MATRC

MATRC Regional Best Practices Toolkit

Overview of Best Practices and Lessons Learned

in COVID Response Efforts


Thanks to the contribution of our MATRC Advisory Board Members, we have gathered best practices and lessons learned for multiple settings across the Mid-Atlantic region in COVID response efforts. Our aim is to provide you with experiential insights into technology, process, and resource considerations from subject matter experts implementing patient-centered telehealth solutions during this pandemic. As best practices continue to evolve, we will update this site with new information. Our hope is for these best practices and lessons learned to serve as enduring resources beyond the COVID-19 pandemic.

  • Congregate Care Settings

  • Federally Qualified Health Centers

  • Home and Home Health

  • Hospital and Health System

  • Multi-Practice Specialty Groups

  • Public
    Policy

  • Schools and Childcare Settings

  • Solo Practitioners

Site Navigation Instructions

  • To explore all features of the toolkit, click the navigation arrows
  • To return to this page from anywhere in the toolkit, click on the home icon
  • For high-level setting-specific insights, click on the applicable icon
  • For critical success factors and themes across all settings, click here
  • Success Stories provide insight into organization-specific response efforts
  • Implementation Toolkits provide detailed insights on how telehealth was applied within a specific setting/population

MATRC Regional Toolkit

CRITICAL SUCCESS FACTORS

The following common themes have emerged across all settings to drive sustainable, patient-centered telemedicine response efforts to COVID-19:

  • Dedicated clinician champions
  • Consistent and frequent communication and engagement
  • Telemedicine solution aligned with and customized to specific patient setting and needs
  • Education and training on workflows and technology
  • Technology agility and versatility
  • Real-time technology support
  • Pre-visit calls to patients
  • Community broadband networks
  • Adequate staff and resource deployment

MATRC Regional Toolkit

SETTING: Hospital and Health System

  • Create multidisciplinary teams with key stakeholders early in the process
  • Identify immediate needs and engage Executive Leadership to support necessary resource allocation
  • Use redeployed staff creatively to fill FTE gaps
  • Work with agility, be ready to change constantly
  • Change management a critical element to success, overcommunicate with everyone

Featured Success Stories and Toolkits

MATRC Regional Toolkit

SETTING: Home and Home Health

  • Make calls in advance of the telehealth visit
  • Use support staff with a customer service background and appropriate IT training
  • Facilitate test calls, especially for the first call with well-trained resources
  • Create a stand-alone toolkit that has everything needed by a clinic to deploy telehealth on their own. It is important to have a support team that can help them, but for mass deployment, a telehealth/IT support team cannot do all the work for each department/division/clinic. The toolkit must facilitate independent deployment
  • Having a telephone for an audio-only connection as a last option is important, especially for mental health visits. Try to do the video first. Don’t allow default to the easiest audio-only visit
  • Try to do personal technical assistance to address the patient’s concerns. Before COVID, work with local people to have local support. Possibly offer community location such as a local library as a point of access for network connectivity
  • In-home installation and patient competency validation are optimal
  • For RPM, focus on long-term behavior change with high patient engagement. Encourage independent recognition by the patient of what they should do to bring behavioral change that is not dependent upon close scrutiny of a monitor

Featured Success Stories and Toolkits

MATRC Regional Toolkit

SETTING: Solo Practitioners

  • Support a robust community broadband network to bring connectivity to the clinics and the homes of the clinics’ patients
  • Define the clinical needs and evaluate clinic workflows before vendor selection
  • Create a central resource for solo practitioners to consult with to understand: 1) Legal and regulatory options and limitations of telehealth, and 2) billing/coding/financial implications of telehealth
  • In order to reach solo practitioners, enlist the help of the State Medical Licensure Board, professional associations and hospitals/health systems that may have these providers on staff
  • Leverage the buying power of professional associations to contract for telehealth vendor technologies across multiple practices
  • Promote broad-scale marketing efforts to increase the community awareness of the availability of telehealth
  • Establish a call center and email response team with staff trained with the most up-to-date information

MATRC Regional Toolkit

SETTING: Congregate Care Settings

  • Identify adequately trained staff to support and conduct telehealth, including consideration of non-clinical staff and locum tenens providers
  • Develop processes to access technology in a secure environment and how to overcome challenges related to broadband barriers
  • Ensure staff training and education is tailored to the audience. Identify resource to support real-time troubleshooting when necessary and offer re-training opportunities
  • Engage DON and Medical Director in long-term care facilities and identify strong facility-based champions, establishing regular check-ins for improved understanding of staffing other challenges and opportunities to better leverage telehealth
  • Evaluate technology platform in the context of facility limitations – for example, would Bluetooth enabled devices to work more optimally than Wifi gave coverage capabilities? Develop contingencies based on the chosen technology for example a centralized clinic space for telemedicine visits with strong Wifi connectivity
  • Develop a process to obtain verbal surrogate consent for patients without decision-making capacity in long-term care settings

Featured Success Stories and Toolkits

MATRC Regional Toolkit

SETTING: Multi-Practice Specialty Groups

  • Conduct pre-clinic calls to first time telemedicine patients to resolve any technical questions — schedule a date in advance of clinic
  • Medical Assistants can help facilitate a call to the patient within 15 minutes of their telehealth visit to do all the pre-provider activity that would normally be done in clinic, such as the medication reconciliation
  • Utilize a chat feature with virtual care staff to coordinate and troubleshoot issues related to patient care, including billing, coding, and placing orders.
  • Evaluate how the EMR can push the appropriate information to the patient in advance of a telemedicine visit and establish a dedicated Help Desk for telemedicine patients

Featured Success Stories

MATRC Regional Toolkit

SETTING: Schools and Childcare Settings

  • Engage parents/guardians as telepresenters. Parents/guardians can obtain vital signs with home-based blood pressure cuffs or use a phone camera for dermatology skin assessments
  • Develop online resources for students to access health education, crisis information, and counselors
  • Expand services beyond primary care to include behavioral health services
  • Maintain privacy and confidentiality for visit, encourage providers to confirm if anyone other than the patient is present at the time of the telehealth visit
  • Proactively conduct outreach to students and families about telehealth appointment availability and send text reminders about upcoming telehealth visits
  • Identify creative ways to engage students and families, including virtual office hours to address questions
  • Conduct outreach to students with asthma, ADHD, or other chronic conditions to encourage them to initiate telehealth visits if needed
  • Remain up-to-date with guidance from applicable sponsoring agency, school district, and local health department
  • Explore asynchronous telemedicine capabilities for management and follow-up of routine issues such as e-Consults
  • *Reference: School-Based Health Alliance: Redefining Health for Kids and Teens. Listening and Learning Sessions: March – May 2020. COVID-19 Resources – School-Based Health Alliance (sbh4all.org)

Featured Success Stories and Toolkits

MATRC Regional Toolkit

SETTING: Public Policy

Considerations for Providers*

  • Stay informed about implications and timing of policy changes for coverage, reimbursement, and licensure requirements
  • Gain familiarity with licensure compacts for cross-state telehealth practice
  • Develop infrastructure, resources, and training to support long-term sustainability of telehealth programs

Considerations for Policy Makers

  • Maintain coverage and payment parity policies beyond the COVID-19 Public Health Emergency (PHE)
  • Maintain as an originating site any geographic location and patient setting, including the home, where telehealth services can be rendered
  • Expand capability of HIPAA for telemedicine, allowing providers to continue to use virtual platforms that have the proper security and privacy features
  • Relax requirements for e-prescription of controlled substances that allow providers to prescribe medications without an in-person evaluation where appropriate
  • More closely align reimbursement rates of telehealth visits compared to in-person visits
  • Eliminate barriers that prevent telehealth providers from practicing across state lines during future public health emergencies
  • *Reference: VanderWerf, M., Bernard, J., Barta, D. Pandemic Action Plan Policy and Regulatory Summary Telehealth Policy and Regulatory Considerations During a Pandemic. Telemedicine and e-Health. 15 Jul 2021.

MATRC Regional Toolkit

SETTING: Federally Qualified Health Centers

  • Hire or designate a widely available technology support staff to help patients navigate telehealth, especially if working with a technologically inexperienced population
  • Create telehealth FAQ resources (including documents and videos) for both staff and patients to help conduct technology trainings
  • Where funding allows, provide bluetooth scales, blood pressure cuffs, glucometers, and other remote monitoring technology to patients when necessary to allow them to take these measurements at home
  • Utilize a language line that can be connected to audio and video appointments for those patients experiencing a language barrier
  • Conduct staff surveys and/or regular in-person meetings with providers to share what is working and what is not working in the telehealth process and identify new training needs
  • Provide the option for patients to take telehealth appointments from a clinic-designated location with strong connectivity for those without proper technology or internet connection

Note: These best practices resulted from MATRC participation in the FQHC Subject Matter Expert Interview Project with the California Telehealth Resource Center

Featured Success Stories

MATRC Regional Toolkit

Success Story

Nicole Winkleman
Director of Telehealth
Appalachian Regional Healthcare
Internet connectivity to the home was very limited in rural areas. A curbside care service was launched to overcome this challenge for patients who had to drive to a physical site whereby tablets were brought out to cars to facilitate a telemedicine visit.

The Appalachian Regional Healthcare System leaned on “go-to” staff members in each department who implemented curbside visits for patients who did not have access to the proper technology or reliable internet connectivity within more rural areas.

Read More

MATRC Regional Toolkit

Success Story

Steven Dean
Director of Telehealth
Inova Health System
iPads were placed in isolation areas to minimize the need of provider entry in COVID positive patient rooms. Clinicians observed and visited the patients virtually through the iPad reducing infection exposure and the use of PPE.

Inova assembled a committee of providers in order to encourage collaboration on telehealth implementation in addition to expanding/revising the tele-ICU program to decrease traffic in and out of COVID-positive patient rooms and conserve PPE.

Read More

MATRC Regional Toolkit

Success Story

Jared Lucas, MD
Telemedicine and Digital Health Fellow
The George Washington University Medical Faculty Associates
We used our tele-urgent care service to provide telehealth
consultations and care recommendations to patients enrolled in the COVID-19 remote patient monitoring program for patients discharged after being seen at GW’s ER.

The GW MFA group implemented a tele-urgent care option for patients to use when experiencing symptoms that would normally send them to an urgent care facility.

Read More

Neal Sikka, MD
Professor of Emergency Medicine
Director, Innovative Practice and Telemedicine Section
The George Washington University Medical Faculty Associates, Department of Emergency Medicine

MATRC Regional Toolkit

Success Story

Angela Skrzynski, DO
Clinical Lead,
Urgent Telehealth & Care After COVID & COVID-19
Remote Patient Monitoring – Inpatient & ED
Virtua Health
Inpatients with confirmed COVID who would benefit from additional monitoring are released home with a Vivify kit which includes a tablet and Bluetooth enabled pulse oximeter, blood pressure cuff, and weight scale. Patients are prompted to enter vitals and answer questionnaires about their health daily.

Virtua utilized two COVID-focused remote patient monitoring programs that allowed patients to operate medical devices in their own homes and follow up with providers via virtual telehealth appointments.

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MATRC Regional Toolkit

Success Story

Angela Diop, ND, CHCIO
Vice President for Information Systems
Unity Healthcare
Historically, our no-show rate is around 35 to 36 percent. And the televisit no-show rates are anywhere from 10 to 15 percent. Patients perceive the quality of care and they rated it. The patient's perceptions of in-person and televisits were comparable. We have data that shows that patients had a higher perception of the quality of care for video visits.

Unity provided multiple options for patients to choose from when selecting telecare and also supported populations experiencing homelessness during COVID by utilizing local hotels as quarantine/isolation housing and providing care to those staying there.

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Andrew Robie, MD
Chief Medical Information Officer and
Family Medicine Physician
Unity Healthcare