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This resource provides context, learning opportunities, and implementation resources to support the effort of reimagining how training and technical assistance (TTA) and the operating environment can be strengthened to build a sustainable future for telehealth across the health center community.

Using the Ready-Set-Go approach, you can:

  1. Ready: Gain a background understanding of the changing telehealth landscape.
  2. Set: Learn about the telehealth priority areas through a series of microlearning videos.
  3. Go: Access telehealth resources and tools in the Clearinghouse to adopt or adapt to meet the needs of your health center.

READY: Introduction to Telehealth

Telehealth – the use of technology to provide and coordinate health care at a distance – is an increasingly critical component in the delivery of health services. Using technology to provide healthcare remotely is seen as a major strategy to address the continuous increase in the demand for care. 

The FQHC Telehealth TTA Partners Roundtable has identified eight telehealth priority areas to provide easier access to targeted resources with the goal of accelerating telehealth expansion. For more information about the FQHC Telehealth TTA Partners Roundtable, access the Summary Report: Health Centers Telehealth TTA Partners Roundtable Forum.

Goals of the Telehealth Priority Areas:

  • Resources, findings, and recommendations for telehealth expansion are easier to navigate for TTA providers, policy makers, funders, and others.
  • Resources are targeted towards patients community health centers, and TTA providers.
  • Resources are reflective of different phases of telehealth: start-up, enhancement, and sustainability.

Read More About the State of Telehealth

The COVID-19 pandemic pushed Community Health Centers (CHCs) to accelerate the adoption of telehealth as part of an evolution to provide greater access and quality care for all. “Despite the acknowledged benefits of telehealth, even prior to the pandemic, there were significant barriers to its widespread adoption. When the pandemic hit in March 2020, the stakeholder cost-benefit equation changed overnight.”1

“Within weeks, past misconceptions and concerns were set aside to meet emergency needs of patients “locked down” and unable to access healthcare providers in traditional physical settings. CHC early adopters, telehealth resource centers (TRCs), and a range of primary care associations (PCAs), health center-controlled networks (HCCNs), and national training and technical assistance partners (NTTAPs) began developing and disseminating materials and services to aid the rapid transition to virtual care. Despite a variety of unknowns, the safety net community galvanized around this crisis, and stakeholders of all types, including funders, stepped up to support the telehealth effort.”2

To respond to the need to lay the foundation for a new focus on telehealth, the National Association of Community Health Centers and the National Consortium of Telehealth Resource Centers conducted the National Federally Qualified Health Center (FQHC) Telehealth TTA Partners Roundtable Forum (2020-2021). This resource responds to a number of the roundtable recommendations.

Summary developed by the NorthEast Telehealth Resource Center (2020).

Additional Resources to Get You Started:

  • Telehealth Hub (HRSA). As part of their training and TA resources, HRSA has identified five key collections of telehealth resources.
  • Telehealth Resource Library (HITEQ). A collection of actionable telehealth resources in the areas of telehealth technology, patient use of telehealth, provider use of telehealth, tele-behavioral health, and operationalizing telehealth more generally.
  • Telehealth Etiquette Video Series (South Central Telehealth Resource Center). Short videos from 1-20 minutes that highlight case studies to ensure a positive experience for both patient and professional.
  • FQHC Telehealth Resources (Telehealth Resource Centers). Resources specific to Federally Qualified Health Centers (FQHCs). Example resources include a Critical Access Hospital Telehealth Guide and a webinar on Telehealth Essentials for FQHCs.

SET: Learn Based on Telehealth Priority Areas

1. The Digital Divide: Access, broadband, equity.

This includes issues of access, broadband, and equity. The “digital divide” is the gap between individuals, households, businesses and geographic areas at different socio-economic levels with regard to their opportunities to access information and communication technologies, their digital literacy, and their ability to use the Internet for a wide variety of activities. While TTA can address some aspects of the digital divide, there are significant limitations regarding what can be accomplished without universal broadband access.3

Expanding Telehealth Access, a discussion with Finger Lakes Community Health CEO Mary Zelazny

This microlearning video is taken from Telehealth Office Hours: Access and Telehealth (National Association of Community Health Centers, 2021). You can access the full video through this link.

Access resources from the Clearinghouse that focus on this priority topic area.

2. Implementation & Operations: Workflows, procedures, platforms.

This includes health center workflows, procedures, and platforms. Workflows are those steps, often dependent on and performed by a variety of staff members, to accomplish a particular task; they are the step to actually get work done, not the protocols that have been established to do the work.4 Procedures ensure that workflows align with the health center and stakeholder values and priorities, while having a plan for impact and relying on the appropriate technical platform in use by the health center.5

Understanding the Human Factors of Telehealth Integration, with Elizabeth A. Krupinski, Director of the Southwest Telehealth Resource Center.

This microlearning video is taken from Telehealth Office Hours: Navigating the Current Telehealth Landscape (National Association of Community Health Centers, 2021). You can access the full video through this link.

Access resources from the Clearinghouse that focus on this priority topic area.

3. Quality Assurance: Measurement, data collection, improvement.

This includes measurement, data collection, and improvement. These efforts focus on providing confidence that quality requirements are fulfilled. The confidence that results from quality assurance focuses on (1) internal confidence to management and (2) external confidence to customers, government agencies, regulators, certifiers, and third parties.6

Colleen Lampron, a dental consultant for the National Network for Oral Health Access, discusses quality assurance in the context of teledentistry.

This microlearning video is taken from June 2021 Telehealth Office Hour (National Association of Community Health Centers, 2021). You can access the full video through this link.

Access resources from the Clearinghouse that focus on this priority topic area.

4. Data and Reporting: Definitions, taxonomy, EHR alignment, reporting systems/processes.

This includes definitions, taxonomy, EHR alignment, and reporting systems/processes. The Clearinghouse monitors keywords related to telehealth and codes resources with the appropriate taxonomy, aligned with these eight telehealth priority areas. Documentation of telehealth services through electronic health records to avoid fragmentation/lack of coordination and promote data sharing/reporting has been the subject among state and national leaders.7

Christian Milaster, founder and president of Ingenium Digital Health Advisors, discusses data reporting and quality measures in telehealth.

This microlearning video is taken from Measuring Telehealth Success: You Can't Achieve it if You Can't Measure It (HITEQ, 2021). You can access the full video through this link.

Access resources from the Clearinghouse that focus on this priority topic area.

5. Policy, Financial Reimbursement and Legal: Advocacy efforts, regulatory surveillance

This includes advocacy efforts, regulatory strategies, and surveillance. The federal government has taken steps to make providing and receiving care through telehealth easier. Issues such as HIPAA flexibility for telehealth technology, Medicare and Medicaid policies, telehealth licensing requirements and interstate compacts, prescribing controlled substances, and information on telehealth updates in the American Rescue Plan Act of 2021 are provided in the HHS Telehealth Policy Page.8

Mei Wa Kwong, executive director of the Center for Connected Health Policy, provides telehealth policy updates as of September, 2021 and takes a look at upcoming policy changes.

This microlearning video is taken from Telehealth Office Hours (9/9/21): Navigating the Current Telehealth Landscape (NACHC, 2021). You can access the full video through this link.

Access resources from the Clearinghouse that focus on this priority topic area.

6. Patient Engagement: Patient education, navigation, outreach, technical support.

This includes patient education, navigation, outreach, and technical support. Recent research has shown effective strategies to engage patients in telehealth include responding to patient feedback, developing patient-reported outcome measures, public reporting of performance data, and providing communications training for health professionals.9

Telehealth Etiquette and Patient Engagement

This microlearning video is taken from Telehealth Office Hours: Telehealth Etiquette (NACHC, 2021). You can access the full video through this link.

Access resources from the Clearinghouse that focus on this priority topic area.

7. Clinical Delivery: Clinician-focused services, CME/CEU, clinical skills, competencies.

This included clinician-focused services, provision of CME/CEU, and clinical skills/competencies. The American Telehealth Association provides clinical practice guidelines that form the basis for uniform, quality patient care and safety, grounded in empirical research and clinical experience.10

Amanda Laramie and Adrienne Mann of Coleman Associates discuss how scheduling can help optimize telehealth workflows.

This microlearning video is taken from Telehealth Office Hours: Optimizing Telehealth Workflows (NACHC, 2021). You can access the full video through this link.

Access resources from the Clearinghouse that focus on this priority topic area.

8. Financial Models: Service and payer mixes, reimbursement implications.

This includes balancing service/payer mixes and reimbursement implications. Expert opinion from 22 leaders in the field suggest development of a telehealth business framework, which includes created value, key resources, key activities, key partners, licenses and permissions, product pricing, revenue, marketing, supporting services, and getting feedback from customers.11

Christian Milaster, founder and president of Ingenium Digital Health Advisors, discusses how reimbursement and billing fit into the hierarchy of critical telehealth success metrics.

This microlearning video is taken from Measuring Telehealth Success: You Can't Achieve it if You Can't Measure It (HITEQ, 2021). You can access the full video through this link.

Access resources from the Clearinghouse that focus on this priority topic area.

GO: Access Telehealth Resources

Click on the links below to access telehealth resources from the Clearinghouse aligned with the Telehealth Priority Areas. You can also submit telehealth resources to be included in the collection. These resources have been vetted based on the Clearinghouse Quality Standards.

Need more information after using this page? We have additional resources for you:


References:

1-3 National Association of Community Health Centers. Summary Report: Health Centers Telehealth TTA Partners Roundtable Forum. (2021).

4 Agency for Healthcare Research and Quality. Primary Care Practice Facilitation Curriculum. Module 10: Mapping and Redesigning Workflow. 2015.

5 AHA Community Health Improvement. Community Health Assessment Toolkit. Step 7: Plan Implementation Strategies. 2016.

6 ASQ. Quality Assurance and Quality Control. 2020.

7 National Academy for State Health Policy. Aligning Health Information Technology and System Transformation Efforts: Themes from a Discussion among State and National Leaders. 2012.

8 Department of Health and Human Services. Policy Changes During COVID-19. 2022.

9 Coulter A. “Patient Engagement – What Works?J Ambulatory Care Management. 35(2). Pp. 80-89. 2012.

10 Great Plains Telehealth Resource and Assistance Center and Telligen Health Information Technology Extension Center. Telehealth Start-Up and Resource Guide. Version 1.1. 2014.

11 Velayati F et al. “Key Components and Critical Factors for Developing a Telehealth Business Framework: A Qualitative Study.” BMC Medical Informatics and Decision Making. 21(339). 2021.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $6,625,000 with 0 percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.