NACCHO Telehealth Guidelines. Conducting a Telehealth Session- The Clinical Aspects

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1 NACCHO Telehealth Guidelines NACCHO are working toward the establishment of Telehealth in all 150 member services across Australia by the end of 2015 through training and other support. These guidelines are part of a range of resources to assist you to confidently conduct and establish Telehealth in your service. They have been developed in collaboration with the Australian College of Rural and Remote Medicine (ACRRM). 1 Conducting a Telehealth Session- The Clinical Aspects 1. Selecting patients for Telehealth It is important to consider the suitability of the patient, the health issue and the situation before deciding on Telehealth. There are some instances where Telehealth is not the best solution for providing patient care. It is essential that you consider: Clinical factors: Will this provide the best care for this patient? Will it take into account issues of continuity of care and shared care? Practical factors: Is the appropriate specialist available? Is the technology available? Is a trained local clinical staff member available? The Patient s ability to travel, family and work situation, and cultural factors. Plus: Your organisation s criteria for patient s suitable to Telehealth. Whether your patient is able and willing to participate in Telehealth. NACCHO Setting up Telehealth in your Service: What s needed Department of Health and Ageing Program Overview 1. NACCHO Guidelines have been adapted from the ACCRRM Telehealth Guidelines which were based on the ACCRM Advisory Committee (ATHAC) Telehealth Standards Framework developed from a range of references. These are listed at the end of this document. NACCHO TELH 9 Telehealth Guidelines Page 1

2 2. Informing your patient about the session It is essential that the patient is comfortable and well informed. They need to know: Why they are having a Telehealth consultation. Other options for their care if they don t feel comfortable with Telehealth. The role of each person who is participating: both in the room and on the computer interface. What out-of pocket charges there will be and how the Telehealth session compares to other available options. Who to give feedback to and who to make a complaint to if there are any problems. The level of security and privacy of the system that is being used. A plain language factsheet that is culturally appropriate is helpful, as well as a verbal explanation. NACCHO Using Skype for Telehealth Sessions: Understanding the benefits and the risks NACCHO Telehealth Patient Information Department of Health and Ageing Patient Questions and Answers 3. Getting consent It is essential that the patient gives consent. Consent can be either verbal or in writing. If the session is to be recorded (for example for education or assessment purposes) or if the type of care provided is likely to be very different from usual care, get consent in writing on a standard consent form. NACCHO Telehealth Patient Consent Form NACCHO TELH 9 Telehealth Guidelines Page 2

3 4. Planning the consultation Things to consider: The use of evidence-based guidelines for selecting patients for Telehealth and implementing consultations in the relevant clinical field, or the use an evaluation framework such as the ACCRM ARTS Framework to determine the best fit of Telehealth for the clinical aims. The role of Telehealth in the overall management of the patient: Is it a one off for a particular reason or will there be continuing sessions? Are there limitations to Telehealth for the patient? How can they be overcome or reduced? Is and interpreter or a family support person needed? The need to confirm the patient s identity in the session and their need to confirm yours. The length of time you will need for the consultation and the need to inform the referring health worker and patient about this. A health care provider will need to be with the patient for all or some of the Telehealth session. The patient s privacy. What risks does your Telehealth delivery method have and what are the procedures you have in place for managing these? ACCRM How to Conduct a Video Consultation ACRRM ARTS Framework ACRRM Telehealth Provider Directory NACCHO Setting up Telehealth in your Service: What s needed RANZCP Position Statement #44 Telepsychiatry (see Appendix 1: Quality Practice Guidelines for Telepsychiatry) 5. Practitioner relationships It is important to be clear on the roles of each of the practitioners involved in the consultation and to keep all colleagues who share in the patient s care well informed. Things to consider: Who will you refer the patient to? There are Telehealth provider lists available: for ACRRM s see the resources section below. Is the referee familiar with the cultural context of the patient (if relevant)? What is the arrangement for following the progress of the patient and informing each of the relevant practitioners involved in the patient s care? How will you keep a record of the consultation? It is advisable that both providers take their own notes for their own systems. Are there changes in the usual role of each provider given the remote nature of the consultation? How will these be addressed? Resource ACRRM Telehealth Provider Directory NACCHO TELH 9 Telehealth Guidelines Page 3

4 Conducting a Telehealth Session - The Technology 1. Your equipment and internet connection Your equipment and internet connection must be suitable for supporting Telehealth sessions. It is essential that: The equipment works reliably and well over the locally available network and bandwidth. The equipment is compatible with the equipment used at the other Telehealth sites. Your internet connection (or other means of connection) meets suitable security standards for the storage and transmission of health information. As well, you need to ensure this is the case with the Telehealth sites you are connecting to. Peripheral devices (such as Bluetooth otoscopes, stethoscopes, BP monitors, etc.) are used in a fit-for-purpose manner jointly determined by the patient-end clinician and the distant specialist. When setting up the Telehealth system and equipment ensure: It is installed according to the product guidelines and ideally in collaboration with other organisations/practitioners using the Telehealth system. The system is tested with the participating health care organisations to ensure that everything works as expected. NACCHO TELH 9 Telehealth Guidelines Page 4

5 2. Managing the confidentiality risk No computer or communication system is completely secure and interception and misuse of health information has the potential to adversely affect a person s life. You need to ensure: You have analysed the risk inherent in your system and considered the likelihood and magnitude of potential problems. You have procedures for detecting, diagnosing and fixing equipment problems. Technical support services are used to establish and maintain your system, and are available during the times you will be undertaking your Telehealth sessions. There may be times when the equipment or connection doesn t work well. You need to: Have a back-up plan to cope with equipment or connectivity failure. For non-urgent consultations, rescheduling or completing by telephone may be sufficient. Consider installing an uninterruptible power supply and a second type of connection as a backup if urgent consultations are likely to be part of your Telehealth work. NACCHO Using Skype for Telehealth Sessions: Understanding the benefits and the risks ACRRM Interpretative Guide to DoHA Guidelines ACRRM Telehealth Technical Overview ACRRM Telehealth Technology Directory ACRRM Trouble Shooting Guide Department of Health and Ageing Guidance on Technical Issues Department of Health and Ageing Guidance on Security and Privacy NACCHO Getting the technology right NACCHO TELH 9 Telehealth Guidelines Page 5

6 Telehealth in your Practice- The Context 1. The physical environment The room you use for your Telehealth sessions must be suitable. You will need to consider: The size of the space: is it big enough to allow family and carers to attend, to observe the patient s gait, etc. Does it ensure privacy and make the patient feel physically, culturally and emotionally comfortable. Does it allow the equipment to work well: does it have good lighting, sufficient distance to allow best use of the camera, is it quiet enough so that background noise won t be a problem? 2. The logistics To implement Telehealth there will need to be some changes to the way you organise bookings, and allocate space and equipment. 3. The business environment The business aspects of implementing Telehealth require considered planning. You will need to consider: The business case : What are the costs and benefits of Telehealth. How will you ensure that it is sustainable from a financial perspective? Changes to workflow, staff activities and time as a result of introducing Telehealth. What changes you will need to implement to support implementation? What practitioner (and other staff) training is required, how will you enable this to occur? Insurance: Ensure that Telehealth delivery is covered by professional indemnity and other insurance. Including Telehealth delivery as a component for your ongoing quality improvement programme. NACCHO Setting up Telehealth in your Service: What s needed. NACCHO Conducting a Telehealth Session ACRRM Telehealth Financial Model for Primary Care Practice ACRRM Telehealth Do Not Disturb Door Hanger NACCHO TELH 9 Telehealth Guidelines Page 6

7 References and Contributors ISO draft technical specifications Health Informatics Quality criteria for services and systems for telehealth (ISO DTS 13131) (2012) AHPRA Guidelines for Technology-based Patient Consultations (2012) ACRRM Core Principles for Telehealth (2011) DoHA Guidance on Technical Issues (2012) Maeder A. Telehealth Standards Directions Supporting Better Patient Care (2008) Health Informatics Society of Australia Ltd McConnel FB, Pashen D, McLean R. The ARTS of risk management in rural and remote medicine Can J Rural Med (2007) 12 (4) ACRRM International Review of Telehealth Standards (2010) Australian Medical Associations (AMA) Guidelines (2006) American Telemedicine Association (ATA) Core Standards for Telemedicine Operations (2007) RACGP Standards for general practices offering video consultations (2011) Defence Update MDA National Risk Management for Telemedicine Providers (Autumn 2006) Wade VA, Eliot JA, Hiller JE. A qualitative study of ethical, medico-legal and clinical governance matters in Australian telehealth services Journal of Telemedicine and Telecare (2012) 1-6 ACRRM ehealth staff ATHAC Members ACRRM TeleHealth clinical review panel NACCHO Telehealth Working Group. NACCHO TELH 9 Telehealth Guidelines Page 7