What is Telehealth?
Telehealth is the use of electronic information and telecommunications technologies to support or promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. Example technologies include:
- video conferencing
- telephonic communication
- store-and-forward imaging
- remote patient monitoring
Other health care professions have an extensive history of utilizing technology in the delivery of their patient care.
- emergency department and intensive care unit triaging and monitoring
- primary care visits
- disease self-management education for patients residing in rural areas
- psychiatric evaluations
- physical/occupational therapy
- home health
Nurses—From registered nurses (RNs) to advanced practice nurse practitioners (NPs), the responsibilities of nurses in telehealth are rapidly expanding. Depending on the method of telecommunication, nurses have the ability to:
- take the patient’s medical history
- perform an exam and assessment (utilizing videoconferencing)
- give the patient advice, reassurance, and education
- refer the patient to the appropriate level of care (scheduling an appointment with provider, arranging transportation to a local emergency department, etc.)
- identify life-threatening situations
- assess for risks
Examples of telenursing programs include:
- certified nurse-midwife telephonic psychotherapy
- mobile teledermoscopy delivered by nurse practitioners
- “TeleCaring,” a telenursing service designed to address needs and concerns of home hospice patients
The Model State Pharmacy Act and Model Rules of the National Association of Boards of Pharmacy defines the “practice of telepharmacy” as “the provision of pharmacist care by registered pharmacies and pharmacists located within U.S. jurisdictions through the use of telecommunications or other technologies to patients or their agents at distances that are located within U.S. jurisdictions.”
“Pharmacist care” in the description above is “the provision by a pharmacist of patient care activities with or without the dispensing of drugs or devices, intended to achieve outcomes related to the cure or prevention of a disease, elimination or reduction of a patient’s symptoms, or arresting or slowing of a disease process.” The Model Rules also include definitions for coordinating pharmacy, remote pharmacy, and remote dispensing site.
Types of telepharmacy services:
- Medication therapy management (MTM)
- Chronic disease management (CCM)
- Transitions of care
- Remote dispensing
- Ambulatory care
References for above figure:
DeWalt D.A., Callahan L.F., Hawk V.H., et al. Health Literacy Universal Precautions Toolkit. Prepared by North Carolina Network Consortium, The Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, under Contract No. HHSA290200710014. AHRQ Publication No. 10-0046-EF. Rockville, MD. Agency for Healthcare Research and Quality. April 2010.
Policy and licensure considerations
When delivering pharmacy services across state lines via technology, pharmacists are required to adhere to the policies and regulations of the state in which the patient is located. Many states require health care providers to hold a license in the state in which the patient resides, which presents a significant barrier to the implementation of many telehealth programs.
However, these laws vary drastically from state to state, so it is strongly recommended to consult with each individual state board of pharmacy before initiating telepharmacy services within that particular state. More information:
- Telehealth Resource Center
- Center for Connected Health Policy - National Telehealth Policy Resource Center
- State Regulation of Telepharmacy
Security and HIPAA concerns
The same HIPAA requirements exist for health care providers whether they are administering patient care in person or via telehealth. Electronic files need to be stored securely and extra precaution needs to be taken to ensure that the both sides of the telehealth consultation (i.e., both the pharmacist’s and the patient’s environments) are private. For example, when using video conferencing, windows should be covered to ensure that a passerby cannot inadvertently view patient records and telephonic consultations should be held in a place that would not allow for unauthorized individuals to overhear the conversation.
All technology utilized is required to be encrypted and HIPAA compliant. It is important to consult with an information technology and/or information security team to perform risk assessments prior to first using a new software.
Medicare in general does not reimburse pharmacists for telehealth at all because pharmacists are not recognized providers. Instead, most models with pharmacists are either part of a bundled payment or grant or contract service.
Disclaimer: Each state has different laws about what and who they reimburse, so that is challenging because every state is different. Please refer to your state board of pharmacy for additional details.
Learn about successful telehealth programs! These resources were created by the Telehealth Committee of the Medication Management SIG. Please note APhA members must login to view the PDFs.