Telehealth Policy

Definitions

Telemedicine – The use of electronic communication and information technologies to provide or support psychiatric, medical, or behavioral health care at a distance.  This definition includes: (1) live interactive two-way audio-video communication; and (2) any communication modalities such as phone, fax, e-mail, the internet, and still imaging that are used in conjunction with such live two-way audio-video communication.  The same standards of care and protocol exist with telehealth as are used when assessing and treating the patient on-site. The provider-patient relationship is the same.

Applications/Scope

Services

1. The following services will be available through the use of telehealth:

   1. Pharmacological management

   2. Psychiatric/medical evaluation and diagnosis.

2. Treatment via telehealth will not deviate from standards of care applicable to face-to-face assessment and treatment.

3. The telehealth service may be an adjunct to periodic face-to-face contact or it may be the only contact by the provider.

Locations

Telehealth services will be provided as follows:

1. Patient at remote location/Provider on site – Provider will be at the Dawn Farm site and the patient will be at a remote location.

2. Provider at remote location/Patient on site – Provider will be at remote site and patient will be at the Dawn Farm site.

3. Provider at provider office/Patient on site – Provider will be at their office and patient will be at the Dawn Farm site.

Clinical Oversight

Clinical oversight of the telehealth services will be provided by Dawn Farm Clinical Director and Medical Director.

Contraindications for Use

The consulting provider should request face-to-face consultation if the patient's condition does not lend itself to a telehealth consultation or if visual or sound quality is inadequate.

Providers

1. Telemedicine services will be provided by licensed and credentialed providers who are full/part time employees or have a current contract with Dawn Farm.  The clinical care will be provided within the scope of their licenses.

2. Other providers who may be present during the telehealth service include Dawn Farm staff.  The Dawn Farm staff may provide incidental services to the tele-provider as well as provide monitoring and support services to the patient.

Privacy, Confidentiality And Security

1. Dawn Farm will only use application service providers that meet HIPAA privacy and security standards.

2. The privacy and confidentiality of the telehealth service will be maintained by ensuring that the locations of the patient and provider are secure.   The services will be provided in a controlled environment (closed doors) where there is a reasonable expectation of absence from intrusion by individuals not involved in the patient's direct care. 

3. Dawn Farm staff involved in the patient’s care, family members and technical staff may at times be present in interviews.  Patients will be informed about others present in the room at the distant site if such persons are off camera and appropriate authorizations for disclosure of information will be obtained.   Whenever possible, the presence of non-clinical staff during service will be avoided.

4. If appropriate, a Dawn Farm staff member will be at the site with patient during the telehealth service to ensure the safety of the patient.   

5. The telehealth services will not be audio- or video-taped without written informed consent from the patient. 

Informed Consent

1. Informed consent for telehealth services will be obtained in writing from the patient prior to the service.

2. The patient will be made aware of the potential risks and consequences as well as the likely benefits of the telehealth services, and will be given the option of not participating. Patients will be informed that services will not be withheld if the telehealth encounter is refused, although such care will depend on availability of alternative resources. 

3. The original signed consent will be filed in the patient’s medical record.

Required Documentation 

1. All documentation of telehealth services will be documented in accordance with applicable Dawn Farm and other standards.

2. When equipment failure prevents adequate diagnosis or treatment, a progress note should be written to document such failure. 

Medical Records

1. If a record is kept at the site where the patient is being seen, arrangements will be made to have a copy of the record as well at the site of the treating clinician not only for routine care but in case of emergencies. 

Training, Licensure And Liability

1. All staff members involved in the operation of the system and provision of the services will demonstrate competency in the system’s operation (including equipment operation and limitations and means of safeguarding confidentiality and security).   

2. Providers will be screened to ensure licenses and liability insurance are current. 

Equipment for Telehealth

At a minimum, equipment used will comply with the minimum equipment standards defined by the application service provider.