COVID-19 Telehealth FAQs
 

  • What platform can be used to perform telehealth?

    Microsoft Teams will be the platform used for telehealth interactions during the COVID-19. Microsoft Teams offers video conferencing, which includes audio-visual capabilities. Telephonic visits, though generally not considered to be telehealth, may be necessary for a percentage of our patient population when technology or connectivity is not available to support video conferencing.

  • Who do I call for assistance with technical help?

    Please call the Telehealth Virtual Support Line (VSL) if you are having issues connecting to a telehealth session 347-966-8741 ID: (624 641 277#). Available 9am – 9pm (EST). After hours, please call the help desk at 866-491-8167.

  • Who can participate in an in-center telehealth visit?

    Any patient can participate in a telehealth visit as long as the physician or other IDT members have deemed a telehealth visit appropriate and the patient has appropriately consented. Any member of the IDT can initiate a telehealth visit as needed to continue to provide quality patient care. Any member of the IDT including physicians, physician extenders, patients, and care partners can participate in the telehealth visit. Microsoft Teams does not currently limit the number of participants, but patient permission is required to include non-IDT members.

    Note, in addition to FKC’s patient consents for use of telehealth, the physician or physician extender may have their own patient consent form.

  • When is it not appropriate to use telehealth?

    In person visits are necessary for the following:

            Unstable patients who need a full assessment and physical exam.

            Any time the clinical judgement of the physician, physician extender, or nurse indicates the need for an            in-person visit.

    Note: Patients who are experiencing respiratory distress or acute deterioration should be evaluated in established emergency treatment areas or in the emergency room. Emergency services (i.e., 911) and transport should be used in emergencies or as medical condition warrants.

  • When is telehealth appropriate to use?

    Insurance coordinator consultations and interventions when necessary

    Social worker and dietitian (IDT) consultations and interventions when necessary

    Routine physician dialysis visits

    Ad hoc visits as deemed necessary by the physician, physician extender, or nurse, or requested by the patient

    Kidney Care Advocate (KCA) patient education

  • Should I use video telehealth for all of my in-center dialysis remote visits?

    Telehealth visits (which generally require a video component) are not expected to be needed for the majority of patient/care partner interactions. Telephonic communications can still be used for the day-to-day management of patient needs. For example, most dietitian and social worker interactions and nursing interventions can be supported by telephone. Telehealth visits are preferred to telephonic visits for physician clinic visits with IDT support. Telehealth visits may be used when the IDT believes that a video conference discussion is more appropriate or would add benefit to the interaction.

  • When is it appropriate to do a telehealth visit versus a telephone visit?

    A TELEPHONE visit is appropriate for:

            • Day-to-day management of patient/care partner needs

            • Most social worker, dietitian, and patient/care partner interactions

            • General patient education

    A TELEHEALTH visit is appropriate for:

            • Insurance coordinator consultations and interventions when necessary

            • Social worker and dietitian consultants and interventions when necessary

            • Routine physician visits*

            • Ad hoc visits deemed necessary by IDT member or requested by patient

            • KCA patient education

    *Note: While one comprehensive MCP visit must be completed in person each month for incenter patients, CMS has permitted additional MCP visits via telehealth during the COVID-19 pandemic. Waivers are being requested to remove the comprehensive MCP in-person requirement but are not yet approved or assured. Physicians remain responsible for complying with applicable billing requirements.

  • What is the procedure for conducting a telehealth in-center visit?

    Each dialysis center will be given 3 discrete COVID-19 specific email addresses to be used during the pandemic which will expire in 6 months. These email accounts will be used to schedule telehealth visits using Teams. The clinic staff will create a meeting (i.e. appointment) from this account and send an email invitation to the provider’s preferred email. The clinic will need to confirm the proper email address to be used.

    Scheduling of physician or physician extender visits (rounds) needs to be coordinated to mitigate additional pressure on the in-center clinic staff. This can be established by scheduling blocks of time to complete multiple patient visits during a time most convenient to the clinic schedule (i.e. avoiding changeover or when fewer DPC staff are present).

    By necessity we will try to limit rounds to preferably 1 and no more than 2 providers per shift. We will ask physicians to designate a representative from their group to conduct rounds. When more than one group has patients in the clinic, we ask that locally, the groups work together to establish a schedule.

    Please ensure the rounding tablet or laptop is fully charged in preparation for the telehealth visit. The clinic staff will initiate the visit and identify the patient (name, MRN, and/or DOB) to the provider.

    Rounding tablets or laptops MUST be disinfected between each patient use. If more than one device is available in the clinic, one device can be in use while the other is being cleaned.

    Communication and collaboration will be essential. Providers should document in the EHR while rounding and plan for a post rounding handoff with the nurse to review new and/or changed orders and any additional follow-up needs.

    Scheduling the telehealth visit with the in-center onsite staff and IDT:

            • FKC clinic staff will invite all participants (physician, nurse, dietitian, social worker, patient, and/or            others as appropriate) to a TEAMS meeting using a calendar invite for the scheduled time of the visit.

            • Prompt attendance to the TEAMS meeting will help limit wait time for patients and other members of             the conference.

            • Instructions for accessing the meeting will be provided.

    Completing the telehealth visit:

            • Do not record any part of a telehealth visit.

            • The telehealth visit will, whenever possible, be completed by the patient’s care team (physician, nurse,            dietitian, social worker, as appropriate) and will include, but is not limited to, the following:

    Assess:

            • Fluid status, including patient assessment of weight and blood pressure trends for the last 30 days,            presence of edema and any SOB with or without activity. Adjust estimated dry weight as needed based            on assessment and review current dialysis prescription.

            • Hemodialysis access for hemodialysis patients for signs and symptoms of infection or cannulation             issues.

            • Nutritional status.

            • Social, emotional, and/or financial needs.

    Review:

            • Home medications per policy (which includes reconciliation of medications taken at home).

            • Treatment records.

            • Interim hospitalizations, doctor visits, and ER visits.

            • Most recent labs, including adequacy.

            • Plan of Care, with revisions as indicated based on patient assessment.

            • Emergency procedures during a disaster or pandemic.

            • COVID-19-specific patient instructions and evaluate patient needs.

            • Viral symptoms and changes.

    Provide:

            • Dietary education/counseling.

            • Patient education as indicated.

            • Social support and counselling – please remember to assess the emotional and physical needs of                         patients and care partners during this time of increased anxiety, stress, and concern.

            • Additional patient education on COVID-19 precautions and how to reduce transmission of disease.

            • Education on what to do if symptoms worsen.

  • What do I document for a telehealth visit?

    During the applicable pandemic or disaster, document the telehealth visit in the electronic medical record.

    Registered nurses:

    A clinical note should be completed for all in-center telehealth visits. The note should include the following:

            • “Via telehealth during COVID-19 pandemic,”

                    o Or “via telephone during COVID-19 pandemic”, as applicable

            • Originating site (patient location),

            • Physician and IDT location,

            • Date of visit; and

            • All other pertinent information and summary of visit.

    Social workers and dietitians:

    Complete discipline-specific note in electronic medical record when possible. The note should include the following:

            • “Via telehealth during COVID-19 pandemic,”

                    o Or “via telephone during COVID-19 pandemic”, as applicable

            • Origination site (patient location),

            • Physician and IDT location,

            • Date of visit; and

            • All other pertinent information and summary of visit.