Thank you for sharing this article, which has a tremendous amount of relevant and interesting information as it applies to telehealth, especially among the OT community. I especially took an interest in the various situations and settings in which telehealth has been studied. I appreciate the breakdown of the different steps of a successful telehealth treatment, including tele-evaluation, tele-intervention, tele-consultation, and telemonitoring. It was also very beneficial to see the outline of many different assessments that can potentially be used successfully in a telehealth form of service delivery. I saw that you expressed some frustration as it applies to the lack of specific pediatric assessments being mentioned, and as an aspiring pediatric OTA I share this frustration as well. According to this week’s article, “In the area of pediatrics, teleconsultation has been used to treat children with complex pediatric feeding disorders (Clawson et al.,2008), facilitate coordination and motor control in children with cerebral palsy (Reifenberg et al., 2017),
support school-based services for children with complex medical needs (Cormack et al., 2016), and provide occupation-based coaching for caregivers of young children with autism (Little, Pope, Wallisch, & Dunn, 2018).” I thought this particular part of the article was relevant to mention, as it gives some pediatric examples of potential reasons for telehealth treatment.
Hey @carrie1, now I’m looking at the APTA guidance on e-visits, and I’m still not fully certain how to answer your question. I have to think that more guidance will come out about this… I just haven’t found it yet. I am linking below to what the AOTA, APTA, and ASHA have put out for guidance. (I’m always impressed by ASHA’s content.)
(Related: I would LOVE to feature a documentation example of anyone who has successfully done e-vists, so if anyone has a connection with someone who might be willing to share one, please let me know!)
Thank you for sharing this article at a time where it is so so relevant to what is currently going on across the world. I appreciated your feedback on the article, especially your first point to which the COVID-19 is speeding up the process of telehealth inevitably being implemented in the field of occupational therapy. At first, I was skeptical of telehealth and how effective it could actually be in our field given how hands-on OT really is. One study was done that looked to find caregivers perception of a wellness program delivered via telehealth compared to the normal wellness programs that were offered over the phone or through presentation. The conclusion section of this article emphasized just how much caregivers appreciated the telehealth format because it emphasized the importance of relationship building compared to that of other programs (Serwe, Hersch, Pickens, and Pancheri, 2017). Building relationships is one of the major foundations of occupational therapy, and telehealth offers the ability to build those relationships with individuals in situations, such as the current one we are all facing. However, I think it is important to remember that telehealth is no different than any other intervention we may implement in that not all cases will benefit from this format. It is a case-by-case implementation. I think as time goes on, telehealth is going to progressively become a more and more normal means of implementing treatments, so it is important for us, as practitioners, to continue to educate ourselves on its effectiveness and ensure we are maintaining quality care through this media.
Respectfully,
Rachel A. Bush, OTAS
Serwe, K. M., Hersch, G. I., Pickens, N. D., & Pancher, K. (2017). Brief report- Caregiver perceptions of a telehealth wellness program. *American Journal of Occupational Therapy, 71,*1-5. doi: 10.5014.ajot.2017.025619
Sarah,
I enjoyed reading the information you provided about telehealth and the current predicament we are facing. With the rapid spread of the COVID-19 virus, more and more healthcare practices are looking toward telehealth especially for the elderly and immunocompromised individuals. Telehealth has this special aspect to it that achieves what is known as the TripleAim. The TripleAim according to author Jana Cason, is a term used that focuses on achieving three goals. These goals include “(1) improving the individual experience of care, (2) improving the health of populations, and (3) reducing the per capita costs of care for populations” (Cason, 2015, p. 1). In other words, telehealth has the potential to be a very valuable resource that is not only effective in healthcare delivery but also accessible to a wide population especially in rural areas while being cost-efficient. As occupational therapy practitioners, we have the opportunity to expand our profession working through a telehealth platform. In times like now, demand for this area is higher than ever in my opinion.
Respectfully,
Megan Higgins, OTAS
Reference
Cason, J. (2015) Telehealth and occupational therapy: Integral to the triple aim of health care reform. The American Journal of Occupational Therapy. 69 (2) 1-8 doi: 10.5014/ajot.2015.6920003
Ooooooh @rachel5, I can so agree with this especially the part about RELATIONSHIP. I have learned A LOT this week, including about good ole telephone calls. I had started using them more in the last month, and especially the last week. I immediately noticed a “next level” of rapport being built. (I will note, because I think it’s valuable for context that I also have experience with coaching which I think helped me develop strong questions and topics HOWEVER this also led to another lesson/layer of complexity.)
Due to wanting to more clear within my own company (a large adult home health company) about the differences between “teletriage phone call check-ins” vs “telehealth.” I asked for clarification yesterday. Thankfully, I got a quick and clear response.
What I learned is that, despite me thinking it to be very valuable and possible to USE the phone to ask motiviational interviewing questions and problem solve forward in the OT plan of care, the main currently supported use of the phone calls via CMS (which then dictates how my company pays ME and therefore prefers I spend my time) is JUST for check-ins (i.e. symptom management). I will say that doing this, symptom management, is also HUGE.
It was helpful and humbling to learn that despite my readiness to PROVIDE more over those phone calls (which I was under the impression earlier in my company due to other conversations that had been had on our team) that we COULD venture into this. I now stand corrected.
And YES, I also appreciated the reminder that it will NOT be appropriate for everyone. This has been interesting as I’ve advocated for it and get pushback. It’s about continued development and use of our critical and clinical thinking skills. Will I use it in a case that involves advanced dementia and no caregiver? Nope. Would I jump on it for the hip fracture, no cog impairment who is also newly diabetic? YUP.
And lastly, thank you to you all and especially to those on the front line, be it in research or in patient care. May we be safe, kind and keep exploring.
What assessment are you/is anyone MOST excited to try using for their setting?
Sarah,
I really enjoyed reading your summary of this article and the different areas that you broke down. I also mentioned in my article about the impact that COVID-19 is having on telehealth and I like the way you put it by it speeding up the inevitable. In an article that I found discussed the feasibility of telehealth for patients with dementia. It is great that telehealth is available to people and even more so because of our current situation. Great post!
Respectfully,
Alexandria Bope, OTAS
Gately, M. E., Trudeau, S. A., & Moo, L. R. (2020). Feasibility of Telehealth-Delivered Home Safety Evaluations for Caregivers of Clients With Dementia. OTJR: Occupation, Participation & Health, 40(1), 42–49. https://doi-org.elibrary.huntington.edu/10.1177/1539449219859935
Hi Sarah and Stephanie,
I have a child development centre in Dubai in the UAE and Im looking for research articles on the efffectiveness of Telehealth for children
We primarily use Sensory Integration Therapy. Good to chat to you ladies and know that we are all looking for more information on how to proceed.
Thanks for the fantastic post. Thoroughly enjoyed reading it. As stated in the article, occupational therapy is many times not covered under insurance for telehealth visits. An estimated of 90 million dollars can be saved annually just in the ER setting when telehealth is utilized (Manocchia, 2020). If insurance would cover telehealth occupational services, patients could save money in this same way. Do you think that occupational therapy not having direct access affects insurance covering telehealth? What can occupational therapists do to ensure telehealth is covered under most insurance companies?
Respectfully,
Elise Cormany, OTAS
Manocchia, Augustine. (2020). Telehealth: Enhancing Care through Technology. Rhode Island Medical Journal , 103 (1), 18–20.
Thank you for this in-depth and insightful post. I like how in your takeaways you mentioned how due to COVID-19, telehealth is becoming more of a hot topic and is predicted to become a major component of therapy delivery. In my summary I mentioned how advocating this emerging practice model and educating people on it is something to consider in times like now, when people are not able to leave their house and doing so could risk them becoming infected with the virus. A recent article conducted a study and the conclusion revealed that “it is feasible to provide telehealth occupational therapy home modification services using a smartphone, tablet, or computer to improve home safety and perception of performance” (Renda, 2018). Through the education of technology to individuals, telehealth can be very beneficial for some who are in need of occupational therapy services.
Respectfully,
Jade N. Clement, OTAS
Reference:
Renda, M. (2018). Feasibility and effectiveness of telehealth home modification interventions to improve safety and perception pf performance. The American Journal of Occupational Therapy, 72, https://doi.org/10.5014/ajot.2018.72S1-PO8030
This listing of new changes (seems to change daily) regarding telemedicine and OT coverage is also posted (I will post it but may be easier to read on AOTA webpage: Here Telehealth Updates
Several Medicaid departments have extended telehealth coverage for occupational therapy services, including Alabama , Arkansas, Idaho, Missouri, Nebraska, Oklahoma, South Dakota, Vermont, Washington, and West Virginia.
Governors in Arizona and Utah have issued Executive Orders requiring health plans to provide coverage for health care services provided through telehealth.
Several private plans, such as Blue Cross Blue Shield Alabama , Blue Cross Blue Shield and Health Advantage of Arkansas, Blue Cross Blue Shield of Minnesota, Blue Cross Blue Shield of Nebraska, and Blue Cross Blue Shield of New Mexico have recently specified that telehealth services can be provided.
State Insurance Departments in Maine,Mississippi, and North Dakota encouraged insurers to increase access to telehealth.
The New Mexico Board of Examiners for Occupational Therapy issued guidance for occupational therapy practitioners to utilize telehealth.
State legislatures are also working on legislation related to telehealth and COVID-19– Washington passed legislation that requires telemedicine claims to be reimbursed at the same level as care delivered face to face and prohibits denial of telemedicine claims by insurers.
Now is a great time for writing and advocating for this to become a reality!.
@Sheena not sure if you have seen this recently published article or not but I would think it could be a great resource.
Cole, B., Pickard, K., & Stredler-Brown, A. (2019). Report on the Use of Telehealth in Early Intervention in Colorado: Strengths and Challenges with Telehealth as a Service Delivery Method. International journal of telerehabilitation , 11 (1), 33–40. https://doi.org/10.5195/ijt.2019.6273
Wow! Cynthia, this is all so helpful, I had not seen this update from AOTA yet! Thank you so much for passing it along! I work on adding it our ongoing list of telehealth advocacy opportunities and wins…
I agree that reaching out to decision makers does seem to be working!
I enjoyed reading your thorough summary and takeaways. One part that stood out to me was the ethical considerations you mentioned. While there are numerous benefits of telehealth, there are certain precautions to take when moving in this direction. A few areas mentioned by AOTA include:
Client comfort and competence
Privacy and confidentiality
Quality care
When mentioning client comfort and competence, issues such as privacy arise for clients who are unfamiliar with the technology and needed assistance from other family members. In addition, using telehealth to work on ADLs such as toileting or showering that could be uncomfortable to clients. In addition, AOTA mentioned, “sensory loss due to normal aging…or cognitive, motor, language, or vocal impairments can impede client’s ability to operate technology or benefit from services delivered from a distance” (ethics advisory: telehealth, para. 2). This shows that telehealth is not for all clients, and clinical reasoning should still be used when deciding on whether telehealth should be implemented. As for privacy and confidentiality, HIPAA laws still apply, so practitioners would need to be extra careful to protect client’s health information. Quality care was also mentioned as an ethical consideration due to the lack of research available as to whether telehealth provides reliable assessments. Sarah, I liked how you mentioned that while we always want more research, we rarely find all the answers. As telehealth becomes more popular, I’m sure these ethical considerations will be discussed further.
Thank you, I’m actually really enjoying school. It’s tailored to my professional interest so it’s way more captivating than grad school was!
What is the best way to send you the articles? I’ll get them to you today.
