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This article says that 200 hospitals used Alexa during COVID. It helped staff keep a safe distance but allowed improved communication!!!

Not sure how Alexa can abide by the HIPPA laws, but if it could.. IMAGINE!?!?

I love Alexa in my home. Having an Alexa in patient rooms COULD have some benefits..

what do you think about this????

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Alexa, What Is Your Future in Health Care? | AHA

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Amazon has a huge desire to disrupt health care, and one of its most powerful weapons in this effort is an unassuming device that has gained unrivaled access to consumers. The Echo smart speaker platform and Alexa artificial intelligence-powered virtual assistant now reside in more than 50 million U…

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What is Health informatics?
- Data collection, storage, retrieval, and analysis of information.

The Digital Age
- Electronic health records allow better information sharing
- Quality measure abilities, pulling the data collecting in EHRs
-Streamlining care which reduces costs and duplication of patient testing

Goal/Impact of Informatics
-Patient safety and outcomes
-Evidence based practice
-Cost reduction (Medicare and Medicaid use information gathered to reduce costs for patients and hold providers accountable for what they order and why)

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CMS in cost reduction and clinician burden

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CMS in cost reduction and clinician burden

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Today, the Centers for Medicare & Medicaid Services (CMS) is announcing the creation of the Office of Burden Reduction and Health Informatics to unify the agency's efforts to reduce regulatory and administrative burden and to further the goal of putting patients first. The new office is an outgrowth of the agency's Patients over Paperwork (PoP) Initiative, which is the cornerstone of CMS's ongoing efforts to implement President Trump's 2017 executive order to "Cut the Red Tape" and eliminate duplicative, unnecessary, and excessively costly requirements and regulations. This announcement permanently embeds a culture of burden reduction across all platforms of CMS agency operations.

Removed unnecessary, obsolete, or excessively burdensome conditions of participation for hospitals and other healthcare providers saving an estimated 4.4 million hours of time previously spent on paperwork with an overall total projected savings to providers of $800 million annually.

Removed 235 data elements from 33 items on the Outcomes and Assessment Information Set (OASIS) assessment instrument for home health.

Established within the Quality Payment Program (QPP), a consolidated data submission experience for the different performance categories of the Merit-based Incentive Payment System (MIPS) so that clinicians no longer need to submit data in multiple systems.

Eliminated 79 measures, through modernizing proposals to advance our Meaningful Measures Initiative, resulting in projected savings of $128 million and an anticipated reduction of 3.3 million burden hours through 2020.

Implemented changes resulting in faster processing of state requests to make program or benefit changes to their respective Medicaid programs through the state plan amendment (SPA) and section 1915 waiver review process.

Today's announcement continues CMS's burden reduction efforts from both before and during the COVID-19 pandemic. When President Trump declared a national coronavirus emergency on March 13, 2020, CMS took action nationwide to aggressively respond to COVID-19. In March, CMS announced unprecedented relief for the clinicians, providers, and facilities participating in Medicare quality reporting programs, including the 1.2 million clinicians in the Quality Payment Program who are on the front lines of America's fight against COVID-19, by granting them exceptions to reporting requirements and extensions for reporting measures and data.

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS and @CMSgov

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CMS Unveils Major Organizational Change to Reduce Provider and Clinician Burden and Improve Patient Outcomes | CMS

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Today, the Centers for Medicare & Medicaid Services (CMS) is announcing the creation of the Office of Burden Reduction and Health Informatics to unify the agency's efforts to reduce regulatory and administrative burden and to further the goal of putting patients first.

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Competencies for Health Informatics
- Adequate knowledge, skills and abilities to perform specific informatics tasks.
- Having basic computer knowledge in healthcare is essential
TIGER Initiative
- a shared vision, strategies, and specific actions for improving nursing practice, education, and patient-care delivery through the use of health information technology

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Abstract

Background: To manage the high volume of generated data and enhance the quality of nursing care in the healthcare system, nurses need informatics competencies including 1) basic computer skills, 2) informatics knowledge and 3) informatics skills.

Objective: The aim of this study was to evaluate the informatics competencies of nurses working in hospitals.

Methods: The present study was conducted in 2018 on 200 nurses working in hospitals. The tool used to collect data was the localized Staggers standard questionnaire.

Results: The results of this study showed that 60.6% of nurses have few capabilities regarding informatics competencies. Also, practicing nurses were more able in the area of informatics knowledge rather than the other two areas of basic computer skills and informatics skills.

Conclusion: Informatics competencies of practicing nurses were not at an adequate level which requires the attention of universities and colleges and educational planning in this field.

Introduction

Today, information technology is a critical part of our health care industry and requires healthcare providers to have basic computer knowledge, as well as informatics competencies, to manage and use technology to deliver care (Pordeli, 2017). In early 2000, the American Institute of Medicine (IOM) suggested that hospitals use electronic solutions to improve the quality of care provided to hospitalized patients (Baker, 2001). Previous studies on the consequences of the use of health information technology suggested that countless positive effects on healthcare system had been realized (Buntin et al., 2011). The use of technology and computer systems can facilitate nursing care and support educational resources for nursing studies (Darvish et al., 2014; Rouleau et al., 2017). In addition, the use of information technology in the workplace enables nurses to spend less time documenting patient care and spend more time delivering quality care to patients (Kelley et al., 2011; Chaudhry et al., 2006). In general, the benefits of using information and communication technology in nursing include improved patient safety and improved efficiency of nursing professionals (Rouleau et al., 2017).

Due to extensive integration of health information technology in healthcare, competencies and capabilities in information and communication technology are essential for nursing professionals as healthcare providers (Honey, 2017; Nagle, 2013). In the study conducted by Yang et al. (2014), it was found that nursing managers' informatics competencies were at a medium level (77.6). Choi and De Martinis (2013) showed that nursing students had the required capabilities in the field of informatics.

Nursing informatics competencies can be defined as adequate knowledge, skills and abilities to perform specific informatics tasks (Hunter et al., 2013). Informatics competencies include three features: basic computer skills, informatics knowledge and informatics skills. Basic computer skills refer to the knowledge and ability to use a computer and related technologies (Goldhammer et al., 2013). Informatics knowledge refers to the knowledge to use computer technologies to deploy information sciences. In addition, informatics skills can be defined as the skills to implement instructions, tools and specific methods in informatics (Staggers et al., 2002).

Since the appearance of computer and information technologies in healthcare, the assessment of nursing informatics competencies has become a favorite subject for researchers (Darvish et al., 2014). To meet these increasing needs, a scale for self-assessment of nursing informatics competencies was developed to evaluate informatics competencies in nursing students and practicing nurses. Generally, an instrument's validity and reliability scores depend on the characteristics and specifications of the sample under investigation. The Staggers list of valid competencies is a standardized instrument. However, it has been developed and tested more in communities with a high level of computer knowledge and skills (Sunmoo and Po-Yin, 2009); therefore, this scale must be evaluated in a variety of societies based on development and growth patterns of informatics competencies and according to different backgrounds and cultural contexts (Chang et al., 2011). This study aimed to assess nursing informatics competencies within healthcare organizations.

Methods

This cross-sectional study was conducted in 2018. Data were collected using the researcher- developedquestionnaire. A review of previous studies and evaluation of existing tools and scientific resources associated with nursing informatics competencies was done initially. Based on the study done by Staggers et al. (2001), primary items were extracted with 74 points regarding competencies in three areas including basic computer skills, informatics knowledge and informatics skills. Next, the questionnaire was reviewed by eight nursing experts holding a master's degree or faculty members with at least five years of work experience with hospital information systems and by four information technology professionals holding a bachelor's degree and a minimum of five years of work experience with hospital information systems. Experts assessed the importance of each point using a 5-point Likert scale ranging from "strongly disagree" to "strongly agree."

Questionnaire validity was assessed by experts using a content validity index (CVI) and content validity ratio (CVR) (Farzandipour et al, 2017). The test-retest method was used to assess questionnaire validity and to ensure reproducibility. For this purpose, a validated version of the questionnaire was given to 20 nurses. After a period of two weeks, the participating nurses were asked to fill out the questionnaire again. Cronbach's alpha was used to assess data reliability. Data reliability was calculated as 0.97. A sample of 200 individuals participated in the study. Simple, random sampling was done using a list of nurses with a bachelor's degree or higher and three years of work experience in educational and medical hospitals. Questionnaires distributed among the nurses were composed of two parts: the first part included demographic characteristics including age, sex, marital status, employment, education, work experience, familiarity with computers, frequency of using computers, and interactions with the hospital information system (HIS); the second part included questions related to informatics competencies subscales in a scale of 48 questions. Questionnaire items were rated using a 4-point Likert scale ranging from "completely" to "very low." Data analysis was performed using SPSS software version 20 including descriptive and analytical statistics.

Ethical Considerations

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed and approved by the Ethics Committee of the Institutional Review Board.

Results

Out of 200 questionnaires distributed among nurses, 197 were returned with 98.5% of items answered. Regarding occupational status, the majority of participants (77%) were ward nurses and 11.5 % were directors of nursing. Also, 11.5% were matrons and supervisors. The majority were females (75.5%), 68.5% of whom were married.

The majority of participants (96%) held a bachelor's degree. In terms of years of service, the majority (56.3%) had three to 11 years of work experience. Also, according to respondents' views, 66.5% had relatively good familiarity with computers. In terms of frequency of using computers, the vast majority (59%) used computers more than once a day. In addition, regarding interaction with HIS, the majority (59%) spent less than an hour per shift interacting with the system.

As evident in Table 1 showing the combined scores for questions related to basic computer skills, informatics knowledge and informatics skills, 39.2% of respondents indicated having a high level of knowledge and competence. In the area of informatics skills, 37.4% of respondents reported a high level of competence; this score was lower than that of those who reported high competence in basic computer skills (39.6%) or the percentage of those who reported high competence in informatics knowledge (41%).

Table 1: Distribution of nurses' comments on informatics competencies (number of responses, total %)

Most participants aged 40 and higher had lower computer familiarity skills (P<0.02). Thus, a significant relationship was observed between age and familiarity with computers and basic computer skills (Table 2).

Table 2: Distribution of nurses' comments on the potential in the area of basic computer skills (number of responses, total %)

With regard to informatics knowledge, there was a significant relationship between marriage, familiarity with computers and interaction with the HIS, and nursing informatics knowledge (P<0.02). To be more specific, most single individuals, those familiar with computers, and those who had more HIS interaction had higher informatics knowledge (Table 3 and 4).

Table 3: Distribution of nurses' comments on the potential in the area of informatics knowledge (number of responses, total %)

Table 4: Distribution of nurses' comments on the potential in the area of informatics skills (number of responses, total %)

Discussion

The findings of this study showed that more than half of the nurses participating in the present study seem to have little ability or skills in the area of informatics competencies. In addition, findings indicate that practicing nurses had higher capabilities in the area of informatics knowledge rather than the other two areas of basic computer skills and informatics skills. Furthermore, they had the least ability in the area of informatics skills. Similarly, Yang et al. (2014) examined current informatics levels of nurse managers. Their findings indicated that informatics competency of these nurse managers was at a moderate range and their computer and informatics skills were lower than informatics knowledge. They suggested that low scores in computers skills and informatics skills be increased through education or training.

Nurses' informatics competencies in Yang et al.'s study (2014) were higher than those of the present study. This could be attributed to the population in Yang et al.'s study having a different level of education, nursing management experience and informatics education compared with the present study, which could influence nurses' informatics competencies. However, similar to the present study, Yang et al. found that the level of informatics competencies of nurse managers is not ideal and, by identifying influential factors, recommended the evaluation of these factors and obstacles.

Results showed that nurses may have higher ability in basic computer skills such as using the Internet and search tools on the Internet and using Windows operating systems and Microsoft Office applications. However, they might be less adept in areas such as backing up files and systems, using antivirus software programs, solving common errors on the computer, changing the default printer, and using computer systems safely. Findings of several studies (Gilmour et al., 2016; González et al., 2017; Saeidi et al., 2014) showed that nurses had the highest skills in working with the Internet, computers, word processors and operating systems. However, the lowest level of ability was observed in the field of documenting care plans, skills and knowledge in informatics, and qualification associated with data entry (Fetter, 2009). As can be observed, the findings mentioned correspond with those of the present study. It seems that practicing nurses need more training on basic computer skills. Hence, to empower nurses in the dynamic healthcare environment, reduce time-consuming paper documentation, improve clinical decisions, reduce errors, reduce duplication and allow nurses to focus on providing patient care, their basic computer skills need to be strengthened.

According to the findings of this study, in informatics knowledge competency the nurses had better understanding and capability in searching for key information on concepts related to the nursing profession. Nevertheless, they had lower capabilities in other areas such as knowledge of file management function in the operating system, recognizing the limitations of computer programs, and analysis of patients' information needs. Other studies show a direct relationship between nurses' knowledge and their skills (Kerie et al., 2018; Munezero et al., 2018). Informatics knowledge is a conceptual and theoretical base for each specialty, without which informatics skills will not be properly obtained. Therefore, it can be concluded that informatics knowledge is the infrastructure for acquiring informatics skills. Thus, as the first step, the level of knowledge and information literacy of nurses needs to be increased through training and appropriate orientation.

Based on the findings of this study, nurses seem to have little ability in terms of informatics skills. Regarding this, results showed that more than half of the nurses participating in the present study had the ability to use HIS to store, retrieve and transmit patient data and the ability to collect data and information related to clinical care. However, they were not proficient in functions such as participation in selection, design, implementation and evaluation of systems; correcting defects when working with the system; or the use of information technology for patient education. Due to the fact that nurses are required to use HIS on a daily basis in the workplace and apply it to patient care, they manifested more competencein this regard. Nonetheless, it seems that since nurses were not involved in the other fields of informatics and had no need to learn these skills, the level of their informatics skills was low.

The results of the study conducted by Jebraeili et al. (2010) confirmed the fact that preparation of human resources for implementation of electronic health records, which is one of the objectives of the Ministry of Health and Medical Education in Iran, was not required. To achieve an acceptable level of preparation, factors which can increase nurses' preparation need to be considered more seriously and nurses need to be trained so that their computer skills and knowledge can be strengthened.

The U.S. National Advisory Council on Nurse Education Practice (NACNEP, 2009) recommended preparing nurses with the aim of adopting intelligent and quality-based information technology use in patient care by implementing five strategies: providing core informatics courses to nursing schools, educating nurses specialized in informatics skills who are able to solve related issues, offering more powerful nursing care through the implication of telecommunication projects, preparing more nursing faculties in the informatics field to facilitate students' skills enhancement, and enhancing collaboration to advance informatics.

In their study on informatics courses, Elahi et al. (2018) included a plan for designing a curriculum of nursing and medical informatics experts. Most experts considered designing a nursing informatics curriculum as necessary and expressed their positive views on nursing informatics as a missing link in the application of knowledge and information that can prove beneficial in nursing, has the potential for innovation and promotion of health and is the basis of professional knowledge development. The curriculum was designed as 12 units of compensatory courses, 16 units of compulsory courses, 14 optional units, 4 units of thesis, and required workshops.

Conclusion

The quality of patient care can be better ensured by communicating effectively and sharing accurate information. This increases the continuity of care, enabling higher quality of care for patients (Casey & Wallis, 2011). Thorough documentation and knowledge development to support evidence-based practice, developing nursing informatics knowledge and nursing informatics competencies seem to be urgently required in Iran since nurses require proper and sufficient information knowledge and communication technology skills for better information management. The teaching of informatics in nursing faculties in Iran is at the level of basic computer skills in a single semester and almost nothing has been done regarding knowledge and skills in informatics. Therefore, a policy based on careful planning and expert review should be adopted in the country and by the Ministry of Health to further nursing informatics lessons in the curriculum of nursing students to raise knowledge, skills and the inclination of nursing students towards informatics in their professions. Therefore, as the basis of nurses' professional skills is shaped through the academic training courses they take ( Alberto et al., 20 05), inclusion of informatics lessons in university curricula may lead to improvement of their informatics skills (Elahi, et al., 2018).

In this regard, in addition to required and specialized courses, it is suggested that nursing informatics curricula include courses of data base management, clinical information systems, informatics theories and issues, system analysis and design, health data security, information technology project management, and clinical-nursing informatics practicum (University of Pittsburgh, 2018; University of South Alabama, 2017; Vanderbilt University, 2018) to improve nurses' informatics competencies. Despite significant advances in medical science, a lot needs to be done in Iran so that the country can develop in terms of nursing informatics. Hence, it seems necessary to develop this field to enhance nursing in educational, research, clinical and management areas by utilizing the services provided by specialists in this field.

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

Online Journal of Nursing Informatics

Powered by the HIMSS Foundation and the HIMSS Nursing Informatics Community, the Online Journal of Nursing Informatics is a free, international, peer reviewed publication that is published three times a year and supports all functional areas of nursing informatics.
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Casey, A., & Wallis, A. (2011). Effective communication: principle of nursing practice. Nursing Standard, 25(32), 35-7. https://doi.org/10.7748/ns2011.04.25.32.35.c8450

Elahi, N., Afra, A., Langarizadeh, M., & Beirami Pour, A. (2018). Designing Master Curriculum of Nursing Informatics in Iran. Journal of Nursing Education, 7(6), 14-23.

Farzandipour, M., Mohamadian, H., Akbari, H & Safari, S. (2017). Designing and psychometric of Nursing Informatic Competencies tool. (Master' Degree), Kashan University of medical sciences and health services, Iran.
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González, V. S., Manzanares, M. T. L., & Peinado, J. A. A. (2017). Nursing Students' Satisfaction during their First Year of Study in a Private University as regards the Integration of ICTs. International Journal of Educational Excellence, 3(2), 35-74. https://doi.org/10.18562/IJEE.027.

Honey, M. L., Skiba, D. J., Procter, P., Foster, J., Kouri, P., & Nagle, L. M. (2017). Nursing informatics competencies for entry to practice: the perspective of six countries. Studies in Health Technology and Informatics, 232, 51-61. https ://doi:10.3233/978-1-61499-738-2-51.

Jebraeili, M., Ahmadi, M., Hajavi, A., Gouhari, M. R., Sedghi, J. M., & Zare, F. E. Z. (2010). Electronic Health Records: Personnel Readiness Assessment. Journal of Health Administration, 13(39),17-24.

Kerie, S., Tilahun, A., & Mandesh, A. (2018). Triage skill and associated factors among emergency nurses in Addis Ababa, Ethiopia 2017: a cross-sectional study. BMC Research Notes, 11(1), 658.

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Pordeli, L. (2017). Informatics Competency-Based Assessment: Evaluations and Determination of Nursing Informatics Competency Gaps among Practicing Nurse Informaticists. (Degree Doctor of Nursing Practice with Specialization in Leadership), Jacksonville University.

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Saeidi, M., Yaghmaei, F., Ranjbaran, M., Godarzvand, L., Hariri, G., & Imanzad, M. (2014). Knowledge, skills, access and usage status of computers, internet and databases in nursing students and some of the related factors. Advances in Nursing & Midwifery, 24(83), 43-50.

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Author Bios
Mehrdad Farzandipour is a full professor and head of the Health Information Management Research Center and a faculty member in the Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, IR. Iran.

Hashem Mohamadian is an assistant professor and member of the Research Centre for Social Determinants of Health and a faculty member in the Department of Health Education and Promotion, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR. Iran.

Hossein Akbari is an assistant professor and member of the Clinical Research Center and a faculty member in the Department of Biostatistics and Public Health, Kashan University of Medical Sciences, Kashan, IR. Iran.

Samira Safari, MSc, is a member of the Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, IR. Iran.

Monireh Sadeqi Jabali, Ph.D. student, is a member of the Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, IR. Iran.

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Self-Assessment of Nursing Informatics Competencies in Hospitals

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The aim of this study was to evaluate the informatics competencies of nurses working in hospitals.

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TECHNOLOGY INFORMATICS GUIDING EDUCATION REFORM (TIGER)

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TECHNOLOGY INFORMATICS GUIDING EDUCATION REFORM (TIGER)

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Have we become lazy in education requirements??
Since COVID, huge changes were put in place including more seminars online which made it easier for people to be involved. But has it taken away from human interaction???

Most facilities like my hospital use online platforms for competency education for staff. Example "LEARNMORE"

PROS:
Ease of use
Comfortability for computer savvy people
Great for an introvert
You can do it on "your time"

CONS:
Promotes less human interaction
Less engagement in some cases
Decreased knowledge if you are skipping to the test
Less hands on experience for visual and tactile learners

What is your take on these online competencies??

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2. Focus on curation and creation-not just absorption-of content.

In CBL, content is a means, not an end. Choices about which and how much content to learn are driven by alignment to the competencies students need to develop. Because it offers access to the enormously rich library of content on the internet, online learning presents the opportunity for students to develop competency in curation and creation of content. Rather than all students absorbing the same content at the same time and at the same pace, they can develop essential critical thinking skills by identifying, assessing, and sharing high-quality content on their own. In addition, students can practice higher-order thinking skills by remixing, reimagining, and applying curated content into new artifacts. ( Learn more about how to rethink the role of content.)

3. Personalize pace with asynchronous learning.

The question of which and how much content students need to absorb inevitably raises questions about pace. By using asynchronous online learning with the explicit goal of allowing students to learn at their own pace and produce their best work, we can support competency-based learning. ( Learn more about how schools developed synchronous and asynchronous schedules during COVID-19.)

Instead of relying on synchronous time for delivering content, create playlists of content that students can explore at their own pace. These playlists can be made up of content you (and, perhaps, students) curate and create. Make these playlists multimodal: there should be items for students to read, watch, and listen to. Asynchronously, students have more flexibility to revisit content multiple times if they need to.

Make some discussions asynchronous. At GOA, we want to use synchronous time for connection and conversation, but incorporating asynchronous discussions allows students to reflect on a prompt, pause, compose, and share ideas more at their own pace. This is especially beneficial to students who want or need more processing time and/or who might be reticent in synchronous conversation. Online asynchronous discussions are also multimedia: students can articulate ideas via text, audio, or video.

Allow for multiple attempts on formative assessments. Think of formative assessments as practice. Online tools like the quiz feature of Learning Management Systems (LMS), Quizlet, and EdPuzzle allow a teacher to embed formative assessments in online experiences, assessments that check for understanding and often offer immediate, automatic feedback for students. Explicitly communicating to students that they can take these assessments multiple times (and, if you grade formative assessments, that their best attempt will be the grade you record) lowers the stakes and builds the learner habit of seeing formative assessment as practice towards mastery.

4. Increase student agency.

When teaching online, you do not have the benefit of a captive audience: your students are most likely logging in at different times and from different places (maybe even in different time zones!). This new dynamic requires a shift in the role of the teacher, from leading a class to empowering individual students to take an active role in their own learning. A student engagement strategy that has worked at GOA is to worry less about student compliance and accountability and to spend more time designing opportunities for students to make important decisions as part of the learning process. Some ways to do this:

Allow students to become their own project managers. Project management requires a number of highly relevant learning skills. Let's say you have two weeks to cover a unit online. Rather than dictating to students a day-by-day plan for that unit, invite them to design their own pacing guides. Acknowledge that they know their own schedules and contexts well, and can, using broad parameters set by you, define and communicate how they will complete the work ahead of them. (Learn more about designing high-quality online projects.)

Elevate peer and self-assessment. Giving, receiving, and processing feedback are essential skills for lifelong learning. It benefits both students and teachers, then, to invest time in practicing effective peer feedback and self-assessment skills. Online, leveraging high-quality protocols both synchronously and asynchronously works well. The simple act of self-explanation can be a powerful assessment tool and works beautifully asynchronously. Engaging students as partners in feedback pushes them to engage more deeply. The key is to take the time required to allow students to learn these skills. (Learn more about feedback and self-assessment in online learning.)

Publish, don't submit. Online environments are conducive to connecting students to an authentic audience. Rather than having students merely submit assignments to you for assessment, ask them to share their work in an asynchronous discussion space or on a synchronous call so they can teach and receive feedback from their peers. Invite experts, families, or community members to review student work. Create online spaces that showcase student work and invite visitors to attend. GOA's Catalyst Conference is an example of this. These authentic audiences can encourage students to find meaning and purpose in doing their best work.

5. Reimagine time and space.

An essential mindshift: "online learning" doesn't mean a student is constantly staring at a computer. Instead, online spaces can be used as a way to keep students connected to their teachers and peers as they have experiences in the world beyond school. Competency-based learning recognizes that learning happens everywhere, not just in brick-and-mortar schools. Students learning online can pursue projects, internships, research, or other experiences in their local communities (and beyond) and use technology to document, reflect on, and share those experiences with teacher and classmates. If students have laptops or mobile devices, they can check in with teacher and classmates from anywhere with an internet connection. They can develop relationships with mentors and experts from beyond their school. ( Learn more about rethinking time and place in schools.)

6. Prioritize relationships and equity.

The COVID-19 crisis has revealed two essential truths about education: 1) students want to feel connected to a community and 2) we haven't done nearly enough to ensure all students have the resources and support they need to learn effectively online. It's important to remember that competency-based learning began as an equity movement: innovative public schools like Boston Day and Evening Academy and Big Picture Learning adopted CBL as a way to fight systemic inequities in American education and to celebrate the uniqueness of each learner.

In order for online learning to support CBL, we must adopt strategies, systems, and tools that allow for high-quality online communication and connection among teachers and students, and all learners must have what they need to maintain those connections and to learn deeply. None of the above strategies can be implemented effectively unless we have made investments in knowing who our students are, what their goals are, and what they need to reach them.
To explore competency-based learning with GOA, join our summer online program, Competency-Based Learning: From Theory to Practice, or purchase our Competency-Based Learning Toolkit. For more resources on learning online during the COVID-19 crisis, visit our resource page. Stay connected by following us on Twitter.

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How to Use Online Learning to Support Competency-Based Learning

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2. Focus on curation and creation-not just absorption-of content. In CBL, content is a means, not an end. Choices about which and how much content to learn are driven by alignment to the competencies students need to develop.

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"Big Data" allow mass collection of data in order to tailor needs and interventions.

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In our healthcare system, the way they have worked to increase interoperability is switching from Meditech to a more broadly used electronic health record called "EPIC". This change has intoroduced us to more sharing of data from other facilities but we are still lacking in some areas.

We can now download ECG strips form our monitors, add media images into the computer, and search lab values from certain EPIC using facilities.

There is still much work to do however!!

What computer system do you use?

EPIC? Meditech? LMR?

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Conquering Interoperability Challenges

A major data integration milestone has been reached at Southcoast Health, a community-based health delivery system with multiple access points in southeastern Massachusetts and East Bay, Rhode Island, an area that serves more than 700,000 people. As of October 1, 2015, Southcoast had completed a multi-year project that established an Epic enterprise EMR platform that now ties together clinical, operational and revenue-cycle systems.

James Feen, executive director and associate CIO, called that platform "a key asset for the organization" - in place to accommodate tremendous growth in Southcoast's 415-strong physician group, a number of acquisitions and expansion in physical locations. "We had disparate systems running across different environments and an IT department that was very MEDITECH-centric, very hospital-centric," he explained.

The project required putting in a framework to allow those disparate systems to come together and the staging of the Epic conversion over a 21-month period. It also called for an organizational shift toward providing services across the continuum of care.

Enabling technology

Reflecting on what enabled Southcoast to successfully complete its transition, Feen credited Corepoint Health's integration engine, which facilitated development of interfaces to connect internal applications and external facilities. Along with establishment of a master patient index, Southcoast ultimately brought together systems to pass medical records from at least 12 different EMRs and create a single patient record in support of the Epic project.

"We had moved off of an interface engine that was not designed for the type of load that we were to put on Corepoint," said Paul Labonte, Southcoast's manager of business intelligence and systems integration. "It was designed for some niche tasks within the interface space. Although it served those functions, it would not have stood up to the volume we pushed through Corepoint."

Southcoast CIO Joan McFaul said she and Feen prioritized which interfaces would be most important to the various decision-making bodies within the organization. They also guided selection of third-party systems with which Southcoast would have to interface, as well as outside sources that would require the health system's data.

That process revealed several internal areas that needed special attention:

Epic doesn't have a native blood bank system, so Southcoast needed to set up several interfaces between a third-party blood bank system, Mediware, and the Epic EMR.

Southcoast brought its medical oncology service line into Epic; however, Epic lacks a radiation oncology component. Southcoast installed Mosaiq, an oncology information system from Elekta, to support the radiation oncology process with six interfaces to Epic for functions such as scheduling and basic demographics.

Clinical engineering systems such as radiology/PACS and EKG monitoring needed to be interfaced.

Telehealth systems used by nurses within the Homecare and Hospice division required interfaces to allow management of patients monitored by those systems.

"Corepoint has been a very large factor in dealing with anything internal to the health system's data movement." - Paul Labonte,Manager, Business Intelligence & Systems Integration, Southcoast Health

Looking Outward

The Massachusetts Health Information Highway (Mass HIway), a secure statewide network launched in 2012, facilitates the transmission of healthcare data and health information among providers, hospitals and other healthcare entities in Southcoast's area. Although Southcoast has not had a lot of activity with Mass HIway to date, the health system is starting to look at how it will connect to the state-level health information exchange.

In the meantime, Southcoast has interacted with other health networks in the region that are also using Epic to achieve interoperability in terms of basic document exchange and care summaries. "One of the great points of Epic and how patient data is integrated at the client is that a tool like Corepoint is going to allow us to implement a strategy for CCD and C-CDA integration with a number of our affiliates in the area," said Feen.

"There's going to be high demand for a level of interoperability across our affiliates in the region that the toolset we have in place between Epic and Corepoint will allow us to achieve in time." James Feen,Executive Director & Associate CIO, Southcoast Health

Southcoast is also using Corepoint for interfaces with outside laboratories. "As we're working with practices that we support from a reference lab perspective, we'll use Corepoint to deal with all those interfaces," added Labonte.

Organizational Benefits

Southcoast faced a tight timeline with its Epic implementation, especially considering the large number of third-party systems that needed to be integrated. Feen reported that Corepoint generated efficiencies and cost savings in allowing Southcoast to replicate connections, "not to mention solving some pretty complex problems when it came to aggregating data."

Transforming and staging data "as we brought in historical information for providers to our new platform would not have been feasible in the timeline in the absence of the Corepoint engine," he said.

Labonte looked at the benefits of using the integration engine from a slightly different perspective. "When we went forward, particularly in the ambulatory space, we actually spoke with another company that had some success with conversions for organizations like ours, moving from a legacy platform to Epic," he recalled. "It went far enough for us to know that there was a significant cost savings for us not to leverage another company like that. It would have become cost-prohibitive, so we stayed on point with what we were doing with Corepoint."

Labonte continued, "I think the other piece to it - even when we were in the MEDITECH environment - was that we found more than one instance where the choice was either to purchase another interface from the core vendor or use the engine to split connections. We used the engine to split connections or repurpose connections quite often. I don't have an exact number, but it was at least a six-figure savings of not purchasing additional interfaces from the source EMR."

Where from here?

Even though Southcoast has completed the Epic conversion, additional work likely lies ahead for the Corepoint Integration Engine. For starters, according to McFaul, the health system is in the process of moving its legacy enterprise resource planning - financial, supply chain, human resources and payroll data - to a PeopleSoft platform during 2016.

Additionally, Southcoast is active in software development to fill niche clinical and business needs. "Corepoint Integration Engine is going to help us solve some of those development tasks to help try and round out our enterprise system and other specific tools that clinicians and providers have in place," said Feen. "There are key things that we will be able to leverage from an integration standpoint, with Epic and with the third-party systems, in trying to get data more accessible, more mobile. The engine is going to play a key role in helping us solve some of those niche business needs that aren't otherwise solved through our enterprise vendors."

That may mean tapping data as it goes through the engine and then using it to solve some of those business needs, according to Labonte. One possible area would be filtering lab results that are currently only going to outreach markets. "There are folks at Southcoast who could help build an application that would [build on] that, and then someone could see that value and do something from a clinical perspective and react to it," he said.

And not to be overlooked are Southcoast's reported merger talks with Care New England, one of Rhode Island's largest health systems. A consolidation would create a company with about $2 billion in annual revenue, eight hospitals and more than 1,700 doctors and other providers, the Boston Globe reported.

Whether Southcoast pursues new areas of opportunity from continued growth or ventures farther along the Mass HIway, Corepoint Integration Engine will be humming along to advance IT capabilities.
Written in Partnership with HIMSS Media One of the largest and fastest-growing hospital systems in Massachusetts and Rhode Island
Hospital System: 4 Hospitals with a total of 815 beds.
EHR System: Epic
Physician Network: In addition to its hospitals and a physician network of more than 450 providers, Southcoast has more than 55 service locations across the South Coast of Massachusetts and Rhode Island. This includes more than 40 physician practices as well as urgent care centers, a Visiting Nurse Association, the Centers for Cancer Care, outpatient surgery centers, and numerous ancillary facilities.

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A major data integration milestone has been reached at Southcoast Health, a community-based health delivery system with multiple access points in southeastern Massachusetts and East Bay, Rhode Island, an area that serves more than 700,000 people.

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EPIC has become one of the top EHRs in the U.S.
This site states "The majority of U.S. News and World Report's
top-ranked hospitals and medical schools use Epic"
Our southcoast Hospitals group changed over to EPIC in 2015, and it was STRESSFUL! I actually cried the first day because I was so overwhelmed and I consider myself "tech savvy".
There are known quality improvements since changing to EPIC. Information sharing has also improved.

Pharmacies now share their refill history and outside pharmacies like the VA and Primacare also show up in our EHR so we can more easily find medications patients are on (that are not in our system base). This improves patient care and satisfaction.

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Founded in a basement in 1979, Epic develops software to help people get well, help people stay well, and help future generations be healthier.

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The lowest rate of EHRs is in specialty care, assuming that is due to it being smaller offices. As providers, we rely heavily on specialists so having them included in EHR access would be beneficial to the patient and providers as we could then have more streamlined care and an interoperable system potentially!!! ** https://www.healthit.gov/data/quickstats/adoption-electronic-health-records-hospital-service-type-2019-2021

There are three basic components of meaningful use:
1) The use of a certified EHR in a meaningful manner.
2) The electronic exchange of health information to improve quality of health care. 3) The use of certified EHR technology to submit clinical quality and other measures.

These basic components will be implemented gradually through three stages. Fulfillment of the requirements of each stage, attesting to each stage, is required to access incentives and avoid penalties as of 2015.

https://www.aanem.org/getmedia/bb9480ae-f5b3-4c64-b55a-55c457d325a8/EHR-and-Meaningful-Use.pdf.aspx

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Benefits of CPOE:

Reduce errors and improve patient safety

Improve efficiency

Improve reimbursements

Reduce errors and improve patient safety

Some studies have been done with handwritten orders vs CPOE and have noted a decrease in errors from 6.7% to 4.8% respectively.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1297620/?tool=pubmed
Studies prove that scannning meds and having CPOE have reduced errors
https://eds-s-ebscohost-com.ezproxy.simmons.edu/eds/detail/detail?vid=4&sid=94012645-96cf-45d8-a94f-e5993a35f32f%40redis&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=T903265&db=nup

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Computerized Provider Order Entry: The Basics

Computerized provider order entry (CPOE) refers to the process of providers entering and sending treatment instructions - including medication, laboratory, and radiology orders - via a computer application rather than paper, fax, or telephone.

Why It Matters

CPOE has several benefits. CPOE can help your organization:

Reduce errors and improve patient safety: At a minimum, CPOE can help your organization reduce errors by ensuring providers produce standardized, legible, and complete orders. In addition, CPOE technology often includes built-in clinical decision support tools that can automatically check for drug interactions, medication allergies, and other potential problems.

Improve efficiency: By enabling providers to submit orders electronically, CPOE can help your organization get medication, laboratory, and radiology orders to pharmacies, laboratories, and radiology facilities faster, saving time and improving efficiency.

Improve reimbursements: Some orders require pre-approvals from insurance plans. CPOE, when integrated with an electronic practice management system, can flag orders that require pre-approval, helping you reduce denied insurance claims.

In short, CPOE is safer and more efficient for providers and patients.

Achieving Meaningful Use

CPOE is a core meaningful use objective for Stage 1 and Stage 2 meaningful use. Learn more:

For More Information

For more information about CPOE, see the following resources.

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What is computerized provider order entry?

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Computerized Provider Order Entry: The Basics Computerized provider order entry (CPOE) refers to the process of providers entering and sending treatment instructions - including medication, laboratory, and radiology orders - via a computer application rather than paper, fax, or telephone. Why It Matters CPOE has several benefits.

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CurrentCare " Rhode Island Quality Institute

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Rhode island has a HIE called CurrentCare

Only about 1/2 of RI residents utilize this free service to keep all healthcare information in one spot.

I live in RI and have never heard of it so maybe they need a bigger push when you go to healthcare facilities it your PCP.

This would aid in information sharing in afterhours for pharmacies for med reconciliation

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We gather information from multiple sources and store it on a secure network. This includes primary care physicians, specialists, labs, medications, etc. We give authorized healthcare clinicians secure access and patients access to their own healthcare information.

More than half of all Rhode Islanders have enrolled in CurrentCare and hundreds of primary care and specialty practices, community health centers, hospitals, long-term care facilities and visiting nurse agencies participate in CurrentCare.

CurrentCare is operated on behalf of Rhode Island's healthcare community by the Rhode Island Quality Institute (RIQI), a not-for-profit organization intent on building a safer, higher value health system for all Rhode Islanders. Rhode Island state law protects the rights of all participants in CurrentCare. The Rhode Island Health Information Exchange Act of 2008 contains a number of important privacy and data security protections for Rhode Island consumers enrolled in CurrentCare. We want you to be as informed as we are, so please read the full text of the Act.

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CurrentCare " Rhode Island Quality Institute

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We gather information from multiple sources and store it on a secure network. This includes primary care physicians, specialists, labs, medications, etc. We give authorized healthcare clinicians secure access and patients access to their own healthcare information.

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Because strokes are so time limited, having neurologists on telehealth is very convenient and beneficial. Having the neurologist on camera for our patients in a timely fashion for consult has aided in many cases around the world. This article describes ways the American Academy of Neurology Telehealth can be of benefit but also the barriers they come across.
One of the biggest barriers in the ER with this is technological problems.. either we have no wifi service or they have difficulty calling in.
This leads to delays and can potentially lead to errors in medicine and diagnosis.
We rely heavily on their assessment so without that, the patient is being treated by the ER doctor alone, without the consult of the neurologist who specializes in this.

Technological problems are one of the biggest barriers in telehealth of all kinds!

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Abstract

Telehealth services complement in-person neurologic care. The American Academy of Neurology supports patient access to telehealth services regardless of location, coverage for telehealth services by all subscriber benefits and insurance, equitable provider reimbursement, simplified state licensing requirements easing access to virtual care, and expanding telehealth research and quality initiatives. The roles and responsibilities of providers should be clearly delineated in telehealth service models.

Introduction

The American Academy of Neurology (AAN) is the world's largest neurology specialty society, representing more than 36,000 neurologists and clinical neuroscience professionals. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. This update to the 2014 AAN position statement on telemedicine reflects recent advances in telehealth practice and research and changes in related regulations, policies, and legislation. The AAN advocates for policies that ease unnecessary restrictions to virtual care, offers guidance about the clinical practice of telehealth, and identifies important gaps in the telehealth knowledge base. To ensure delivery of safe, high-quality virtual care, stakeholders, including providers (defined in this article as neurologists and other qualified health care professionals who provide neurologic services), regulators, policymakers, and payers, need to consider access, standards, reimbursement, practicing across state borders, professional liability, and coordination of patient care with local providers.

Definition of Telehealth

Telehealth, also known as virtual care, uses digital information and telecommunication technologies to provide health care when participants are separated by distance or time. Participants include physicians, other qualified health care professionals, and additional members of the health care team connected virtually with patients, family members, and other care providers. Telehealth facilitates the exchange and interpretation of text, data, images, audio, or video, with synchronous (e.g., provider and patient available at the same time) or asynchronous communication. Examples of telehealth services include real-time 2-way interactive audio-video conferencing, mobile health applications, store-and-forward evaluation and management services, virtual check-ins, electronic interprofessional consultations, telephone services, and remote patient monitoring. The choice of telehealth modality for a specific virtual encounter is determined by the needs of the patient, their ability to access and use the necessary technology, the legal and regulatory landscapes, and the available supporting evidence.

Benefits of Telehealth

Telehealth can benefit patients and providers. Examples include:

Enhanced comfort, convenience, and safety, particularly for patients with limited mobility due to their medical condition or need for home medical support equipment

Evidence supports the effectiveness of telehealth in inpatient and outpatient settings, for acute evaluation and routine assessment and for multiple neurologic subspecialties. During the early part of the coronavirus disease 2019 (COVID-19) pandemic in 2020, neurology practices had one of the highest uptake rates for ambulatory telemedicine (47.9% of total visits) and a smaller decline in total visits when compared with other specialties. In acute emergency department or inpatient hospital settings, patients may be assessed and rapidly triaged to determine whether they would be best served at their current location or transferred to another facility. This benefits patients by allowing them to remain in their communities when possible and expedites access to advanced services when appropriate, thus optimizing resource utilization.

Video visits have proven to be cost-effective. However, they do not necessarily reduce the practice expenses incurred in delivering care compared to in-person visits because of needs for technical infrastructure and support, security and privacy measures, patient education and logistics, and a potentially wide range of central and remote office and hospital network collaborations among essentially every node of patient care. A thorough analysis of the practice expense must be a focus of investigation.

Potential Solutions for Barriers to Telehealth

Access

Patients should have access to high-quality telehealth services in the United States and its territories and when traveling abroad. Initially, telehealth programs were focused on patients living in rural settings with no access to specialized ambulatory and inpatient health care services. However, many other patients also have barriers to health care access, including those (1) who live in nursing homes and rehabilitation facilities; (2) with conditions that make travel excessively burdensome; (3) who are unable to drive; (4) who live in remote military settings; (5) who live in densely populated urban areas where traveling even short distances can be time-consuming or expensive; (6) whose safety would be compromised by in-person visits (e.g., at risk for infection or with a need for home medical support equipment); and (7) who seek to improve continuity of care when they are traveling (including those who may spend several months of the year at another residence).

Telehealth should be an option for both new-to-practice and established ambulatory patients provided they are appropriately triaged to the visit type that meets their unique needs. In addition, care gaps affecting patients admitted to hospitals with no neurologic consultation coverage could be addressed by expanding inpatient teleneurology services.

One potential benefit of expanding telehealth as a national model of health care is improving convenience and democratizing access to expert subspecialists throughout the nation. However, an unintended consequence could be negatively affecting the sustainability of local practices that currently offer the benefits of in-person and long-term continuity of care. Furthermore, without the provider understanding community social and medical resources and local rules (such as driving restriction rules), the remotely practicing provider may be delivering care with significant gaps. Further investigation is required to address this paradox.

The AAN encourages actions to minimize the digital divide by supporting affordable nationwide high-speed Internet access to limit disenfranchisement of those with inadequate or unaffordable network connectivity and efforts to promote digital literacy and alleviate other technology or device limitations. Because some patients have barriers related to language and visual or hearing impairments, resources to assist with translator services and appropriate, easily accessed adaptive technology must be available and reimbursed at equitable rates. Telephone-only visits should be available for encounters that require real-time two-way interaction but in which an audio-video encounter may not be necessary, e.g., medication reconciliation, some counseling situations, discussion of treatment side effects, or when patients do not have or cannot use more advanced telehealth modalities.

Reimbursement and Payment Parity

The complexity of various coverage policies, service and procedure codes, reimbursement rates, and documentation standards across Medicare, Medicaid, and numerous private payers creates important barriers to providers trying to incorporate telehealth services into their practices. The definition of "parity" varies by state and insurer. Moreover, the cost borne by the patient is difficult to determine in advance of the provision of services. Reform should be based on the following principles:

Patient financial responsibility (e.g., fees and copays) for telehealth encounters should not exceed comparable in-person expenses.

Coverage and the professional component of reimbursement for two-way real-time interactive encounters should be independent of setting (in-person, audio-video, telephone), provided that standards of care for the encounters are met, because the provider's cognitive work is equivalent.

The practice expense of providing a two-way real-time interactive telehealth service may be different from that of providing an in-person service and should be determined by evidence- and resource-based methodologies.

Professional and practice expense reimbursement for providing other telehealth modalities such as store-and-forward digital evaluation and management services, interprofessional consultations, and remote physiologic monitoring should be evidence- and resource-based.

To best address the needs of the patient and their health, the appropriateness of a telehealth evaluation should be determined on a case-by-case basis by the provider and the patient, not by the payer.

When traveling out of state, patients should have coverage for telehealth access to their home state providers.

If there are no local providers practicing a certain specialty, patients should have telehealth access covered for that specialty.

Policies should support and encourage the development of telehealth care models in addition to audio-video encounters that can potentially improve patient outcomes and reduce costs. Examples may include remote monitoring and asynchronous evaluation and management services.

In addition to fee-for-service reimbursement models, value-based telehealth models should be developed to optimize health care resource utilization at multiple levels: insurance, practice, patient, and society.

Telehealth Practice Across State Borders

Each state defines and regulates the practice of medicine, including telehealth, within its boundaries. State regulations dictate what constitutes a physician-patient relationship, what services are permissible once a relationship is established, if and what medications can be prescribed, scope of practice, and malpractice policies. These variations pose significant barriers to the practice of telehealth across state borders. Licensing, prescribing, and related policies should be simplified. A desirable solution could include blanket reciprocity and an expedited licensing process that would require one unrestricted state license, a new background check for each state in which telemedicine is practiced, and reduced annual fees for limited practices. This would ensure protection of patients' rights to receive telehealth services as they require. The Interstate Medical Licensure Compact (IMLC), an agreement among 29 participating US states, the District of Columbia, and Territory of Guam to streamline the state licensing process for physicians who qualify, maintains the state's authority to regulate the practice of medicine within its borders. Whereas the IMLC simplifies the application process, it does not standardize practice requirements.

Medical liability for telehealth services varies from carrier to carrier. Unless this changes, neurologists must understand individual carrier policies to ensure that telehealth encounters are covered by their policy and apply to the states in which their patients are located.

Hospital Credentialing

Hospital credentialing requirements and procedures vary between hospitals. This complex process can delay patient access to needed care. Simplification of hospital credentialing requirements and widespread utilization of certified credentials verification organizations would improve patient access to inpatient teleneurology services.

Streamlining Other Telehealth Processes

Currently there is considerable variability across payers, sites of service, and health care organizations regarding the need and type of consent required prior to a telehealth encounter, requirements for billing compliance, and the necessity for an in-person encounter prior to a virtual encounter. Barriers to practicing telehealth would be decreased if these processes were simplified or standardized.

Delineation of Roles and Responsibilities

To prevent confusion and maximize quality and safety of the telehealth care provided, the roles and responsibilities of participating facilities, clinicians (including, but not limited to, physicians, advanced practice providers, nurses, and trainees), and hospital and practice staff should be clearly delineated. In view of the limitations of telehealth (e.g., requiring nuanced or detailed neuromuscular, ophthalmologic, and vestibular examinations), the medical community should practice responsible behavior regarding appropriate remote evaluation in instances where the lack of an in-person examination may compromise medical decision-making. It is also helpful to clarify the expected nature and duration of the therapeutic relationship, including the relationship between a consultant seen via telehealth for a second opinion relative to the patient's usual care team and expected follow-up if the provider is prescribing medications or suggesting diagnostic testing.

In instances in which telehealth services are provided to a remote clinic or hospital, the AAN agrees with the American College of Emergency Physicians that "the best patient care occurs when there is no ambiguity as to which provider is responsible for care of a patient." Agreements between local and remote sites need strict clarification of respective roles prior to initiating patient care. This includes, but is not limited to, the scheduled availability of the telehealth provider; who is responsible for placing orders, following up test results, and assessing the patient after consultation; billing responsibilities; and IT support.

Limitations of Telehealth Services

Adequacy of Telehealth Evaluations

As telehealth becomes more commonplace, including telehealth encounters with patients in their homes, it is important that patients and consumers understand the benefits, limitations, and their rights regarding these services. The ability to effectively triage new patients and concerns via telehealth has not been well-studied. Although telehealth can be used to evaluate new patients or new symptoms, it may be difficult to determine whether the appropriate assessment and medical decision-making can be adequately performed via telehealth. Patients and referring health care providers should be informed of the possibility that patients may still need to seek in-person care if their concerns cannot be safely addressed via telehealth. In addition, a provider may lack knowledge about, and availability of, social and medical resources near the patient. National initiatives to educate patients and provide standard language regarding the use of telehealth can help inform and protect patients and providers.

Cost

The initial economic investment to establish a telehealth practice may be a limitation for some practices and is based on the settings where telehealth will be provided; the proportion of the practice consisting of telehealth; necessary staff to help with setting up, scheduling, triaging, and greeting the patient during the telehealth visit prior to the provider connecting to the visit; coding; and billing. Additional expenses potentially include the cost of the platform used and hardware such as computers, tablets, carts, or accessories such as microphones and cameras at the provider and patient locations. In addition, the need for information technology support and new staff or training of existing staff are factors to be considered.

Fraud

Telehealth modalities can provide substantial benefits to patients, but these care models are potentially vulnerable to the same fraudulent practices that may occur with in-person evaluations. Payers are concerned the cost of care could increase if patients are asked to follow-up more often than necessary or that visits could be fabricated or billed at levels higher than warranted. Providers fear that these concerns may prompt regulators to inappropriately limit telehealth access or lead to a disproportionate cost of compliance for providers offering telehealth services. Data on billing behavior can help determine whether fraud or abuse has occurred, and the digital footprint of visits is traceable, thus reducing the risk of fabricated visits. The programs in place to monitor in-person activities will be adequate to monitor for telehealth fraud.

Cybersecurity

Telehealth expansion raises concerns for cybersecurity and risk of access to private patient information, malware infections, ransomware attacks, and system breaches. Although not specific to telehealth, these concerns must be considered and addressed given increased risk of compromise for practices that do not appropriately protect their systems.

Research Gaps

To expand the evidence base of telehealth, further research is needed spanning the spectrum of virtual health care delivery models including maximizing the value and quality of the encounter and minimizing the cost. Conversely, modifications to coverage, licensing, and liability policies will necessitate understanding the effect of these changes on access to telehealth care and on clinical practices, including community physicians.

Given the known marked racial, ethnic, and socioeconomic disparities in access to neurologic care and outcomes, we must better understand and address technological literacy and the digital divide as well as patient perspectives on quality, trust, privacy concerns if living in crowded living conditions, or regions with inadequate Internet bandwidth.

Optimal examination techniques for direct-to-patient telehealth, limitations of the current virtual neurologic examination and methods to work around them, and applications of technology-enhanced examination methods (e.g., biosensors or smartphone-based tasks) require further investigation. Assessment of patient functioning in the home can be enhanced with use of passive and smartphone-based sensors to permit unobtrusive remote patient monitoring and artificial intelligence algorithms to interpret these data. Understanding of the effect of telehealth visits on clinical outcomes, both short-term (e.g., types of concerns best assessed, diagnostic accuracy, indications for triage to in-person evaluations) and long-term (e.g., neurologic disability progression, quality of life), is needed. These clinical outcomes can be weighed against costs from patient, payer, clinical practice, and health system perspectives, and against the effect on care value. Research into optimal methods of graduate and postgraduate training in telehealth care is also needed.

AAN Policy Guidance for Telehealth

The AAN recommends that all stakeholders support the following:

Advocating for the needs of our patients and members in legislative, regulatory, and payment policies that pertain to telehealth

Promotion of telehealth services to improve access to care, patient satisfaction, and safety; enable providers to practice in care models that promote career satisfaction and well-being; and reduce health care costs

Determination of the appropriateness of a telehealth evaluation on a case-by-case basis by the provider and the patient to best protect the interests of the patient, not by payment policy

Access to telehealth services for all patients located in any US state or territory, regardless of geographic location of the patient, provider, or payer

Support and encouragement of the development of a variety of virtual care models with the potential to improve patient outcomes and reduce costs, including remote monitoring and asynchronous visits

Payer coverage for translation and adaptive services for patients who speak a different language or are visually or hearing-impaired

Payment parity for the professional component of two-way interactive real-time virtual services regardless of the method used (e.g., in-person, video, telephone) provided standards of care are met

Evidence- and resource-based determination of practice expenses of telehealth services, which may be different from practice expenses for providing in-person services

Resource-based valuation for reimbursement including provider work, practice expense, and liability insurance expenses for emerging communication-based technology services including audio-only encounters, store-and-forward digital evaluation and management services, interprofessional consultations, and remote physiologic monitoring

Comparable patient financial responsibility (e.g., fees and copays) for telehealth encounters and in-person evaluations

Understanding currently applicable state-specific laws regarding the practice of telehealth for each location in which patients are seen

Simplified state medical licensing, prescribing, hospital credentialing, medical liability policies, insurance coverage, and reimbursement schedules for telehealth across state borders

Unambiguous delineation of where responsibility of the teleneurologist ends and the local admitting or consulting physician's responsibilities begin for each telehealth encounter

Appropriate remote evaluation in instances in which the lack of an in-person examination limits medical decision-making

Support for further technological innovations to better enhance patient confidentiality and safety

Research and development of virtual care models, including patient triage, which are cost-effective and expediently evaluate and manage patients in any setting remote from their provider

Research on the benefits and limitations of telehealth, as well as its effect on health equity, including access to care for socioeconomically disadvantaged populations

Development of optimal methods for graduate and postgraduate training in telehealth

The AAN predicts that telehealth will continue to play an essential role in the care of patients with neurologic conditions. We will best serve our patients and our members by advocating for increased access, broader insurance coverage, fair reimbursement, reduced regulatory and legislative barriers, and expanding the telehealth evidence base by promoting research on its proper roles and value in neurologic care and on the costs associated with providing telehealth services.

Position Statement History

Update drafted by Jaime M. Hatcher-Martin, MD, PhD; Neil A. Busis, MD; Bruce H. Cohen, MD; Rebecca A. Wolf, MBA; Elaine C. Jones, MD; Eric R. Anderson, MD, PhD; Joseph V. Fritz, PhD; Steven J. Shook, MD, MBA; and Riley M. Bove, MD, MMSc.

Original drafted by Vernice Bates, MD; Pushpa Narayanaswami, MBBS, MD; Sarah Song, MD; Jeffrey A. Switzer, DO; Jack W. Tsao MD, DPhil; and Tim Miller (AAN Staff).

Study Funding

The authors report no targeted funding.

Disclosure

J.M. Hatcher-Martin is employed by SOC Telemed, which is a teleneurology company; serves in a compensated role on a scientific advisory or data safety monitoring board for Acadia and Neurocrine; serves in a compensated role as a speaker and site reviewer with the National Parkinson Foundation; and has a noncompensated relationship as an advisory board member with Cerner that is relevant to AAN interests or activities. N.A. Busis serves as alternate CPT advisor for and has received personal compensation for speaking engagements from the AAN. B.H. Cohen serves as an associate editor for Continuum, Mitochondrion, and Pediatric Neurology; serves as the chair of the scientific and medical advisory board of the United Mitochondrial Disease Foundation; serves as a consultant for Minovia Therapeutics, Modis Therapeutics (Zogenix), NeuroVive Pharmaceutical AB, Reneo Pharmaceuticals, Inc., and the US Department of Health & Human Services; serves as a CPT consultant for the AAN; receives research/grant support from BioElectron Technologies (PTC Therapeutics), the NIH (U54NS078059), and Stealth BioTherapeutics Inc. and publishing royalties from Elsevier; and has received personal compensation for speaking engagements from the AAN and Stealth BioTherapeutics Inc. R.A. Wolf is employed by the AAN and has an immediate family member who has received compensation for serving as an employee of Blue Cross Blue Shield of Minnesota. E.C. Jones is employed by SOC Telemed, which is a teleneurology company; and serves as Deputy Editor of Neurology®: Clinical Practice for the AAN. E.R. Anderson is employed by SOC Telemed and Corticare, which are teleneurology companies; and is the owner of Intensive Neuro, a medical consulting company. J.V. Fritz receives consulting support from McKesson Corporation, Biogen Pharmaceuticals, and Philips Healthcare; and is an owner in the consulting firm NeuroNetPro LLC. S.J. Shook reports no disclosures relevant to the manuscript. R.M. Bove has received research support from Akili Interactive, Biogen, and Roche Genentech; is a Harry Weaver Scholar of the National Multiple Sclerosis Society; has received research support from the UCSF Weill Institute for Neurosciences, Hilton Foundation, California Initiative to Advance Precision Medicine, and the Sherak Foundation; and received personal compensation for consulting from Alexion, Biogen, EMD Serono, Novartis, Roche Genentech, and Sanofi Genzyme. Go to Neurology.org/N for full disclosures.

Footnotes

Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Approved by the Practice Management and Technology and Health Policy Subcommittees on November 17, 2020; by the Medical Economics and Practice Committee on November 25, 2020; and by the AAN Institute Board of Directors on December 11, 2020.

Received January 5, 2021.

Accepted in final form April 19, 2021.

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Abstract

The ethical principles of self-determination and autonomy govern the practice of . A patient's right to shared decision-making and assent prior to invasive procedures, therapeutic interventions, and research projects is protected by law. Foundational informed consent nursing roles of communication, education, and patient advocacy compel advance practice nurses to formulate methods that safeguard patients' rights. Legal implications of informed consent may vary, leaving nurse practitioners juxtaposed between judicial and ethical responsibilities. The goal of this study is to examine legal and ethical components of informed consent and to assist nurse practitioners in developing proactive practice strategies related to informed consent.

Section snippets

Origin and Ethical Roots of the Informed Consent Process

A patient's right to participate in health care decisions arises from the individual's moral right to choose one's own plan for life and action.1, 3 Far removed from today's litigious climate, the concept of informed consent may be traced as far back as Hippocrates, Plato, and Galen, and likely originally intended to protect the provider rather than the patient. In the Hippocratic Oath, physicians have historically sworn to "prescribe a regimen for the health of the sick" and "utterly reject

What Is Informed Consent?

Informed consent is a process. The patient's signature on a document does not, by itself, constitute informed consent. Rather, the process of informed consent includes providing the patient with information about his or her health status, diagnosis, treatment options, and prognosis. The patient should participate in the development and decision-making of the plan of care, including the right to consent to or refuse medical or surgical treatment. Finally, the patient should receive adequate

When Is Informed Consent Required?

Generally, informed consent is necessary before performing surgery as well as certain medical treatments, therapeutic interventions, and invasive procedures. The Joint Commission's Standard RC 02.01.01EP4 requires that the properly executed informed consent form is placed in the patient's medical record before surgery, except in emergencies. ¹² In its Conditions for Participation for Hospitals, Section 482.13(b)(2), the Centers for Medicare and Medicaid Services requires the "patient's or the

Who Performs Informed Consent?

It is generally accepted that legal responsibility for obtaining informed consent lies with the provider performing the procedure. ¹¹ The Joint Commission requires that the "licensed independent practitioner or other licensed practitioners with privileges about the care, treatment, and services that the patient will receive" be responsible for ensuring that the patient has been provided with sufficient information and understands such information to provide informed consent. ¹⁵ The Joint

Documentation Considerations

A preprinted form containing information regarding the risks and benefits of certain medical treatments and procedures may assist in facilitating proper documentation regarding the informed consent process, but the form alone is not sufficient. The Joint Commission standards for hospitals require that a properly executed informed consent document be placed in the medical record before surgery. A properly executed informed consent document is defined as one structured to "contain[ ]

Shared Decision-making

Patients have not only the right but the responsibility to participate in their care. Discussions regarding research activities, therapeutic modalities, and invasive procedures are a critical part of the plan of care and should occur as often as necessary between the patient and provider in order to achieve effective informed consent. Shared decision-making is a principle first discussed in 1982 and is founded on concepts of patient-centered care. ³ The informed consent model is an element of

Conclusion

NPs must understand the nuances of the informed consent process and engage all patients in shared decision-making. To effectuate the patient's right to direct what happens to his or her body NPs should assess all patients' understanding and consent regarding proposed interventions. Whether the medical care or treatment involves tasks as routine as medication administration or as complex as surgical intervention, the NP should determine whether the patient understands the need for and has agreed

Linda Farmer, MSN, ACNP-BC, is an acute care nurse practitioner at Meridian, MS. She can be reached at .

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O'Shea T. Consent in history, theory, and practice. The Essex Autonomy Project, Green Paper Report. University of...

A review of surgical informed consent: past, present, and future. a quest to help patients make better decisions

Doctors, patients, and lawyers-two centuries of health law

Centers for Medicare and Medicaid Services. Conditions for participation for hospitals. 2016....

There are more references available in the full text version of this article.

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Informed Consent: Ethical and Legal Considerations for Advanced Practice Nurses

# data[].attributes.attachment_link.description
The ethical principles of self-determination and autonomy govern the practice of . A patient's right to shared decision-making and assent prior to invasive procedures, therapeutic interventions, and research projects is protected by law. Foundational informed consent nursing roles of communication, education, and patient advocacy compel advance practice nurses to formulate methods that safeguard patients' rights.