepoint.com/:w:/r/sites/VHA-Telehealth

6. REVIEW

Annually, at minimum at recertification, when there are changes to the governing document (for example, national policy or a health care accreditation body mandate), and any regulatory requirement for more frequent review. Documentation of the review

Attachment D.24 RFP 36C24224R0049 https://vaots.blackboard.com/bbcswebdav/xid-510063_1 https://dvagov.sharepoint.com/sites/vha-telehealth/docs/vvc-spp.pdf https://dvagov.sharepoint.com/sites/vha-telehealth/docs/tmh-spp.pdf https://vaww.infoshare.va.gov/sites/telehealth/docs/tmh-emgproc-tmplt.docx https://dvagov.sharepoint.com/:w:/r/sites/VHA-Telehealth/docs/vvc-prv-brw.docx?d=wbad8cd2c39994a4eac0b0b37a79fb5fc&csf=1&web=1&e=0I0eY7 is located within the Syracuse Telehealth Department SharePoint site.

https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth%20Founda tions/th_manual/th_manual/TH-manual.html

7. RECERTIFICATION

This SOP is scheduled for recertification on or before the last working day of June 2026.

In the event of contradiction with national policy, the national policy supersedes and controls.

8. SIGNATORY AUTHORITY

JOSEPH R. GONZALES

Facility Telehealth Coordinator Date Approved: June 30, 2021

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

DISTRIBUTION: SOPs are available at: Syracuse Medical Center Document Control SharePoint (DCS). https://dvagov.sharepoint.com/sites/VHASYR/svdc.

Attachment D.24 RFP 36C24224R0049 https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth%20Foundations/th_manual/th_manual/TH-manual.html https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/Telehealth%20Foundations/th_manual/th_manual/TH-manual.html https://dvagov.sharepoint.com/sites/VHASYR/svdc/ https://dvagov.sharepoint.com/sites/VHASYR/svdc/