Lesson 2 Setting Up Your Video-Based Office for Telehealth.pptx
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Lesson 2 Setting Up Your Video-Based Office for Telehealth.pptx
- 1. Setting Up Your Video- Based Office for Telehealth Lesson 2
- 2. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. Consulting, Staffing, Credentialing and Professional Training (CEs) in Ethically – Required Competencies www.telehealth.org Telebehavioral Health Institute, LLC 2
- 3. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • WHO WE ARE: We are licensed healthcare professionals, attorneys and other consultants. • TELEHEALTH GOAL: Our goal is educational only. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in our training for your specific circumstance. • YOUR PART: You are encouraged to seek practice-specific advice from your own legal, regulatory, ethical and liability authorities before offering any telehealth services or programs to consumers/clients/patients. Obtain all such opinions in writing, and have your informed, trusted, local, legal counsel review those written responses for their full significance. Disclaimer 3
- 4. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • You may want to turn off your cell phone, close your email & lock your door • I often take questions as I go instead of only at the end of the hour. Just type them into our interface as those questions occur to you • Our slides and this recording will remain available 24/7 for 6 months from registration through the firewall-protected TBHI Training Center. Login is required • You are automatically enrolled to our in-house mailings along with your registration, so you will be notified of our insider news, eLearning tips and specials every month • Today's bonuses include FREE access to the TBHI HUB learning community forum, and a FREE profile page for you to network with our community of like-minded professionals 4 Optimizing Your Learning
- 5. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • The HUB allows you to ask questions of us as well as each other. We strongly encourage you to participate • Your webinar handout has a Iink at the end for you to click to give us feedback about today’s event. We hold a drawing to give free training to a lucky webinar participant who gave us feedback within 24 hours of our webinar. Help us help you • If you want to learn more about telemental health and have financial hardship, consider our Work/Study program, where you can work for TBHI in exchange for free Platinum Plus training • This month’s special will be announced at the end of the hour. It will only be valid until the first of next month and could be exactly what you need 5 We are here to help. Let us know what you need: www.telehealth.org/contact Optimizing Your Learning
- 6. © 1994-2022. Telebehavioral Health Institute, LLC. All Rights Reserved. Explain why privacy protection is the #1 technology-related concern of practitioners, insurers, licensing boards and other governmental agencies Learning Objectives 6 Describe 2 reasons that the use of Skype is not HIPAA compliant Identify 3 different HIPAA-compliant alternatives to Skype for videoconferencing Explain what it means to have a Business Associate Agreement" and how to get a company to sign one 1 2 3 5 6 4 Explain how adherence to HIPAA and HITECH are both relevant to both state law and ethical codes Identify at least 3 basic technology tools needed for telemental health practice
- 7. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Telephone • Land line or mobile • Email • Video • Text messaging • Apps Basic Technology Tools 7
- 8. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. Types of Video Platforms • Video, Chat (some have a firewall} • T-1 or T-3 Fiber optic • Web-based with download Videoconferencing 8
- 10. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 10 All Existing Legal & Ethical Rules Apply
- 11. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • American Association of Marriage and Family Therapists. (2015). AAMFT Ethical Code • American Counseling Association. (1999, 2005, 2014). ACA Code of Ethics • American Medical Association. (2000). Guidelines for Patient-Physician Electronic Mail • American Mental Health Counselors Association. (2000). Code of Ethics of the American Mental Health Counselors Association, Principle 14, Internet On-Line Counseling • American Psychological Association. (1997). APA Statement on Services by Telephone, Teleconferencing, and Internet, A statement by the Ethics Committee of the American Psychological Association • American Psychological Association. (2013). Telepsychology Guidelines Telemental Health Standards & Guidelines 11
- 12. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • American Telemedicine Association. (2009). Evidence-Based Practice for Telemental Health • American Telemedicine Association. (2009). Practice Guidelines for Videoconferencing-Based Telemental Health • American Telemedicine Association. (2013). Practice Guidelines for Video-Based Online Mental Health Services • Australian Psychological Society. (2004). Guidelines for Providing Psychological Services and Products on the Internet • British Psychological Society. (2009). The Provision of Psychological Services via the Internet and Other Non- direct Means • Canadian Psychological Association. (2006). Ethical Guidelines for Psychologists Providing Psychological Services via Electronic Media 12 Telemental Health Standards & Guidelines
- 13. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Federation of State Medical Boards of the United States, Inc., Report of the Special Committee on Professional Conduct and Ethics. (2002). Model guidelines for the appropriate use of the Internet in medical practice • National Association of Social Workers. (2005, 2016). Telemental Health Guidelines • National Board for Certified Counselors and Center for Credentialing and Education. (2001). The Practice of Internet Counseling. (2001) • New Zealand Psychological Psychologists Board (2011). Psychology services delivered via the internet and other electronic media • Ohio Psychological Association. (2010). Telepsychology Guidelines 13 Telemental Health Standards & Guidelines
- 14. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 14 HIPAA, HITECH & Your State Law
- 15. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Federal laws are the floor • State law prevails • If two state laws conflict, the more restrictive is the one to follow Federal vs State Law 15
- 16. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Government, professional association regulations • Can be devastating to patients and their families • Professionals must deal with both legal and ethical mandates • Hackings / hackers are commonplace • Most infractions are due to lack of practitioner and/or system’s preparedness • Easy to prevent / difficult to remedy 16 Privacy is #1 Consumer Complaint
- 17. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Transmission • Privacy • Security Three HIPAA Rules 17
- 18. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Privacy is the client or patient’s legal right to express themselves selectively • Confidentiality is a health care professional's legal duty to protect a client or patient’s right to privacy 18 Privacy vs. Confidentiality
- 19. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. Data are “individually identifiable'' if they include any of the 18 types of identifiers, listed below, for an individual or for the individual’s employer or family member, or if the provider or researcher is aware that the information could be used, either alone or in combination with other information, to identify an individual: HIPAA Privacy Rule 19
- 20. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 1. Address (all geographic subdivisions smaller than state, including street address, city, county, zip code) 2. All elements (except years) of dates related to an individual (including birth date, admission date, discharge date, date of death and exact age if over 89) 3. Telephone numbers 4. Name 5. Fax number 6. Email address 20 HIPAA Privacy Rule (cont.)
- 21. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 7. Social security number 8. Medical record number 9. Health plan beneficiary number 10. Account number 11. Certificate/license number 12. Any vehicle or other device serial number 21 HIPAA Privacy Rule
- 22. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 13. Device identifiers or serial numbers 14. Web URL 15. Internet Protocol (IP) address numbers 16. Finger or voice prints 17. Photographic images 18. Any other characteristic that could uniquely identify the individual 22 HIPAA Privacy Rule
- 23. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Informed Consent • Limit Equipment Used • Limit Use of Unsecured Wifi • Risk Analysis • Business Associates Agreement • HIPAA audits have ramped up significantly in 2016 • Private practitioners have been the #1 group to be disciplined for several years in a row 23 HIPAA Risk Management
- 24. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 24 Skype and “Skype for Business”?
- 25. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 25 HIPAA requires an "audit trail“. Skype doesn't provide audit trails - and isn't obligated to...
- 26. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 26 HIPAA requires “breach notification tools“. Skype doesn't provide…
- 27. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Skype may gather and use info about us or our clients • ldentification data (e.g. name, username, address, telephone number, mobile number, email address) • Electronic identification data (e.g. IP addresses, cookies) • List of your contacts and related data • Content of instant messaging communications, VMs, video messages 27 Skype’s Privacy Policy
- 28. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Skype uses its own cookies for a variety of purposes, including to • Provide internal and customer analytics and gain statistics and metrics about our websites • Skype’s analytics, ad-serving and affiliate partners may also set and access cookies on your computer • Skype will take appropriate organizational and technicaI measures to protect the personal data and traffic data provided to it or collected by it with due observance of the applicable obligations and exceptions under the relevant legislation 28 Skype’s Privacy Policy
- 31. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 31 Which Technologies to Use? • No Guesswork Needed
- 32. Internet based, VTC Companies Claiming HIPAA Compliance www.telehealth.org/directory
- 33. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Use HIPAA compliant technologies and develop written processes • Regular risk analyses • Document policies • Security & privacy policies • Repairs • Staff training • Breach notification, etc. 33 HIPAA Policies
- 34. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Business associates of covered entities are directly liable for compliance with HIPAA Privacy and Security Rules requirements. Includes contractors, subcontractors and business service companies working for health care providers, (e.g., companies providing electronic health records software, teleconferencing, data back-up and storage, billing, transcription and other IT services) • Raises the maximum penalty for data breaches from a previous cap of $250,000 to a maximum penalty is $1 .5 million per violation 34 HIPAA “Final Rule” January 17, 2013
- 35. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • lnfrastructure, documentation, and procedures for information privacy and security, and data encryption and disposal will have to be evaluated and brought into compliance 35 HIPAA “Final Rule” • Companies need to provide formal security training to all employees, designate a security official and implement appropriate business associate contracts with their own subcontractors.
- 36. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 36 HIPAA Business Associates and HITECH • All Business Associates in health care must sign a Business Associate Agreement (BAA) stating their adherence to HIPAA standards • Transactions • Security • Privacy
- 37. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 37 HIPAA Business Associates and HITECH • BAAs are required for every service you use • It is now enforced by the HITECH ACT
- 38. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Insurers require specialized credentialing for reimbursement • Several issues are involved, but one is verification of the appropriateness of your equipment • lnsurers will not reimburse if they know that you use an illegal, non-HIPAA compliant technology 38 Reimbursement?
- 39. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 39 Explain why privacy protection is the #1 technology-related concern by practitioners, insurers, licensing boards and other government agencies
- 41. HIPAA Wall of Shame https://ocrportal.hhs.gov/ocr/breach/breach_ report.jsf
- 42. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Email • Laptop • Portable devices • EMR • Network Server Types of Technologies involved in HIPAA Infractions 42
- 43. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Name • Addresses • Phone numbers • Full facial photos • Social security numbers • Financial information • Insurance ID numbers • Medical records Protected Health Information Issues Commonly Involved with HIPAA Violations 43
- 46. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Availability of a Business Associate Agreement (BAA) • Reputation in the community • “Down time” • Fees Video Essentials for Healthcare 46
- 47. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Clinical requirements for video-based healthcare may be dictated by the needs of the population being served and their setting, but also may include the following: • Adaptive devices for special needs populations • Multiple cameras for assessments • Screen sharing • Access from multiple locations Video Clinical Needs 47
- 48. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. • Types: • Hospitals and clinics = credentialing and privileging • Training - certificate to help distinguish you as a certified professional in the field • Credential by the Coalition for Technology in Behavioral Science (CTiBS) http://ctibs.org www.telehealth.org/courses Credentialing 48
- 50. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 50 30 questions to ask of your video vendors
- 51. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 51 How long have you been in business? What, if any, are your consumer ratings? Example: Better Business Bureau or objective 3rd party review sites.
- 52. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 52 Is your system HIPAA- compliant and/or HIPAA- compatible?
- 53. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 53 Do you offer a Business Associate Agreement (BAA)?
- 54. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 54 Do you have a training video that is located on a dedicated page for my first-time clients/patients? If yes, does that video pitch your other products or services?
- 55. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 55 What are your most frequent questions from new purchasers?
- 56. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 56 What type of recording services do you offer? Where are videos stored? How long? Extra fees? Who will have access?
- 57. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 57 How many parties can connect during a session (i.e., if different family members want to connect from 2-3 different location)?
- 58. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 58 Can I broadcast out to a group? Will I see everyone in the "room” or will they just see me? If I see everyone, how many people can I reasonably "tile" on my screen?
- 59. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 59 Can I show my desktop to my client /patient? What type of desktop sharing solution do you use? Does it prevent accidental information exposure to my client/ patient?
- 60. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 60 What is your mobile compatibility? Which mobile devices are supported? What are the limitations to using such devices?
- 61. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 61 Do you offer a calendar and appointment scheduling software? What type? What is the granularity of your calendar (i.e., does it segment time hourly, on the half-hour, quarter hour?) Can I launch my video session from within your calendar?
- 62. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 62 Are you set up to work with Electronic Health Records (EHRs)? If yes, which one(s)? Extra fees?
- 63. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 63 Is secure email service built into your platform? If yes, how does it work?
- 64. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 64 What type of internal, HIPAA- compliant text-messaging service do you offer?
- 65. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 65 Who will have access to my patient files? What are your personnel screening procedures (i.e., to avoid hiring convicted felons, etc.)?
- 66. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 66 What is your policy regarding subpoenas? When and how will I be informed? How much prior notice will I be given?
- 67. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 67 Do you carry liability insurance? What are the limits of your policy? Is a copy of the face sheet available for viewing?
- 68. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 68 Is there a download to get into your platform? (WebRTC?) How many clicks are required by a client/patient the first time?
- 69. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 69 Which type of technology training options are available to me as your client?
- 70. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 70 Which forms do you provide for my use with my clients/patients? Who developed your forms?
- 71. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 71 Which type of audit trails do you provide? How do they work? How can I access them? How often? Is there a charge for access?
- 72. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 72 Which type of breach notification tools do you provide? How is the notification sent? Example: email, text message, etc. How long after a breach will it take for me to be notified?
- 73. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 73 Do you provide a virtual waiting room for clients/ patients before I enter the treatment room?
- 74. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 74 Do you provide any "branding" of my URL or other aspect of what my clients/patients will see (i.e., my logo, insert images, color selection, etc.)?
- 75. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 75 Does your system allow me to conduct webinars as well as individual sessions?
- 76. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 76 What is the average response time needed from your technical support team if I have a problem with your system?
- 77. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 77 What's the quality of your connection versus your competitors (i.e., audio, video)?
- 78. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 78 What's your “downtime" in the last 3 months? In the last year? What is the industry standard for downtime? What percentage of the time is your signal choppy? What's your video "lag?"
- 79. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 79 Do you offer real-time technical support? How can I contact your support desk?
- 80. © 1994-2022 Telebehavioral Health Institute, LLC All Rights Reserved. 80 What is your process for making system-wide changes based on customer complaints or suggestions? How often do you update or upgrade your system?