Telerehabilitation or Telemedicine?
- No professional associations 50 years ago
- Power-based relationships – students, clients, consumers
- Asynchronous vs. synchronous? Store-and-forward (dermatology and radiology) use one way communications to help diagnose patients. Interactive video is synchronous because it happens in real time.
- “Follow the money”
- Who had the most control in 2011? Payers, consumers, providers?
- Ossifying technologies? Eg: BLACKBOARD in academia
“Store-and-Forward” Technologies in Telerehabilitation
- Asynchronous sharing for home exercises and physical therapy prevention of falls. Content server contains files, videos such as a home exercise library.
- Poor broadband connection in Australia?
Is your Telerehabilitation Practice HIPAA Compliant?
- Is Voice Over Internet Protocol (VoIP) HIPAA compliant? Is VoIP a Business Associate (BA) under HIPAA?
- If VoIP is a BA then they must meet the HIPAA Privacy Rule requirements. If VoIP (eg: Skype) works for a covered entity then they are a BA.
- Top 10 Risk Assessment: 58 question checklist (is the checklist validated and published?)
- Non-recorded data falls under the Privacy Rule but not the Security Rule. If data is not in electronic format at the time of transmission (eg: a fax piece of paper or a real –time synchronous video chat) the data does not fall under the Security Rule.
- Hackers are ALWAYS thinking about how to gain access to PHI but are hospital administrators ALWAYS thinking about how to protect their data?
Licensure and Reimbursement for TeleRehabilitation
- SLP doesn’t have “practice acts” but have “licensure laws”.
- SLP Assistants not recognized by Medicare.
- Texas has prescriptive (3 pages) in practice act. Some experts state that “…Texas is a leader...” in telerehabilitation
- APTA Definitions and Guidelines recommend a PT be licensed in the state in which they practice telemedicine.
- Some experts surprised that this definition was not provided by the Federation of State Boards of Physical Therapy (FSBPT)
Model Telerehabilitation Program for Rural Areas
- Kentucky pilot telerehabilitation in rural areas
- Community based rate $89/ 1-hr. session
- Telehealth rate $63/ 1-hr. session
Model Telerehabilitation Program for Occupational Therapy
- 30 sessions on telehealth at AOTA 2011.
- Works in the home. Training spouse/family members. Cash-based OT practice in West LA. Lots of DSL and 4G networks.
- Life coaching for cancer survivors – 12 week program.
- Work in industry using video conferencing to assess work stations and make recommendations for adaptive equipment.
- Does not see an issue with offering “wellness” services for Medicare patients and is able to avoid the “opt out” issue for physical therapists in private practice.
- Using mobile and video devices to connect with patient in a direct access model with “store-and-forward” technology that enables therapists and patients to interact asynchronously (at different times).
Your assessment would not be incorrect...
Can anyone help me define and refine this field for physical therapists?