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Policies,Clinical,UW Health Clinical,Medical Records and Communication,Communication

Live Interactive Video Telemedicine for UW Health (3.3.2)

Live Interactive Video Telemedicine for UW Health (3.3.2) - Policies, Clinical, UW Health Clinical, Medical Records and Communication, Communication

3.3.2


UW HEALTH CLINICAL POLICY 1
Policy Title: Live Interactive Video Telemedicine for UW Health
Policy Number: 3.3.2
Category: UW Health
Type: Inpatient
Effective Date: August 13, 2015

I. PURPOSE

To establish a standardized process for the provision of patient care for UW Health patients via live
interactive video telemedicine and to promote the quality, safety, and effectiveness of these evaluations
such that a standard of care consistent w ith an in person patient evaluation is maintained.

II. DEFINITIONS

Telemedicine: the use of medical information exchanged from one site to another via electronic
communications to improve, maintain, or assist a patient’s clinical health status. For the purpose of this
policy, telemedicine applies to live, interactive video telemedicine for UW Health patients and providers only.

Telehealth: a broader definition of remote healthcare that does not alw ays involve clinical services.

Telepresenter: a credentialed clinician, or health professional student w orking under the supervision of their
preceptor, located at the patient site that provides support to the patient and the telehealth consulting
provider in completing the physical examination and/or telehealth ac tivity.

Originating Site: location of the patient at the time the service is being furnished via a telecommunications
system.

Distant Site: site at w hich the physician or other licensed practitioner delivering the service is located at the
time the service is provided via telecommunications system.

Peripheral Equipment: any device attached externally to a computer (e.g. exam camera, scanners, mouse
pointers, printers, keyboards, and clinical monitors such as examination instruments, patient medication
delivery device, etc.).

III. POLICY ELEMENTS

A. This policy applies broadly to the practice of live interactive telemedicine, regardless of the specif ic area
of practice or practice setting in w hich telemedicine is used. Providers w ill act in accordance w ith the
expectations set by this policy in all instances w hen telemedicine is practiced. Only providers w ho have
completed proper training for telemedicine should conduct telemedicine evaluations. Providers shall
follow federal, state and local regulatory and licensure requirements related to their scope of practice
and shall abide by the state board and specialty training requirements.
B. Providers should exercise their clinical judgment to determine w hether telemedicine is appropriate on a
case-by-case basis. Providers must consider w hether telemedicine w ill enable them to satisfy all
relevant and applicable legal and professional obligations and meet the standard of care of an in-person
patient evaluation. In certain cases, such as those requiring physical assessment of the patient, a
telepresenter or bedside staff must be present w ith the patient during the exam to assist in the conduct
of the assessment.
C. Providers and telepresenters must be trained in the use of video and peripheral equipment and
competent in its operation.
D. The w orkspace for telemedicine evaluations should be secure, private, and reasonably soundproof.
E. The telemedicine equipment, transmission speed, and quality must be technically suff icient to support
clinical needs and approved by UW Health Information Services. If peripheral equipment is required to
assess the patient, it must provide adequate resolution and quality for clinical decision making.
F. Appropriate quality and safety metrics w ill be monitored by the Telehealth Program to ensure the best
care of our patients.
G. All clinical services provided through telemedicine evaluations w ill conform to established procedures
for confidentiality and maintenance of records. All policies and procedures applied to storage and
security of clinical information and patient privacy w ill apply to telemedicine evaluations to the same
extent as in-person patient evaluations.



UW HEALTH CLINICAL POLICY 3
Policy Title: Live Interactive Video Telemedicine for UW Health
Policy Number: 3.3.2


IV. PROCEDURE

A. Preparing for a live interactive telemedicine provider-patient or provider-family consult
i. The clinician initiating the consult w ill place a consult order in Health Link AND contact the
consulting team; method of contact should be based on preferred method by the consulting service
(i.e., page, phone, review of consult list, etc.)
ii. A conversation should occur betw een the consultant and the consulting team to review the
follow ing:
a. Reason for and urgency of the consult
b. Appropriateness of consult for telemedicine evaluation
c. Individual w ho w ill serve as telepresenter during the consultation/visit and w hat portion(s)
of the consult they might be required to stay for
d. Information about the patient that is particularly relevant in performing a telemedicine
consult (e.g. visual/hearing impairment, cognitive impairment, preference for family
member presence, laboratory results, etc.)
e. Timing of consultation (i.e., start time and anticipated duration)
f. If needed, specially trained staff in addition to the telepresenter to perform parts of the
physical exam
g. The contingency and emergency plan for a clinical change, loss of video connection, or
other emergency.
h. If it is decided that a live interactive telemedicine consult is not appropriate (i.e., patient
discomfort, failure of technology), alternative consult procedures should be provided to
continue to meet the standards of care.
iii. The telepresenter or bedside staff w ill discuss the potential benefits and limitations of telemedicine
w ith the patient using appropriate educational materials including:
a. An explanation that w ritten consent w as given during admission/registration,
b. The patient has the option to stop the video visit if they are not comfortable
c. The patient should ask questions just as in an in-person patient evaluation.
d. What portions of the physical exam might be performed
iv. The video equipment should be moved to the location of the consult, including any peripheral
equipment (as necessary), and then turned on in advance of the encounter to allow for testing and
troubleshooting.
v. As appropriate, signage may be utilized to designate a room is occupied by a video consult.
vi. The provider and clinician at the patient’s bedside w ill determine the minimum acceptable levels of
privacy, lack of distraction and background noise, and other environmental conditions that may
affect the quality of the encounter.
B. Telemedicine Consult Procedure
i. The telemedicine consult w ill begin w ith the camera focused on the patient and the telepresenter or
bedside staff (if they are present).
a. The telepresenter or bedside staff should remain in the room w ith the patient if assistance
is requested or required by the telemedicine provider or the patient.
ii. The provider and patient should verify their identities at the start of the consult.
iii. The provider w ill verbally confirm that the patient agrees to a telemedicine consult, and can
appropriately see and hear the provider
iv. Physical examination w ill be performed as appropriate for the purpose of the consult.
a. The telepresenter may perform basic and specif ic assessments w ithin their scope of
practice under the direction of the telemedicine provider.
b. The provider w ill ensure that the reliability, quality and timeliness of the patient information
obtained via the telemedicine examination is suff icient for clinical decision making.
v. The provider w ill review the plan of care w ith the patient/family and the telepresenter or bedside
staff and provide any clarif ications as needed.
vi. Once the consult has concluded the provider and/or telepresenter w ill ensure the video consult has
ended by clicking the end call/hang up button.
vii. The provider w ill appropriately document the telemedicine consult in the patient’s medical record in
Health Link.
a. Medical records of telemedicine interventions should be maintained according to standard
practice.



UW HEALTH CLINICAL POLICY 3
Policy Title: Live Interactive Video Telemedicine for UW Health
Policy Number: 3.3.2

b. A note w ill be completed to document the consult. To ensure proper coding and charges,
the term “video consult” must be included in the note.
viii. The telepresenter or bedside staff w ill follow infection control policies/guidelines for sanitizing
equipment used during telemedicine consults and return the equipment to its designated storage
location.
C. Emergency Planning
i. An emergency plan w ill be maintained for telemedicine consults.
a. The telepresenter or other bedside staff w ill follow area specif ic procedures in case of
medical, behavioral, location or other emergency during a telemedicine consult.
b. An emergency phone number w ill be established for the telemedicine provider to contact
at the originating site in case a medical, behavioral, location, or other emergency occurs
during the telemedicine consult.

D. Contingency Planning
i. The telepresenter or other bedside staff w ill follow area specif ic procedures for back-up technology.
If there is not back-up technology available or if there are technical issues causing it to not function
properly the telemedicine provider w ill conclude the visit by telephone or transfer to a standard in-
person visit at another time.
ii. The UW Health Help Desk should be notif ied if any technical issues arise during a telemedicine
encounter (608-265-7777).
E. Patient Safety and Quality
i. Signif icant or serious patient safety events should be reported through the PSN system via
standard policies. The care team leader and requesting service at the patient site should be notif ied
immediately.
ii. Non-emergent events should be addressed through the Telehealth Program
(telehealth@uw health.org).


V. COORDINATION

Author(s): UW Health Telehealth Coordinator
Senior Management Sponsor: Chief Ambulatory Administrative Officer
Review ers: Medical Director, UW Health Telehealth Program; Chief Medical Information Officer; Clinical
Assistant Professor Family Medicine; UWMF Legal Department; UWHC Legal Department
Approval committees: UW Health Clinical Policy Committee; Medical Board
UW Health Clinical Policy Committee Approval: July 20, 2015

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates .

VI. APPROVAL

Peter New comer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VII. REFERENCES

Dahler Penticoff, M. and DeVany, M. (2013). Overview : Key Issues in Specialty Consultation Telemedicine
Services. Great Plains Telehealth Resource and Assistance Center. Retrieved from:
http://w w w.gptrac.org/resource-center/proven-practices-and-models/

Council on Medical Service, American Medical Association (2014). Coverage of and Payment for



UW HEALTH CLINICAL POLICY 3
Policy Title: Live Interactive Video Telemedicine for UW Health
Policy Number: 3.3.2

Telemedicine. Retrieved from: http://w w w.ama-assn.org/ama/pub/about-ama/our-people/ama-
councils/council-medical-service/reports-topic/e-health.page

Federation of State Medical Boards (2014). Model policy for the appropriate use of telemedicine
technologies in the practice of medicine. Retrieved from:
http://w w w.fsmb.org/Media/Default/PDF/FSMB/Advocacy/FSMB_Telemedicine_Policy.pdf

American Telemedicine Association (2014). Core operational guidelines for telehealth services involving
provider-patient interactions. Retrieved from: http://w w w.americantelemed.org/resources/telemedicine-
practice-guidelines/telemedic ine-practice-guidelines

American Telemedicine Association (2014). Practice guidelines for live, on demand primary and urgent care.
Retrieved from: http://w w w.americantelemed.org/resources/telemedicine-practice-guidelines/telemedicine-
practice-guidelines


VIII. REVIEW DETAILS
Version: Original
Next Revision Due: August 13, 2018