While it is too early to assess the damage caused by this global pandemic, there are signs that it will permanently change the way society functions. From its impact on the global economy to our daily lives, COVID-19 will leave an enormous impact on the ways in which we consume, how we learn, work, socialize, communicate and of course, how we stay healthy.
Society runs on information and connections, and your patients live in an age where both are immediately accessible, anytime, anywhere. During the pandemic, in just a few short months, everyone, the very young and very old are learning to zoom, skype and facetime, in an effort to see grandkids and friends. Cyber skills are being honed globally at an incredible rate of speed.
Crisis tends to do that to technology. Just as the healthcare community is ramping up technology to find a cure, it has also had to ramp up to stay connected to patients using Telehealth and Telemedicine tools. While these resources have existed for years, the urgency to adopt them in daily medical operations has exploded. As a result, security and safety concerns regarding patient data has also begun to surface as part of the community conversation. In monitoring a variety of medical group and healthcare worker forums, I have logged hours of posts dedicated specifically to this topic.
Two weeks ago, the federal government decreed the relaxing of stringent HIPAA regulations around patient information, in order to make telehealth more accessible. “We are empowering medical providers to serve patients wherever they are during this national public health emergency. We are especially concerned about reaching those most at risk, including older persons and persons with disabilities” said Roger Severino, OCR Director. In a statement online the OCR website announced it will “exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This notification is effective immediately. “
So, with the blessing of the federal government, healthcare as a community now wades deep into the waters of telehealth. If your familiarity with telehealth tools is limited, that’s okay. There are plenty of readily available sites your team can join to get up to speed quickly.
Significant research regarding the effectiveness of telehealth is still relatively limited, but the library is growing rapidly. For example, a 2016 review of studies found that both telephone-based support and telemonitoring of vital signs of people with heart failure reduced the risk of death and hospitalization for heart failure and improved quality of life.
While telehealth has the potential to improve coordinated care, it also runs the risk of fragmentation. Fragmented care may lead to gaps, overuse, inappropriate use of medications and unnecessary or overlapping care models. Committing to follow-up with patients via email or phone is thought to aid in maintaining human contact between providers and patients. Using the tools as a conduit while leveraging actual communication skills to get to know patients better. To become a touch point for health without actual touching.
The potential benefits of telehealth services may be limited by other factors as well, such as the ability of consumers to pay for these services. Insurance reimbursement for telehealth still varies by state and type of insurance. Also, some people who would benefit most from improved access to care may be limited because of regional internet availability or the cost of connected mobile devices.
So, what should the main goals be in a pivot to telehealth? Subject matter experts in the field agree that major points include:
- Making health care accessible to people who live in rural or isolated communities.
- Providing ready service to people who are circumstantially or involuntarily stuck at home, with limited mobility, time or transportation options.
- Delivering unprecedented access to medical specialists regardless of geographic location.
- Improving communication and coordination of care among members of a health care team and a patient in need.
- Provide support for the new normal of health care self-management
Under the temporary federal Notice, healthcare providers may now choose to use popular video chats to see and interact with their patients. APPS like Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, are all on the table to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with HIPAA Rules. They may provide options for a technically challenged audience as they are more familiar in both platform and design than formal tools designed specifically for healthcare.
OCR does recommend notifying patients that these sites introduce privacy risks. You should confirm that your use of any system is fully enabled with available encryption and privacy modes for telehealth appointments.
The OCR did call out certain public facing streaming/recording APPs like Facebook Live, Twitch and TikTok, to name a few, stating that they should NOT be used in the provision of telehealth by covered health care providers. Personally, I can’t get enough YouTube videos of CEOs leaving unfortunate filters on and conducting their meeting as a potato… but we would want to avoid such hilarious incidents for the purposes of telehealth at all costs!
Here is a list of OCR compliant APPS:
- Skype for Business / Microsoft Teams
- Updox
- VSee
- Zoom for Healthcare
- me
- Google G Suite Hangouts Meet
- Cisco Webex Meetings / Webex Teams
- Amazon Chime
- GoToMeeting
- Spruce Health Care Messenger
Under the emergency notice, OCR also states that they “will not impose penalties against covered health care providers for the lack of a BAA (Business Associate Agreement) with video communication vendors or any other noncompliance with the HIPAA Rules that relate to the good faith provision of telehealth services during the COVID-19 nationwide public health emergency. “
Clinics may provide virtual appointments via online videoconferencing. Providers may also institute web-based visits with staff. These may work well for minor illnesses, prescribing medications, suggesting home care strategies or recommending additional medical care.
Similarly, a nursing call center may be staffed with nurses who use a question-and-answer format to provide advice for care at home. A nursing call center doesn’t diagnose an illness or prescribe medications but can be a comforting and helpful resource for patients with questions. It can also provide a pass-through for triage to a higher level of diagnostic assistance if indicated.
Providers should let patients know that their personal doctor may not always be available during this time-intensive crisis period. Nurse practitioners, other doctors and front facing staff may be involved in the communication process. Sharing with patients that this is all new to everyone is probably a good way to communicate the universality of stress. Providing a platform to ask questions and voice concerns will offer an additional layer of care.
Communication, openness and respect are still the most important elements to encouraging patients to address their health issues. Utilizing telehealth is simply a conduit to providing comprehensive care.
RESOURCES REGARDING TELEHEALTH INCLUDE:
OCR has published a bulletin advising covered entities of further flexibilities available to them as well as obligations that remain in effect under HIPAA as they respond to crises or emergencies at: https://www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf – PDF
Guidance regarding BAAs, including sample BAA provisions, is available at: https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html
Additional information about HIPAA Security Rule safeguards is available at: https://www.hhs.gov/hipaa/for-professionals/security/guidance/index.html
HealthIT.gov has technical assistance regarding telehealth at: https://www.healthit.gov/telehealthpatients. APPS like Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, are all on the table to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with HIPAA Rules. They may provide options for a technically challenged audience as they are more familiar in both platform and design than formal tools designed specifically for healthcare.
OCR does recommend notifying patients that these sites introduce privacy risks. You should confirm that your use of any system is fully enabled with available encryption and privacy modes for telehealth appointments.
The OCR did call out certain public facing streaming/recording APPs like Facebook Live, Twitch and TikTok, to name a few, stating that they should NOT be used in the provision of telehealth by covered health care providers. Personally, I can’t get enough YouTube videos of CEOs leaving unfortunate filters on and conducting their meeting as a potato… but we would want to avoid such hilarious incidents for the purposes of telehealth at all costs!
Here is a list of OCR compliant APPS:
• Skype for Business / Microsoft Teams
• Updox
• VSee
• Zoom for Healthcare
• Doxy.me
• Google G Suite Hangouts Meet
• Cisco Webex Meetings / Webex Teams
• Amazon Chime
• GoToMeeting
• Spruce Health Care Messenger
Under the emergency notice, OCR also states that they “will not impose penalties against covered health care providers for the lack of a BAA (Business Associate Agreement) with video communication vendors or any other noncompliance with the HIPAA Rules that relate to the good faith provision of telehealth services during the COVID-19 nationwide public health emergency. “
Clinics may provide virtual appointments via online videoconferencing. Providers may also institute web-based visits with staff. These may work well for minor illnesses, prescribing medications, suggesting home care strategies or recommending additional medical care.
Similarly, a nursing call center may be staffed with nurses who use a question-and-answer format to provide advice for care at home. A nursing call center doesn’t diagnose an illness or prescribe medications but can be a comforting and helpful resource for patients with questions. It can also provide a pass-through for triage to a higher level of diagnostic assistance if indicated.
Providers should let patients know that their personal doctor may not always be available during this time-intensive crisis period. Nurse practitioners, other doctors and front facing staff may be involved in the communication process. Sharing with patients that this is all new to everyone is probably a good way to communicate the universality of stress. Providing a platform to ask questions and voice concerns will offer an additional layer of care.
Communication, openness and respect are still the most important elements to encouraging patients to address their health issues. Utilizing telehealth is simply a conduit to providing comprehensive care.
RESOURCES REGARDING TELEHEALTH:
OCR has published a bulletin advising covered entities of further flexibilities available to them as well as obligations that remain in effect under HIPAA as they respond to crises or emergencies at: https://www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf – PDF
Guidance regarding BAAs, including sample BAA provisions, is available at: https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html
Additional information about HIPAA Security Rule safeguards is available at: https://www.hhs.gov/hipaa/for-professionals/security/guidance/index.html
HealthIT.gov has technical assistance regarding telehealth at: https://www.healthit.gov/telehealth