10/16/2018 Incorporating Telehealth into Your Practice Troy Cascia, Au.D. Lead Senior Audiologist, UCSF 1
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10/16/2018 “The mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self ‐ management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self ‐ management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.” CA Business & Professions Code Sec. 2290.5 1. Its purpose is to provide clinical support. 2. It is intended to overcome geographical barriers, connecting users who are not in the same physical location 3. It involves the use of various types of ICT 4. Its goal is to improve health outcomes 4
10/16/2018 • Increase access to audiology services • Improve outcomes with consistent continuity of care • Provide services to patients who cannot travel or have limited access to healthcare • Convenience to patients • Increased patient satisfaction Synchronous • Live • Videoconferencing Non ‐ synchronous • Store and forward transfers • Cloud based • Hearing aid/cochlear implant programming • Hearing screening/test apps 5
10/16/2018 Desktop/laptop computer Tablet Smart phone Synchronous interaction (real time) • Individual videoconferencing • Counseling • Group videoconferencing • Interdisciplinary collaboration • Information sessions • Support groups 6
10/16/2018 Videoconferencing apps • Facetime • Skype • WebEx • Zoom 7
10/16/2018 • Non ‐ synchronous interaction (store and forward transfer) • Several hearing aid manufacturers have products capable of remote programming • Resound LiNX 3D, ENZO 3D, and LiNX Quattro • Signia Primax, NX, and Styletto • Starkey Livio and Livio AI • Oticon Opn and Siya (pending) • Tech savvy • Has computer, laptop, tablet, smart phone • Has WiFi or internet connection • Long distance • Mobility or transportation challenges 8
10/16/2018 California law • Provider must be licensed in the state where the patient is located at the time of the appointment • Must verbally consent to participation in a telehealth appointment, and must be documented • Limited to the scope of practice allowed by licensure • H.R.2550 ‐ Medicare Telehealth Parity Act of 2017 introduced to expand Medicare coverage of telehealth services to audiologists (and others). Pending. HIPAA • All transmissions must be encrypted to prevent breach of protected health information (PHI) • All PHI must be protected as with any in ‐ person patient 9
10/16/2018 • If the patient isn’t known to you, verify identity by checking two patient identifiers (e.g. full name and birthdate) or have patient show ID • Be sure provider badge is visible on screen to patient • Do not record encounters • Both provider and patient must have appropriate technology • Hardware and software • Connectivity • Adequate bandwidth • Must be comfortable using technology • Limited appointment types / No physical contact required • HIPAA compatible • Inertia 10
10/16/2018 • Schedule as video visit • Send instructions to patient • Call patient to make sure they checked their equipment • Check your own equipment • Ensure space is available for visit • Consider starting with a pilot program with 1 or 2 providers (including a “telehealth champion” and 1 support person • Eventually provide training for all providers and support staff • Perform routine equipment and connectivity checks • Have a back up plan if connectivity fails • Have IT support available, if needed 11
10/16/2018 • Not covered by insurance • Visits must be no charge or self pay https://www.audiology.org/practice_management/resources/tele ‐ audiology ‐ toolkit https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934956§ion=Resources https://www.speechandhearing.ca.gov/licensees/telehealth.shtml https://www.medicare.gov/coverage/telehealth https://www.dhcs.ca.gov/provgovpart/Pages/Telehealth.aspx 12
10/16/2018 Ben Thompson, Au.D. Kylie Hill, M.A. Christina Melora, Au.D. Patty Nason, M.B.A. 13
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