How To Make A Telehealth Service Available To Veterans

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1 ECC Board of Trustees Date: January 29, 2015 Subcommittee: Student Affairs Agenda Item: Memorandum of Agreement between VAWNYHS Buffalo and Erie Community College This item is for: For Board's Approval Backup Documentation: Attached to this document Background Information: The VA Hospital offers a service called Telehealth which allows a veteran to log in to a secure site and via webcam and communicate directly with a healthcare or mental health provider. The VA has offered to install the software on one computer in each of the campuses Veterans Access Center. In order to do so, the VA has submitted an MOU to outline the agreement and services that will be provided. Reasons for Recommendation: By installing Telehealth on a computer in the secure space of the Access Centers, ECC Students will be able to contact the VA for physical and mental health support without having to leave campus. This helps to alleviate issues oftransportation to and from the hospital and time missed from classes. This would be the first implementation oftelehealth on a college campus in WNY and provide ECC Student veterans with easier access to VA Hospital services that will provide a better opportunity for veterans to be retained through additional on campus services. Fiscal Implications: The cost of a webcam and headsets with a microphone is less than $100 per campus as per Joe Lundin. The Veterans Services Office has the available funds to cover this in the ASC Student fees budget. Consequences of Negative Action: ECC will not be able to install the Telehealth system without the signed MOU. This could reduce services on campus and create an opportunity for the student to miss class or possibly not persist based on having to leave campus for services. Steps Following Approval: Pending EVP Legal Affairs approval.

2 Contact Information If Any Questions: Dan Frontera, Veterans Services Coordinator

3 MEMORANDUM OF AGREEMENT VA WNYHS BUFFALO I ERIE COMMUNITY COLLEGE CAMPUS, NORTH, SOUTH, AND CITY 1. Purpose and Goals The purpose of this Memorandum of Agreement (MOA) is to establish a working relationship between VAWNYHS BUFFALO, (Buffalo VA), and the Campuses oferie COMMUNITY COLLEGE, (ECC). This agreement will allow Buffalo VA and ECC in Erie County to provide program services and screening to eligible student Veterans in the Erie County area. The overall goal of this initiative is to provide greater access to student Veterans, by providing convenient, private, area within the college Veterans center for Veteran student to communicate with VA providers for the purposes of clinical and administrative support Collaborative Buffalo VAMC services and ECC to coordinate a Tele-Social Services communication access point. Shared resources to provide ongoing, cross-organizational tele-health services. Technical, clinical, and business processes for the effective implementation of the Telehealth services between the two facilities. 2. Background College in Erie County is often a Veteran's first priority in assimilating back into civilian life. The Veteran Centers located at the site provide a point of contact in accessing VA Benefits and learning about VA Healthcare. When a Veteran presents at ECC, the Veterans Service center coordinator, acts as a counselor, and with the help of Telehealth, can connect the Student Veteran to services at the Buffalo VA. Normally these appointments would be held at the Buffalo VA Medical Center which would require transportation or would be held at a later date. The Buffalo VA Medical Center agrees to provide Clinical Video Telehealth, (CVT), services for student Veterans along with case management and therapeutic services to support mental health and other disciplines which will be delivered primarily through the use of the Telehealth technology during normal business hours. The use of telehealth will decrease transportation barriers and decrease the amount of time to a Veteran's first appointment and subsequent case management/therapeutic appointments with the VA. 3. Scope This MOA covers the proposed tele-services between the ECC site(s) and Buffalo VAMC programs. These services will be conducted using video conferencing from the Buffalo VA 1

4 Hospital to the ECC Campus Veteran Center sites. The focus will be to provide access for the veteran to VA Telehealth services in a secure environment without having to travel away from the campus to meet and consult with providers. Outcome measures will include qualitative assessments by providers, patients, and project managers as to overall success as well as quantitative assessments of provider and patient satisfaction. Eligibility will be limited to student Veterans enrolled in ECC with continued Veterans eligibility status. The remainder of this MOA will focus on details specifying rules of engagement for this pilot project including Credentialing and Privileging, Quality Management and Security, Financial Remuneration, Emergency Procedures and Safety, Medical Documentation, Clinical Procedures, Informed Consent, Privacy, and General Roles and Responsibilities. 4. Credentialing and Privileging The Centers for Medicare and Medicaid Services (CMS) and accrediting organizations such as The Joint Commission (TJC) recently modified requirements to reduce the burdens associated with privileging Telehealth care providers by permitting patient-end facilities to accept the privileging decisions of provider-end facilities. These modifications are colloquially known as "privileging by proxy". The entity providing the telemedicine services must ensure that all services provided by individuals who are licensed independent practitioners will be within the scope of the licensed independent practitioner's privileges. The entity providing the services as well as the facility receiving the services must confirm in this agreement that the resources to support the telemedicine services are adequate and appropriate. The Accreditation Association for Ambulatory Health Care (AAAHC) has provided written notification of concurrence with these standards (Appendix 1 ). Signature of this MOA demonstrates approval for the above referenced "privileging by proxy" agreement such that Erie Community College will accept the privileging decision of the Buffalo V AMC providers. This decision assumes that following criteria are followed and maintained for the duration of the initiative. a) Buffalo VA is accredited by TJC or other appropriate accrediting entity designated by the Chief Medical Officer. b) The distant site Erie Community College Campus sites will provide staff contact numbers to alert in the event of an emergency that may arise in the Clinical Video to College visit. c) At a minimum, the Buffalo VA and Erie Community College Veteran Centers must exchange information regarding all adverse events that result from services provided during the course of this pilot. 2

5 5. Clinical Procedures, Informed Consent, and Privacy The Buffalo V AMC will provide professional, diagnostic, therapeutic, and related consultations to Veterans located at Erie Community College campuses with respect to health care delivery as defined by this agreement. All diagnostic, therapeutic, and consultative services will be documented in the VA medical record system utilizing the local CPRS (see Medical Documentation below) and other appropriate medical record applications/tools consistent with the policies and procedures of Buffalo V AMC. Authorized originating and distant sites, and providers, for this program must also have the following capabilities. a) Provide patients with a secure and private setting. b) Provide appropriate Technical support, including access by local emergency services should the need arise. c) Provide Equipment, computer, webcam and internet access. d) Meet any other capability requirements established by the Chief Medical Officer. Informed Consent. Buffalo V AMC will obtain informed consent and documentation will be provided to the VA providers for entry directly into the medical record. There are no absolute contraindications for Telehealth appointments and patient refusal is generally considered the primary exclusion criteria and will be determined during the informed consent process. However, the providing clinician should also consider the following criteria for exclusionary purposes: immediate need for hospitalization, acutely violent or unstable patients with poor impulse control, active suicidal or homicidal ideation, currently severe decompensation, active dementia, current psychotic disorders that may be exacerbated by telehealth technologies, current untreated substance abuse/dependence, multiple medical problems that may significantly affect cognitive/behavioral states, and environmental emergencies in setting that necessitate evacuation. Scheduling. The two parties agree to develop a scheduling process by which veterans can be seen within 72 hours (business days). Services will be scheduled between ECC campuses and the consulting telehealth provider at Buffalo V AMC. Either side may initiate a request thru either secure or via phone. Details of scheduling shall be worked out between the two parties as program is rolled out. The Buffalo VAMC telehealth provider will conduct one ofthe following actions: perform the services with respect to requested care, advise Student Veteran via that additional patient history/information or other information is required to perform the Services, decline to provide services within timeliness standards and provide rationale in format, or indicate that services cannot be provided (with reason). Buffalo VAMC Telehealth will monitor when the service request has been submitted to ensure services meet 3

6 agreed upon standards. It is the responsibility ofthe student Veteran to notify the Veteran Center Coordinator or his designee 48 hours prior to the appointment, to allow the room and equipment to be reserved. Timelines to deliver care and reasons for not providing care will be documented as success measures. 6. Quality Management and Security Effectiveness in meeting health care needs will be determined by extent to which the care provided meets timeliness, quality, and satisfaction evaluation standards established by V AMC. V AMC and Erie Community College Veteran Centers will comply with all applicable laws and regulations including laws and regulations concerning patient records, and the Health Insurance Portability and Accountability Act of 1996 (HIP AA). Both parties will have responsibility to notify the other by telephone or when there are issues, concerns or problems related to data/information transmissions, patient identification questions, confidentiality, incomplete information, or patient safety. Reviews will be conducted by Buffalo V AMC to assess any deficiencies in professional performance following procedures defined by V AMC and Erie Community College Veteran Centers. This should include a review of any collected timeliness, quality, and satisfaction measures by already established performance improvement committees at both facilities. Use of already established committees promotes the bidirectional sharing of information, discussion of performance monitors, review of incidents and complications, and identification of process deficiencies. Systemic discrepancies will be documented and may result in corrective action. All incidents leading to serious adverse event or outcome will be reported to the review committees within 24 hours. Reviews may be used to support the provider's continued competency and granting of privileges. 7. Financial Remuneration This program anticipates no financial remuneration will be required. Modifications to this will be conducted as required and documented as appropriate. Active Veterans that are eligible will not be billed for these services. 8. Emergency Procedures and Safety Erie Community College Campuses Veteran Centers will provide Buffalo V AMC with points of contact to immediately contact Erie Community Campus personnel for communicating patient safety concerns (i.e. suicide risk, medical) and or problematic findings that require urgent or 4

7 emergent local intervention. The (GA) 911Emergency response will be the first line of contact, with a back-up point of contact also provided. All ECC Sites will follow all local emergency and safety procedures in the event of an emergent situation. 9. Medical Documentation All required medical record documentation will occur in the CPRS electronic medical records system. As this is classified as CVT to Home, Buffalo V AMC providers will be responsible. 10. Additional Roles and Responsibilities a. Buffalo V AMC will: Confirm that Buffalo VAMC has all appropriate and necessary resources to support the agreed upon provision of services including space, staffing, equipment, support services, and clearly identified emergency response processes and personnel, Comply with all applicable laws, regulations, and IT security mandates, Assure proper privileging and credentialing of all telemedicine providers including verification that privileges include the care to be delivered via telemedicine, Provide ECC Veterans Center Coordinator with the provider's contact information, Validate that each encounter is documented and recorded in the patient's medical record and that documentation meets all health information requirements, and Be responsible and accountable for meeting the VHA Office oftelehealth Services Conditions of Participation, Joint Commission and AAAHC standards for the provision of relevant services and is responsible for addressing all Joint Commission and AAAHC standards for the provision of care, Assist Erie Community College with coordination of all relevant VA procedures and policies necessary for care delivery including, but not limited to, provider credentialing and privileging, health records integration, and Comply with all requirements such as HIPAA included and any other reasonable requirements not included in this agreement. Provide necessary staff to support the delivery of these services from their Campus locations for this pilot. b. Erie Community College Campus Veterans Service Center site will: Identify an appropriate site that is secure and private to conduct the video session. Consult with Buffalo V AMC for technical support and technology considerations, 5

8 Assure availability of all necessary space, equipment~ staffing, support services, and other resources needed to provide requested services via telemedicine prior to the initiation of these services. Assure clear and appropriate transmissions that are of sufficient quality to allow telemedicine providers to perform the agreed upon Services. Comply with all requirements such as HIP AA included and any other reasonable requirements not included in this agreement. 11. Other Resources: Buffalo V AMC and ECC Veterans Service Center points of contact will confirm that their site(s) have appropriate and necessary resources to support the agreed upon provision of services, including but not limited to: space, staffing, equipment, support services, clearly identified emergency response processes and personnel. IT: Buffalo V AMC and ECC Veterans Service Center points of contact will coordinate regarding IT connectivity, identifying a Telehealth!IT point of contact at each site to establish and test connectivity. Each site will comply with all applicable laws, regulations, and IT security mandates. 12. Points of Contact (VISN 2 TeleHealth Lead) Name: LaRock, Michelle Title: Network Health System Specialist Mailing Address: Phone: +1 (518) Michelle.Larock@va.gov (Buffalo FTC) Name: Paul Galantowicz, FTC Title: Facility TeleHealth Coordinator Mailing Address: 3495 Bailey Ave, Phone: Paul. Galantowicz@va.gov (Director: VHA WNYHS-Buffalo) Name: Stiller, Brian (SES) Title: Director Mailing Address: 3495 Bailey Ave,

9 Phone: Brian. gov (Director: Eire Community College Veterans Center) Name: Dan Frontera Title: Veterans Center Coordinator Mailing Address: 121 Ellicott Street Phone: (716) Effective Date This MOA is effective for 2 years following the date of final signature, or until completion of the agreed upon number of patient evaluations, whichever occurs soonest. This MOA may be modified upon the mutual written consent of the parties and will remain in effect for 1 year following modifications unless terminated by either party. Either party, upon 30 days written notice to the other party, may terminate this MOA. Should it be determined that this service will continue after the pilot program concludes, an addendum to this agreement will delineate any future activity. 14. Signatures NAME Date NAME Date Director: Director: VHAWNYHSVAMC Erie Community College 7

10 Jack Quinn, President Erie Community College Date STATE OF NEW YORK COUNTY OF ERIE On the day of, before me personally came Jack Quinn, to me known to be the individual described in, and who, executed, the foregoing instrument and acknowledge that he executed the same. Notary Public Approved as to Form: Kristin Klein Wheaton, Executive Vice President, Legal Affairs Date Document Assignment # Approved as to Content: Benjamin A. Packer, Executive Vice President of Student Affairs Date