More than three-fourths of hospitals are currently using or implementing telehealth.
What is Telehealth?
As defined by the American Telemedicine Association (ATA) “telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status”. The Agency for Healthcare Research and Quality (AHRQ) states, “telehealth is the use of telecommunications technologies to deliver health-related services and information that support patient care, administrative activities, and health education”. The Centers for Medicare & Medicaid Services (CMS) define it as “a two-way, real- time interactive communication between a patient and a physician or practitioner at a distant site through telecommunications equipment that includes, at a minimum, audio and visual equipment.”1 The terms telemedicine and telehealth are considered synonymous and are used interchangeably to describe use of electronic information and telecommunications technologies to support clinical health care, patient and professional health-related education, public health and health administration.2
How to get started with Telehealth
The initial phase of any telehealth project includes assessing needs, setting goals, and identifying the resources. Establishing a broad-based support team is essential to the successful identification, development and implementation of the program. Following are key team members:63
Responsible for managing contracts, communicating with and recruiting the telehealth partners (typically vendors, insurers, or service providers) and identifies office personnel support roles. This team member may also be responsible for identifying any regulatory issues regarding the use of telehealth in their region. View sample job description.
Responsible for understanding the costs and revenues, formulates the business plan and monitors the financial dynamics over time. It is crucial to have a clear understanding of payment for telehealth in the region.
Responsible for identifying clinical support needs, training needs for staff in telehealth work flow and procedures, defining the workflow of telehealth encounters, developing and approving care protocols, and monitoring clinical quality over time. This member should also be well versed in local and national the telehealth policies and regulations.
Responsible for assessing bandwidth and equipment needs, explores integrations with existing telehealth systems in the region, medical records, scheduling and payment systems, participates in installation and ongoing training in the use of the technology.
Once the team is formed, the team should establish/utilize a checklist of activities required before launching. It is also helpful to identify a start date to assist the practice with preparing for these transitions in the workflow. A "soft go-live" is helpful as this can help the team to work out unexpected kinks and receive feedback from the office on the processes in advance of the true start date. The AMA Steps Forward Initiative also includes a downloadable checklist for primary care providers or specialists.
Billing and Coding
Medicaid, Medicare and many private insures will offer reimbursement of telehealth care, however it will vary by state. The infographic below summarizes the pay structure for telehealth.
The National Consortium of Telehealth Resource Center provides telehealth policies by state, guides and templates for getting started with telehealth including checklists, sample evaluations, and job descriptions.
The American Academy of Pediatrics’ Section on Telehealth Care (SOTC), offers an online compendium, a compilation of resources for pediatricians who want to incorporate telehealth into their practice. You can also search for telehealth programs within the United States in a comprehensive directory.
Children with Special Health Care Needs
Approximately 14.6 million children ages 0–17 years in the United States (19.8%) have special health care needs.57 Children and Youth with Special Health Care Needs (CYSHCN), are defined as “those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.”58 These children have a need for increased health care access, health promotion activities, and overall life stress reduction throughout the life course. While 65% of CYSHCN experience more complex service needs that go beyond a primary need for prescription medications to manage their health condition,57 only 43% of those receive ongoing, coordinated, comprehensive care within a medical home.59
The number of child neurologists in the U.S. is estimated to be at least 20% below the national needs, although many believe that this is a conservative estimate.54 According to the 2018 American Academy of Neurology Insight Reports, there are only 1,327 child neurologists in the United States. The result is limited access to care for children and youth, especially in rural and underserved communities.53
Practices can reduce the gap in access to care by partnering with neurologists and other health care providers to provide tele-visits.
AIM-ET is a quality improvement project that improves access and clinical outcomes for children and youth with epilepsy by partnering Pediatric neurologists with pediatricians in rural or underserved areas to provide care via telehealth.
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References for this page can be found here.
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U23MC26252, Awareness and Access to Care for Children and Youth with Epilepsy/ cooperative agreement. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.