THE CHICAGO HIT REGIONAL EXTENSION CENTERBringing Chicago together through health IT

Implementing Telehealth and Supporting Users

Telehealth Series: Webinar 2

May 20, 2020

This webinar was developed with support from the Office of National Coordinator for Health Information Technology, the Centers for Medicare &

Medicaid Services, and the Illinois Department of Healthcare and Family Services. The contents of this presentation do not necessarily reflect the

opinions of our state and federal grant partners.

This webinar is jointly sponsored by CHITREC educational programming through the Illinois Medicaid Promoting Interoperability Program Help Desk

and the Quality Payment Program of Illinois Help Desk.

CHITREC does not have any preferred partnerships with technology vendors or financial relationships with telehealth service providers. We encourage

our partners, and all attendees/viewers of this webinar, to perform due diligence in researching options and make a selection that best fits the

unique needs of their organization.

Background research and content development has been provided by Second Opinions, a pro-bono consulting firm for community healthcare

organizations.

Second Opinions was founded by Northwestern medical students with experience in strategy consulting at top-tier firms. They assemble teams of

medical students to work on projects with an experienced Case Team Leader and support of an advisory network of faculty members and other experts

from Northwestern Medicine. Please visit http://www.secondopinionsfsm.org to learn more.

Agenda

• Timeline for Telehealth Implementation

• Steps for Telehealth Implementation

• Helping the User

• Q&A

• Appendix

General Timeline

Estimated Completion Time: 6 Months

Pre-Implementation

Identifying a Need

Forming the Team

Defining Success

Evaluating the Vendor

Making the Case

Contracting

Implementation

Designing the Workflow

Preparing the Team

Partnering with the Patient

Implementing

Evaluating Success

Scaling

1

2

3

4

5

6

7

8

9

10

11

12

See https://www.ama-assn.org/system/files/2020-04/ama-telehealth-implementation-playbook.pdf for further details.

The American Medical Association has released a general timeline for implementing telehealth during normal times.

Rapid Implementation Timeline

Laying the Groundwork

Picking the Vendor

Designing the Workflow

Preparing the Team and the

Patient

Implementing and Improving

1

Estimated Completion Time: 2 – 4 weeks

2 3 4 5

Narrowing the scope to small practices during the COVID-19 pandemic can accelerate and simplify the timeline.

Agenda

• Timeline for Telehealth Implementation

• Steps for Telehealth Implementation

• Helping the User

• Q&A

• Appendix

Step 1: Laying the Groundwork

“Under current constraints, how can we utilize telehealth and measure success?”

Understand regulatory constraints and constraints

unique to the individual practice

• Budget constraints: available capital for telehealth, minimum necessary operating revenue

• Billing constraints: Medicare and Medicaid updated policies, new CPT codes, major private insurer updated policies

• Regulatory constraints: HIPAA updated policies, liability insurance coverage

Determine the particular use cases the practice would like to

implement

• Telehealth visits: audio and video visits that are generally reimbursed at the full in-person rate

• Virtual check-ins: less formal audio-only visits with reduced reimbursement

• E-visits: asynchronous communication with patients, possibly including health data sharing

Determine a set of metrics the practice can track to drive

improvements

• Implementation metrics: number of visits, billed revenue

• Process metrics: rate of medication reconciliation, rate of up-to-date chronic disease follow-ups

• Patient-centered metrics: waiting times, overall satisfaction score

Step 2: Picking the Vendor

“What is the best platform for our use cases and constraints?”

See Webinar 1: Choosing a Telehealth Service Provider for more details

Admin Schedules

Visit

Patient Logs On

Admin Checks In

Clinician Joins

Admin Checks Out

Obtains consent

Gives instructions

Sends appointment reminders

Confirms visit Troubleshoots

connection

Collects co-pay Checks in

patient

Conducts virtual encounter

Concludes and sets follow-up

Documents, enters orders, and bills

Checks out patient

Gives patient visit summary

Solicits feedback

Schedules follow-up

Step 3: Designing the Workflow

“What telehealth-specific roles do we need to assign?”

Sample generalized workflow; actual steps will vary based on the individual practice.

Step 4: Preparing the Team and the Patient

Device and Internet Vendor Support

Patient Education Dry Run or Soft Open

Community Resources

Healthcare Partners

“What do our team and our patients need to maximize the telehealth experience?”

Step 5: Implementing and Improving

“How can we address unanticipated problems in a rapid and organized way?”

Suggested Cycle Length: 1 – 2 weeks

Due to the accelerated implementation, it is likely that key process improvements will need to occur during go-live

Conceptualize the implementation phase as a series of PDSA cycles

• Plan: Meet as a team to discuss changes to the workflow based on feedback and metric data

• Do: Implement changes while continuing to track metrics and feedback• Study: Informally examine interim data to see if changes are successful• Act: Make small tweaks to workflow as needed

Prioritize collection of feedback and metric data to identify problems

• Patient feedback: ensure every patient is invited to fill out a feedback survey after each visit

• Team feedback: standardize the collection of feedback comments from each team member

• Metrics: maintain continuous tracking of metrics defined in Step 1

Sample forms from the American Medical Association on collecting feedback available in Appendix 1.

Agenda

• Timeline for Telehealth Implementation

• Steps for Telehealth Implementation

• Helping the User

• Q&A

• Appendix

Tip 1: Familiarize yourself with the software.

Set up test calls between providers

in your practice

• Learn the features your vendor offers

• Practice using these features

• See what the interface looks like from the patient side

• Familiarize yourself with account creation and software setup

Browse the resources your software offers

• Most vendors have comprehensive resource guides for both the patient and provider

• Read through user guides

• Have links to user guides/FAQs readily available to share with patients and providers

Understand common pitfalls before

launching

• Recognize common errors in setup and how to solve them (e.g., patient’s video/audio not turned on)

• Make sure all providers have training (formal or informal) on how to use the video software

A template for provider resources and sample provider resources will be made available to attendees along with a copy of today’s slide deck.

Sample guide to resources for providers

Tip 2: Prepare the patient for success.

Give the patient advance notice that visits will be virtual

• Connect with your patient ahead of time via email, text message, or patient portal

• Allow enough time for patients to respond with questions or concerns

Provide the patient with basic setup

instructions

• Vendor setup guides are often difficult to access and more detailed than necessary

• Send out a set of simple instructions with pictures/screenshots to make setup as easy as possible for the patient

Consider trial runs with patients who

need the most technical support

• Certain patient populations (e.g., elderly) may not be technologically savvy

• Consider having a staff member available to walk them through the process prior to their visit

A template for patient instructions and sample patient instructions will be made available to attendees along with a copy of today’s slide deck.

Sample message sent prior to telehealth visit

Agenda

• Timeline for Telehealth Implementation

• Steps for Telehealth Implementation

• Helping the User

• Q&A

• Appendix

Contact Us

CHITREC’s Help Desk services are currently offering additional support with telehealth to keep you on the path to successful participation with Medicaid and Medicare reporting programs.

• For organizations participating in the Illinois Medicaid Promoting Interoperability Program, please contact our Help Desk at 855-684-3571 (855-MU-HELP-1) or muhelpdesk@chitrec.org.

• For small practices (15 and fewer providers) participating in the Medicare Quality Payment Program, please contact our Help Desk at 844-777-3375 (844-QPP-DESK) or nu@qpp-il.org.

Join us next week for part two of our telehealth series, which will address a process for implementing telehealth and supporting providers and patients with virtual visits!

Agenda

• Timeline for Telehealth Implementation

• Steps for Telehealth Implementation

• Helping the User

• Q&A

• Appendix

Collecting Feedback: Sample forms from the American Medical Association

Appendix 1

Additional forms available at https://www.ama-assn.org/system/files/2020-04/ama-telehealth-implementation-playbook.pdf.

Telehealth Practice Tips Sheet & Patient Instructions

Zoom

Telehealth Practice Tips SheetZoom

• Sign Up and Activate your Zoom account

• Updating Your Profile• Download the Zoom app

Initial Setup

• Tips for Telehealth• Zoom for Healthcare (optional

paid plan)

Tips and Tricks

• Scheduling a Meeting• Hosting a Meeting• Inviting Patients to your

Meeting• Using your Meeting Controls

Initiating a Call

• Frequent Issues• FAQs• Zoom Technical Support

Troubleshooting

Hello, We will be conducting your visit via a video platform called Zoom. At the time of your scheduled appointment you will be able to access the visit via the link sent to you in your appointment confirmation email either on a laptop or phone. You can see a brief video explaining the steps to follow at https://www.youtube.com/watch?v=hIkCmbvAHQQ or follow the steps below. Joining the Meeting (laptop or phone)

1. Once you click on the Zoom link providing in your email, the following screen should open up.

2. If you already have Zoom downloaded onto your device, it will automatically open the

meeting. If it does not open, click on “download & run zoom” in the red box as shown below.

3. The small tab in the image above should pop up. Click on “open.zoom.us” in the red box as shown below. Zoom will automatically download. If you are using a phone, you may have to accept the app download through your phone’s app store.

4. Once Zoom has downloaded, it will open the meeting automatically. You may see the

screen below until your physician also joins the call.

5. Once your physician joins, you should see the screen below. Click on “Join with Computer Audio” as in the red box shown below. You will then be able to hear your physician.

Using Zoom The control panel is the black bar with multiple icons at the bottom of your screen outlined in the red box below. The various options and buttons are explained below from left to right.

Mute / Unmute: Click the gray microphone to mute and unmute your microphone so your physician can hear you. Start Video / Stop Video: Click the gray video camera icon to turn your camera on or off. Invite: You will not need to use this button. Participants: You will not need to use this button. Chat: Click on this chat bubble icon. It will open up a chat window on the right of the screen where you can type questions or see things that your physician sends you. Record: You will not need to use this button. Reactions: These provide brief reactions to the content if you choose to use. Leave Meeting: You can leave the meeting at any time by clicking the red button. When your visit has come to an end, your provider will end the call. Thank you and we look forward to seeing you for your video visit. All images taken from public Zoom Rooms User Guide

Telehealth Practice Tips Sheet & Patient Instructions

Doximity

Telehealth Practice Tips SheetDoximity

• Sign up for Doximity as a

physician, NP, pharmacist, or

med student and get verified

• Sign up for Doximity as a nurse,

MA, or other care team

member

• Download the Doximity app

• Enable the Doximity dialer and

set the office number as the

Caller ID

Initial Setup

• How to set up a care team on

Doximity

• Dialer Video Patient resources

Tips and Tricks

• In the Doximity app, navigate to

the Dialer tab

• Enter the patient’s smartphone

number and press “Video Call”

to open the video chat room

• Press the “+” sign in the top-

right corner to send a link to

additional people (e.g. medical

students, nurses) to join the call

Initiating a Call

• Dialer Video Troubleshooting

• Dialer Video FAQ

Troubleshooting

Hello, We will be conducting your visit via a video platform called Doximity. At the time of your scheduled appointment you will be able to access the visit via text link. Clicking the link will connect you to your provider. If your provider is not in the call when you join, please wait for them to join the call; they have been notified and may be finishing up with another patient.

Open the text from 882-86 and follow the link provided to open a weblink to your video visit.

Tap the button to join the video call.

If prompted, accept permissions for your microphone and camera.

If your provider is not in the call when you join, please wait for them to join the call; they have been notified and may be finishing up with another patient.

During your visit, your provider will be able to see and hear you via video. When your visit has come to an end, your provider will end the call. Thank you and we look forward to seeing you for your video visit. All images taken from public Doximity user guides.

If you are disconnected, return to your text messages and open the weblink again to be reconnected.

This symbol reverses the camera so that you can show your provider a physical concern, e.g. on the arms or legs.

Telehealth Patient Instructions

MendNow

When your provider is ready, you will be connected to your video appointment.

You will be able to see your provider and they will be able to see you.

Open the text or email containing thevideo link. Follow the link

provided to open a weblink to your video visit.

Hello, We will be conducting your visit via a video platform called MendNow. At the time of your scheduled appointment you will be able to access the visit via email link or text link. Clicking the link will connect you to your provider. There may be a waiting room page. Please wait on this page for your provider to join the call; they may be finishing up with another patient.

Chat can be accessed by clicking the 3 dots.

You and your provider may chat or share files or pictures during the appointment.

Your provider may share images, lab results or diagrams during the visit.

Chat can be accessed by clicking the 3 dots.

You and your provider may chat or share files or pictures during the appointment.

Your provider may share images, lab results or diagrams during the visit.

During your visit, you will be able to interact with your provider in a variety of ways. Your provider will be able to see and hear you via video, but you or your provider may also: Chat or share files (pictures, documents, etc.) with your provider via message. Share diagrams or drawings to enhance explanations.

Your provider may also draw pictures to better provide better explanations.

Your provider may create additional documents to share with you after the visit (notes for work, after visit summaries, etc.)

Click the cloud to download and view the file.

When your visit has come to an end, your provider will end the call or your provider will transfer your call to a patient representative, who will facilitate patient “check-out”. Thank you and we look forward to seeing you for your video visit. All images taken from MendNow user guide.

Your provider may also draw pictures to better provide better explanations.

Your provider may create additional documents to share with you after the visit (notes for work, after visit summaries, etc.)

Click the cloud to download and view the file. A pop up will

appear and click to finish the download.

Your provider willend the call and this message will appear.

A pop up will appear and click to finish the download.

Your provider willend the call and this message will appear.