Resources for Telehealth at Safety Net Settings
Delivering healthcare through telehealth within safety net settings may pose barriers not typical in other settings. To rapidly respond to the COVID pandemic where telehealth uptake is high, we have gathered resources here to help support patients who may have limited digital literacy or limited English proficiency in using video visits. This includes examples of workflows and multi-lingual how-to videos.
CVP core faculty Courtney Lyles, PhD and Associate Professor of Obstetrics and Gynecology Malini Nijagal, MD, MPH developed and collated these resources with funding support from the Donaghue Foundation.
- Zoom Visit Instructions
- Videos on How to Download Zoom
English (Android – not iPhone)
The following is a list of resources to help clinicians get started using Zoom for video visits
Considerations for using Remote Visits within Safety Net Healthcare Settings
Limited Digital Literacy
- When working with a patient with limited digital literacy skills (e.g., not currently using apps):
- We have to be aware of each patient’s Internet/data access and what type of device they own and are most comfortable with.
- We don’t want to use up their data plan if it’s their only source of internet access during a time of social isolation.
- Current free and low cost Internet plans available during COVID-19 crisis can be found here: https://www.digitalinclusion.org/free-low-cost-internet-plans/
- Desktop may be possible, but we almost always start with smartphone first, unless the patient tells us otherwise.
- How to find or reset Google account on Android devices
- Video on how to reset Apple ID and password
- Basic Digital Literacy Resources
- Cybercrime Prevention & Online Safety Videos
Limited English Proficiency
- When working with a patient with limited English proficiency
- Follow best practices, such as not taking shortcuts with interpreters
- Tips Document - developed by clinician experts in language access
- To facilitate this, work with interpreter services to determine a video (and phone) visit workflow that is inclusive of interpreters and protects patient from seeing direct interpreter contact information
- Using audio interpreters in video visits
- Video interpreters are preferred if possible, but only audio is better than no interpreter
- Ensure digital literacy efforts (patient education, outreach, or instructions) are inclusive of language needs
- Zoom download videos above may be helpful
- Any standard patient instructions should be made into a system's threshold language
- COVID-19 Fact Sheets in over 30 languages
Sample Clinic Workflows
The following is an example of a high-level, simple workflow and decision tool for clinics to use to convert remote telephone visits to video visits.
- Each health system and clinician is encouraged to adapt the example provided for their own needs. Alterations are often necessary for your clinic environment
- Offering video visits and technology solutions more than once has been shown effective in other work, such as signing patients up for online portal access
- Keep up best practices for privacy during the video or phone visit session
- Confirming unique medical identifiers of the patient at the beginning of the visit
- Ensuring a private space for the conversation, without others present if possible
Center for Care Innovations (CCI) Samples
Telehealth Policies in Response to COVID-19
- Prior to the COVID-19 pandemic, each healthcare system had to have a Business Use Agreement with the video vendor like Zoom to cover medical liability, even if that vendor was HIPAA compliant. However, the current loosening of regulations allows systems to proceed with HIPAA compliant video platforms without the insurance coverage.
- Center for Connected Health Policy’s Summary of State Actions (updated frequently as policies evolve)
Reimbursement for Medicare & Medicaid
Telehealth Coverage Policies (updated frequently as policies evolve)
- CCI’s Practicing Virtual Care During a Pandemic – detailed resources on telehealth through video, phone, texting, patient portals, and remote monitoring
- American Medical Association's Digital Health Implementation Playbook
- UCSF Health's COVID-19 Clinical Resources
Accessible Internally Only
Please let us know if these resources were helpful and if you have any suggestions at this survey: http://tiny.ucsf.edu/telemedsurvey.
Updated 2020-04-24 4:40pm PDT