Feb 2014

Dudding, C.C. (2014) GSHA Conference 1

Carol  C.  Dudding,  Ph.D.  James  Madison  University  

 

Telepractice: What’s It All About?

Credits: friends and colleagues Mike Campbell, Sue Grogan-Johnson, Sena Crutchley, Mike Toomey, Ellen Cohn …et al.

Disclosure  

•  Financial  interest:  –  Financial  support  from  GSHA  for  this  presenta8on  

–  State  level  grant  funding    

•  Non-­‐financial  interest:  – Member  of  ASHA  SIG  18  and  ATA  Telerehab  SIG  member  

.  

AFer  comple8ng  this  session,  you  will  be  able  to:  

 •  Select  appropriate  teleprac8ce  model  based  on  needs  assessment  

•  Discuss  technology,  confiden8ality  and  security  issues  related  to  various  teleprac8ce  models  

•  Develop  training  plan  for  persons  engaged  in  teleprac8ce  

•  Discuss  issues  related  to  licensing  and  reimbursement  related  to  teleprac8ce  

 

DETERMINING  EQUIPMENT  AND  INFRASTRUCTURE  NEEDS  

What do you want to be able to do? Types of services Setting Clients/patient needs Delivery model

What resources are available? Equipment Tech Support Bandwidth/internet

What are the start up costs? Equipment Tech support/ service agreements Bandwidth/internet

Levels  of  Digital  Videoconferencing  

Mobile  Devices  •  Tablets  •  Smart  phones  

Desktop  • Webcam  •  SoFware  

Small  mee?ng    •  Dedicated  unit  

•  Integrated  

Telepresence  •  Highly  interac8ve  

•  Immersive  

Mobile  Devices  •  Smartphone/Tablet  •  Accessibility  •  Apps  •  Limited  control  of  video  and  audio            quality  •  Security/encryp8on    

Feb 2014

Dudding, C.C. (2014) GSHA Conference 2

Desktop/Personal  DVC  •  Webcam  •  Low  bandwidth  requirements  •  Readily  available  soFware    •  Minimal  equipment  costs  •  Accessibility  •  Limited  control  of  video  and  audio            quality  •  No  (limited)  ability  to  control  far  camera  view  •  Security  and  encryp8on  considera8ons  

Small  Mee8ng  /  Mid-­‐level  •  Dedicated  digital    videoconferencing  equipment  

•  Moderate  equipment  costs  •  Technical  knowledge  of  firewall    and  internet  technologies    

•  Higher  bandwidth  requirements  •  Control  of  video  and  audio  quality  •  Control  of  far  camera  view  •  Encryp8on  and  security    

 

Telepresence  

•  Immersive    •  High  end  technologies  •  Advanced  collabora8on  

tools  •  Network  management  

services  •  High  cost  $300,000  +    

Peripherals  

SoFware    

SoFware  •  “Free”  ware    –  Skype    –  Yahoo  Messenger  –  Windows  Live    Messenger  –  Face8me  –  Jabber  

•  Commercial  soFware  –  MicrosoF  Office  Live  –  Adobe  Connect  –  Elluminate  –  Vidyo    

•  Interac8ve  sites  –  Highlights  for  Kids  –  Scholas8cs  for  Kids  –  PBS  Kids  

For a list of resources: MATRC – www.matrc.org SLPs- Check out Judith Kuster’s website http://www.mnsu.edu/comdis/kuster2/welcome.html

Equipment  Checklist  

ü Digital  videoconferencing  device  

Format    Compa8bility  with  other  devices/peripherals  Bandwidth  requirements  

ü Monitor  ü Sound  system  –  microphones/sound  cards  

ü Internet  connec8on    Access  Bandwidth  Security    

 

ü Peripherals  Document  cameras  Scanners/printers/fax  Carts  Monitoring  devices  Cell  phone  

Feb 2014

Dudding, C.C. (2014) GSHA Conference 3

Service  Delivery  Models  

Mobile  Health  Monitoring        Online  Speech  Services      Store-­‐and-­‐Forward  

Point-­‐to-­‐Point  DVC          Web-­‐based  Consulta8on  

E-supervision

JMU  Equipment  

•  Two  way  interac8ve,  high  defini8on  videoconferencing  equipment  

•  Flat  screen  tv/monitor  

•  Fax/copier/printer    •  Therapy  materials  •  Document  camera  

 JMU  Lessons  Learned  

•  Caseload  selec8on  

•  Coordina8on  of  resources  

•  Start  up  investment  

•  Ways  to  enhance  

interac8vity  

Lessons  Learned  

•  Marke8ng  

•  Importance  of  local  personnel      

•  Value  of  mee8ng  with  family  

and  administrators  •  Communica8ng  with  school  staff  and  parents  at  a  distance  

•  Room  Design  

•  Applicable  Laws  –  FERPA  (Family  Educa8onal  Rights  and  Privacy  Act)  – HIPAA  (Health  Insurance  Portability  and  Accountability  Act  of  1996)    

•  Privacy  –  Policies  and  procedures  must  be  kept  up-­‐to-­‐date.  

•  Technology  –  Security  considera8ons  –  Encryp8on    –  Does  HIPAA  require  encryp8on?  –  Firewall  protec8on  –  Records  -­‐  Storage  and  sharing  

•  Recommended  resource:  Center  for  Telehealth  and  e-­‐Health  Law  (CTEL)  

PRIVACY  &  SECURITY   Privacy and Internet-Based Telepractice Ellen R. Cohn and Valerie J. M. Watzlaf Abstract Speech-language pathologists and audiologists have historically been attuned to protecting the privacy of their clients. The recent proliferation of Internet-based communication for telepractice has resulted in new and constantly evolving threats to client privacy. This article provides an overview of key legal protections to privacy. With a focus on Voice over Internet Protocol (VoIP; e.g., Skype), the authors present an approach to risk assessment that includes a HIPPA Compliance Checklist (Watzlaf, Moeini, & Firouzan, 2010) and a team approach to oversight. Upholding Internet-based privacy within the current environment is an ongoing and challenging responsibility. Division 18 Telepractice : Perspectives doi:  10.1044/tele1.1.26  Perspec'ves  on  Teleprac'ce  September  2011  vol.  1  no.  1  26-­‐37      

Feb 2014

Dudding, C.C. (2014) GSHA Conference 4

§  Client  Selec8on  –  appropriate  based  on  the  unique  needs  of  the  client.    

–  not  appropriate  in  all  circumstances,  and  a  variety  of  factors  need  to  be  considered.  

–  The  need  for  physical  contact  must  be  addressed.  

–  SLP  must  assess  if  services  are  effec8ve  

§  Facilitators  need  to  be  well-­‐trained.  

CLIENT  SELECTION  

ASHA - TECHNICAL REPORT (2005

 

• Facilitator  training  • SLP/Graduate  clinician/CF    training  • Informed  Consent    •   No8fica8on    *  Acceptable  in  some  states  in  place  of  informed  consent  

• Permission  to  video/audio  record  • Properly  document  when  a  session  is  held  by  teleprac8ce.  

DOCUMENTATION  

•  Prac88oner  must  be  licensed  in  the  state  where  the  client/pa8ent  is  located  as  well  as  the  state  where  the  SLP  is  located.  

•  Logis8cal  &  financial  disincen8ve  

•  Check  with  your    State  Boards  of  Examiners  

•       See  hop://www.ncsb.info/state-­‐regula8ons  •  Proposed  Interstate  licensure  models  

               

 LICENSURE  

•  Hospital  and  healthcare  systems  

•  Private  and  public  insurers  

•  Federal  Medicare  

•  State  Medicaid  

•  Agency  benefits  –  (VA,  DOD,  DOC)  

REIMBURSEMENT  

•  Hospital  and  

healthcare  systems  

•  Private  and  public  

insurers  

•  Federal  Medicare  

•  State  Medicaid  

•  Agency  benefits    

•  Other    

REIMBURSEMENT  FOR  SLP  AND  AUDIOLOGY  

 

ETHICAL  CONSIDERATIONS  •  Must not violate professional code of ethics

•  Meet standards of care

•  Demonstrate competence

• Informed consent

• Assure confidentiality

APA Tele-psychiatry draft guidelines posted July, 2012

Feb 2014

Dudding, C.C. (2014) GSHA Conference 5

ASHA  -­‐  CODE  OF  ETHICS  (2010)    THE  FACILITATOR  

o  “Individuals  who  hold  the  Cer8ficate  of  Clinical  Competence  shall  not  delegate  tasks  that  require  the  unique  skills,  knowledge,  and  judgment  that  are  within  the  scope  of  their  profession  to  assistants,  technicians,  support  personnel…”    

o  “Individuals  who  hold  the  Cer8ficate  of  Clinical  Competence  may  delegate  tasks  related  to  provision  of  clinical  services  to  assistants,  technicians,  support  personnel,  or  any  other  persons  only  if  those  services  are  appropriately  supervised,  realizing  that  the  responsibility  for  client  welfare  remains  with  the  cer8fied  individual.”  

 o  “Individuals  shall  not  misrepresent  the  creden8als  of  assistants…

support  personnel…”  

 

ETHICAL  CONSIDERATIONS  

•  Check  with    liability  insurance    •  Liability  may  apply  to  teleprac8ce  consulta8ons  •  Standards  of  Care:    Are  there  standards  specific  to  teleprac8ce  &  are  they  suitable  for  the  student?  

•  Determine  who  is  responsible  for…    –  student  safety?  –  equipment  failure?  –  training  facilitator?  –  no8fying  parents?  

LIABILITY/MALPRACTICE  (FLEISHER  &  DECHENE,  2004)  

AREAS  OF  TRAINING  

       Technology  –  Digital  video  conferencing  equipment  (webcam  or  stand-­‐alone)  

–  Peripherals  –  Room  set  up  –  Security  and  privacy  –  Troubleshoo8ng  

Communica8on  – Professionals  at  remote  site  

– Roles  and  responsibili8es  of  SLP/Graduate  Student/Paraprofessional  

– Planning,  data  collec8on  and  documenta8on  

AREAS  OF  TRAINING  

•  Supervision  requirements  

•  Models  of  teleprac8ce  

•  Appropriate  client  iden8fica8on  

•  Outcomes  measures  

•  Modifica8on  of  therapy  materials  and  strategies  

•  Strategies  for  encouraging  engagement  and  interac8on  

AREAS  OF  TRAINING   ATA  Key  Principles  •  Administra8ve  •  Clinical    •  Technical    •  Ethical  David  Brennan,  MSBE,  Senior  Research  Engineer,  Na8onal  Rehabilita8on  

Hospital,  Washington,  DC;    Lyn  Tindall,  PhD,  Speech-­‐Language  Pathologist,  Department  of  Veterans  

Affairs  Medical  Center,  Lexington,  KY  Janet  Brown,  MA,  CCC-­‐SLP,  Director,  Health  Care  Services,  American  

Speech-­‐Language-­‐  Hearing  Associa8on,  Rockville,  MD  Mike  Campbell,  MS,  MBA,  CCC-­‐SLP,  Director  of  the  Speech  and  Hearing  

Program,  The  University  of  North  Carolina  at  Greensboro,  Browns  Summit,  NC  

Jana  Cason,  DHS,  OTR/L,  Assistant  Professor,  Auerbach  School  of  Occupa8onal  Therapy,  Louisville,  KY  

Diana  Chris8ana,  MAT,  CCC-­‐SLP,  President/CEO,  Clinical  Communica8ons,  Sugar  Land,  TX  

Alan  Lee,  PT,  DPT,  CWS,  GCS,  Associate  Professor,  Mount  St.  Mary’s  College,  Doctor  of  Physical  Therapy  Program,  Los  Angeles,  CA  

David  R.  Smith,  Director,  Telehealth  Resource  Center,  Marqueoe  General  Hospital,  Marqueoe,  MI  

Deborah  Theodoros,  PhD,  Associate  Professor  and  Head,  Division  of  Speech  Pathology,  School  of  Health  and  Rehabilita8ve  Sciences,  The  University  of  Queensland,  Queensland,  Australia  

Access the full document at http://www.americantelemed.org

Feb 2014

Dudding, C.C. (2014) GSHA Conference 6

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www.asha.org/telepractice

ATA Telerehabilitation SIG

ASHA’s SIG 18: Telepractice Online Community