Clinical Telemedicine Process

Scheduling:

The UPTN and Information Technology department at MGHS developed an electronic scheduling option for telemedicine consultation requests. This electronic version allows for increase productivity, increase efficiency, and decrease transcription error rates when scheduling telemedicine consults.

As the network clinical telemedicine applications grew it became apparent that we needed to look at a more efficient process with scheduling consults. We worked closely with our information technology department, originating sites, and speciality offices to look at an electronic scheduling option. Two processes were developed as some of our speciality offices have access to the network secure Lotus Notes email and others did not. Thus sites can access through Lotus Notes or a Web based schedule option. The Web version is password protected to assure confidentiality of the limited patient information available in this way.

· An electronic scheduling request is created and is sent, by a click-of-a- button, to our operations staff at MGHS.

· Operations staff & local clinical site coordinator will electronically confirm site, room and system availability. At this point the operations staff and local site coordinator will accept or decline the consult. This information goes back to the speciality office that will either book the appointment or reschedules related to a decline notice.

· Once the appointment is confirmed the speciality office fax's the telemedicine orders to the originating site clinical coordinator (see attached example).

All scheduling for clinical telemedicine was approved through our information technology compliance officer to assure compliance with HIPAA regulations.

Web Electronic scheduling procedure click here:

Lotus Notes Electronic scheduling procedure click here:

Originating site (local clinical site coordinator) contacts the patient to explain what time to arrive for the consult, gives them directions on where to go, and answers any questions they may have about telemedicine.

Consult Day:

1. Originating site registers the patient as an outpatient to their facility. This allows a medical record to be generated.

2. Originating site has the patients sign necessary consents/authorizations. These consents/authorizations remain in the medical record at the originating site.

3. Videoconference systems are connected at least 15 minutes prior to the consult to assure ample time to technical triage.

4. Speciality office staff or nurse is the first contact on the system and verbally requests information they need from the originating site presenter: weight, vital signs (from the physician orders faxed during scheduling). The specialist is the second contact on the system and discusses with the patient their plan of care.

5. When the consult is complete the far site documents the consult per their hospital/clinic process.

6. The originating site marks the telemedicine consult in the electronic schedule as "was held" "was not held" and submits electronically. In addition the originating site completes a UPTN Videoconference Paper Log for all connections done point-to-point (without assistance from the bridge). This log is requested from each site to send, on a quarterly basis, to the Hub. This allows a mechanism of reconciling data and gathering statistics on clinical encounters and overall individual system utilization (administrative, educational, clinical, etc.).

Billing:

Credentialing:

Forms:

UPTN documentation tool

Example of orders a specialty office would use for telemedicine

Example of our telemedicine consent form

Susan Makela, BSN, MPA
smakela@mgh.org

Joint Commission
Accredited

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