Arrange: Activities
to Arrange for a telemedicine interaction
begin when a referring provider and the patient
discuss the need to consult another provider
for medical advice or opinions. The referring
provider explains to the patient that the encounter
will be conducted from a telemedicine-equipped
site in the local area, identifies who will
serve as the consulting provider, discusses
the organization’s
Notice of Privacy Practices (NPP) with the patient,
and obtains the patient’s signed acknowledgement
indicating understanding of the NPP. The referring
provider discusses the case with the consultant
(and might use store & forward techniques to
send relevant patient medical data to the consultant)
and takes appropriate steps to schedule the interaction
to occur at a telemedicine provider site in the
community. (“Scheduling” involves setting
a time when the necessary elements of the interaction—patient,
consultant, and essential resources such as staff,
video-equipped rooms, and appropriate medical equipment—are
all available.)
Conduct: Activities
to Conduct the interaction might occur only
once, or might (if authorized by the referring
provider) be repeated for a series of visits.
The interaction begins with the consultant
reviewing the patient’s
clinical history and, if necessary, requesting
additional information from the referring provider.
Upon arriving at the local telemedicine site, the
patient signs forms as appropriate (e.g., the site’s
NPP, registration forms, and/or consents) and receives
some orientation to the consult room and the telehealth
technologies. Next, telehealth technologies are
utilized to establish an interactive videoconferencing
connection between the consulting and patient sites.
The patient and consulting provider introduce themselves
and any other individuals who are in the consult
rooms, and the patient indicates who may be present
during the encounter. If appropriate, the staff
arranges for the patient to sign an Informed Consent
for the procedure. Consultant and patient then
discuss the patient’s clinical problems,
medical history, etc., and the consultant determines
the diagnosis and plan of care. The consultant
develops recommendations (e.g., diagnosis,
treatment plan, prescriptions, and a decision
about whether a follow-up visit should be scheduled),
discusses the recommendations with the patient,
communicates orders for new or changed plan
of care to the patient and telemedicine site
staff, and terminates the session. To conclude
the visit, staff of the local telemedicine
site order/fill prescriptions and schedule
a follow-up appointment if appropriate, and
the patient leaves the site.
.Document: Activities to conclude,
or Document, the interaction begin upon completion
of the encounter (or authorized series of encounters).
The consultant prepares the Consult Report summarizing
the case, has it transcribed, and forwards it to
the referring provider. The encounter is formally
concluded when both providers have appropriately
filed or disposed of documentation related to the
case.
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