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:|
|Sustainability Curve 2:|
|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
Business, IT, staffing, privacy, and usability should all be considered when selecting a telehealth platform.
- 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?
- 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?
- 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?
- 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?
- 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?
Vendor Selection Checklist, Lowell CHC
A checklist for choosing a telehealth vendor from Lowell Community Health CenterPDF ↓
An overview of common telehealth platforms and their key features (updated July 2020)PDF ↓
Vendor evaluation checklist, AMA Playbook
Vendor evaluation checklist pages 32-38Visit website
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.
Digital Needs Screening Questions, UCSF
Screening questions for digital needsPDF ↓
National and local resources may be available to provide resources such as free phones or reduced cost internet services.
Lifeline is a federal program that lowers the monthly cost of phone and internetVisit website
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.
Remote Patient Monitoring Driver Diagram
A RPM Driver Diagram from the Telehealth ConsortiumPDF ↓
Critical elements for a successful RPM program implementation fall into four main areas:
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?
RPM Vendors Overview
An overview of RPM vendors & platforms and their key features (updated December 2022)PDF ↓
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
|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 HTN||Patients with HBA1c > 9 or diabetes complications||Patients who are at risk for complications (COPD, Asthma, etc.)|
|Patients on 3 or more HTN drugs||Patients on insulin or multiple oral agents||Patients with baseline O2 Saturation <94%|
|Patients at risk for cardiovascular complications||Patients at risk for cardiovascular complications||Patients 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 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?”
Digital Needs Screening Questions, UCSF
Screening questions for digital needsPDF ↓
Digital Equity Screening, Caring Health Center
Questionnaire to screen for digital need that can be adapted into the EHR flowsheetXLSX ↓
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
Health centers may want to develop a policy specific to RPM
|Patient Education Materials|
Some vendors may provide patient training and education materials
Or other system to evaluate outcomes
RPM Consent Form
A sample remote patient monitoring (RPM) patient consent formPDF ↓
Remote Patient Monitoring Policy, CHC of Cape Cod
A remote patient monitoring (RPM) policy from Community Health Center of Cape CodPDF ↓
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 programPDF ↓
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 programPDF ↓
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 practicePDF ↓
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.
RPM Clinical Pathway for Hypertension
A Sample Remote Patient Monitoring (RPM) Clinical Pathway for HypertensionPDF ↓
RPM Program Roles and responsibilites
A successful RPM program requires coordination between the patient, clinical care team, and the IT team.