The Doctor Will Call You Now

It’s been the credo of AHIMA for a while now: “Health information where and when it’s needed.” Telehealth has brought an unexpected new angle to this mission, changing expectations for what the “where” and “when” can—and should—be. From remote consultations with specialists otherwise inaccessible for rural-based patients to “second pair of eyes” remote monitoring programs in intensive care units, the possibilities for telehealth technologies continue to unfold. There are even commercials now that directly market to everyday consumers the virtues of telehealth technologies, such as the promise of on-demand late night video consultations for new parents wondering whether they need to bring their baby to the emergency department. But as telehealth and telemedicine technologies proliferate, so do the challenges and questions that must be addressed—many of which sit squarely in health information management (HIM) professionals’ wheelhouse.

Telehealth the Talk of Healthcare

Department of Health and Human Services (HHS) Secretary Alex Azar has voiced support for the continued growth of telehealth technology. During a congressional hearing on February 15, Azar stated that he would like to work with Congressional representatives and HHS “to help find ways to alleviate reimbursement challenges that are in the way of telehealth exploding and bringing medicine to the nooks and crannies of every part of America.” Azar’s comments are further indication that telehealth is on the rise in the US, with no sign of slowing.

While consumers might hold a more traditional expectation of what telemedicine services look like—an extension of care from their local hospital via virtual visits, perhaps—the reality of the applications for telemedicine technology is vast. “I think we are just on the tip of the iceberg with this technology,” says Patty Buttner, MBA/HCM, RHIA, CDIP, CHDA, CPHI, CCS, a director HIM practice excellence at AHIMA. Hospitals, physician practices, emergency departments, skilled nursing facilities, psychiatric facilities, and pharmacies are just some of the places one could expect to find telemedicine in action.

A partnership between the University of Rochester Medical Center (URMC) and the Rochester City School has made it possible for children’s primary care providers to use telemedicine as a means to communicate with in-school nurses, ensuring proper medication therapy. The program was aimed at reducing emergency department visits for children with asthma. “We know that asthma is a significant problem particularly for kids living in the city in terms of causing ongoing symptoms, missed school days and emergency visits,” Jill Halterman, MD, chief of the Division of General Pediatrics at URMC, told Health Data Management. Halterman noted that a lack of appropriate medication therapy could be a contributing factor. A study on the effects of school-based interventions such as supervised asthma treatments and telemedicine visits reduced the likelihood of emergency visits for asthma-related symptoms by almost half.

Several states have turned to telehealth technology as an answer to the challenges of providing adequate mental healthcare to inmates in state prisons. The need for mental health care in prisons is significantly higher when compared with the overall US population. “Of the 2.2 million people currently in prison or jail in the U.S., 26% of those in jail and 14% of those in prison met the Bureau of Justice Statistics’ ‘threshold for serious psychological distress,’ compared to just 5% in the general population,” according to Modern Healthcare. With the US facing an overall shortage of mental health providers, the greater ease of access that telehealth technology, such as video visits, provides is invaluable—especially since prisons represent a challenging environment for providers. In addition to safety concerns, prisons are often in remote locations that require providers to travel hours for each visit.­

Telehealth’s Many HIM Issues

HIM professionals should take notice of these telehealth trends—their work is directly impacted. To help guide HIM professionals through this new landscape, AHIMA has released a Telemedicine Toolkit. As telemedicine and telehealth technologies reach more and more consumers, “health information professionals need to ensure that appropriate documentation is reflected in the record and adherence to all regulatory requirements are met,” according to the toolkit. Perhaps the best thing that HIM professionals can do is to make sure they’re involved with telehealth projects early on, so that they can provide crucial input on such questions as how to store records of a virtual visit and how to address privacy concerns.

If a patient has received care via telehealth from another provider that is not equipped to share that data with a primary care physician, should an attempt to capture data on those visits be made? If an organization is planning to implement a telehealth program, how will that information be integrated into the electronic health record? What are the privacy and security implications? What is the risk of a data breach? How will the information from telehealth encounters be documented? How can identity verification policies ensure no duplicate records are created for patients that receive both virtual and in-person care? These are conversations that HIM professionals need to be a part of—and even lead—as telehealth continues to grow and evolve.

“There needs to be discussion on how the data is captured, retained, shared, and destroyed. Policies and procedures need to be clear on processes surrounding this technology,” says Buttner. Not only does documentation need to be accurate and complete, it should also note when telehealth and telemedicine technologies are used. “This impacts not only the accurate picture of the condition of the patient, but how the services are coded and reimbursed. Data can be collected from the codes assigned, which can provide valuable information to the organization on how many patients are provided with this service. This data can be used for benchmarking, trending, and planning,” she says.

Information governance (IG) is an important consideration when it comes to running telehealth and telemedicine programs. “Aligning the telemedicine program with current IG best practices will allow for trustworthy, reliable, and secure data and information to be used to make strategic business and clinical decisions surrounding telemedicine that will transcend throughout the organization’s business units,” according to the Telemedicine Toolkit. The participation of stakeholders throughout the organization in steering the program can align telehealth efforts with the organization’s strategic objectives, such as reducing readmissions.

And having a working knowledge of healthcare information technology can be invaluable to HIM professionals involved with the development, implementation, and ongoing maintenance of a telehealth program. Telehealth capabilities and applications are continuing to evolve, and “HIM professionals must be able to work collaboratively with IT professionals and others to answer questions related to the logistics of storing video and audio files within the health record” if—or perhaps more likely, when—the time comes, according the 2014 Journal of AHIMA article “Healthcare On Demand.”

HIM professionals are on the frontlines when it comes to advocating for patients, educating them about their rights as well as the importance of their health information—and the impact that patients can have when they engage with their care. As telehealth continues to proliferate, so too will questions about information access and availability. When healthcare goes to the patient when and where they need it, relevant health information needs to go with them. The question is how this must be accomplished.

Despite Tech Advances, Care Coordination Still a Problem

While the industry has recognized the issue that the current lack of interoperability presents, the current absence of widespread effective interoperability solutions means patients will most likely need to take on the mantel of care coordination among disparate virtual encounters and providers—just as they often must take on the burden of care coordination when they see physicians at different facilities or organizations. HIM professionals are in an ideal position to partner closely with patients as they take on this role, providing the support and education that will help consumers keep up as care delivery methods continue to evolve.

Even when your healthcare provider fits in the palm of your hand, health information management is no small matter.


Sarah Sheber is assistant editor/web editor at Journal of AHIMA.

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