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Updated July 9, 2024

Maturity Model

The Maturity Model provides high level guidance for advancing telehealth capabilities. It’s the “what” we hope to achieve. This is the model for People; view the full Maturity Model.

Sustainability Curve 1:
Covid-19 Response
Sustainability Curve 2:
Sustainability Curve 3:
Rapid adoption of phone/video visits by health centers; variability in digital access for patientsCare teams competent in using telehealth for patient care and engaged in ongoing innovation; all patients able to access telehealth modalitiesProviders routinely utilize access to specialty consults; patients engage in tech-enabled community-based care

Drivers of Success

The Drivers of Success represent “how” to improve performance. These are the drivers for People; view the full Driver Diagram.

  1. Provider & staff training
  2. Patient education
  3. Digital equity
  4. Satisfaction/Engagement surveys: patients, staff, providers

Provider and Staff Training

A comprehensive provider and staff training approach includes the following steps:

The provider champion and telehealth team, with the support of the health center leadership, need to develop or adapt existing training tools for use at the health center. Trainings and updated workflows should be shared broadly through several avenues: email, intranet, handouts, and live or recorded meetings. Remember to encourage discussion and feedback on new processes and workflows, and emphasize the importance of iterative improvement. Be sure to document changes over time.

training tools checklist
Use of the telehealth technology platform(s)
Updated workflows for nurse triage, scheduling, patient outreach, care team huddles, and “virtual rooming” of patients
Training on “webside manner”
Decision tree and workflow for scheduling telehealth and in-person visits
Documentation and billing for telehealth services
  • Resource

    Telehealth Classroom, NETRC

    This Telehealth Classroom training portal has been developed by the federally funded Northeast Telehealth Resource Center (NETRC), to assist regional stakeholders, including health systems, health centers, and providers to successfully implement telehealth

    Visit website
  • Resource

    Digital Navigator Learning Community: Digital Access

    A training on digital access and equity for digital navigators

  • Resource

    Provider Communication Strategies for Telehealth, PCDC

    A one page guide for providers that highlights communication strategies that can be utilized during virtual visits

  • Resource

    Provider guide: Telehealth visit best practices, Stanford Department of Medicine

    Short checklist of best practices for set-up, webside manner, virtual physical exam

    Visit website
  • Resource

    Provider guide: Telehealth etiquette, Southeast Telehealth Resource Center

    Short videos for providers on the good, the bad, and the ugly of telehealth etiquette.

    Visit website
  • Resource

    Provider guide: Telehealth visit etiquette, AMA

    Short checklist for telehealth visit etiquette from the AMA

    Visit website

Patient Education

The primary goals of patient education are to help patients understand how telehealth can be used as another method of receiving health care, to prepare patients for a telehealth encounter by teaching them how to use the necessary technology, and to empower patients to access the modality of care that best meets their needs.

In order to ensure the diverse patient populations of community health centers are able to take full advantage of the opportunities offered by telehealth, it is important for the telehealth team, with support from health center leadership, to develop a strategy for helping patients understand the benefits of telehealth and how to “navigate” the technology:

  • Empower Community Health Workers (CHWs), Patient Navigators, or Telehealth Navigators to work with patients and community members to help them navigate the technology and understand the role telehealth can play in their care
  • Spread awareness about the role of telehealth during all encounters with patients (virtual and in-person) via patient portal messages, signs in waiting rooms and exam rooms, at the point of scheduling, via social media, and on the health center website
  • Ensure health center staff have a consistent message to share with patients about the role of telehealth in their health center
  • Utilize in-person encounters to train patients on the use of technology that may be needed for telehealth
  • Review all training materials and documents to ensure that they have been vetted and tested for accuracy before distribution to patients
  • Resource

    Patient Guide: Making the Most of Your Virtual Health Care Visit, Comagine Health

    Detailed checklist for patients

    Visit website
  • Partner Resource

    Telehealth Brochure for Patients, Holyoke Health Center

    A patient-facing brochure that serves as a telehealth guide for patients

  • Partner Resource

    Virtual Care Appointment Guide Brochure, Lowell CHC

    A patient-facing brochure that serves as a virtual care appointment guide and resource for patients

  • Partner Resource

    Patient Guide to Telehealth & Zoom

    Fenway Health’s information on their website for their patients about telehealth, including how to prepare for a visit (English and Spanish)

    Visit website
  • Resource

    Patient Guide to Virtual Visits, CHC Inc.

    Step by step guide from a community health center; includes detailed zoom instructions

    Visit website
  • Resource

    Patient Guide: What to Expect From a Telehealth Visit (video)

    Video provides information for patients on what to expect from a telehealth visit from home.

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  • Partner Resource

    Patient Information Sheet (English)

    One-page patient handout about how to prepare and what happens during a telehealth visit, from the Telehealth Consortium (English version).

  • Partner Resource

    Patient Information Sheet (Spanish)

    One-page patient handout about how to prepare and what happens during a telehealth visit, from the Telehealth Consortium (Spanish version).

  • Resource

    Video: Speak Up At Your Telehealth Visit

    This video provides a visual for how patients can advocate for themselves during their telehealth appointments.

    Visit website

Digital Equity

While telehealth has been embraced throughout the COVID-19 pandemic for its convenience and ease of access, many people served by health centers face barriers to effectively accessing telehealth and, in particular, televideo visits and remote patient monitoring (RPM). The barriers include: 

  • Reliable access to broadband internet
  • Reliable access to smartphones and/or computers
  • Reliable access to private spaces to carry out telehealth visits
  • The need, in many instances, to add interpreters to appointments
  • Understanding of and engagement with telehealth as a safe and effective modality of care
  • Digital literacy in general and knowledge of the telehealth interface, specifically 

Collectively, the lack of access to telehealth and other online services is known as the digital divide. Addressing digital equity means eliminating this divide and ensuring that individuals and communities have the tools and information needed for full participation in not only telehealth, but also educational supports, social services, and the economy.

Telehealth navigators

On the health center side of the health equity equation, health center providers have reported that they spend a great deal of time educating patients on the usefulness and pragmatism of telehealth. Such education could easily and perhaps even more effectively be carried out by others on the care team. Providers also report that they typically conduct these telehealth appointments on their own, rather than with the care team supports they have in place for in-person visits.

To enable a diverse population to take full advantage of telehealth, health centers may add a new role, called Telehealth Navigator, or expand the role of existing Community Health Workers to help patients understand the benefits of virtual care services and how to “navigate” the technology. Responsibilities of the navigation role include:

  • Calling patients in advance of scheduled telehealth visits to ensure they are trained and confident in their ability to participate, and to confirm availability for the visit
  • Ensuring that their equipment is working and that they can access the technology
  • Arranging to add interpreters to telehealth visits, if needed
  • Reaching out to patients who are overdue for a visit
  • Scheduling telehealth visits and providing associated training
  • Providing training on remote patient monitoring equipment
  • Providing education for patients on-request by providers
  • Providing community-based education through outreach and engagement with local community-based organizations.
  • Partner Resource

    Telehealth Navigator Job Description

    A sample job description for a Telehealth Navigator that was developed by the Consortium


Broadband access

Within Massachusetts, access to broadband services is correlated with race and socioeconomic status, namely: people who are non-white and of lower socioeconomic status have poorer access to broadband. In 2020, 101,000 health center patients did not have access to broadband. In predominantly minority census tracts, 1 in 4 households are without broadband, compared to tracts that are 95% white, which have only 1 in 8 households without broadband. Moreover, many health centers lack the necessary network equipment and broadband capabilities to carry out secure telehealth sessions with patients. With more health care taking place over the internet, under-resourced communities with limited broadband services can find themselves cut off from telehealth.

Map of braodband internet access in Massachusetts
Map of Massachusetts broadband access by Norman Leventhal Map and Education Center. Download the full map.

To achieve advanced telehealth capabilities and serve patients equitably, health centers will need to implement new strategies:

  • Screening patients for technology access (device, internet, digital literacy) perhaps as a part of the routine health related social needs screening process
  • Referring patients to state and local resources that provide reduced cost internet services or equipment
  • Resource

    Digital Needs Screening Questions, UCSF

    Screening questions for digital needs


Patients with Disabilities

While implementing telehealth in health centers, it is essential that equity and access be extended to those with disabilities. Patients who are physically disabled, deaf, blind, or with intellectual/ developmental disabilities may need additional accommodations for effective care.  

Why Offer Telehealth Services?

For patients with intellectual/developmental disabilities or mobility challenges, telehealth can be a great alternative option for high-quality care right from the comfort of their home.

  • Patients with Intellectual/ Developmental Disabilities: Overstimulation from new environments may lead to added anxious feelings during in-person visits. Providing care from homes can bypass these stressful situations for some patients.
  • Patients with Mobility Limitations: Traveling for an in-person visit may lead to long travel times and missed appointments; therefore, telehealth is a great option to ensure accessible care.
Recommendations to Accommodate Patients with Disabilities
  • Providers must offer all patients regardless of their disability status the ability to participate in telehealth visits at equal value to those patients who do not have a disability.
  • Establish reasonable modifications to practices, policies, and procedures that support patients with disabilities.
    • Allow additional time before, during, and after telehealth visits.
      • Scheduling additional time allows patients to get familiar with the telehealth platform and software.
    • Introduce policies that allow patients to have a support person, family member, or interpreter present to help with accessing and navigating appointments.
    • Provide communication aids for provider availability, records access, scheduling, and during an appointment:
      • Deaf/ Hard of Hearing Patients: Provide access to a sign language interpreter and add real-time close captioning to video conferencing.
        • Please Note: Patients should NOT be required to bring their own interpreters.
      • Blind/ Visually Impaired Patients: Assure documents are screen-reader compatible, provide phone services as an option instead of video conferencing, add text equivalent with description to every image.
        • For more information about how to implement these task please see the resources below.

(Adapted from the U.S. Department of Health & Human Services, Guidance on Nondiscrimination in Telehealth)

  • Resource

    Guidance on Nondiscrimination in Telehealth: Federal Protections to Ensure Accessibility to People with Disabilities and Limited English Proficient Persons

    Visit website
  • Resource

    Website Accessibility Under Title II of the ADA

    Details information on how to improve digital accessibility for those who are deaf and blind.

    Visit website
  • Resource

    Web Content Accessibility Guidelines

    Visit website
  • Resource

    Guidance and Resources for Electronic Information Technology: Ensuring Equal Access to All Health Services and Benefits Provided Through Electronic Means

    Visit website

Satisfaction & Engagement Surveys

Patient, provider, and staff satisfaction are important measures of success for your telehealth program. Satisfaction survey data should be used by health centers to evaluate and improve processes and workflows.

Patient satisfaction surveys

Patient satisfaction is a common indicator of quality of care. To identify potential disparities in care, patient satisfaction survey results should be analyzed by race, ethnicity, and language when possible.

  • Partner Resource

    Patient Satisfaction Survey, Lowell CHC

    A patient satisfaction survey from Lowell Community Health Center that is sent to patients after their visit

  • Partner Resource

    Telehealth Patient Experience Survey

    Patient experience survey for telehealth visits from the Telehealth Consortium


Provider satisfaction surveys

Provider engagement plays an important role in the success of care delivery transformation efforts. As health centers update and adjust workflows, processes, and team roles with the growth of telehealth, its important to measure and understand the provider and staff experience.

Massachusetts Health Quality Partners (MHQP) developed the “Together for Better Telehealth” program to understand providers’ experience with telehealth during the COVID-19 pandemic. Results from this series of surveys are available in the resource below.

  • Resource

    Telehealth Provider Survey Results, Massachusetts Health Quality Partners, 2020

    “Together for Better Health” survey of Massachusetts clinicians includes practical solutions, useful ideas, tips and tricks for how to improve telehealth

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