Telehealth Policy
PURPOSE:
To ensure adherence to all applicable laws, rules, and regulations while ensuring patient access to OptiHealthRx telemedicine through the use of “live two-way audio-visual communication.” By implementing these procedures, OptiHealthRx will provide “long distance” medical services to patients.
I. DEFINITIONS
Telemedicine - The use of electronic communication and information technologies to provide or support medical care at a distance. This definition includes:
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Live interactive two-way audio-video communication.
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Any communication modalities such as phone, fax, e-mail, the internet, and still imaging that are used in conjunction with live two-way audio-video communication.
The same standards of care and protocol exist with telemedicine as are used when assessing and treating the patient on-site. The provider-patient relationship is the same. Even though an “in person” examination is not performed, a physical inspection is performed utilizing the video chat, and a thorough history, assessment, plan, and laboratory evaluation is performed, thus establishing a provider-patient relationship.
Medical Providers/Providers – A licensed MD, DO, NP, or PA.
II. APPLICATIONS/SCOPE
Services
The following services will be available through the use of telemedicine: Weight Loss Medicine
Treatment via telemedicine will not deviate from standards of care applicable to face-to-face assessment and treatment. The telemedicine services provided by the medical provider may be an adjunct to periodic face-to-face contact or it may be the only contact by the medical provider if the medical provider deems it unnecessary to have an in-person evaluation.
Locations
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Patient at remote location / Provider at remote location – The medical provider will be at a location of their choosing operating under OptiHealthRx, and the patient will be at a location of their choosing, such as their home.
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Clinic Oversight
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Clinical oversight of telemedicine services medical care will be provided by random audits of patient charts by the OptiHealthRx clinical directors. Medical providers will have access to clinical directors for clinical questions as they arise.
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Contraindications for use
The consulting provider should request face-to-face consultation if the patient's condition does not lend itself to a telemedicine consultation or if visual or sound quality is inadequate.
III. PROVIDERS
Providers will be licensed in each respective state they provide services to. Each provider will be board-certified and have an unrestricted DEA license.
Providers are responsible for being aware of and abiding by the current rules/laws governing the state of practice relating to prescribing medications and telemedicine law.
Providers will complete provided training material and obtain CME credit before providing medical services unless experience dictates otherwise.
IV. PRIVACY, CONFIDENTIALITY AND SECURITY
The privacy and confidentiality of the telemedicine medical service will be maintained by ensuring that the locations of the patient and medical provider are secure. The services will be provided in a controlled environment (closed doors) where there is a reasonable expectation of absence from intrusion by individuals not involved in the patient's direct care. “Do Not Enter” signs will be recommended to be posted on the outside doors of facilities used in order to notify individuals not to enter the room during the telemedicine visit.
OptiHealthRx staff, or ancillary contracted staff, involved in the patient’s care, family members, and technical staff may at times be present in interviews. Patients will be informed about others present in the room at the distant site if such persons are off-camera, and appropriate authorizations for disclosure of information will be obtained. Whenever possible, the presence of non-clinical staff during the telemedicine visit will be avoided.
The telemedicine medical service will not be audio- or video-taped without written informed consent from the patient.
V. INFORMED CONSENT
Informed consent for telemedicine services and medical care will be obtained from the patient prior to the service. The patient will be made aware of the potential risks and consequences, as well as the likely benefits of telemedicine services, and will be given the option of not participating. If patients choose not to participate in care provided by OptiHealthRx, the provider will refer the individual to their primary care provider (PCP) or a specialist for further management.
The content of the consent will be discussed fully, and a note will be documented in the record that this has occurred. The original signed consent will be filed in the patient’s medical record.
VI. REQUIRED DOCUMENTATION
All documentation of medical services will be documented in accordance with applicable standards, guidelines, by-laws, rules, and regulations. Providers will be expected to document in the provided cloud-based EMR. A Progress Note will be completed by the medical provider to document each visit with the patient. The progress note will be completed within 24 hours of the visit. Upon admission to OptiHealthRx, an initial visit will be conducted by the medical provider and documented in the patient’s record. Prescriptions will be documented within the EMR for each patient every time a prescription is issued. Orders for lab work and notation of review of lab work will be documented in the progress notes. When equipment failure prevents adequate diagnosis or treatment, a progress note should be written to document such failure and later transcribed into the EMR.
VII. MEDICAL RECORDS
Medical records will be saved in the cloud-based EMR and are available/accessible for routine care and in emergency situations.
VIII. TRAINING, LICENSURE AND LIABILITY
All staff members involved in the operation of the EMR and provision of the services will demonstrate competency in the system’s operation, including EMR functionality and limitations, as well as the means of safeguarding confidentiality and security. Such training will be provided by OptiHealthRx and courses that are readily available through the EMR.
Background Checks and License Verifications
All medical providers will have a background check performed and license verifications prior to employment and yearly thereafter.
Malpractice Insurance
Medical malpractice insurance in a claims-made or occurrence policy will be furnished by OptiHealthRx. It is recommended that all medical providers hold separate professional occurrence-based policies.
IX. EQUIPMENT FOR VIDEOCONFERENCING
All medical providers will be expected to have a personal computer, laptop, or tablet that is capable of video conferencing and operating the EMR.
X. SPECIFIC OPERATING PROCEDURES AND EXPECTATIONS
Scheduling of appointments for medical services will be predominantly performed online through the cloud-based EMR’s scheduling portal, accessible via the website. Patients will select the medical provider in their respective state based on available open times and create an appointment. If a patient calls requesting an appointment, they will be directed to the online portal to schedule it themselves.
OptiHealthRx’s answering service will be provided by an independent third-party answering service. This answering service will be responsible for answering patients’ basic questions, coordinating scheduling, and referring them to appropriate clinical staff. An RN will be within the call tree, and clinically relevant questions will be answered by the RN and redirected to medical providers if deemed necessary.
XI. PROVIDER RESPONSIBILITIES
The provider will be responsible for answering clinically relevant questions, concerns, or urgent/emergent matters that the on-call RN cannot address. The provider will be responsible for addressing these matters for the patients they provide care to. It will be expected that the matter will be addressed within 2 hours of notification. Providers are responsible for this during the hours of 8AM to 12MN. Providers should anticipate this happening very sparingly, as weight loss services are well tolerated by most patients.
Providers will be required to complete the necessary training, maintain licensure, and adhere to OptiHealthRx’s policies related to liability and malpractice insurance.
Providers will be responsible for following OptiHealthRx's standard operating procedures, which include clinical guidelines, documentation protocols, and patient care standards during telemedicine consultations.
The provider will be responsible for ordering labs through the Rupa Health Care and other lab services portal at the end of the patient encounter. The provider will input the patient’s demographic data into the lab portal and initiate the order. After the order is placed in the Rupa Health/and other Lab services portal, the provider must also input the lab charge into the EMR.
The provider is responsible for reviewing the patient’s lab work prior to the initiation of the follow-up visit. It is the clinical director’s responsibility to address any critical values that the lab will call into OptiHealthRx.
Prescriptions will be called in or eRx by the provider. It is the provider's responsibility to ensure they follow lawful prescribing practices for controlled substances. The provider must coordinate an in-person evaluation prior to prescribing a controlled substance. Prescriptions for controlled substances should not exceed the amounts permitted by law.
During the initial consultation, it is the provider’s responsibility to ensure that informed consent is reviewed, absolute and relative contraindications are assessed, and a complete medical history is performed.
After the initial consultation, lab work will be ordered, and a follow-up visit will be scheduled in 2-4 weeks. During the follow-up visit, the lab work will be reviewed, and a treatment plan will be developed.
It is the provider’s responsibility to stay up to date with current medical practices regarding Weight loss telemedicine services
It is the provider’s responsibility to educate the patient on the importance of establishing, following up, and maintaining care with a primary care provider outside of services provided by OptiHealthRx.
It is at the provider’s discretion to obtain a full physical examination of the patient prior to initiating treatment. An inspection examination will be performed during the initial video visit. A physical examination can be done by the patient's primary care provider or at an urgent care facility and sent to OptiHealthRx.