HHS Telemedicine Hack - Project Echo
HHS Telemedicine HackWeek 4: Office Hours #2August 12, 2020
Welcome to Telemedicine (TM) Hack! 10-week learning community to accelerate telemedicine implementation for ambulatory care providersPeer-to-peer learning Case studies and discussion boards Modeled after CMS-led learning collaboratives (e.g., Transforming Clinical Practice Initiative) Inclusive and diverse All ambulatory care providers invited to participate Designed as 10-week sprint Urgency due to public health need Optimize telemedicine readiness in anticipation of fall COVID-19 surgeGOAL: At least 90% of participants will have conducted and billed 1 or morevideo-based telemedicine visits by September 30, 2020Saving Lives. Protecting Americans.2
“HHS Telemedicine Hack” CurriculumSession #1: Telemedicine– Where Do I Start?July 22nd, 12-1PM ETOffice Hours # 1July 29th, 12-1PM ETOffice Hours # 2Session #2: Workflows & DocumentationAugust 5th, 12-1PM ETYou are hereAugust 12th, 12-1PM ETSession #3: Overview of Telehealth Billing & Reimbursement PoliciesAugust 19th, 12-1PM ETOffice Hours # 3August 26th, 12-1PM ETSession #4: Clinical Best Practices & the Art of the Tele-Physical ExamSeptember 2nd, 12-1PM ETOffice Hours # 4September 9th, 12-1PM ETSession #5: The New Normal– Making Telemedicine Part of Your Permanent PracticeSeptember 16th, 12-1PM ETOffice Hours # 5September 23rd, 12-1PM ETGOALAt least 90% of participants will have conducted and billed 1 or more video-based telemedicine visits bySeptember 30, 2020Saving Lives. Protecting Americans.3
“HHS Telemedicine Hack” Data Use Project ECHO collects registration, participation, questions/answers, chat comments, and poll responses for this programand shares this data with HHS/ASPR. Your individual data will be kept confidential. These data may be used for reports,maps, communications, surveys, quality assurance, evaluation, research, and to inform new initiativesSaving Lives. Protecting Americans.4
Logistics Use Q&A function on Zoom for questions and comments for speakersUse Chat function on Zoom for technical/logistical issuesThis session is being recorded. Your attendance is consent to be recorded.CME/Continuing Professional Development (CPD) credits—Link is in today’s Project ECHO email announcement and will alsobe placed in the Chat at end of session.Saving Lives. Protecting Americans.5
How to Ask Questions on TM Hack Please be as specific as possible—More details, the better! Information that will help facilitate answering your question include: Specific state where the patient is locatedWhere the telehealth interaction is taking placeWhere the provider is locatedType of provider (e.g., hospital, FQHC, solo practitioner, nurse, PT/OT)For billing/reimbursement issues, please include if you are asking about Medicare, Medicaid, or private payerPlease post additional questions to the TRAIN discussion boards TRC staff will review discussion boards periodically; Answers available to entire TM Hack communitySaving Lives. Protecting Americans.6
Today’s Agenda Case #1: Three’s Company: Adding More People and Value to Virtual Visits– Kyle Knierim, UCHealth, Denver, CO (10 min) Q&A Follow-up (5 min) Ask Our Panelists Your Workflow Questions (35 min) – Moderated by Dr. Christian Ramers. Panelists are: David Dansereau, MSPT — Member Expert, Digital Medicine Society Tollie Elliott, Sr., MD — Chief Medical Officer, Mary’s Center Kyle Knierim, MD — Associate Director of Practice Transformation, UCHealth Dara Koppelman, RN, MHSA — Chief Nursing Officer, Mary’s Center Elizabeth Krupinski, PhD, FSPIE, FSIIM, FATA, FAIMBE — Co-Director, Southwest Telehealth Resource Center Fay MacDonnell — Senior Workflow Engineer, OCHIN and California Telehealth Resource Center Tabassum Salam, MD, MBA, FACP — VP, Medical Education, American College of Physicians John Scott, MD, MSc, FIDSA — Medical Director of Digital Health, UW Medicine Eric Shah, MD, MBA— Director, Gastrointestinal Motility, Esophageal, and Swallowing Disorders Center, Dartmouth-Hitchcock Health Leah Shoval, BSN, RN, IBCLC — Director of Care Coordination, Mary’s CenterTwo TRC staff—Rebecca Picasso (California TRC) and Andrew Solomon (Northeast TRC)—will answer questions in Q&A box that are not posed to the panel.Saving Lives. Protecting Americans.7
Three’s CompanyTelehealth Experienceat the University of ColoradoDepartment of Family MedicineKyle Knierim, MDAssociate Director Practice Innovation Program @ CUAugust 12, 2020
University of Colorado DFM Clinics5 Clinics Spread Across Denver Metro Area CU School of Medicine clinics affiliated withUCHealth, a nonprofit network of hospitals,provider groups and facilities in Colorado,Nebraska and Wyoming All NCQA Level 3 recognized, CPC Integrated Care Team Faculty Physicians: 62NP: 4, PA: 2FM Residents: 18RN’s, tele-psychiatry, embedded psychology, clinicalpharmacists, SW, care managers, QI coaches at eachsite, tele-legal coming this fall. MA: 2.5 MA:1 provider (ideal state) Platforms: Epic EHR; Vidyo integration; Doximityvideo and phone as backup
Virtual Care Maintained Patient Access andPrimary Care Volume During 962398608398 99% of allvisits were inperson inOctober 61Nov71Dec96Jan69FebMar2019Virtual Visits32031922AprMayJun2020In Person Visits2867Total VisitsJul 73% of allvisits wereVirtual inApril 2020
Timeline of DFM Clinic’s Virtual Visit ExpansionOnline Scheduling ofVirtual Visits via MHC (4/9)Prework (Before Sept 2019) Local Technical Training250 Initial equipment purchases Vidyo-Epic integrations200 Early adopters pilot virtual visitsResidents & BH fully remote, faculty“Crop Rotations” Begin (3/20)Patient LineSchedules FirstVirtual Visits (3/18)15010050DFM Virtual VisitChampions Start(10/1)Pilots of fully remoteprimary care sessions(Dec 2019)DFM virtual visit trainingdeveloped (Jan ILY VIRTUAL VISITS300OctNov2019DecJanFebMar2020Apr
Relatively well prepared by FebruaryMedical ProvidersBH ProvidersGME99%100%100%90% 54% of medical providers in DFMclinics had experience withvirtual visits by February 2020PERCENT OF TOTAL PROVIDERS80%70%54%60%49%50%39%40%30%20%10% DFM focused attention to VirtualVisits began in October 201926% 99% of all 75 medical, behavioralhealth and GME providers haddone virtual visits within 2 weeksof COVID disruptions29%13%13%13%13%13%0%0%0%0%0%OC TNOVD ECJANFEB0%M ARAP R
1. 3 participants for the whole visit “In room” scribingInterpreter servicesSupport for patients with disabilitiesExtra family members or caregivers2. The Warm HandoffCommon scenarioswith 3 people Tele-psychiatry co-consults On-demand Behavioral Health Clinical pharmacy3. Supervising Trainees Family Medicine residents Psychology interns and externs4. Virtual group visits Advance Care Planning Centering Pregnancy Group counseling using Health and Behavior codes
1. 3 participants for the whole visit “In room” scribingInterpreter servicesSupport for patients with disabilitiesExtra family members or caregivers2. The Warm HandoffCommon scenarioswith 3 people Tele-psychiatry co-consults On-demand Behavioral Health Clinical pharmacy3. Supervising Trainees Family Medicine residents Psychology interns and externs4. Virtual group visits Advance Care Planning Centering Pregnancy Group counseling using Health and Behavior codes
1.Pick telehealth platforms that allow for 5 users to joinsimultaneously2.Make Access Consistent and Easy Preferred: EHR Portal Integration Link to virtual room automatically generated forcertain visit types Care team enters room using link accessed in EHRon their computer or mobile app Patients access link from their secure patientportal account Back up: Stand alone Platform Virtual room created on the fly using Doximity Link is sent to both patient and care team via text Special (rare) cases: HIPAA-compliant versions of MS Teams or Zoomused for large group virtual visits3.Prepare, practice, tweak, repeat.The Basics Elements
ApproachProsConsEHR PatientPortal Integration One login for care teams Synchronized e-Checkin with consents,insurance verification, co-pay collection, etc. More time to share link Promotes use of portal for its other features(self-scheduling, med refills, results, etc.) Extra steps more chances forthings to go wrong (emailaddress, portal account, proxyaccess for caregivers/parents,navigation, Vidyo bugs, etc.)Stand alonePlatform Patient: Simple. Just need a smartphone and Consents and otherclick on a link.compliance items handled Provider: Create virtual room in 30 sec.,separately.share with others quickly. Outside of normal EHR Nice back up before resorting to phone-onlyworkflowsvisit.
Details on Specific Scenarios - InterpretersIdeal Contracted with 3rd partyinterpretation company; interpretersgiven EHR access Interpreter scheduled to join virtualroom at the same time as the patient Currently set up for two commonlanguages: American Sign Languageand Spanish, expansion underway toother languagesWork Arounds Securely send virtual room link tointerpreter on the fly (best/hardest) Provider & patient on video,interpreter on speaker phone (clunky) 3-way telephone call without video(easiest)
Details on Specific Scenarios – Warm Handoffwith Behavioral Health Provider (BHP)IdealWork Arounds BH team creates on-demand schedulegiving a BHP few, if any, scheduled visits.Staff and medical providers reminded ofon-demand BHP prior to each session. BHP tied up at the moment: BHP repliesin chat and communicates a time to callpatient later in the day. Medical providerinforms patient of the plan. Medical provider explains rationale forengaging BHP, sends secure chat to BHPgiving brief sketch of the patient’sneeds. No BHP scheduled at the time (night,weekend, etc): provider puts in referraland patient schedules a 1:1 visit withBHP at a future date. BHP joins room, medical providerintroduces BHP and either stays for covisit or leaves room to see next patient
1. 3 participants for the whole visit “In room” scribingInterpreter servicesSupport for patients with disabilitiesExtra family members or caregivers2. The Warm HandoffCommon scenarioswith 3 people Tele-psychiatry co-consults On-demand Behavioral Health Clinical pharmacy3. Supervising Trainees Family Medicine residents Psychology interns and externs4. Virtual group visits Advance Care Planning Centering Pregnancy Group counseling using Health and Behavior codes
My telemedicine lifehack is . . .Over-prepare your team.Kyle.Knierim@cuanschutz.edu
Your Telemedicine Questions,AnsweredPlease submit your questions through the Q&A boxSaving Lives. Protecting Americans.21
TRAIN is Your One-Stop Shop for TM Hack Resources Visit www.train.org Login if you have an account, or create an account if you don’t have one To access discussion boards, slides, and recordings Click on “Your Profile” (under Your Name on the top right) to access the “Manage Groups” screen Enter “TMHACK” under “Join by Group Code” Save your profile and then click the Discussions tab Click here for a TRAIN User Guide with step-by-step instructions Other TRAIN benefits HHS training certificate, if you complete 8/10 TM Hack sessions Access to other trainings, including COVID-19 resourcesSaving Lives. Protecting Americans.22
TRAIN Discussion Boards Discussion Boards (n 11) 8 topical boards Getting Started in Telemedicine (Week 1) Workflows & Integration (Week 3) Regulations, Compliance, and Documentation (Weeks 3 & 5) Billing Policy, Coding, and Reimbursements (Week 5) Scaling Up & Sustainability (Week 9) Equitable Access Miscellaneous Technology Specialty Connect Slides, Recordings, and Session Materials Telehealth Resource Centers (TRCs)Saving Lives. Protecting Americans.23
TM Hack Updates TRC Picks—Frequently Used Telehealth Resources Midpoint survey To be conducted after next week’s session Healthcare providers and non-healthcare providers will both be able to complete survey Save-the-Date—“Bonus Hack” on Tele-behavioral health (Thu, Sept 3, Noon-1 PM ET) Separate invite and registration from main TM Hack seriesSaving Lives. Protecting Americans.24
Billing and Reimbursement #1 “pressing need” of TM Hack registrants ( 20%) Next week’s session (Week 5—“Overview of Telehealth Billing and Reimbursement Policies”) Many factors impact what is reimbursed and how to bill for services provided This session will provide an overview of some of those factors and how they impact telehealth billing andreimbursement policies for Medicare, Medicaid and commercial payers in the time of COVID-19 Week 6—Office Hours #3Saving Lives. Protecting Americans.25
“HHS Telemedicine Hack” CurriculumSession #1: Telemedicine– Where Do I Start?July 22nd, 12-1PM ETOffice Hours # 1July 29th, 12-1PM ETOffice Hours # 2Session #2: Workflows & DocumentationAugust 5th, 12-1PM ETYou are hereAugust 12th, 12-1PM ETSession #3: Overview of Telehealth Billing & Reimbursement PoliciesAugust 19th, 12-1PM ETOffice Hours # 3August 26th, 12-1PM ETSession #4: Clinical Best Practices & the Art of the Tele-Physical ExamSeptember 2nd, 12-1PM ETOffice Hours # 4September 9th, 12-1PM ETSession #5: The New Normal– Making Telemedicine Part of Your Permanent PracticeSeptember 16th, 12-1PM ETOffice Hours # 5September 23rd, 12-1PM ETGOALAt least 90% of participants will have conducted and billed 1 or more video-based telemedicine visits bySeptember 30, 2020Saving Lives. Protecting Americans.26
See One, Do One, Teach Onetmhack@hhs.gov(Use this email toreach TM Hackorganizers directly)Saving Lives. Protecting Americans.27
TRC Picks—Frequently Used Telehealth Resources Telehealth COVID-19 Policies—Federal and State State Medicaid Telehealth Policies How to Select Technology–TTAC Tool Kits What to Expect in a Telehealth Visit (for patients) Telehealth Implementation Checklist FDA Medical Devices Fact SheetSaving Lives. Protecting Americans.28
Saving Lives. Protecting Americans. 4 “HHS Telemedicine Hack” Data Use Project ECHO collects registration, participation, questions/answers, chat comments, and poll responses for this program and shares this data with HHS/ASPR. Your individual data will be kept confidential.
Square format works for Twitter, Facebook, and Instagram. 4. Sharable :15s videos (5 versions) Square format works for Twitter, Facebook, and Instagram. Included: 3-Point Lighting Hack, Teleprompter Hack, Plank Cam Hack, Punch Sound Hack and Reflector Card Hack Try and make reference to the hack in your post, so the
The impact of telemedicine on the medical development of remote regions 24 Prof. Louis Lareng , Director of the European Institute of Telemedicine in Toulouse, and Dr Monique Savoldelli , CHU Toulouse Telemedicine actors Telemedicine Ð Bringing health closer to citizens 27 Marina Geli , Catalan Minister for Health
Project ECHO Annual Meeting Survey N 17 Mean (1-5) Project ECHO has diminished my professional isolation 4.3 Participation in Project ECHO has enhanced my professional satisfaction 4.8 Collaboration with Project ECHO is a benefit to my clinic 4.9 ECHO has expanded access to HCV treatment for pts in our community 4.9 HCV expertise/consultation is a major area of need for you and your .
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HTC Clients SBIR/STTR - 30M Company Client Status Total Funds ( )* Loan SBIR I SBIR II STTR I STTR II Agencies Archimage Former 5,019,915 1 3 HHS Aros, Inc. Graduate 423,885 3 DOD; HHS CorInnova, Inc. Graduate 248,233 2 NSF; HHS DNAtrix Former 160,632 1 HHS Endothelix Graduate 94,375 1 HHS Ensysce Biosciences, Inc. Former 298,072 1 HHS
The Health and Human Services (HHS) Enterprise Architecture (EA) Governance Plan describes the major activities of the HHS EA Prog ram and, especially, the interaction of HHS EA Program activities with related functions, processes, and initiatives within and outside HHS. The Governance Plan defines . 3.2.5 HHS Data Architecture Work Group .
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A02 Authorised: return title page only to supplier A03 Authorised: keep as complimentary copy, credit will be given in full A04 Hold pending further investigation A05 Return to supplier regardless of condition A06 Claim authorised for credit Although it remains customary for the distributor to require the return of the complete book before giving credit, the code lists also provide for .
