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Topic starter
OK, been working on Telemedicine here and a few things:
1) Created a document type for Telemedicine. Beware, need to change privileges to allow for signing a new document type. But, this provides a way to quickly determine the TM visits.
2) While my current approach is to create a TM document by copying a normal office visit, and bolting on extra questions, there is also the thought to creating a front-end stand-alone document that is purely TM questions. That would allow an encounter to easily add the TM issues to be addressed.
3) The following is a quick summary of the issues/questions necessary for TM. And additions people can think of?
Type of visit = audio or video
video provider/company
patient phone & email address
Visit details
Location of provider = clinic, other medical, home, other
Location of patient = home, work, other
Other participants
Time in minutes
Respiratory issues (perhaps useful later for analysis)
Patient provided vitals (stored, where possible, to alternate OBS codes)
height, weight, temperature
bp
respiration, heart rate (alternate Patient-provides OBS codes?)
Preceptor (for residents or anyone requiring for billing)
Thanks for any suggestions.
Joe Gillis
Posted : March 19, 2020 12:27 am
Joe, let me know if you need any help with the form. Happy to give development time. Have seen several requests for this but I'm not sure what actually needs to be documented.
Posted : March 19, 2020 9:51 am
Hey Joe
Can you send me the form you have created? We are starting telehealth ASAP.
Thanks, Mary
Posted : March 20, 2020 2:52 am
Will you also send me a copy of the form when completed? Our group is also using the normal office visit type, but do need the additional questions.
Thanks so much!
Posted : March 20, 2020 4:22 am
Topic starter
Below is the first draft at a standalone module. It is still in test/debug status.
Interested to hear any comments, etc...
Thanks.
Posted : March 20, 2020 4:35 am
Joe,
As someone who creates Clinical Content in CPS I really like what I see in the screenshot you shared. Would you mind sharing this with me a well. I would be interested in seeing "how" you coded things "behind the curtains" so to speak.
Posted : March 20, 2020 6:07 am
Topic starter
Good afternoon all.
Thanks for suggestions. A couple minor tweaks to the image previously shared, but essentially the same thing. If anyone find a mistake or has further suggestions, please let me know.
I did try to pick new OBS codes that are part of the standard GE set, to store the patient-reported vitals. I did not want to mix non-clinically gathered/measured info with what a patient may report.
FInally, the idea of this form is one that can be added into most any type of office visit - whether a general visit, or specialty follow-up, or even social work.
Special thanks to David Shower, who did a quick QA on my development efforts, and made a few parts a little better also.
Good luck all.
Posted : March 20, 2020 7:30 am
A version of Joe's form has been posted to the Marketplace. It has a few additional features and please let me know if there are other things that are needed for documenting this type of encounter.
Posted : March 20, 2020 9:41 am
An updated version of this form has been posted in the Marketplace:
Posted : March 23, 2020 10:00 am
Good morning Joe, could you share with me the source that backs up the necessary info to include in the documentation.
Type of visit = audio or video
video provider/company
patient phone & email address
Visit details
Location of provider = clinic, other medical, home, other
Location of patient = home, work, other
Other participants
Time in minutes
Respiratory issues (perhaps useful later for analysis)
Patient provided vitals (stored, where possible, to alternate OBS codes)
height, weight, temperature
bp
respiration, heart rate (alternate Patient-provides OBS co
One of our providers thinks differently and I have been trying to find documentation of this and have not had much luck.
Linda
Posted : March 25, 2020 2:34 am
I don't know that this answers your specific questions Linda, but here is the CMS info:
Posted : March 25, 2020 3:18 am
Hi Linda,
I hope you don't mind me chiming in here, but here are the links I used to support much of what was on the form:
http://ctel.org/library/research/
https://www.telehealthresourcecenter.org/who-your-trc/
Sample document:
https://southwesttrc.org/sites/default/files/resources/forms/Standard%20Protocols.pdf
You are correct in that much of the information out there is difficult to find and rather vague. I suspect that it has more to do with an emerging technology and approach than anything else so the rules are not clearly defined. Complicating matters, is the fact that each state has established their own guidelines for telehealth, so it is not a simple one size fits all, unfortunately.
I suspect that most offices that are jumping into telehealth right now are doing so out of need and possibly without an intended long term plan or commitment to continue after the COVID-19 episode is resolved. As such, I would think recording items not generally listed such as the call type, service provider company, locations, etc. would all be important records 6 months post use, especially for medial legal defense, should it be needed.
Mentioning that aspect, I would suggest that providers do two things:
1) Contact their legal reps for additional information if something is in question, in fact, have them approve each item/field to ensure they are comfortable with it. They have to defend it, afterall.
2) Contact their Malpractice Insurance and ensure they have or obtain coverage for telehealth visits and verify if they have specific documentation needs as well.
Just because the rules have been relaxed does not mean the tort laws have been too. By default, most malpractice insurance policies do NOT cover telemedicine.
Posted : March 25, 2020 3:29 am
Hello Joe,
Are you willing to share the telemedicine form you created? If so, that would be very much appreciated!
My email is: [email protected]
Thank you,
Rachel Christenson
Posted : March 31, 2020 2:34 am
Thank you so much for your input Lee!
Linda
Posted : March 31, 2020 3:12 am
Can you add the Primary Care Name or Referring Physician Name or where it comes automatically and also the Type Visit (Tele-Consult or Tele-Established) this would be very Helpful for the Specialist who are using this Encounter form. Also like the extra time but I don't think it adds that extra time?
You have done a great job with the encounter form in this short period of time!!
Thank you
GI
Posted : April 10, 2020 10:26 am
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