As the world continues to adjust to the sweeping social and cultural changes imposed by the pandemic, healthcare professionals have worked hard to find new ways to deliver care in ways that keep both them and their patients safe. Foremost among the emerging trends is the practice of telehealth, which provides a virtual meeting space for therapists and patients, offering opportunities for meaningful interactions despite physical distance.
What is telehealth?
The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.
While the goal is singular — providing exceptional long-distance patient care — the means are varied. Some forms of telehealth may be interactive, where the patient and therapist use real-time video and audio to communicate. Other forms may be asynchronous, involving recorded clips that may be stored and played or streamed later.
Important legal considerations
A few key elements must be in place before a therapist can start offering telehealth options.
First, the legal aspects. PTs/OTs and PTAs/OTAs must ensure that they are adhering to state and federal practice guidelines and payer contract agreements. Practitioners will need to review and understand their state’s practice act regarding the delivery of physical or occupational therapy services via telehealth.
The American Physical Therapy Association (APTA) and American Occupational Therapy Association (AOTA) recommend that physical and occupational therapists use their discretion as to the nature and frequency of using telehealth, and do so within their scope of practice while abiding by any state practice act restrictions, as well as their obligations to their profession.
Important to note: Telehealth provision or use does not alter a covered entity’s obligations under the Health Insurance Portability and Accountability Act (HIPAA), nor does HIPAA contain a section devoted to telehealth.
If any aspect of the telehealth session involves protected health information (PHI), practitioners must meet the same HIPAA requirements they have in place if the service were being provided in-person.
Next to consider are the practical aspects. About a week before the initial telehealth appointment, the therapist should send an email to the patient explaining some of the basics of what to expect for the first visit. At a minimum, this should include:
- An explanation of necessary equipment. The patient will need to have a phone or camera available and be able to place it so the therapist can see the patient clearly throughout the session.
- An expectation for the session. Prepare the patient to answer questions that will allow the therapist to better understand their symptoms.
- An explanation and preparation for a movement evaluation as appropriate for the specific condition.
- Confirmation that the patient has access to the portal to be used in the session.
Learn more about telehealth for PTs and OTs in the CE course, Telehealth for Physical and Occupational Therapy.
Performing an exam
While an objective evaluation can be limited in the telehealth setting, the subjective evaluation can help to fill in the gaps created in the absence of what may be found using a hands-on approach.
Practitioners should ask both qualitative and quantitative questions regarding not only the patient’s physical challenges with pain, strength, and movement, but also external challenges that may hinder positive outcomes.
Even with video and audio providing a real-time connection, there is always the chance of delayed feedback. Make sure to offer the patient plenty of time to respond fully to questions.
Given the virtual setting, completing the objective portion of an exam can be complicated. Clear and concise instructions are key. For example, to evaluate the patient’s feet, they cannot simply point the phone to their feet. The therapist must first instruct them to position their phone or computer so that their body can be seen relative to the feet.
The importance of follow-up
Establishing professional rapport over the internet comes with unique challenges. Frequent follow-up after the telehealth session is key to building that trust and keeping communication channels open.
Scheduling the next session during the current session is a good practice, as are periodic check-ins between sessions to make sure the patient is complying with any assigned home programs. In most cases, a simple email is sufficient for check-ins.
Rules, forms, and regulations
When arranging a telehealth session, staying compliant with state and HIPAA regulations should be a top priority for all practitioners. To be HIPAA-compliant, a video conferencing platform with built-in security is required, as are specific consent forms.
Remember: While most patients are required to sign a general consent form when starting therapy, these forms don’t always include telehealth sessions. Double check all applicable state and national laws and regulations to ensure compliance before starting a telehealth program.
Staying in touch
Keeping patients apprised of what to expect is critical to the success of any telehealth session. Simple, clear instructions and regular communication will help reduce the anxiety patients may feel in trying a new format.
Offering telehealth options gives both practitioners and patients the flexibility to continue care even in an unpredictable and ever-changing healthcare environment.
This article was adapted from the course, Telehealth for Physical and Occupational Therapy, written by Pieter L. de Smidt, PT, DPT.