covid-19 and telemedicine...everything is ready for telemedicine services to operate at full...

COVID-19ANDTELEMEDICINEToolforassessingthematuritylevelofhealthinstitutionstoimplementtelemedicineservicesVersion3.0,July2020

COVID-19ANDTELEMEDICINE‒Toolforassessingthematuritylevelofhealthinstitutionstoimplementtelemedicineservices

COVID-19ANDTELEMEDICINEToolforassessingthematuritylevelofhealthinstitutionstoimplementtelemedicineservices

Introduction..............................................................................................................................................3

I.Organizationalreadiness.....................................................................................................................4

II.Processes...............................................................................................................................................6

III.Digitalenvironment...........................................................................................................................7

IV.Humanresources...............................................................................................................................9

V.Regulatoryissues..............................................................................................................................10

VI.Expertise...........................................................................................................................................11

Guidelinesforanalyzingtheresults...................................................................................................11

Referencesandothertoolsforfurtherself-assessment................................................................12

Projectteam..........................................................................................................................................13

Appendix.Contributorstothedevelopmentofthistool...............................................................13

COVID-19ANDTELEMEDICINEToolforassessingthematuritylevelofhealthinstitutionstoimplementtelemedicineservicesIntroductionThis tool has been designed to help health institutions assess their level of maturity to offertelemedicineservices.Furthermore, it facilitatesthe identificationofpossiblegapsorareasthatcouldrequiremoreattentionandexperttechnicalsupport.Thelevelofmaturityisscoredfrom1(lowest)to4(highest).

Levelofmaturity

None(1) Beginner(2) Advancing(3) Ready(4) Requeststechnicalsupport

Noinitiativeisinplace.

Somestepshavebeentaken,buttheinstitutionisstillfarfrombeingabletoimplementservices.

Goodprogress,andsometelemedicineservicescouldbegintobeimplemented.

Everythingisreadyfortelemedicineservicestooperateatfullcapacity.

Requiresexperttechnicalsupporttomakefurtherimprovements.

Thistoolformspartofthesupportforpandemicresponseoperations.Itsdesignisbasedonthemodelsthat have been implemented by different health institutions with different levels of complexity inseveral countries. The tool was developed collaboratively with institutions and experts specialized intelemedicine and in the use of information technology (IT) in public health, from the Region of theAmericasandSpain(seeAppendix).The tool has been developed with the understanding that there is an institutional commitment toimmediatelyimplementtelemedicineservices.However,itwillalsobeusefultoinstitutionsthatalreadyhavetelemedicineprogramsupandrunning,whichwanttoperformaself-assessmenttoredefinetheirpriorities in light of the pandemic. The tool comprises a series of questions, organized into the sixcategoriesindicatedbelow.

I.Organizationalreadiness

QuestionLevelofmaturity

1 2 3 4Requeststechnical

support

1 Isseniormanagementcommittedtoofferingtelemedicineservices?

2 Isitclearlyunderstoodwhichservicescanbeofferedviatelemedicine?

3 Havetheservicestobeofferedviatelemedicinebeenidentified?

4 Isthereabudgetavailableforofferingtelemedicineservices?

5 IstheITstafftrainedtoprovidesupportservicesfortelemedicine?

6 Dothenationalorlocalregulationsallowtheimplementationoftelemedicineservices?

7 Doestheinstitutionhavereliableinternetaccess?

8 Doestheinstitutionalreadyhavesomekindoftelemedicineprograminoperation?

9 Doestheinstitutionhaveanyexperienceinusinginstantmessagingortextingforhealthpromotion?

10 Doestheinstitutionhaveanyexperienceinhealthservicedeliverythroughvirtualconsultations?

11 Doestheinstitutionhaveanyexperienceinremotemonitoringofpatients?

12 Couldthefundingoftelemedicineservicesbeextendedbeyondtheinitialplanningandpilotstages,tobecomeasustainablemodel?

13 Ismedicalstafftrainedinprovidingtelemedicineservices?SeesectionIV(onhumanresources)belowformoreinformation.

14 Ifthescoregivenonthepreviousquestionis1or2,havetelemedicinetrainingoptionsbeendetermined?

15 Doestheinstitutionhavetheinfrastructurenecessaryforprovidingtelemedicineservices?

15.a ● Sufficientspace

15.b ● Reliableelectricitysupply

15.c ● Acceptableilluminationlevels

15.d ● Supportteams

16 Hasanyonebeendesignatedtoberesponsiblefortelemedicineservices?1

17 Ismedicalstaffinagreementwithofferingtelemedicineservices?

18 Hasanythingbeendonetoaddressresistancetochangesinroutineswithwhichphysiciansfeelsafeandcomfortable,andtoanewandunknownsysteminvolvingacertaindegreeofinitialuncertainty?

19 Ifthescoregivenonthepreviousquestionis1or2,canthisproblembesolvedthroughparticipatorydialogue?

20 Haveanyincentivesbeenputinplacetopromotetheuseoftelemedicine?

21 Ismedicalstafffamiliarwithprivacyandsecuritypracticesbasedoncurrentethicalandlegalprinciples?

22 Hastheworkloadinvolvedinlaunchingthistypeofprograminthecurrentenvironmentbeendefined?

23 Doestheprogramhavethesupportofaninstitutionspecializedintelemedicineservices?

24 Hastheinstitution’sstaffbeeninformedoftheintentiontoimplementorexpandtelemedicineservices?

25 Havethepotentialbeneficiariesofthesetelemedicineservicesbeeninformedoftheirlaunchorexpansion?

26 Havepatientcareagendasbeenchangedduetotheneedforremoteconsultations?

27 Whatistheexpectedlevelofacceptancefortelemedicineservicesfromtheirpotentialbeneficiaries?

28 Arethereculturalorlinguisticbarriersthatcouldcausedifficulties

1. This individual isresponsibleforoverseeingtheservice,offeringsupportforreferrals,secondopinions,clinicaldecisions,operationofthe

program,andevolutionofthesystemingeneral.

duringthedeliveryoftelemedicineservices?

29 Isthelevelofconnectivityofpotentialpatientsknown?

30 Isthelevelofdigitalliteracyofpotentialpatientsknown?

31 Havegovernancemechanismsbeenestablished?

32 Havecontinuousassessmentmechanismsbeenestablished?

II.Processes

Question

Levelofmaturity

1 2 3 4 Requeststechnicalsupport

33 Havetheduties,roles,andresponsibilitiesassociatedwiththetelemedicineservicesbeendefinedforallstaffwhowillbeinvolved?

34 Havetheduties,roles,andresponsibilitiesrelatedtothetelemedicineservicesbeendefinedforalladministrativestaff?

35 Haveproceduresbeendefinedtoaddressthesecurityconsiderationsregardingpatientsandinstitutionallegalresponsibility?

36 Haveproceduresbeendefinedtosafeguardthesecurity,confidentiality,andbackupofthedataandinformationgeneratedbytelemedicineservices?

37 Areproceduresinplacetorecordthelevelofpatientsatisfactionwithtelemedicineservices?

38 Arenotificationproceduresinplaceintheeventofincidentsoradverseeventsduringtelemedicineconsultations?

39 Aretherestandardizedprocedurestonotifyanddocumentpossibletechnicalfailuresduringaconsultationthatcouldaffecttheclinicaloutcome?

40 Arethereformalprocedurestoremotelyobtaininformedconsentfrompatients?

41 Arethereproceduresortoolsforstaffandpatientstosharetheir

concerns,suggestions,orcommentsregardinghowthetelemedicineprogramisworking?

42 Isthereastrategyandoperationplantoorienthealthcareproviderstowardsoptingforoutpatientteleconsultationsandremotemonitoringoftheirpatients?

43 Aretherecommunicationmechanismsforinformingandeducatingthepublicabouttherecommendeduseoftelemedicine?

44 Isthereaprocedureoremergencyplanforphysicianspracticingtelemedicineiftheyconsiderthatapatientshouldbereferredtoanintensivecarecenter?

III.Digitalenvironment

Question

Levelofmaturity

INTERNETCONNECTIONANDCONNECTIVITY

45 Isaregular,reliableinternetconnectionavailable?

46 Doestheavailablebandwidthmakeitpossibletooffertelemedicineserviceswithoutaffectingotherservices?

47 Istheinstitutionabletocalculatethebandwidthnecessaryforprovidingtelemedicineservices?

48 Isthenecessaryminimumhardwareavailable?

49 Ifthescoregivenonthepreviousquestionis1or2,isthereabudgetavailabletoprocurethenecessaryequipment?

50 Istheretechnicalsupportavailabletosolveproblemsrelatedtoconnectivity?

51 Isthereacybersecurityplan?

52 Aretechnicalsupportmanualsavailabletoaddressconnectivityissues?

53 Isthereacontingencyplanintheeventofequipmentorconnectivityfailures?

54 Hasthepossibleimpactofthenewtelemedicineservicesonthecurrenttechnologicalinfrastructurebeenconsidered?

APPLICATIONS(SOFTWAREFORMANAGINGMEDICALRECORDS,PATIENTPORTALS,ETC.)

55 Isthereanelectronicpatientrecordsystem?

56 Isthereapatientportal?

57 DoestheinstitutionknowwhatsoftwareorITsolutionsarenecessarytooffertelemedicineservices?

58 Aretherestandardoperatingproceduresformanagingthedataandprocessesinvolvedintelemedicinedelivery?

59 Arethereguidelineson:

59.a ● Patientsafety?

59.b ● Privacyanddataconfidentiality?

60 What is the level of interoperability among the telemedicineservices’differentsystemsanddatabases?

61 AretheretermsofreferencefortheprocurementofITsolutions?

62 HasitbeendecidedwhethertelemedicineITsolutionswillbeintegratedintootherexistingsystemsandprocesses,suchasthoseformedicalrecords,patientportals,andmessaging?

63 Aretherestandardoperatingproceduresformanagingdataandprocessesrelatedtoprovidingcaretopatients?

64 Dothemedicalrecordsplatformsusedinthetelemedicineserviceshavethecapacitytoincludecopiesofalltheelectroniccommunicationsrelatedtothepatient?

APPLICATIONS(ADMINISTRATIVESOFTWAREFORBILLING,PAYMENTS,MONITORINGHOURS,ETC.)

65 Aretheadministrativemanagementplatformsreadytoworkwiththeimplementationoftelemedicineservices?

TECHNICALEQUIPMENT(HARDWAREANDOTHEREQUIPMENT)

66 Isthereaninventoryofallthetechnicalequipment,includingthebrand,model,timeinoperation,andserialnumber?

67 Isthereasecurelocationtostoretheequipmentwhenisitnotin

68 Isthereamaintenanceprogramforthetechnicalequipment?

69 Hasconsiderationbeengiventothetechnologicalcapacityforstorageandsecuritythatwillbenecessarytodocumentandrecordface-to-facemeetings?

70 IstechnicalsupportavailablefromITspecialists?

71 Arethereplansforupdatingtechnicalequipment?

IV.Humanresources

Question

Levelofmaturity

HEALTHWORKERS

72 Istherestaffavailabletoparticipateinthetelemedicineprogram?

73 Hasitbeenclearlydefinedwhichstaffmemberswillworkontelemedicineservicesorspecialties?

74 Havetheminimumskillsetsnecessaryforthedifferenttelemedicineservicesbeendefinedforthosewhowillbeworkingintelemedicine?

75 HasthepossibilityofimplementinganexpeditedtrainingplanbeenconsideredforstaffwiththelowestlevelofITskills?

76 Isthereaccesstoexpeditedtrainingprogramsatotherinstitutions,ifnecessary?

77 Arethereplanstoprovidetelemedicineservicesoutsidetheusualface-to-facehours?

78 Whatisthelevelofstafftrainingnecessarytoprovidetelemedicineservices?

ITSTAFF

79 Istherein-houseITstafftosupporttelemedicineservices?

80 Iffewerthan3ITstaffareavailable,isitclearwhatqualifications

shouldberequiredforthosewhowillbeprovidingtelemedicineservices?

81 Istheretrainedstaffabletocriticallyassessanyequipment,andtheITthatshouldbeprocured?

82 IstherestaffwiththenecessaryexperiencetonegotiatewithprovidersforpurchasingorcontractingITorsupportservices?

83 Howqualifiedistheinstitution’sITstafftoprovidetelemedicineservices?

V.Regulatoryissues

Question

Levelofmaturity

84 Areallthelegalissuesassociatedwiththedeliveryoftelemedicineservicesperfectlyclear?

85 Isthereaprocedureinplacetokeepstaffwhoprovidetelemedicineservicesuptodateonpossiblechangesinregulations,statutes,federalandsubnationalpolicies,andlegislationrelatedtotelemedicineservices?

86 Doestheinstitutionhavein-houselegaladvisoryservices?Doesithaveaccesstoaspecializedconsultancytoreceiveexpertadviceonlegal,ethical,privacy,andsecurityissues?

87 Isitknownforcertainthatthepatientsarelocatedwithinthesamecatchmentarea(e.g.state,province,ormunicipality)astheinstitutionprovidingthetelemedicineservices?

88 Arethemalpracticeissuesrelatedtothetelemedicineserviceswellunderstood?

89 Hasaprocessbeenputinplaceforobtaininganddocumentingtheconsentofpatientsbeforetheyparticipateinatelemedicinevisit?

90 Istherearegulatoryframeworkforauthorizing,integrating,andreimbursingtelemedicineinthedeliveryofcaretoallpatients,particularlyduringemergenciesandoutbreaks?

91 Arenewregulationsorlegaltechnicalframeworksnecessarytoimplementtelemedicineservices?

VI.Expertise

Subject

Levelofmaturity

92 Indicatorsfortelemedicineprojectsastoolstoreduceinequitiesinhealth.

93 Treatmentprotocolsfortelemedicine.

94 ITstandardsinhealthandinteroperability.

95 Managementofchange.

96 Architectureofpublichealthinformation.

97 Technologicalreadinessinpublichealth.

98 Datagovernanceinpublichealth.

99 Implementationframeworkfortelemedicineservices.

GuidelinesforanalyzingtheresultsTheresultsshouldbediscussedininterdisciplinaryteamscomprisingspecialistsfromthedifferentareasinvolved.Ifthereisenoughtime,theyshouldalsobevalidatedbyexpertsinhealthservicesandITwhohavetelemedicineexperience.

Questions that are answered “requests technical support” will serve as the basis for developing acollaborationagreementwithspecializedpartners.Thefollowingguidelinesshouldbeusedtointerprettheresults,sectionbysection.

Levelofmaturity

None(1) Beginner(2) Advancing(3) Ready(4) Requeststechnicalsupport

Noinitiativeisinplace.

Somestepshavebeentaken,buttheinstitutionisstillfarfrombeingabletoimplementservices.

Goodprogress,andsometelemedicineservicescouldbegintobeimplemented.

Everythingisreadyfortelemedicineservicestooperateatfullcapacity.

Requiresexperttechnicalsupporttomakefurtherimprovements.

● Ifamaturityscoreof1or2isgivenforanyofthequestionsbetween1and7,therecommendation

istodelay implementationoftelemedicineservicesuntil levelofmaturity3 isachieved,bytakingthefollowingactions:○ Formulate an action plan and an evidence-based budget for discussion at the decision-

makinglevels.○ Setupataskforce.○ Ensurereliableinternetaccess.○ Definewhichhealthcareserviceswillbeofferedviatelemedicine.○ IdentifyITstaffspecializedintelemedicineorinmorecomplexinformationtechnologies.○ Carryoutaspecificlegalconsultation,takingasanadditionalreferencethequestionsin

sectionV(onregulatoryissues)ofthistool.

● Any questions for which amaturity score of 1 or 2 is given should serve as the main basis forplanning the necessary actions and investments to be incorporated into the final telemedicineprogram.

● Thosequestionsforwhichamaturityscoreof3or4isgivenshouldbeanalyzedinamacro,rather

thananindividual,contexttodeterminewhetheritispossibletobeginofferingsometelemedicineservicespartially and securely. In this situation, it is suggested that theprocessbe validatedwithexpertsinhealthservicesandITwhohaveexperienceintelemedicine.

● If someof thequestions fromnumbers8 to11aregivenamaturityscoreof3or4, thenaquick

analysis should be conducted on lessons learned that could lead to recommendations for thecurrentsituation.Thiswouldmeancarryingoutanassessmentontheinitiativesthatareorwereinoperation.

● Workingwithoutsideexperts isrecommendedtodesignaroadmapbasedonanalysisoftheendresults.

● Aframeworkformonitoringandevaluatingtheprocessisstronglyrecommended.Referencesandothertoolsforfurtherself-assessment• PanAmericanHealthOrganization.FrameworkfortheImplementationofaTelemedicineService.

Washington,D.C.:PAHO;2016.Availableat:https://iris.paho.org/bitstream/handle/10665.2/28414/9789275119037_eng.pdf?sequence=6&isAllowed=y

• NationalFrontierandRuralTelehealthEducationCenter.TelehealthCapacityAssessmentTool(TCAT).NFARtec;2013.Availableat:https://www.nfartec.org/wp-content/uploads/2018/08/nfar_tcat_508.pdf

• U.S.DepartmentofJustice,OfficeofJuvenileJusticeandDelinquencyandWesternRegionalChildren'sAdvocacyCenter.TelemedicineReadinessAssessmentTool.Availableat:http://www.westernregionalcac.org/tmhresourcecenter/getting-started-introduction/getting-started-assessing-readiness/

• UniversityofMarylandSchoolofMedicine.TelehealthReadinessAssessmentTool.2019.Availableat:https://mhcc.maryland.gov/mhcc/pages/hit/hit_telemedicine/documents/TLHT_TRA_Tool.pdf

Projectteam

PanAmericanHealthOrganization/WorldHealthOrganization• SebastianGarciaSaisó,Director,DepartmentofEvidenceandIntelligenceforActioninHealth,PAHO/WHO• MarceloDAgostino,DepartmentofEvidenceandIntelligenceforActioninHealth,PAHO/WHO• MyrnaMarti,DepartmentofEvidenceandIntelligenceforActioninHealth,PAHO/WHO

Inter-AmericanDevelopmentBank• FerdinandoRegalia,DivisionChief,SocialProtectionandHealth,IDB• LuisTejerina,SocialProtectionandHealth,IDB• JenniferNelson,SocialProtectionandHealth,IDB• AlexandreBagolle,SocialProtectionandHealth,IDB

Appendix.ContributorstothedevelopmentofthistoolThefollowinginstitutionsandexpertsintelemedicineandtheuseofITinpublichealthfromtheRegionoftheAmericasandSpainhavecontributedtodevelopingthistool:

● SocialProtectionandHealthDivision,Inter-AmericanDevelopmentBank.● Departmentof IT inHealth, ItalianHospitalofBuenosAires (PAHO/WHOCollaboratingCenter for

InformationSystemsandDigitalHealth)● OpenUniversityofCatalonia(UOC)(PAHO/WHOCollaboratingCenterforeHealth)● Center for Health Informatics, University of Illinois (PAHO/WHO Collaborating Center on Information

SystemsforHealth).● Salud.uy,AgencyforeGovernmentandtheInformationSociety(AGESIC)ofUruguay● TelemedicineNetworkfromBrazil(RedeRUTE)● TheCentralAmericanHealthInformaticsNetwork,RECAINSA

PAHOInformationSystemsforHealth(IS4H)networkofexperts

covid-19 and telemedicine...everything is ready for telemedicine services to operate at full...

Documents

telemedicine presentation_aigilis

telemedicine programs

telemedicine in japan 2013 - jtta｜一般社団法人...

building a telemedicine program from scratch …...building...

web view• ecommerce (including mcommerce) • telemedicine...

telemedicine solutions

telemedicine (1)

when telemedicine does deliver!: telemedicine and diabetes...

telemedicine go

prognocis telemedicine overview telemedicine

ottet telemedicine

who telemedicine

prehospital telemedicine

telemedicine leads

telemedicine proposal

telemedicine · telemedicine parity laws (including...

telemedicine regulatory, compliance, and valuation ... ·...

telemedicine telemedicine: an essential technology … ·...

telemedicin. titles introduction. telemedicine. telehealth....

telemedicine ppt