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ATA Adopts Telehomecare Clinical Guidelines

Patient Criteria

  1. Informed written consent must be obtained from the patient or designee before beginning the use of video visits and should be a part of the plan of care and in the clinical record.
  2. During the initial visit an assessment should be conducted to determine access to utilities and safety concerns appropriate for the installation of the equipment.
  3. The patient may un-enroll from telehomecare at any time without fear of retribution (loss of home healthcare agency service).
  4. Patients (or their designated caregiver) must demonstrate the ability to use and maintain the equipment according to agency's policy.
  5. Patients who require interpreters must be so identified and agency policy and procedures to deal with language barriers must be followed to assure that these patients are not discriminated against.
  6. Patients or their designees, who cannot demonstrate the ability to operate equipment appropriately, and for whom translation is not available, should be excluded from participating in telehomecare.
  7. Patients need to be trained and provided written information in their homes regarding procedures to operate and maintain equipment. Such information may include diagrams to assure patients are placing equipment, i.e. placement of a stethoscope on the appropriate part of the body.
  8. Patients can not be viewed through the video without their knowledge or prior written consent. If other agency personnel or visitors come into the viewing site, the patient must be made aware of their presence, and the patient's approval must be o btained for such personnel to participate in the video visit. If a third remote site is participating in the video visit, the patient must again be aware and approve of such participation.
  9. Patient satisfaction regarding video visits should be a part of the CQI Protocols.
  10. The first and the last home visit to the patient's home must be in person and not through a video visit.

Health Provider Criteria

  1. A home health care agency may provide telehomecare visits to accomplish and/or enhance patient care under circumstances when "hands-on care" is not required.
  2. A physician order to integrate telehomecare into the plan of care must be obtained.
  3. Video visits may be provided by RNs, social workers, LPNs, physical therapists, speech therapists, occupational therapists, nutritionists, physicians and/or nurse practitioners or others within the pre-existing scope of practice for that category o f practitioner.
  4. The agency personnel providing telehomecare must document each video visit in the patient's chart.
  5. All telehomecare providers listed in item #3 above must be trained and demonstrate the ability to do video visits on the technology being used by the agency
  6. In case of equipment failure an in person visit should be scheduled as soon as possible to assure adherence to plan of care.
  7. The staff should demonstrate the ability to correctly use the technology and troubleshoot common problems and should have written troubleshooting guidelines to follow and a method for follow-up if problems are not quickly resolved.
  8. Each state will decide if they will allow "across state line video visits".
  9. Changes in video visit frequency are to be treated like changes in other parts of the plan of treatment and should be approved by the physician.
  10. Agencies must provide clearly written information to patients regarding use of the equipment, in addition to in person training provided at the onset of telehomecare.
  11. Patients must be given clear written instructions as to who to call in case problems arise. Patients need to be regularly informed in writing of the difference between using telehomecare and an emergency medical response system to avoid a potenti al delay in need for "911"emergency care.
  12. Agencies should provide a plan of action to provide unscheduled video visits (supervisors or other staff in the office should be available if the patient case manager is absent).
  13. Video visits can be incorporated into critical pathways
  14. If twenty-four hour telehomecare service is available, agencies must provide written instruction for patients to contact after-hours care providers.
  15. After hours video visits coverage could be accomplished by a) on-call or after hours staff, b) call center staff, or c) emergency room staff. Arrangements for this application could be done through a remote central location.

Technology Criteria

  1. The technology used should be based on the patient's clinical and functional needs. Based upon the clinical needs of the patient, many components may be included such as: a) two way interactive video, b) telephonic stethoscope, c) blood pressure a nd pulse. Other optional equipment may include oximetry, EKG, glucose meter, other medical devises, Internet capabilities, etc.
  2. The equipment based at the central station should include a log-in code and password to maintain patient privacy and record security.
  3. Upon installation, the telehomecare equipment should be checked for accuracy against standard devises.
  4. Procedures must be written and in place to clean and maintain equipment (per agency health and safety codes and infection control standards) at installation, while in the patient's home, and on return to agency.
  5. Installation kits should be developed with written instruction for the staff and should include supplies needed to assure best picture quality, e.g., small table lamp if necessary and extension cords. Supplies will be according to site and technol ogy chosen.
  6. Safety instructions should be given to patients and reviewed on installation and at future times as necessary.
  7. Instructions on whom to call for patient questions and concerns regarding equipment must be provided to patients and agency staff.

 

 

 

© 2001 American Telemedicine Association
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