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Host: MetaStar Health IT Radio is a podcast series that features consulting content experts and covers topics regarding the Wisconsin Medicaid EHR Incentive Program Promoting Interoperability, formerly Meaningful Use as well as a Behavior Health Technical Assistance Initiative. Episodes covered will guide your practice, clinic, hospital, or hospital system through the complex federal and state requirements of the PI program.

MetaStar has helped more than 2000 providers attest to promoting interoperability as Wisconsin's regional extension center since 2010 and continues to provide at a station assistance and audit preparation as a consulting service. We are joined by Jonathan Neufeld, the Director of the Great Plains Tele-Health Resource and Assistance Center to share some more information about Tele-Health.

This is MetaStar Health IT Radio. I'm your host Caitlin Whyte. So, Jonathan, what is gpTRAC and how do you work with clients?

Dr. Jonathan Neufeld: We are one of 14 Tele-Health Resource Centers funded by the federal government, in the Department of Health and Human Services. We provide training and assistance to organizations of all kinds, primarily safety net providers, but we work with all across the healthcare spectrum, helping organizations understand and implement and sustain and expand and evaluate Tele-Health programs of all kinds.

Host: Now, like you said, you work with a wide variety of organizations and provider types. What are some of the most important things that you've learned about Tele-Health over the years?

Dr. Jonathan Neufeld: Well, you know, one of the most important things that comes up over and over is that Tele-Health is a lot of different things to a lot of different people. And that is especially true, since the pandemic started, it has been or since before that. But we're recognizing how many different variations and geographic locations and programs and all of that go into Tele-Health. What most people see as Tele-Health is, you know, sitting on your couch at home, talking to your doctor, but there's been a 50-year history of doing this already, 20 years of it having been funded by Medicare. And lots of other designs and lots of other types of programs that have been going on as well. We know that one size doesn't fit all for resources, for answers. We get calls all the time where people will say, is this service funded or reimbursed, or can I do this or this other thing via Tele-Health?

And it depends a lot on the state you're in, the payor you're talking about. I mean, there's lots of different things that go into that. And then the terms and the concepts vary from various programs. There's a lot of sort of terms of art, but there are also marketing terms and programs that have a certain, they're called a certain thing by a certain payor or by a certain health system. And it's just important to recognize those differences so that we don't mistakenly think that we're talking about something when we're actually talking about something else.

Host: Now do you have like a top 10 list of tips and tricks?

Dr. Jonathan Neufeld: You know, the most important things that I, that I tell people, and it's a lot like healthcare generally, and that, and that is that preparation is absolutely essential. You have to develop policies, you have to think about training and have some workflows or some scripts in place. There's just, it's not different, that different, than working in person, but it's different enough that, that it takes some preparation. The second, say thing that I tell people all the time is practice.

You don't, even though you may be a well-seasoned clinician, working by video or working on audio only now that we're doing that, um, does take some time and some planning and, and I mean, it's the same set of skills, but it, it, there's enough difference that, that practice helps. And then the other thing that we're constantly talking about, whether we're talking about experienced providers or young new trainees, is that your professional presence and your professional presentation is different than your private self on, on social media or on video with family or friends or whoever. And it takes, it's worth some effort to try and think about, not that you're going to put on some sort of persona necessarily, but there are professional standards for how you appear and how you interact, uh, there aren't the same as just personal standards that we have and hold ourselves to in casual conversation.

Host: So as the pandemic evolves and hopefully, we see a finish line, and say, you know, providers will still be doing Tele-Health; how do they decide when to use it and when not to?

Dr. Jonathan Neufeld: You know, like I said before, one size doesn't fit all and there are a lot of people that are asking questions like this, you know, what's, what's an ideal, uh, proportion of Tele-Health visits or, you know, how do I decide when to use it and when not to? And I think what we're going to find is that, Tele-Health is good, it's a tool. And just like a craft person, you know, knows when to use a tool and when not to, or when, when is a good time to get the most value out of this type or another type, we're going to realize that Tele-Health has a lot of uses and can be used in a lot of ways. And it's going to vary a lot on setting, case presentation, provider preference, patient preference. Another common tool is an umbrella. Umbrellas are fabulous, but not many people carry them around when it's not raining. And so here we are in a pandemic and everybody's discovering the value of Tele-Health as a tool, but in fact, a little bit unlike an umbrella, it does have a lot of uses when there isn't a pandemic, whether it's severe weather, whether it's people who can't, who have significant difficulties traveling to the clinic or, you know, a variety of other things as well.

So I think what we're going to see, is people getting smarter about how and when to use Tele-Health, rather than there being just one, one way to decide whether or not it's possible.

Host: So tell us more about having a professional presentation.

Dr. Jonathan Neufeld: You know, yeah, this is one of the things that we get asked a lot, or that comes up a lot because it's, as I said before, it's different when you're on video with, you know, your kids who are studying in Europe or away at school or your grandparents or your parents. A professional need just, just like you dress differently, going into the office, then you dress on the weekend. You need to be sure that you're not only dressed and appear like a professional. We're talking mostly about live video. But also that you understand a little bit about the technology. So, that for example, your lighting is bright and balanced. You don't have, you know, windows shining behind you or mirrors behind you or other things on screen that shouldn't be. You want to frame yourself so that your whole personality gets communicated. I'm a Mental Health Practitioner. So I make sure that my hands are on screen because I use them, um, to make various points. I gesture a lot and it helps to build rapport. The camera arrangement can be set up such that you simulate eye contact. It's one of the things that, that puts people off sometimes with Tele-Health. But my doctor wasn't looking at me like he usually does, well, there are ways to arrange your workspace, so that at least it's not obvious that you're not looking at the screen so that it looks a little more like a normal interaction and then various other ways to, to optimize, uh, the workspace so that you appear professionally on screen, just like you do when you walk into the exam room in person.

Host: Jumping off that question, what are some other best practices for people to consider when structuring their Tele-Health encounters?

Dr. Jonathan Neufeld: Well, you know, that, it's a it's a good point. A good question. One of the most important things is just to structure it, to not wing it, to be thinking about structure because we, the whole, the Tele-Health encounter is sort of like you remember, you remember concentrated orange juice. I remember growing up, my mom would buy concentrated orange juice and put in the water. Tele-Health is in a sense constant. Yeah. It's concentrated healthcare you've got, and we, the sessions tend to go, go shorter, go quicker. You're looking at a tiny little screen or a, you know, a small screen versus the 3D world.

And so structuring that is really important. Also it's a new space for a lot of patients often. And so providing intros and outros, whether they're even structured or scripted or stereotyped, like, you know, like confirming a patient's identity. That happens all the time in healthcare, but we think, okay, now that we're connected, I don't have to ask for the patient's name and birthday. Well, maybe we should, as a way of sort of invoking the healthcare encounter. And then at the end saying, you know, do you know what you're going to do now? We often review what we've covered in the session. And, um, so have a structured review, even a scripted sort of review at the end so that the patient knows what, what comes next and what the next step is, and we're going to sign off now, not, you know, so we don't have this awkward hanging on at the end or whatever. Those kinds of structures are just very, very helpful as a best practice. And then as well, there are technical things to, having a backup plan for connections and connectivity and having a pathway for patient technical support, which is a thing that is now discovered that not everybody can click click and join a call. Sometimes patients need help and we have to have a way to do that and provide that.

Host: Well, it's such a new field for some people. I mean, what are some challenges, some things to watch out for and how can providers prepare for those instances?

Dr. Jonathan Neufeld: You know, yeah and providers are in very different spaces. You know, the, the person who's working in a large medical center, is going to have a lot of their decisions made for them with regard to technology and practice versus the private practitioners hanging up a shingle and has to be responsible for all of that, him or herself. Um, I think the biggest things though, that people need to be aware of, are patient technical issues. Like I mentioned before, that there needs to be some sort of pathway or resource. If you find out or realize the patient can't connect, what's plan B? Some clinics or other systems will have a dedicated technical people who can follow up with that.

Some people call the patient ahead of time and make sure that all of that works, but that's one, but the other category is patient safety issues that come up. You can't physically intervene. And you don't want to be, you know, you don't want to end a session and then be writing your notes and say, yeah, the patient started choking. There was nothing that I could do. So I hung up and that was the end of the session. You, you need to have some plan in place. And the idea with physical onsite emergencies is that you turn care over to a suitable onsite person who can manage things, whatever that is. If that's the parent, who's outside the room. If that's a neighbor, if that's local EMS, if it's the police, if it's whatever it is you need to be thinking through, what would I do if you know, the patient started having a panic attack or, or fell out of their chair and hurt themselves. Or these are kind of one in a million conditions and you don't need to necessarily have a complete plan, but a generic plan and recognizing that you need numbers to their emergency police and fire and whatever, not yours, 9-1-1 rings in your neighborhood, not theirs, necessarily. So, so you need to 9-1-1 services don't work the same way. So you need to have that set up ahead of time and know that you have at least a few major steps to take when these types of things arise, like patients calling in, when they're driving in the car, you don't want to have that happen.

So, what do you, do you have a script to go through or, you know, patients who are calling when it's obviously not, not private and really not a good time. How do you, how do you reroute that and say let's reschedule. I mean, those are smaller, smaller kinds of issues that can come up, but yeah. But you need to have a range of sort of tools that you can pull out and say, oh, it looks like we're in this kind of situation. Let's go this direction with the encounter.

Host: So wrapping up here, Jonathan, how can people contact you?

Dr. Jonathan Neufeld: We are accessible on the good old, worldwide web at GPtrac.org and people can also email us gpTRAC. That's G-P-T-R-A-C, GPtrac@umn.edu. We are housed at the University of Minnesota in the Twin Cities Minneapolis, St. Paul.

Host: Thank you Jonathan, for sharing all of this information with us today. It's so important during this pandemic and for more on this topic and to access the resources mentioned, please visit metastar.com/podcast. That's M-E-T-A star.com/podcast. If you enjoyed this episode, you can find more like it in our podcast library and be sure to share it on all your social channels.

This is MetaStar Health IT Radio. I'm your host, Caitlin Whyte. We'll see you next time.