Emerging Practices in Telehealth: Best Practices in a Rapidly Changing Field

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Emerging Practices in Telehealth: Best Practices in a Rapidly Changing Field
Copyright
Foreword
Contributors
1. The basics of telehealth
	Introduction
	Statistics
	Common approaches/types of telehealth
	Telemedicine versus telehealth
	The benefits of telehealth
	Choosing a vendor+platforms
	Setting up for telehealth
	Tips for success
	A short primer on basic billing for telehealth
	Welcome to telehealth
	References
2. Telehealth technology infrastructure and implementation strategies
	Introduction
	Universal technical infrastructure requirements of telehealth
		Access to broadband internet
	Disparities in broadband internet access
		Imaging technology (audio-video capabilities)
		Technical support staff
			Patients
			Clinicians
			Technical support staff
		Staff training
	Digital literacy
		Evaluating telehealth platforms
	Implementation strategies in areas without reliable broadband internet and low digital literacy
		Prioritize telephone encounters and consider low broadband options
		Implementation strategies for enterprise healthcare organizations
			Identify key stakeholders and develop a leadership team for strategy planning and implementation
			Pilot small but with scalability in mind
	Implementation strategies for individual or group clinician practices
		Take advantage of the ability to move quickly and rapidly identify the most reliable, cost-effective solution with least di ...
	Implementation strategies for virtual-only services
		Find a specialized area that is underserved by the current market and create a service for the user that provides exception ...
	Conclusion
	References
3. Telehealth implementation in clinical practice: integration into electronic medical records and clinical workflows
	Introduction
	Pre-implementation: implementing telehealth into clinical practice
	Integration into the EMR
	Clinical workflows: focusing on patient centered approach and best practices for telehealth visits
	Conclusion
	References
4. Billing basics and fundamentals
	Key stakeholder payors
	Medicare and Medicaid
	Private payors
	VA's Veterans Health Administration and Department of Defense (VHA &DOD)
		Providing health care for veterans
	Coding and billing (Fig. 4.1)
	Basic understanding coding systems
	Code modifiers
		Audio-only specific modifiers
	Telehealth place of service (POS)
	Communication technology-based (CTB)
	Telehealth pre-pandemic (Fig. 4.2)
	Medicare
	State Medicaid
	Private insurers and state telehealth coverage
	US Department of Veterans Affairs (VA)
	Pandemic Fig. 4.2
	Medicare expansion of service
		Medicaid
	Private insurance
	US Department of Veterans Affairs (VA)
	So what happens after the end of the PHE? Fig. 4.2
	References
5. Optimizing the patient experience for telehealth and remote patient monitoring programs: Best practices and requirements fo ...
	Introduction
	What are the requirements for a positive patient experience?
		Set clear goals for telehealth or remote patient monitoring programs
		Establish “what's in it for me” for patients
		Invest in patient and provider training
		Ensure 24/7 access to care
		Collect and give regular feedback
		Don't just treat. Identify gaps in care
		Triage patients based on real-time data
		Make technology useable
		Ensure connectivity
		Take a whole-person view
		Consumerize healthcare
		Measure patient experience and optimize
	Conclusion
	References
6. Legal considerations
	Legal and regulatory compliance in an era of rapid innovation
	Telehealth and the practice of medicine
		State licensing
		Standard of care
		Telehealth practice standards
	Remote prescribing of drugs and controlled substances
		Non-controlled substances
		Controlled substances
	Tort liability
		Malpractice insurance coverage
	The corporate practice of medicine
		The friendly PC model
	Fraud and abuse laws
		Federal
		State antikickback, fee splitting, and patient brokering laws
	Digital health technology
		Privacy and security
		Online services and federal communications commission rule
	Subscription fee models and insurance laws
	Hospital telehealth credentialing and privileging
	Telehealth payment policy and reimbursement
		Medicare coverage of telehealth services
			Remote patient monitoring
		Medicaid coverage of telehealth services
		Commercial health insurance coverage of telehealth services
			Telehealth commercial coverage laws
			Telehealth payment parity laws
		No surprises act and its impact on telemedicine
	Conclusion
7. Continuous cardiology: the intersection of telehealth and remote patient monitoring
	Introduction
	What is remote patient monitoring?
	How did we get here?
	The current RPM landscape in cardiology
		Heart failure
		Atrial fibrillation and other arrhythmias
		Hypertension
		Physical activity and cardiovascular disease prevention
	The medicare model for RPM
	How can we best combine telehealth and RPM?
	Current challenges and future directions
		An evolving regulatory landscape
		Safety and privacy challenges
		The promise of artificial intelligence
	Conclusion
	References
8. Creating the perfect telehealth product
	Introduction
	What is the perfect telehealth product?
	A brief history, challenges, and opportunities of telehealth products
	New product design and development
	Telehealth product building blocks and construction
	Heartbeat Health, a telehealth product case study
	Future directions of telehealth products
	Conclusion
	References
9. Increasing access and decreasing disparity with telehealth
	Introduction
	Improving internet access and connectivity to help decrease disparities in telehealth
	Training of providers and support staff to help increase digital literacy and improved access to telehealth
	Improving budgets to increase access to telehealth and decrease health care disparities
	Improved reimbursement to increase access to telehealth and decrease disparities
	Conclusion
	References
10. The international telemedicine experience: Russia
	“Doctor–doctor” telemedical interaction
	“Patient–doctor” type of telemedicine
	References
11. International telehealth implementation—the Indian experience, project CardioGram
	The Indian healthcare system
	National digital health mission
	Project CardioGram inception
	Evolution
		PHC characteristics
		Staff characteristics
		Patient characteristics
		Diagnostic capacity
		Medicines availability
		Staff
		Instruments
		Timings
		Workflow (the patient queue can proceed in the following order)
	Lessons from early implementation
	References
12. Global telehealth and digital health: how to support programs and infrastructure
	Key points
	Traditional healthcare models undergoing transformation
	Understand the healthcare ecosystem
		Who are the stakeholders and how might a potential digital health solution affect them?
		Public-public collaboration is growing and important
	Evaluate the politics and geopolitical context
		Healthcare across borders
	Evaluate the potential, specific role of digital health technology
		Use principles of design thinking to your advantage
	Choosing the right digital health technology
		Precision health and broader directions of digital health technology
	Evaluate the local development with an eye to scaling
	Putting it all together: launching the program
		Build stakeholder trust
		Create roadmaps of short-term, medium-term, and long-term ROI
		Implement with eye toward scrutiny of impact and demonstrating early wins to grow buy-in
		Maintenance, growth, and scaling the effort
	Conclusion
	References
13. The rise of AI in telehealth
	Artificial intelligence and its subtypes
	Telehealth and its subcategories
	Applications of AI in telehealth
	AI in telemedicine
	AI in remote patient monitoring
	AI in mobile health (mHealth)
	AI in store-and-forward: imaging and pathology
	Challenges of AI in tele-health and future directions
	References
14. Pearls of wisdom from the past 5years of working in telehealth
	Introduction
	Changes that paved the way for telehealth adoption
		Technical capabilities
		Recognition of telehealth as an element of clinical care
		New payment models
		Consumer demand
	The effects of COVID-19 on telehealth adoption
		Early stages of the pandemic
		Defining the role of telehealth beyond times of crisis
			Consideration 1. categorizing clinical interactions
			Consideration 2. ensuring telehealth makes financial sense
			Consideration 3. integrating telehealth into provider's workflow
			Consideration 4. improving technology accessibility for patients
			Consideration 5. ensuring telehealth care delivery advances health equity
	Emerging innovations in telehealth
		New technologies
		New modes of care delivery
	Conclusion
	References
Index
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