D.6 36C26126R0014 MCP 11-122_Telehealth Program.doc

January 24,2022

MCP 11-122

Telehealth Program

MCP 11-122

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

VANCHCS Director

Responsible Owner:

VANCHCS Chief, Clinical Informatics Rescinded Document:

MCP 11-122, 11-122a, 11-122b, Telehealth Program, dated Nov 30, 2012 Effective Date:

January 24,2022 Recertification Date:

January 24,2027

1. POLICY

This medical center policy (MCP) establishes policy on the use of telehealth modalities, also known as virtual care, for clinical care, consultation, and coordination of care where such use is deemed appropriate and will benefit patients and their family members and other caregivers.

2. JUSTIFICATION

This MCP exists to establish policy, responsibility, and procedures for the VA Northern California Health Care System (VANCHCS) Connected Care/Telehealth Program, including My HealtheVet (MHV), Home Telehealth (HT), Clinical Video Telehealth (CVT), VA Video Connect (VVC), and Store and Forward Telehealth (SFT) in order to ensure compliance with VISN and National Connected Care/Telehealth Initiatives as well as standards of practice as related to 1914 VHA DIRECTIVE.

3. RESPONSIBILITIES

a. VANCHCS Medical Center Director. The Director is responsible for: the planning, coordination, implementation, and evaluation of clinical and administrative applications of connected care/telehealth and video conferencing technology.

b. VANCHCS Chief of Staff (COS). The COS is responsible for the overall coordination and operation of connected care/telehealth, to include but not limited to:

(1) 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.

(2) Ensuring the documentation of services complies with VHA and health care system policies.

(3) Verifying that telehealth providers have the required skills and competencies to provide telehealth services in the health care setting in which it will be used.

(4) Identifying and providing the appropriate staff to deliver telehealth services.

(5) Acquiring the appropriate telehealth equipment and telecommunication platforms.

(6) Establishing and utilizing appropriate VHA and VISN workload reporting and data management systems and performing systematic audits of telehealth workload reporting systems, processes and data.

(7) Ensuring that core clinical, business and satisfaction quality and performance measure monitors related to telehealth programming are tracked and improvement processes are implemented.

(8) Maintain collaboration with service level support between IT and TH services.

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

(10) Ensuring the telehealth programs support and utilize the principles of System Redesign and have established linkages with available Advanced Clinic Access processes in primary and/or specialty care.

c. VANCHCS Facility Telehealth Coordinator (FTC). The FTC reports to and works closely with the Clinical Informatics Service Chief to ensure the specifics of the telehealth program are administered and operationalized. This individual is a resource for clinical and support staff involved with providing connected care/telehealth services. Besides demonstration of general program management skills, he/she possesses the educational background, experience, and training consistent with the program’s mission, goals and objectives. The FTC will:

(1) Participate in VISN 21 Telehealth Workgroup meetings.

(2) Ensure technical and/or administrative support is provided for telehealth applications.

(3) Ensure the use of resources (rooms, equipment, bandwidth, etc.) and patients for the telehealth program is planned and coordinated.

(4) Serve as a liaison between image reviewers, primary care providers, specialty care providers, patients and other VA personnel.

(5) Ensure activities between originating and distant sites are coordinated as needed.

(6) Provide general oversight of the telehealth program, serving as a resource for the business, technology and clinical aspects of the program.

(7) Directly supervise and ensure the inter-professional development and performance support of telehealth program staff. Ensuring that continuing education is available and provided to the telehealth staff on a regular basis.

(8) Works with each program lead who assesses competency of program staff and ensures orientation of new employees and continual training appropriate to each program is available and provided.

(a) As is appropriate, various national telehealth certification and training requirements will be completed by all involved staff.

(b) Technical training will be provided for all staff involved in telehealth programs and competency related to equipment usage and set-up, troubleshooting, use of software and data, and equipment refurbishment will be documented.

(c) Works with Quality Management to ensure staff practices within their licensure, training, and current competency and scope of practice.

d. VANCHCS Telehealth Advisory Subcommittee (TASC). The TASC will include appropriate representation from departments/sections of the health care system using telehealth modalities and responsibilities will include:

(1) Provide the network infrastructure for the coordination and operation of the VANCHCS Telehealth Program.

(2) Facilitate the expansion of health care services through network teleconsultation based on facility need assessments and network resources for specific disease population data.

(3) Provide guidance, educational support and recommendations for VANCHCS telehealth projects.

(4) Ensure that Standard Operating Procedures for coding and scheduling are documented and consistently implemented.

(5) Assist with workload and data capture issues related to telehealth by ensuring audits of workload reports are completed.

(6) Communicate and disseminate information regarding local, VISN and Office of Care Coordination Service initiatives and news to appropriate contacts within the health care system.

(7) Ensure that VISN Information Technology (IT) linkages and facility service level agreements are in place.

e. Home Telehealth Care Coordinator (HTCC): Care Coordinators are typically Registered Nurses, Registered Dieticians, or Licensed Clinic Care Social Workers functioning as Care Coordinators using in home telehealth technology. HTCC report to a Nurse Manager of Home Telehealth and the Nurse Manager of HT is responsible to report metrics to the FTC. HTCC responsibilities include:

(1) Emphasize collaboration and engage in processes that assess, advocate, plan, implement, coordinate, monitor, and evaluate health care options and services so that they meet the needs of the individual patient.

(2) Provide initial and ongoing comprehensive assessment to include a review of systems which establish a comprehensive plan of care.

(3) Through the treatment plan assesses, identifies, analyzes and prioritizes problems, interventions and appropriate measurable goals (i.e., Simple, Measurable, Achievable, Realistic, Time-oriented (SMART) goals).

(4) Complete the treatment plan (an extension of the Veteran’s primary care plan) in collaboration with Patient Aligned Care Teams, Home Based Primary Care, Mental Health and other specialty care services as appropriate for each Veteran enrolled in the program.

f. Facility My HealtheVet Coordinator:

(1) Following established procedures to maintain and ensure the privacy of any individual with respect to access to any My HealtheVet portal and for training any VHA staff members with access to any My HealtheVet portal on such procedures.

(2) Informing the VISN Coordinator of staffing or permission changes.

(3) Identifying and reporting any perceived privacy complaint or potential privacy breach received through or about a My HealtheVet user.

(4) Identifying, issuing access to, and tracking VHA staff within their facility who require access to a My HealtheVet portal such as Authenticators, Secure Messaging and/or Calendar Administrators.

(5) Deactivating those VHA staff within their facility who no longer require access.

g. Telehealth Video Tele Conferencing Manager (VTCM): The VTCM reports to the FTC is responsible for:

(1) Possessing a broad range of technical, managerial, and administrative duties associated with video teleconferencing.

(2) Having a primary focus on supporting health care being provided via Clinical Video Telehealth.

(3) Supporting the use of video teleconferencing technology for other clinical and administrative purposes.

h. Telehealth Programs Coordinator (TPC): The TPC reports to the FTC and has the primary responsibility to:

(1) Support the NCHCS Telehealth program by coordinating the technical, logistical, and administrative aspects of starting new / maintaining existing Telehealth programs.

(2) Serves as technical coordinator and project manager of all telehealth services within the VA Northern California Health Care System.

(3) Takes responsibility for the ongoing maintenance of the technical, clinical, and business aspects of existing telehealth programs to ensure the on-going operations of these programs.

i. Lead Telehealth Clinical Technician (Lead TCT): The Lead TCT reports to the FTC and is a resource for clinical and support staff involved with providing telehealth services. The lead TCT ensures:

(1) Orientation of new TH employees

(2) Continual training of current TCTs per national guidelines/standards as part of the national preceptor program.

(3) Monitor telehealth performance measures and takes action to improve facility performance.

j. Telehealth Clinical Technician (TCT): The TCT reports to the FTC with a dotted line to the TPC, VTCM, and Lead TCT and serves as the telehealth subject matter expert at their site. The TCT:

(1) Monitor telehealth operations and intervenes as appropriate to provide technical support and training to providers and support to patients utilizing telehealth modalities.

(2) Attains and maintains certifications in the roles of: CVT Telepresenter and SFT Imager as determined by the individual needs at each specific site and per National standardized training and certification standards.

(3) Trains site staff to assume the role of CVT Telepresenter and SFT imager at their site satisfying the expectation that clinical services will extend their care modalities into Telehealth.

(4) Receives telehealth consults, reviews for appropriateness and provides scheduling instructions or forwards to a specialized clinician for additional guidance.

(5) Advanced TCTs are a special subset of the TCT that have advanced knowledge in clinical processes and equipment installation and management at point of care.

k. Telehealth SFT, CVT, or Master Preceptor (TH Preceptor): The TH Preceptor reports to the FTC and is an Advanced TCT formally trained as a nationally certified instructor capable of administering the skill checks required to deliver telehealth care. The TH Preceptor:

(1) Is recommended for training by the FTC based on performance quality as an advanced TCT.

(2) Completes a TH Preceptor training cohort reviewed and approved by the Office of Connected Care.

(3) Trains and certifies (skill checks) VHA employees to perform telehealth per Office of Connected Care guidelines.

l. Clinical Video Telehealth (CVT) Telepresenter: The telepresenter reports to the FTC if a TCT or has dotted line to the FTC if supervised by another service. The telepresenter:

(1) Attains and maintains certification in the role of CVT Telepresenter through a combination of Nationally required TMS, hands on learning, and skills check from a Nationally certified CVT or Master Preceptor ensuring CVT imager has special skills necessary to

(2) Receive consults for CVT care from ordering provider and ensure scheduling of patient

(3) Greet the patient at the visit, checks him/her into the EHR system, arranges the environment for an optimal teleconferencing experience.

(4) Attend to any clinical needs for the visit, e.g. placing digital stethoscope, exam camera, or other telehealth peripheral device.

(5) Check the veteran out at the conclusion of the visit

(6) Document the patient site visit activity in CPRS which includes closing the "patient side" encounter.

m. Store and Forward (SFT) Imager: The SFT Imager, if a TCT reports to the FTC, or has a dotted line to the FTC if supervised by another service. Imager duties include:

(1) Attains and maintains certification in the role of SFT Imager through a combination of Nationally required TMS, hands on learning, and skills check from a Nationally certified SFT or Master Preceptor ensuring SFT imager has special skills necessary to

(2) Image capture, store, and forward images to the appropriate reader (provider) and is responsible for the quality of the image captured and provided to the Telereader.

(3) Receives consults for SFT care from ordering provider and ensures scheduling of patient

(4) Greets the patient at the visit, uses the EHR system to check in the Veteran upon arrival, and arranges the environment for an optimal imaging experience

(5) Provides basic information to patients regarding telehealth processes and may also provide disease specific patient education if written and directed by ordering or reading provider.

(6) Captures images of provider requested patient anatomy for purposes of patient care.

(7) Checks the patient out at the conclusion of the visit

(8) Creates consult for reading provider and attaches image(s) and alerts a SFT Telereader.

(9) Documents the visit activity in CPRS, including closing the "patient side" encounter.

n. Ordering Provider: The Ordering Provider is a clinician located at the originating site who reports to the Chief of their service and is responsible for:

(1) Ensuring the program specific TH consult criteria for the consulting provider is met before placing the consult.

(2) Initiating a patient consult

(3) Following up on consultant recommendations.

(4) Notifying the patient of results of Telehealth care.

o. Store and Forward (SFT) Telereader: The SFT Reader (typically a clinical specialist) reports to the Chief of the Specialty, is located at the distant site, and is responsible for:

(1) Attaining and maintaining National standardized training and certification for SFT Telereader provision.

(2) Responding to consult requests and providing clinical care using telehealth technology (viewing and interpreting digital images acquired at the originating site).

(3) Documenting in the EHR and closing the “provider side” encounter.

p. Consulting CVT Provider: The Consulting Provider is typically a clinical specialist who reports to the Chief of their service and is located at the distant site, responsible for

(1) Attaining and maintaining National standardized training and certification for CVT Provider provision.

(2) Responding to a consult request from the originating site by engaging in real-time telehealth clinics with patients and/or clinical staff located at the originating site.

(3) Documenting in the EHR and closing the “provider side” encounter.

q. Telehealth Scheduler: The TH Scheduler reports to a Service or BDMS and is responsible to:

(1) Attain and maintain education on scheduling systems, policies, and procedures.

(2) schedule the patient’s appointment and a “provider side” appointment if needed.

(3) Manage appointment rescheduling and cancellations.

4. PROCEDURES

a. General Telehealth Procedures:

(1) Telehealth providers must comply with mandatory security requirements including security controls commensurate with risk. All telehealth devices that use computers or are networked are subject to information technology (IT) tracking requirements for planned acquisitions. Telehealth providers must adhere to patient confidentiality and privacy policies and standards.

(2) To initiate a VA Video Connect (VVC) Clinic: A provider or clinician completes the appropriate TMS training course, requests equipment through Telehealth, and submits a LEAF request to BDMS to get their clinic built.

(3) To initiate a CVT or SFT Clinic: A provider or clinician notifies the Facility Telehealth Coordinator or the Telehealth Programs Coordinator. Telehealth staff will assist the requesting provider in completing the following:

(a) Completion of a Needs Assessment. The needs assessment serves as a mechanism to proactively identify patient populations by access risk and clinical need that will benefit from the new telehealth service, and to identify the resources needed to support the clinic.

(b) Completion of a clinic set-up form to request the appropriate EHR clinic and appointment grid configuration.

(c) Completion of required provider trainings.

4. Completion of a Telehealth Service Agreement (TSA) which encompasses clinic and program specific details, including:

4. The originating (patient) and distant (provider) site locations.

4. The type of telehealth modality to be employed.

4. The scope of the services provided to the patient(s).

4. The inclusion and discharge criteria of the program.

4. The methods of communication and key contacts for appointment issues, questions regarding recommendations of the consultant, urgent care situations and last-minute cancellations.

4. Any clinical information, including labs, history, or imaging, required to be ordered prior to the consultation visit.

4. The consultation and response procedures.

4. The clinical protocol, technology and staffing requirements.

4. The site and clinic specific emergency procedures.

4. For inter-facility telehealth clinics (between two different health care systems) the TSA must be signed by appropriate Service Chief and/or Chief of Staff at each facility and the Facility Telehealth Coordinator of each facility.

4. For intra-facility telehealth clinics (between two sites within VANCHCS), the facility Director's approval of this policy shall satisfy the signature requirement for TSAs.

4. Copies of all Telehealth Service Agreements will be stored on the VANCHCS telehealth SharePoint site and will be available for review by facility and service level leadership, telehealth staff, and telehealth service providers.

4. Educational brochures regarding telehealth will be made available to patients and will include the mission and scope of services of the telehealth program. Each new enrollee will be provided either paper or electronic documentation which reviews their rights and involvement in patient choice and decision making. It also informs the patients and family that they may decline or terminate their involvement in a telehealth program at any time without adverse effect to their continued access to health care services.

4. Patient and family willingness and ability to participate in the telehealth program is assessed prior to enrollment.

4. Enrolled Veterans are provided informed consent as appropriate.

4. For the purpose of informed consent, telehealth is part of the treatment or procedure used to deliver health care services. The patient should be provided a full explanation of telehealth, alternatives for obtaining care through an in-person visit and the patient’s right of refusal at any time.

4. Prior to undertaking any treatment or procedure using telehealth, the provider must obtain an informed consent which must be documented in the medical record following VHA Handbook 1004.01. See also Policy Statement 11-61, Informed Consent for Clinical Treatments and Procedures.

4. 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.

4. In the event the telehealth session is part of a research study, written consent must also be obtained per VHA as specified by the current guidelines issued by the Office of Research Administration ORD Policies and Guidance Documents (va.gov)

4. All contacts and processes involved with patients and information preserve confidentiality, privacy, and security.

4. Clinical staff are contacted and informed of the telehealth program and how it can effectively be used for patient care. Education is provided through meetings and through written materials. Individual clinicians determine the appropriateness of a telehealth program for each patient and use the appropriate consult for referral to the program.

4. Appropriate codes for telehealth programs have been established and are appropriately used with each patient encounter.

4. Standardized documentation is utilized by each clinician involved in telehealth as is appropriate for the individual program. This includes standard titles and note templates.

4. Emergency contingency plans for each program are documented on the TSA. Plans include both technology emergencies and patient condition/behavior emergencies. Every attempt to minimize disruptions of care due to environmentally related and technology related emergencies will be made. The urgency can involve the Veteran patient or the technology.

4. Urgent patient health situations are handled in collaboration with staff that are present with the patient and may involve following emergent procedures of any patient with an emergent/urgent status.

4. In the event of a technology failure which cannot be remedied by the provider or TCT, the VHA Technology help desk or local IT are to be contacted. When technology fails and a visit cannot be completed, arrangements for the patient to be seen locally or at another time must be made unless the session can be completed by phone.

4. Provisions for patient management in the event of equipment or telecommunications failure must be in place and documented on the TSA. On-site staff should be able to address the patient’s needs, or the remote clinician should be able to communicate with the patient by phone. It is important that the patient be informed in advance of possible equipment failures and what will happen in the event of such a failure.

4. Patient complaints and grievances are handled in the same manner as all patient issues, utilizing the patient representative and established documentation programs. Feedback from the Patient Representative is provided to the Facility Telehealth Coordinator and program leaders through the Telehealth Advisory Subcommittee on a regular basis.

4. Adequate physical space and consideration of lighting is considered to enhance viewing/listening and ensuring efficiency and patient privacy and safety within the various telehealth programs.

4. Collaboration between the Facility Telehealth Coordinator, Office of Information and Technology (OI&T) and Bio-Medical is essential to insure the compatibility and maintenance of telehealth equipment. OI&T and BioMed staff will be consulted prior to the purchase, and installation of telehealth equipment, and to ensure preventive maintenance and troubleshooting procedures.

4. Credentialing and Privileging

Consistent with current Joint Commission standards, all VHA practitioners involved in the provision of clinical telehealth services are subject to all existing requirements for credentialing, as identified in VHA Handbook 1100.19, Credentialing and Privileging, and Amendments thereto. The VISN Telehealth Memorandum of Understanding (MOU) for Credentialing and Privileging ensures compliance with VACO Credentialing and Privileging Handbooks and Amendments as issued. Medical Centers will sign and abide by the Telehealth MOU for Credentialing and Privileging.

4. Continuous Process Improvement

4. Telehealth in general and each specific program has various core quality and performance measures with continuous monitors. The Facility Telehealth Team reviews and assists with recommendations for performance improvement efforts for all connected care/telehealth programs.

4. Performance improvement initiatives include front line staff in each program and the principles of system redesign for performance improvement activities.

4. All connected care/telehealth programs follow national guidance.

5. DEFINITIONS

a. Telehealth. the electronic provision of health care and information services for the direct benefit of patients and their families. Telehealth technologies are information technology-based tools that collect clinical indices in the form of vital signs, disease management data, still images, and live video from the originating site where the patient is located. These data are sent via 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.

b. Home Telehealth (HT). A program into which Veterans are enrolled that applies care and case management principles to coordinate care using health informatics, disease management, and technologies such as in-home and mobile remote patient monitoring, messaging and/or video technologies. Home Telehealth provides non-urgent/non-emergent care and case management that also includes tracking and trending vital signs and other biometric data and symptoms.

c. Clinical Video Telehealth (CVT). Telehealth modality that employs “real-time” interactive exchange between the patient and the provider via Telehealth technology (e.g. video teleconferencing). The provider delivers care from a distant or remote VA or teleworking site, while the patient receives care from a local VA / originating site.

d. VA Video Connect (VVC). Telehealth modality that employs "real-time" interactive exchange between the patient and the provider via Telehealth technology (e.g. video teleconferencing). The provider delivers care from a distant / remote VA or teleworking site, while the patient receives care from the comfort of their own home or non-VA site. Patients and Providers access a virtual medical room via an e-mail link; both sides need appropriate audio/video/Internet capabilities to participate in the video visit. VVC visits can be on-demand or scheduled as needed.

e. Store and Forward Telehealth (SFT): Telehealth modality that employs an asynchronous exchange involving a form of technology where a single image, series of single images, audiovisual clip, or other form of multi-media clinical data is derived and stored during a clinical patient encounter. The data is forwarded to (or retrieved by) a “reader” provider at a later time for the purposes of providing a consultation or report.

f. Home Telehealth Care Coordinator (HTCC): Care Coordinators are case managers that are specialized, highly skilled and have specific training and competency in the use of disease management, healthcare informatics and Home Telehealth technologies with complex Veteran patients.

g. Facility Telehealth Coordinator (FTC): The VA staff member who assumes responsibility for telehealth activity for a particular health care system and affiliated outpatient clinics.

h. Telehealth Video Tele Conferencing Manager (VTCM): The VTCM is responsible for a broad range of technical, managerial, and administrative duties associated with video teleconferencing. The VTCM has a primary focus on supporting health care being provided via Clinical Video Telehealth and supporting the use of video teleconferencing technology for other clinical and administrative purposes.

i. Telehealth Programs Coordinator (TPC): The TPC reports directly to the Facility Telehealth Coordinator and assists clinical services with setting up new programs by conducting needs assessments and Telehealth Service Agreements.

j. Lead Telehealth Clinical Technician: In addition to fulfilling the role of TCT, the lead TCT serves as a mentor/resource for other TCTs and assists with various operational and administrative functions with the Telehealth department as needed.

k. Advanced Telehealth Clinical Technician (TCT): The Advanced TCT is a health technician or LVN responsible for overall operations of the telehealth program at their site. TCTs are telehealth generalists that support CVT (Tele Presenter) and SFT (Imager) activities. In addition, they support real-time telehealth encounters by establishing connectivity and troubleshooting technical problems; provide education to patients; training to staff; and ensure Telehealth clinics are covered when staff call-in or take time off. They work closely with site staff to make sure Telehealth operations are running smoothly and escalate major issues to the FTC and/or Service Chief.

l. Distant/remote/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.

m. Local/originating/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.

n. Consulting provider: The provider who completes the request for telehealth activity; used interchangeably with remote, distant, provider-site, or provider-side.

o. Ordering provider: The provider who initiates the request for telehealth activity.

p. Reader: In Store-and-Forward Telehealth applications, the Reader (typically a licensed independent practitioner) is responsible for viewing and interpreting digital images acquired by the imager at the patient/originating site and making recommendations for further treatment.

q. lmager: This individual has been educated and is certified to capture, store, and forward images to the provider at the distant site.

r. Interfacility Consult (IFC): A request generated within the CPRS system for care, to be delivered by a provider who is privileged to practice at a different facility or health care system. The consult request and the subsequent results of the request "travel" across facility EHR/CPRS record system boundaries.

s. Intrafacility Consult: A request generated within CPRS 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 EHR/CPRS record system boundaries.

6. REFERENCES

a. Public Law 104-191, The Health Insurance Portability and Accountability Act of 1996, Current, https://www.congress.gov/104/plaws/publ191/PLAW-104publ191.pdf

b. VHA Handbook 1004.01(5), Informed Consent for Clinical Treatments and Procedures, Current, https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2055

c. VHA Handbook 1100.19, Credentialing and Privileging, Current, https://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910

d. VHA Directive 1914, Telehealth Clinical Resource Sharing Between VA Facilities and Telehealth from Approved Alternative Worksites, Current, https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8807

e. VANCHCS Policy Statement 11-61, Informed Consent for Clinical Treatments and Procedures, Current, http://vaww.northern-california.med.va.gov/policies/chief_of_staff/PS-11-61.doc

f. VANCHCS Policy Statement 138-34, Medical Equipment Management Program, Current, https://dvagov.sharepoint.com/:w:/r/sites/VHANCal/sop/Policies/PS-138-34.doc?d=w54bd646e976b4b7aaa01f2d394ad87c7&csf=1&web=1&e=VM0ko9

g. SOP, Office of Connected Care: Quality Program Standard Operating Procedures, Current, https://dvagov.sharepoint.com/sites/vha-telehealth/docs/sop-qd-r.docx Conditions of Participation Telehealth Quality and Performance - Conditions of Participation - VHA Telehealth Services Intranet (va.gov)

h. SOP, Home Telehealth Operations Manual, Current, https://vaots.blackboard.com/bbcswebdav/library/LibraryContent/RPM-HT/RPM-HT-Home%20Telehealth%20Operations%20Manual%20%28ht-ops-manual%29.pdf

i. SOP, Telehealth Emergency Response and Crisis Intervention Procedure, dated TBP, https://dvagov.sharepoint.com/sites/VHANCal/sop/SitePages/Home.aspx

j. VA Form 10-3203, Consent for Production and Use of Verbal or Written Statements, Photographs, Digital Images, and/or Video or Audio Recordings by VA, Current, https://vaww.va.gov/vaforms/medical/pdf/VA%20Form%2010-3203%20Fill.pdf

k. Master Telehealth Document Library at https://dvagov.sharepoint.com/sites/VHA-Telehealth/docs/Forms/AllItems.aspx

7. RESCISSION

Policy Statement 11-122 Telehealth Program, and attachments 11-122a, and 11-122b dated November 30, 2012 is rescinded.

8. REVIEW

This MCP 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 MCP is scheduled for recertification on or before the last working day of January 24,2027– 5 years from effective date. This MCP will continue to serve as local policy until it is recertified or rescinded. In the event of contradiction with national policy, the national policy supersedes and controls.

10. SIGNATORY AUTHORITY

David Stockwell, MHA VANCHCS Director

Date Approved: January 24,2022 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 1/24/22. MCPs 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.