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Technology & Tools

Updated June 26, 2023

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 Technology & Tools; view the full Maturity Model.

Sustainability Curve 1:
Covid-19 Response
Sustainability Curve 2:
CARE INTEGRATION
Sustainability Curve 3:
EXPANSION & SUSTAINABILITY
Rapid deployment for phone visits; some videoEHR-integrated, HIPAA-compliant, video-enabled; patient devices, data plans, and remote monitoring deployedSpecialists integrated through eConsults and synchronous patient visits

Drivers of Success

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

  1. Telehealth platform, integrated with EHR
  2. Accessibility to smart phones and data plans for patients
  3. Remote patient monitoring

Telehealth Platforms

Business, IT, staffing, privacy, and usability should all be considered when selecting a telehealth platform.

Business:

  • Does the vendor offer expertise in the health services your organization offers?
  • Is the vendor cognizant of federal and private payer requirements?
  • What cost is tenable for your organization to devote to telehealth?
  • Which parts of your organization should be involved in the decision-making process?

IT:

  • Does your IT system have the bandwidth and staffing to handle telehealth visits?
  • What features are you looking for in a telehealth video platform?*
  • Who retains responsibility for troubleshooting telehealth visits?
  • What level of technical support does the vendor offer?

Staffing:

  • How can your current staff be trained and integrated in scheduling telehealth visits?
  • How can your current staff be trained and integrated in the visit workflow?
  • Does the platform integrate translators and if so, in what manner?

Privacy:

  • What is the liability structure in case there is a data breach?
  • To what extent can the patient access the data?
  • How can patients indicate consent in the video platform?

Usability

  • What will be the workflow for your healthcare providers and patients to access the platform?
  • What technology do the patients and the provider need to use the platform?
  • How easy is to use the video portion of the platform?
  • How easy does the platform make it to bill patients and payors for the telehealth visit?
  • Partner Resource

    Vendor Selection Checklist, Lowell CHC

    A checklist for choosing a telehealth vendor from Lowell Community Health Center

    PDF
  • Resource

    Telehealth Platforms

    An overview of common telehealth platforms and their key features (updated July 2020)

    PDF
  • Resource

    Vendor evaluation checklist, AMA Playbook

    Vendor evaluation checklist pages 32-38

    Visit website
  • Resource

    Telehealth and Digital Tools Equity Assessment

    An assessment tool that contains questions that health centers can ask potential vendors to ensure their tools support equitable access and address the needs of the health center’s population (HITEQ Center)

    PDF

Patient Access to Technology

In order to effectively participate in telehealth, patients need to have access to devices, such as smartphones, tablets, or laptops, and internet or data plans. Screening patients for digital needs may help care teams better understand which patients lack the equipment, internet, or skills needed to successfully engage with telehealth.

  • Resource

    Digital Needs Screening Questions, UCSF

    Screening questions for digital needs

    PDF

National and local resources may be available to provide resources such as free phones or reduced cost internet services.

  • Resource

    Lifeline Program

    Lifeline is a federal program that lowers the monthly cost of phone and internet

    Visit website
  • Resource

    FCC Affordable Connectivity Program

    The Affordable Connectivity Program is an FCC benefit program that helps ensure that households can afford the broadband they need for work, school, healthcare and more. The benefit provides a discount of up to $30 per month toward internet service for eligible households.

    Visit website

Read more about the importance of digital equity and strategies to bridge the digital divide here.

Remote Patient Monitoring

Remote patient monitoring (RPM) is a telehealth technology that enables care teams to gather and monitor clinical data, such as vital signs, from patients outside of the typical in-person encounter. Patients can use connected devices, such as Bluetooth-enabled blood pressure monitors, at home. The data from the devices is electronically sent to their care team.

Implementing a RPM program can be a challenging process. The Consortium’s RPM Driver Diagram demonstrates the key components needed to implement a RPM program to successfully manage chronic diseases such as hypertension, diabetes, and congestive heart failure.

  • Partner Resource

    Remote Patient Monitoring Driver Diagram

    A RPM Driver Diagram from the Telehealth Consortium

    PDF

Critical elements for a successful RPM program implementation fall into four main areas:

Vendor Selection

preliminary questions

Developing and implementing a RPM program is a complex process. It’s important to think critically about the following questions before beginning a vendor search process. Understanding the answers to these questions will help a health center target their search.

What are your goals for Remote Patient Monitoring?
What do your patients want and need?
How does RPM fit into your organization’s telehealth strategy?
How will you define success for an RPM program?
How is the vendor going to help you meet these success metrics?

key considerations for selecting vendors

With the rapid rise of telehealth technologies brought on by the COVID-19 pandemic, many new companies that offer RPM technologies and services have emerged. Selecting the right partner is critical for success.

  1. Understand their experience
    Have they worked with other FQHCs?
    Can they provide references?
    How long have they been doing this work?
  2. Assess their ability to support your goals
    Are patient-facing materials appropriate for your patients?
    What is their training and support model?
    How long will implementation take?
  3. Assess their ability to support your workflows
    Is it an “out of the box” product, or can it be customized?
    Is interface user-friendly for all users?
    Can it integrate with your EHR?
    What level of staffing is needed?
    Can they provide technical assistance (e.g., getting patients set up)?
    Do they offer virtual clinical support like CCM services?
  • Resource

    RPM Vendors Overview

    An overview of RPM vendors & platforms and their key features (updated December 2022)

    PDF

Patient Engagement

tips for patient engagement

  • Think about why patients might be motivated to participate, and message accordingly
    • Will participation improve their health? Will this save time, and limit their trips to their health center?
  • How will patients find out about this opportunity? Should patients be identified and recommended by their provider? What about text or phone outreach by a population health staff?
  • Ensure patient-facing materials (e.g., BP logs, training guides) and devices are user-friendly and available in languages that meet the needs of your patient population
  • Start with a small group of patients (5-10)

Program Eligibility Criteria: Patients suitable for RPM

HypertensionDiabeteshypoxemia
Patients who regularly engage in care PLUS one of the following:Patients who regularly engage in care PLUS one of the following:Patients with suspected COVID-19 or Influenza PLUS one of the following:
Patients with uncontrolled HTNPatients with HBA1c > 9 or diabetes complicationsPatients who are at risk for complications (COPD, Asthma, etc.)
Patients on 3 or more HTN drugsPatients on insulin or multiple oral agentsPatients with baseline O2 Saturation <94%
Patients at risk for cardiovascular complicationsPatients at risk for cardiovascular complicationsPatients discharged from hospital for a respiratory condition

Some patients may not be suitable for RPM, for varying reasons; no-show history, physical or mental capacity to use a home monitor, availability of interpreter services, digital access & literacy score etc.

training plan

Training plans will differ depending on the scope of the program and target population. Identify the health center staff who will initially train patients on the use of the equipment and technology, and identify who will be available for ongoing education and technical support. Be sure to test the equipment and patient education materials to ensure materials are appropriate.

Screen patients for digital literacy and access to any technology (e.g., internet and smartphone) required for successful use of RPM devices and self-monitoring. If barriers are identified, follow-up by asking “Is there someone at home who can support you?”

  • Resource

    Digital Needs Screening Questions, UCSF

    Screening questions for digital needs

    PDF
  • Resource

    Digital Equity Screening, Caring Health Center

    Questionnaire to screen for digital need that can be adapted into the EHR flowsheet

    XLSX

Clinical Pathways & Workflows

Health centers will need to develop specific guidelines, policies, and other materials before the launch of a RPM program.

RPM Document Checklist
RPM Consent Form
Should be reviewed with the patient and scanned into their chart
RPM Policy
Health centers may want to develop a policy specific to RPM
Patient Education Materials
Some vendors may provide patient training and education materials
Tracking Spreadsheet
Or other system to evaluate outcomes

Remote patient monitoring of hypertension: Clinical Pathway

The following clinical pathways visually demonstrate a year in the life of a patient. Beginning with an in-person visit, the remainder of the year can consist of a combination of touchpoints, including telemedicine visits, phone check-ins, and remote monitoring. Learn more about clinical pathways here.

  • Resource

    RPM Consent Form

    A sample remote patient monitoring (RPM) patient consent form

    PDF
  • Partner Resource

    Remote Patient Monitoring Policy, CHC of Cape Cod

    A remote patient monitoring (RPM) policy from Community Health Center of Cape Cod

    PDF
  • Partner Resource

    SMBP Program Agreement Form, Lowell CHC

    A SMBP program agreement form from Lowell CHC that can be signed by the patient upon enrollment in an SMBP or RPM program

    PDF
  • Partner Resource

    SMBP 14 Day Recording Log, Lowell CHC

    A recording log from Lowell CHC for patients to document their self-measured blood pressure readings while enrolled in a SMBP program

    PDF
  • Resource

    SMBP Implementation Toolkit, NACHC

    A toolkit designed by National Association of Community Health Centers to help organizations design and implement SMBP successfully in their care model and practice

    PDF
  • Partner Resource

    RPM Clinical Pathway for Hypertension, Duffy Health Center

    Comprehensive workflow guide documenting health center’s hypertension RPM program, from program objective to outreach protocol to literature usedn RPM Workflow

    PDF

RPM CARE TEAM

It’s important to align your RPM approach to your practice environment and staffing capacity. Common responsibilities fall under these general roles: program manager, outreach coordinator & trainer, and clinical champion. Many of these roles can also be shared and modified based on the unique needs of your healthcare facility. In some instances, the RPM Care Team consists of primary care provider, a community health worker, and a registered nurse (RN). Other models leverage a clinical pharmacist in lieu of a RN. A successful RPM Care Team clearly defines the responsibilities of each member so that they cover all the steps of the program. Below is a list of team models and roles during key moments in the clinical care of a patient.

EXAMPLE CARE TEams
Example 1: “Provider Initiated”
Primary Care Provider (PCP): identifies suitable patient at point of visit and refers to program; manages patient’s care, including medication intervention
Community Health Worker (CHW): conducts outreach and onboards patient (i.e., enrolls and trains); assists RN
– RN Care Manager: reviews patient data (e.g., BP and weight), provides patient education, triages abnormal readings, coordinates follow up, and sends patient case to PCP
Example 2: “Population Health Outreach”
– Community Health Worker: conducts outreach based on registry report of patients with uncontrolled HTN; assists NP
– Registered Nurse (RN): onboards patients, reviews patient data, manages care by conducting follow-up visits and communicating any clinical changes to PCP
– Primary Care Provider: works with RPM RN to manage patient’s care, including medication intervention
Example 3: “Clinical Pharmacy Situated”
– Prescribing Clinical Pharmacist (CP): identifies patient either through referral or report, onboards and conducts follow-up visits; manages medication when practice is under a Collaborative Practice Agreement (CPA)
– Community Health Worker: assists CP by conducting outreach and triaging alerts
Note: To increase team capacity and knowledge on navigating effective care within the community, consider providing funding for CHW certification for interested staff. To learn more about CHW certification in Massachusetts, read here.

Identifying a member of the team who can act as a clinical champion is critical. They can provide expertise when designing the program’s clinical methodology and for continual advocacy on RPM integration and with other providers at the practice.

  • Resource

    Health Center RPM Resources and Sample Workflows

    Source: Health Center RPM Work Group

    Examples of RPM aim & objective measures, visit process maps, and care team designs.

    PDF