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 video | EHR-integrated, HIPAA-compliant, video-enabled; patient devices, data plans, and remote monitoring deployed | Specialists 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.
- Telehealth platform, integrated with EHR
- Accessibility to smart phones and data plans for patients
- 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?
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Partner Resource
Vendor Selection Checklist, Lowell CHC
A checklist for choosing a telehealth vendor from Lowell Community Health Center
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Resource
Vendor evaluation checklist, AMA Playbook
Vendor evaluation checklist pages 32-38
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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)
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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.
National and local resources may be available to provide resources such as free phones or reduced cost internet services.
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Resource
Lifeline Program
Lifeline is a federal program that lowers the monthly cost of phone and internet
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Partner Resource
Digital Access Resource Guide, Caring
List of digital resources (e.g., tech support, training, discounted devices and data plans) for those who qualify
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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.
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Partner Resource
Remote Patient Monitoring Driver Diagram
A RPM Driver Diagram from the Telehealth Consortium
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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.
- Understand their experience
Have they worked with other FQHCs?
Can they provide references?
How long have they been doing this work? - 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? - 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?
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Resource
RPM Vendors Overview
An overview of RPM vendors & platforms and their key features (updated December 2022)
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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)
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?”
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Resource
Digital Equity Screening, Caring Health Center
Questionnaire to screen for digital need that can be adapted into the EHR flowsheet
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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.
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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
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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
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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
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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
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Partner Resource
Remote Patent Monitoring Hypertension Management Enrollment Workflow, Fenway Health
Example of provider initiated and telehealth navigator initiated workflows for RPM Hypertension program
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Partner Resource
Remote Patient Monitoring Hypertension Management Workflow, Fenway Health
Example established patient workflow for RPM Hypertension program
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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 |
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.
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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.
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