As of March 2020, the Department of Human and Health Services noted that online platforms for telemedicine no longer have to be HIPAA compliant (i.e. FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype)
However this does not include public facing/sharing apps (i.e. Facebook Live, TikTok)
Resources for Screening Susceptible COVID-19 Patients:
MdCalc has a range of tools providers can use for Telehealth consultations
The Centre of Evidence Based Medicine recommends avoiding the Roth score to assess dyspnea via telehealth. The link to the original paper can be found here.
CEBM also offers the following tool to assess for symptoms.
Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. The BMJ. British Medical Journal Publishing Group; 2020. Available from: https://www.bmj.com/content/368/bmj.m1182
Bright.MD COVID-19 Screening Tool: Patient fills in online questionnaire on App -> App uses CDC guidelines and AI automation technology risk-stratify patients -> Patient's personal physician can respond and treat patient all online.
CMS has also temporarily expanded the ability for physicians licensed out-of-state to provide services in a state where they are providing health services.
The following is chart of Telehealth billing codes, specifically for Medicare patients (a full list can be found here):
Access to a medical interpreter is the recommended form of communication between a provider and a patient with limited English proficiency
Visual communication between the patient, translator and provider through videoconferencing is the closest method to face-to-face interpretation
Family/Friend Interpreters:
The use of a patient’s family or friends as an interpreter is discouraged due to patient privacy, inconsistent translation quality, and ethical issues—especially in the case of minors
Translation Apps:
Suitable only in the event that no translator is available
If needed, language apps allowing two-way communication specifically intended for the healthcare setting are encouraged
Eysenbach, Gunther, et al. Language Translation Apps in Health Care Settings: Expert Opinion. JMIR mHealth and uHealth. doi: 10.2196/11316.
Masland, Mary C., et al. Use of Communication Technologies to Cost-Effectively Increase the Availability of Interpretation Services in Healthcare Settings. Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association. doi: 10.1089/tmj.2009.0186.
Once you’ve established the availability of a virtual consultation, there are a few things one may consider to do ease the transition for your patients:
Update your website (if applicable)
Sending an email to patients
Prioritize what to tell patients including but not limited to:
What is Telehealth?
How to assure them their personal information is protected
What types of care you can offer through health?
How this visit may be different from an in-person visit
Scheduling:
How can patients schedule a telehealth appointment?
Preparing for a visit
What videoconferencing tool will patients be using?
What they need to do to use the system
What to do if they need help troubleshooting
Any pre-appointment instructions such as taking their temperature
MATRC provides comprehensive information for clinicians with setting up and administering health and medicine based services as well as also providing a useful COVID-19 toolkit
The Federal Communications Commission (FCC) has allocated $200 million for the COVID-19 Telehealth Program for healthcare providers to expand telemedicine services.
COVID-19 Telehealth Program funding is limited to nonprofit and public eligible healthcare providers.
Federal Communications Commission. COVID-19 telehealth program [Internet]. Federal Communications Commission. 2020 [cited 8 May 2020]. Available from: https://www.fcc.gov/covid-19-telehealth-program
Policy Considerations and flexibility of practice during COVID-19
HHS instituted Notification of Enforcement Discretion to aid health care providers with providing high value care using modern communication applications without violating HIPAA
Under this guidance, providers may use applications such as
Facetime, Zoom, Skype and other video sharing platforms
Text based applications such as I-message
However, under this notice provider may not use “public facing” platforms such as Facebook Live.
Those that see further information regarding privacy concerns should keep in mind to be thoughtful and aware of platforms that may break privacy
CMS (Centers for Medicare &Medicaid Services) have provided the following temporary measures to help facilitate care at this time
Providers may use telehealth and conduct appointment with patients wherever the patient is located, even across state lines.
However, it is only acceptable to practice across state lines if the states involved have waived and/or reserved practice guidelines
Providers may see both new and established patients using telecommunication technology