RWHC Behavioral Telehealth Network: Implementation Activities

Oct 6, 2016NRHRC Webinar

1

Background Behavioral Health Practitioners from “Provider Facilities” are

contracted for blocks of time to provide telehealth services (medication management and psychotherapy) to people at “Patient Facilities.”

Patient Facilities are responsible for administration and billing

Practitioners document directly into the Patient Facility EHRs

3 Pilot programs with 2 psychiatrists, 1 APNP, and 1 psychologist providing services to people at 3 Patient Facilities

1st Pilot go-live was on 9/20; 2nd was on 10/4.

2

PHD Psychologist in Ashlandprovides psychotherapy services to patients in

Dodgeville

Psychiatrists in St. CroixFalls provide psychotherapy

and med management services to patients in Tomah

APNP in Baldwin provides med

management services to patients in Dodgeville and

Baraboo

The Rural Wisconsin Health Cooperative

provides coordination, project management,

technology, credentialing, and contracting

services

Rural Wisconsin Health Cooperative Behavioral Telehealth Network Pilot Projects

Rural Wisconsin Health Cooperative Behavioral Telehealth Program Activities

• Perform CV file and reimbursement credentialing

• Test and implement technology for behavioral telehealth service provision

• Work with network members on reimbursement issues

• Develop/share protocols that network members will need for patient intake, encounter, and post-encounter processes

• Support activities associated with provider documentation in network member EHRs

• Coordinate implementation, mock-encounter, and go-live activities

• Work with network members to increase provider capacity

Credentialing

5

Tomah--St. Croix Implementation Plan and Timeline

ID Project Name Owner

1.0 Credentialing (CV File and Reimbursement) RWHC/TMH/SCRMC

1.1

Patient Facility Submits CV File and reimbursement

credentialing forms, along with privilege forms, to RWHC

Credentialing Service TMH

1.2

Provider Facility submits list of payers that the practitioners

are currently credentialed with to RWHC SCRMC

1.3

RWHC compiles CV File packet and sends to practitioner(s)

contacts RWHC

1.4 Practitioners sign and return CV file packet SCRMC

1.5 RWHC sends completed CV file to Patient Facility RWHC

1.6

RWHC compiles reimbursement credentialing packet and

sends to practitioner(s) contacts RWHC

1.7

Practitioners sign and return reimbursement credentialing

packet SCRMC

1.8 RWHC sends completed credentials file to Health Plans RWHC

Technology Infrastructure

6

3.0 Technology Infrastructure RWHC/TMH/SCRMC

3.1

Patient and Provider Facility Broadband tested and

sufficient RWHC/TMH/SCRMC

3.2 Telehealth transport software Identified RWHC/Planning Committee

3.3 Patient Facility hardware identified and ordered RWHC/TMH

3.4 Provider Facility hardware identified and ordered RWHC/SCRMC

3.5 Patient Facility hardware installed RWHC/TMH

3.6 Provider Facility hardware installed RWHC/SCRMC

3.7 Telehealth transport software configured and implemented RWHC/TMH

3.8

Provider connectivity into Patient Facility EMR established

(VPN/login credentials, etc.) TMH/SCRMC

3.9 Technology downtime/contingency plan developed TMH/SCRMC

Patient Referral/Intake

7

4.0 Patient Intake, Encounter, and Post-Encounter TMH/SCRMC/RWHC

4.1

Intake: Patient Facility and Providers to identify target and

contra-indicated reasons for referral into the service TMH/SCRMC

4.2 Intake: Patient Facility to determine referral source TMH

4.3

Intake: Patient Facility to develop 1 page guideline

document to inform referral process TMH/RWHC

4.4

Intake: Patient Facility to develop county referral forms,

intake screening forms, and informed consent document TMH/RWHC

4.5

Pre-visit: Patient Facility to identify what data will need to be

available in the EMR for practitioner review prior to

encounter TMH/SCRMC/RWHC

4.6

Pre-visit: Patient Facility to identify scheduling blocks for

intake and return visits based on practitioner input. TMH/SCRMC/RWHC

Patient Visit

8

4.7

Workflow mapping: SCH to develop a workflow document

that identifies how each step in the pre-visit, visit, checkout

process will be handled SCH

4.8

Patient visit: Patient Facility to identify attendant(s) who will

be staffing the patient visit TMH

4.9

Patient visit: Procedures identified for patient check-in and

registration TMH/SCRMC/RWHC

4.10

Patient visit: Procedures identified for RN intake of the

patient (scanning of intake form, vitals, nurse

documentation)

4.11

Patient visit: Communication mechanisms between

practitioners and patient attendant established TMH/SCRMC/RWHC

Patient Checkout/Post Encounter

9

4.12

Check-out: Procedures for handling prescriptions

established TMH/SCRMC/RWHC

4.13

Check-out: Procedures for handling patient Instructions

established TMH/SCRMC/RWHC

4.14

Check-out: Procedures for handling follow-up scheduling

established TMH/SCRMC/RWHC

4.15

Post Encounter: Procedures for practitioner documentation

established TMH/SCRMC/RWHC

4.16 Post Encounter: Procedures for lab orders established TMH/SCRMC

4.17

Post Encounter: Patient Facility to determine how

practitioner documentation will be sent back to the referring

provider/agency TMH

4.18

Post Encounter: Procedures for how patient needs will be

addressed between visits TMH

Meetings/Site Visits

10

5.0 Meetings and Visits

5.1 November check-in video-conference TMH/SCRMC/RWHC

5.2 December check-in video-conference TMH/SCRMC/RWHC

5.3 Onsite visit to TMH with video option TMH/SCRMC/RWHC

5.4 Onsite visits to SCRMC TMH/SCRMC/RWHC

5.5 January check-in Onsite TMH/SCRMC/RWHC

5.6 February check-in video-conference TMH/SCRMC/RWHC

5.7 March check-in video-conference TMH/SCRMC/RWHC

5.8 April check-in video conference TMH/SCRMC/RWHC

5.9 May Mock-Encounter TMH/SCRMC/RWHC

5.10 May Go-Live (Postponed to September) TMH/SCRMC/RWHC

5.11 Go-Live Debrief (September) TMH/SCRMC/RWHC

Workflows

11

Mock Encounters

12

Testing Hiccups

• Reasons Why Testing is Important:

– The time a Citrix plug-in installation crashed the psychologist’s system

– Who should the patient call between visits for care questions/issues when referred from county services instead of primary care?

– Why can’t the attendant RN add a “new note” to document the intake?

– Practitioner education: remind me what I need to click on to view the intake form? Etc. Etc.

RWHC and Upland Hills Staff with Dr. Gardner after Behavioral Telehealth Go-Live at Spring Green Clinic