Jana Cason

A blueprint for telerehabilitation guidelines.

Telerehabilitation refers to the delivery of rehabilitation services via information and communication technologies. Clinically, this term encompasses a range of rehabilitation and habilitation services that include assessment, monitoring, prevention, intervention, supervision, education, consultation, and counseling. Telerehabilitation has the capacity to provide service across the lifespan and across a continuum of care. Just as the services and providers of telerehabilitation are broad, so are the points of service, which may include health care settings, clinics, homes, schools, or community-based worksites. This document was developed collaboratively by members of the Telerehabilitation SIG of the American Telemedicine Association, with input and guidance from other practitioners in the field, strategic stakeholders, and ATA staff. Its purpose is to inform and assist practitioners in providing effective and safe services that are based on client needs, current empirical evidence, and available technologies. Telerehabilitation professionals, in conjunction with professional associations and other organizations are encouraged to use this document as a template for developing discipline-specific standards, guidelines, and practice requirements.

A Blueprint for Telerehabilitation Guidelines—October 2010

Committee Members Co-Chairs David Brennan, M.B.E., Senior Research Engineer, National Rehabilitation Hospital, Washington, District of Columbia. Lyn Tindall, Ph.D., Speech-Language Pathologist, Department of Veterans Affairs Medical Center, Lexington, Kentucky. Writing Committee Janet Brown, M.A., CCC-SLP, Director, Health Care Services, American Speech-Language-Hearing Association, Rockville, Maryland. Mike Campbell, M.S., M.B.A., CCC-SLP, Director of the Speech and Hearing Program, The University of North Carolina at Greensboro, Browns Summit, North Carolina. Jana Cason, D.H.S., OTR/L, Assistant Professor, Auerbach School of Occupational Therapy, Louisville, Kentucky. Diana Christiana, M.A.T., CCC-SLP, President/CEO, Clinical Communications, Sugar Land, TX. Alan Lee, Ph.D., P.T., D.P.T., C.W.S., G.C.S., Associate Professor, Mount St. Marys College, Doctor of Physical Therapy Program, Los Angeles, California. David R. Smith, Director, Telehealth Resource Center, Marquette General Hospital, Marquette, Mi...

Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services

Background: Early intervention (EI) services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC, 2011). EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community. Method: A survey sent by the National Early Childhood Technical Assistance Center (NECTAC) to IDEA Part C coordinators assessed their utilization of telehealth within states’ IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified. Results: Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9) indicated that they are either currently using telehealth as an adjunct service delivery model (n=6) or plan to incorporate telehealth within the next 1–2 years (n=3). Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH), speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for the implementation of telehealth as a delivery model within Part C programming included security issues (40%; n=11); privacy issues (44%; n=12); concerns about quality of services delivered via telehealth (40%; n=11); and lack of evidence to support the effectiveness of a telehealth service delivery model within IDEA Part C programming (3%; n=1). Reimbursement policy and billing processes and technology infrastructure were also identified as barriers impacting the implementation of telehealth programming. Conclusions: Provider shortages impact the quantity and quality of services available for children with disabilities and developmental delay, particularly in rural areas. While many states are incorporating telehealth within their Early Intervention (IDEA Part C) services in order to improve access and overcome personnel shortages, barriers persist. Policy development, education of stakeholders, research, utilization of secure and private delivery platforms, and advocacy may facilitate more widespread adoption of telehealth within IDEA Part C programs across the country.

Telerehabilitation: An Adjunct Service Delivery Model for Early Intervention Services

Early Intervention (EI) services for children birth through two years of age are mandated by Part C of the Individuals with Disabilities Education Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telerehabilitation has the potential to build capacity among caregivers and local providers as well as promote family-centered services through remote consultation. This article provides an overview of research related to telerehabilitation and early intervention services; discusses the feasibility of telerehabilitation within traditional EI service delivery models; examines telecommunications technology associated with telerehabilitation; and provides hypothetical case examples designed to illustrate potential applications of telerehabilitation in early intervention.

Telehealth Opportunities in Occupational Therapy Through the Affordable Care Act

Jana Cason, DHS, OTR/L, is Associate Professor, Auerbach School of Occupational Therapy, Spalding University, 845 South Third Street, Louisville, KY 40203; jcason@spalding.edu Occupational therapy practitioners and their clients are poised to benefit from the use of emerging technologies to deliver health and wellness, habilitation, and rehabilitation services across multiple practice settings. The Patient Protection and Affordable Care Act (ACA; 2010) defines a new direction for the U.S. health care system by transforming the current health care system to improve access, quality, efficiency, and transparency of health care services. These goals are addressed by employer incentives, expansion of public programs, premium and cost-sharing subsidies, health insurance exchanges, and coordinated care approaches such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). These aspects of the ACA may increase coverage and access to health care services for millions of Americans.

Telehealth Regulatory and Legal Considerations: Frequently Asked Questions

As telehealth gains momentum as a service delivery model in the United States within the rehabilitation professions, regulatory and legal questions arise. This article examines the following questions: Is there a need to secure licenses in two states (i.e., where the practitioner resides, and where the client is located), before engaging in telehealth? Do state laws differ concerning if and how telehealth can occur? Do any states expressly disallow telehealth? Can services delivered through telehealth be billed the same way as services provided in-person? If practitioners fulfill the requirements to maintain licensure (e.g., continuing education obligations) in their state of residence, do they also need to fulfill the requirements to maintain licensure for the state in which the client resides? Will professional malpractice insurance cover services delivered through telehealth? Does a sole practitioner need to abide by HIPAA regulations?Responses to these questions are offered to raise awareness of the regulatory and legal implications associated with the use of a telehealth service delivery model within the professions of occupational therapy, physical therapy, speech-language pathology and audiology.

Telehealth: A Rapidly Developing Service Delivery Model for Occupational Therapy

Over the past decade, the practice of occupational therapy has been increasingly influenced by technological advances in the use of information and communication technologies (ICT) and associated changes in health care policy. Emergent from this evolution is the application of telehealth to deliver occupational therapy services to a client who is in a different physical location than the provider. This article furnishes an overview of the evidence for telehealth use in occupational therapy, discusses key policy considerations, and provides resources to guide practitioners in the ethical use of telehealth.

Making the Case for Uniformity in Professional State Licensure Requirements

Telehealth, the use of communication and information technologies to deliver health services, was initially envisioned as a way for persons in rural or remote settings to receive otherwise unavailable healthcare services. Now, in addition to overcoming personnel shortages for underserved populations, telehealth shows promise in meeting the needs of a constantly mobile U.S. society and workforce. Fortunately, telerehabilitation can meet the needs of a mobile society and workforce by enabling continuity of care for individuals who are out-of-town, on vacation, in temporary residence as a university student, or on business travel. Unfortunately, outdated legislative and regulatory policies and inhospitable infrastructures currently stand in the way of a seamless continuum of care. In 2010, the American Telemedicine Association’s Telerehabilitation Special Interest Group (TR SIG) convened a License Portability Sub-Committee to explore ways to diminish barriers for state licensure portability with a particular focus on physical therapy, occupational therapy, speech therapy, and audiology. In 2011, the Subcommittee published a factsheet (1) that detailed the challenges and potential solutions that surround the difficult issue of licensure portability. Concurrently, the American Telemedicine Association is advocating for national reform of professional licensure. (2) At the heart of all licensure requirements is the ability to determine who should be granted the authority to practice in a particular profession. This is done by focusing on educational, examination and behavioral requirements that are deemed the minimum necessary to protect the public from harm. States, however, with whom authority for licensure of health professionals rests, have independently defined those minimum requirements. This approach has led to a myriad of requirements that vary from state to state. Licensure portability will best succeed when variability between licensure requirements is minimized and an efficient licensure process exists. In this paper, these two critical factors for licensure portability are referred to as “licensure requirements” and “the credentialing process.” Currently the variability between both of these factors is different between professions as well as between jurisdictions. To find the best solution to licensure portability, it is critical to determine which of these two elements create significant barriers for licensure mobility. This document outlines a method for the professions to begin collecting data to pinpoint the areas where agreement and variations exist in licensure requirements and processes between states. Such information will inform efforts towards uniformity.

Resolving barriers to licensure portability for telerehabilitation professionals.

Rehabilitation professionals (e.g., audiologists, occupational therapists, physical therapists, speech-language pathologists, etc.) can only engage in telerehabilitation in states in which they hold a professional license. The current state-based licensure and regulation of rehabilitation professionals does not facilitate the practice of telerehabilitation across state lines. Given today’s equipment capabilities and consumer adoption of the electronic delivery of many kinds of services, health care providers, including rehabilitation professionals, should be able to serve clients wherever they are needed.

Telehealth and Occupational Therapy: Integral to the Triple Aim of Health Care Reform

Programs and concepts included in the Patient Protection and Affordable Care Act of 2010 are expected to transform health care in the United States from a volume-based health system to a value-based health system with increased emphasis on prevention and health promotion. The Triple Aim, a framework set forth by the Institute for Healthcare Improvement, focuses on improving the health care experience, the health of populations, and the affordability of care. This article describes telehealth as an integral component in achieving the Triple Aim of health care and discusses implications for occupational therapy practitioners.