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  • What is Telehealth?


    Telehealth is a term that refers to any technology-enabled healthcare that allows care to be delivered when the provider and patient are not co-located.

    Asynchronous vs Synchronous Telehealth
         “Asynchronous” Telehealth: the patient and the provider are not talking in real time (e.g., patient portals)
         “Synchronous” Telehealth: interactive audio and video (also known as Telemedicine)

    Other Classification Strategies
         Timing - when a visit occurs 
              Telehealth can be classified by the timing of the telehealth appointment, such as on-demand versus scheduled at a later date. 
         Originating site – the location of the patient at the time of the visit
              If the originating site is in the patient’s home, it is deemed “direct-to-consumer”.
              If one of the individuals is in a medical facility, then it is termed “provider-to-clinical setting”.
              If one provider is consulting with another provider, it is termed “provider-to-provider”.
         Technologies –
              Remote patient monitoring allows for the provision of medical devices to the patient’s home for remote transmission of data such as vital signs.
         Project ECHO 
              Project ECHO is a case-based learning program using videoconferencing and branded out of the University of New Mexico.

    Planning for Telehealth Projects

    Planning of telehealth projects requires a detailed operations approach to ensure efficiency and compliance with regulations. Some of the questions that must be answered include (not an all-inclusive list):

    What is the technology to be used?

    Technology must be HIPAA compliant. However, HIPAA compliance includes having a business associates agreement with the provider of the telecommunications as well as the environment which the patient and provider are in at the time of the visit. This language must be in the consent form.

    Where is the patient going to be at the time of the visit and where is the provider going to be?

    It is important to know this information as the patient may be in their home but may not have access to internet. What plans are in place for patients that do not have access to videoconferencing equipment? In order to ensure equity, we must plan for these contingencies. If the patient is going to be in a clinic, a contractual arrangement must be in place. Furthermore, many facilities have their own IRB’s which will need to review the project in addition to the UAB IRB prior to starting. If the patient is going to present to a clinical facility, what is the staff needed at that facility. Where the provider is going to be at the time of the visit is important as well to ensure HIPAA compliance and access to internet.

    Is the visit going to be recorded?

    Visits done for clinical purposes cannot be recorded unless the patient has a separate consent for this recording. This must be explicit at the onset and in the IRB consent form.

    Is the patient going to have blood drawn or need imaging?

    If labs or imaging is being done, there must be a plan in place for how the outside facility is going to get the order for the provider. How are the images going to get back to UAB for evaluation? UAB has systems in place that can assist with this if needed.

    Will there be billing for the visit?

    In many cases, UAB must distinguish between a visit for clinical services versus a visit for research purposes. In order to do this, there may need to be an encounter generated in our scheduling software and then a dummy code used for billing purposes.

    Where will the documentation take place?

    Depending on the intent of the study, there may need to be documentation within Cerner vs in an external system. If the documentation is done at UAB, is there a need to get the documentation to another site? If so, what is the time frame that the documentation needs to arrive in the external site.

    Will there need to be a call schedule?

    For research being conducted while utilizing telehealth in the inpatient setting, there may be the need to create call schedules for investigators. Additionally, inpatient telehealth typically requires providers to be privileged at each hospital in which they will be operating. Another question for consideration includes ‘Will access to any external electronic medical records be needed?’.

    Will patients be in the state?

    State licensure still applies to telehealth, so it is very important that the practice of medicine (which occurs where the patient is located at the time of the visit) is only done in states in which the provider has a license.

    Telehealth Programs Across the CCTS Partner Network


    The Telehealth Program at the CCTS Hub

    UAB’s Telehealth Program is a comprehensive telehealth program that was branded as UAB eMedicine in 2017. Implementation of telehealth programs requires an in-depth knowledge of telehealth operations, regulations, and technology platforms that can enable the safe provision of medical services to patients that are located remotely from the provider.

    UAB eMedicine started its journey with a telehealth program where patients were located in an originating site that was a medical facility. These programs included both inpatient telehealth with tele-stroke, tele-critical care, tele-nephrology, and tele-infectious diseases. Ambulatory telehealth sites included the Alabama Department of Public Health and ambulatory hubs in external hospital affiliates. During the COVID-19 pandemic, UAB eMedicine was able to rapidly increase telehealth services to patients who were primarily in their homes and delivered over 280,000 telehealth visits.

    Given its successes in telehealth implementation, the UAB eMedicine program is able to assist clinical researchers in the design and implementation of research involving the use of a telemedicine intervention and/or use of telemedicine as a recruitment tool.  UAB eMedicine has a variety of technology platforms that are listed and described in the next tab. The use of telehealth in clinical research must be planned operationally, and regulatory requirements must be followed when technology is used to provide care. The UAB eMedicine team can assist with these planning steps.

  • eMedicine Technology Platforms Available at the CCTS Hub

    Asynchronous Visits

    UAB eMedicine provides asynchronous telehealth through a platform called Zipnosis. Zipnosis is a platform by which patients select their illness type such as upper respiratory infection. After this, they are guided through an FDA-approved clinician support tool where the patient creates his/her own history by means of answering a questionnaire. Once complete, the patient’s data is sent to the provider who then responds based on the computer-collected history. The response is sent to the patient through the platform which enables the patient access through a self-generated account.  Zipnosis, as a vendor, is happy to meet with individuals to discuss customization depending on the needs of the study.

    Texting interventions for asynchronous telehealth are also important. UAB is currently evaluating robust texting platforms and is expected in 2021 to have a texting platform implemented that can be used for both clinical and research purposes.

    The UAB patient portal is also a means by which telehealth can be provided. UAB providers use the patient portal on a routine basis. Research is needed in order to evaluate the effectiveness of the patient portal specifically as it relates to billable encounters.

    eConsults is a type of asynchronous telehealth in which a provider requests a consult from another provider who then reviews the chart and responds.  As such, this telehealth is deemed provider-to-provider. UAB has instituted provider-to-provider eConsults internally at UAB which is accomplished through messaging and ordering within Cerner, the electronic health record (EHR).  Provider-to-provider eConsults external to the UAB Health system is currently being evaluated.

    Ambulatory Synchronous Telehealth

    On-demand synchronous telehealth at UAB is run through a technology platform called AmWell Home.  This product allows for patients to go online and request a provider to respond immediately. When the patient enters his or her request, multiple providers receive a notification and the first provider available responds. Examples of use cases are urgent care and behavioral health. Other applications of on-demand synchronous visits are possible as well and just require start-up fees and planning.

    Scheduled direct-to-consumer visits are currently done at UAB through primarily two platforms, AmWell Hospital and Doximity.  For scheduled visits, one must plan for how these visits are going to be scheduled.  Will they be scheduled only on a research basis, or will they be scheduled using clinical scheduling  (Access Center/IDX). The design of studies using scheduled telehealth visits is important. Efficient workflows such as a hybrid model where providers see both in-person and telehealth visits in the same clinic can be designed using iPads and involve another platform using both AmWell and Cisco Jabber. Clinics for research purposes may use all telehealth visits in a session versus some telehealth and in-person. Depending on the workflow of the researcher to accomplish their goals, workflow must be planned ahead of time.

    Scheduled visits where the patient is in a medical facility can be accomplished using our partnerships in affiliate hospitals such as Whitfield Regional Hospital, North Baldwin Infirmary, Russell Medical Center, and/or Regional Medical Center of Central Alabama. Furthermore, the Alabama Department of Public Health now has 65 of its 67 ambulatory hubs that are able to take patient visits. In this use case, patients are scheduled at an external site and requires the coordination of visits through the eMedicine Coordinating Center, which is a group of individuals dedicated to coordination of ambulatory telehealth.

    Inpatient Synchronous Telehealth

    UAB is currently involved in the provision of telehealth consultations to multiple hospitals. In this high-risk use case, planning and training of external sites is important along with 24/7 monitoring of technology. UAB has implemented AmWell Hospital for this use case which is primarily cart-based, for which UAB uses the AmWell C250 cart. Peripheral devices such as telestethoscopes, tele otoscopes, etc, are available as well. These include the EKO stethoscope and JedMed camera. If image transfer is needed, this must be planned also.

    A full tele-ICU model is also being implemented. Tele-ICU is a more comprehensive telehealth model by which every room in an ICU is outfitted with telehealth equipment as opposed to rolling a cart into each room. Furthermore, remote data can be collected, such as telemetry. Patients are proactively monitored and if intervention is needed, the provider can remote into the room to evaluate the patient. Furthermore, there are eICU nurses. The software used for this is implemented through eCare manager, a Phillips product along with solutions from Advanced ICU. The hardware is provided by Caregility. Research opportunities in this space include the ability to mine data for machine-based learning algorithms to clinical outcomes research.

    Remote Patient Monitoring

    Remote patient monitoring allows for the ability to send patients home with a device and have that data transmitted back to a centralized group of coordinators such that an intervention can be implemented. UAB uses a program called Raziel Health for this activity. Remote patient monitoring requires daily monitoring and as such, costs include a technology provision as well as coordinator time to intervene. Raziel Health is currently fully interfaced with Cerner.  Raziel currently has the ability to monitor glucose, blood pressure, weight, and O2 saturation. Another remote patient monitoring tool in place at UAB is TapCloud.

    Project ECHO

    Project ECHO is a program by which experts at a hub site are able to collaborate and answer questions about de-identified cases with other providers in the community. The primary needs for Project ECHO implementation are that of an ECHO coordinator, a database, and community outreach. UAB has a website for Project ECHO notification to the community, as well as a customizable REDCap database dedicated to ECHO projects.

    Patient Engagement

    Patient engagement tools are varied. These usually allow an asynchronous manner for patients to receive education in a scheduled fashion and interact with staff in order to improve outcomes. Currently, UAB has in place Seamless MD as a patient engagement tool.

    Artificial Intelligence

    UAB continues to evaluate artificial intelligence tools to apply to telehealth strategies. To learn more, contact This email address is being protected from spambots. You need JavaScript enabled to view it..



  • Complete a Telemedicine Submission Worksheet. Here’s why:


    The design of telemedicine-related interventions for the delivery of remote care, technology-assisted healthcare, and for clinical trials can be very complex. The complexities arise from an ever-changing regulatory environment with respect to telehealth billing, cyber security, HIPAA-compliance, and the operations of delivering the intervention. The Telemedicine Submission Worksheet can help connect your project or questions to appropriate resources and guidance. For researchers at the CCTS Hub at UAB, the worksheet can help you avoid unnecessary delays and ensure adherence to sponsor-related timelines and regulatory standards. Please complete the Worksheet below and await a response to establish appropriate planning of your project with a consultation. Ideally, projects will be submitted at the planning stage to enable adequate time to modify a protocol or alter design if needed following the consultation.

    Telemedicine
    Submission
    Worksheet
  • Current Opportunities

    Mental Health

    Diabetes/Obesity

  • Telehealth contact at the CCTS Hub:
    Eric Wallace, MD, FASN
    UAB Medical Director of Telehealth

    General telehealth questions across the CCTS Partner Network:
    This email address is being protected from spambots. You need JavaScript enabled to view it.