econsult Introduction & Training Manual
Table of Contents Introduction to econsult.....3 Certification & Requirements....4 Referral & Scheduling Process....5 econsult Appointments......6 Video Equipment....7 Peripheral Equipment.8 Troubleshooting........9-10 Contact Information Cathy Niklason, econsult Service Line & Innovation Manager Catherine.Niklason@avera.org 605.322.6263 (office) 605.929.6565 (cell) econsult website: www.avera.org/ecare/what-we-do/econsult/facility-support/ Technical Support: 1.877.869.3302 2
Introduction to econsult econsult Appointments An econsult appointment allows for patient and provider interaction through interactive video technology. This communication may include videoconferencing, transmission of still images, remote monitoring of vital signs and continuing medical education. Originating site refers to the location of the patient or customer. Specialty site refers to the location of the physician or other medical professional. Confidentiality and Privacy All personnel are required to follow the same rules and regulations for HIPAA and protected health information compliance as in standard health encounters. Personnel at the originating site ensure the patient has signed routine HIPAA paperwork, just as they would for a regular office appointment. All documentation used for the econsult appointment must meet the originating sites medical record policies. The consultation room should promote both visual and sound privacy for the patient. Patient Rights econsult staff will comply with the originating sites policies on patient rights Patient has the right to refuse an appointment via econsult Patient has the right to stop the econsult visit at any time Infection Control Equipment used for econsult will be cleaned according to the referring facilities infection control policies. Equipment Safety The econsult equipment at both the originating and specialty sites will be monitored for quality of service and biomedical equipment standards approved by Avera ecare. Quality of Service and Certification All participating econsult sites will be subject to quality review of processes and documentation through the Avera ecare certification process. Certification is completed initially, and every two years by an econsult staff member. 3
Certification Requirements Environment Exam location needs to be within normal patient area. Equipment Camera must be mounted on a wall or on an econsult approved cart at a height appropriate for interaction. To decrease the potential for glare, the camera/monitor must not face windows. All cords and ports/outlets for the equipment must be connected and labeled with a port number and the word VIDEO. Equipment cords must be bundled and secured. Fax machines should be in a secure location, close to the exam room, and should be non disruptive if located in room. All equipment must pass Avera ecare system check and biomedical certification. Training All Originating and Specialty staff members associated with econsult will go through an interactive training session on equipment use and on the econsult processes. A copy of the training manual should be in close proximity of the econsult unit for quick reference. Telephones should be in close proximity to the room. If the phone is located in the room, the phone must be silenced and not used while the patient is in the room. All equipment must be econsult approved or updated within two years. All standard presets must be set to Avera ecare standards. Equipment must be stored in a secure area, free of traffic, plugged in, and turned on when not in use to allow for updates to the software. Each unit must be rebooted one time per week. 4
Referral and Scheduling Process econsult The following referral and scheduling process meets requirements for econsult certification with Avera ecare: 1. Referral is initiated and sent to originating site scheduler. 2. Originating site scheduler gathers patient information: Patient name Patient date of birth Patient address Reason for referral Specialty provider s name 3. Originating site scheduler ensures specialist is appropriately credentialed and privileged to provide telemedicine patient care. 4. Originating site scheduler contacts specialty site scheduler to request an econsult appointment and shares patient information. 5. Specialty site scheduler determines if econsult appointment is appropriate for patient diagnosis and need. 6. Specialty site scheduler confirms econsult appointment date with originating site scheduler. 7. Originating site scheduler confirms availability of econsult room, support staff and econsult equipment. 8. Specialty site scheduler confirms econsult appointment date with originating site scheduler. 9. Originating site scheduler confirms availability of econsult room, support staff and econsult equipment. 10. Specialty site scheduler and originating site scheduler add econsult appointment to their electronic calendars. 11. Originating site confirms date and time with patient and informs them to arrive 30 minutes before scheduled appointment time. 12. Specialty site scheduler mails patient the specialty provider information packet with instructions to complete and bring to their econsult appointment. 13. Specialty site scheduler schedules a bridge call, if needed. Bridge Calls If you are out of the Avera network please call 1.877.869.3302 to schedule a bridge connection. 5
econsult Appointment The following econsult process for the day of appointment meets requirements for econsult certification with Avera ecare: 1. Patient arrives and registers 30 minutes before scheduled appointment. 2. Originating site registrar verifies patient identity, copies insurance card and collects specialty information packet. 3. Originating site nurse escorts patient to econsult exam room, and reviews econsult process with patient. 4. Originating site nurse completes medication reconciliation. 5. Originating site nurse takes vitals and performs nursing assessment as indicated by reason for visit. 6. Originating site nurse documents on the approved nursing assessment form. 7. Originating site nurse faxes all patient information and nurse assessment form to specialty provider. 8. Originating site nurse prepares patient as indicated for the specific type of econsult appointment (i.e., remove dressings). This applies to both outpatient and inpatient econsult. 9. If patient does not attend appointment, originating site will notify specialty clinic. 10. If specialty provider is late, specialty clinic will notify originating site. econsult Exam Specialty provider initiates the econsult call. Originating site nurse must remain in the econsult room with the patient. Specialist/patient interaction occurs. Specialty provider advises patient of next steps, need for follow-up appointment and other pertinent information. Specialty provider documents impression and writes orders if indicated econsult exam is completed econsult Conclusion Specialty site faxes provider impression and any written orders to originating site soon after the econsult encounter. Specialty provider dictates history and prognosis and sends copy to referring provider. Specialty site and originating sites complete charge tickets for econsult services and send to their individual billing departments. 6
Equipment Video Unit (HDX 8000) Preset Preset 1 is patient/provider Preset 2 is signage Preset 3 or 4 is exam camera and/or otoscope Presets 5-9 are open for site use To Preset Buttons 1.) Press preset button at top of remote 2.) Press number desired and hold down 3.) Screen will note that the preset is stored Figure 1: Video Unit (HDX 8000) Note: Video system and monitor must remain in the ON position when not in use Video unit must be rebooted once a week Blue light is ON Once powering on you will see Polycom logo and hear music (This may take a few minutes) Yellow light is sleep mode -Move remote to return to ON mode No light means power is off 7
Peripheral Equipment TR-1 EF Telephonic Stethoscope (only approved stethoscope) To turn on, plug in power cable to outlet (located on top left of TR-1EF box) Plug in nine-pin cable on the right (located on back side of video unit) To use chest piece, plug in on the bottom left side of TR-1EF box Button labeled D (Diaphragm) top and B (Bell) bottom should always be set to D To adjust volume, use button labeled Volume Figure 2: TR-1 EF Telephonic Stethoscope Figure 3: Horoscope (Otoscope) HD Digital Video Otoscope Figure 4: Sony Handycam 8
Troubleshooting the econsult Equipment (877) 869-3302 No power to the unit Check to see if the unit is plugged into an active electrical outlet Check the power switch to the unit is ON Is there electrical power to the facility? Plug into an emergency power outlet if no regular Cannot place a call (point-to-point) Replace the call when the system becomes ready again. If unsuccessful, try next tip If possible, have the connecting site call you Contact the site with which you are connecting to make sure their system is turned on, if on ask them to reboot their system Try to connect via the extension number located in the paper directory versus using Not connected to a bridge event prior to start time (bridged connections only): Connect to bridged sites 30 minutes in advance of an econsult visit so there is time for testing and a sound check Can hear sound, but no picture: Make sure the television is turned ON Press camera button on remote and verify main camera is selected On the monitor, verify you are viewing the proper mode. It should be Video 1 source Can see picture, but no sound: Ask the connected site to check that the mute button is not on Try turning your volume up and down by using the Volume buttons 9
Troubleshooting the econsult Equipment (877) 869-3302 Cannot hear clearly from the connected site: Have the connected site move the microphone closer to the patient or provider Can hear yourself repeated back to you from connected site: Try turning your volume down from the remote control using the Volume buttons If you still hear yourself repeated back, ask the connecting site to move the power microphone further away from the unit If you still hear yourself repeated back, ask the connecting site to turn the volume down on their unit Call drops during your session: Wait for the Ready indication from the unit and replace the call (point-to-point connection) Page 1 (877) 869-3302 and ask to be reconnected Exam camera does not work: Press Camera button on the remote and verify the exam camera or TV/VCR is selected Check that the exam camera is plugged into a power source and the cords are securely connected Check that the cord from the exam camera is inserted properly into the videoconferencing unit Verify that the power and light switches on the back of the camera are turned to the ON position 10