Telehealth, Teleconsultation and Virtual Coaching Resources

  • Program-Specific Guidance
    Child Care Health Consultation
    Early Intervention
    Virtual Coaching
    Home Visitation
  • Technology Supports
    Federal Communications Commission’s Keep Americans Connected Pledge
    • The FCC Chairman called on all broadband and telephone service providers to promote connectivity for Americans impacted by the disruptions caused by the coronavirus pandemic. 

    Service Providers
    • Comcast’s Internet Essentials Program. Comcast’s is offering low-cost internet and two months of free internet in response to COVID-19. Even households with outstanding debt owed to Comcast will be eligible for the program as long as approval is received by May 13, 2020. To sign up, applicants can visit www.internetessentials.com (video chat available with customer service agents in American Sign Language) or call 1-855-846- 8376 [English] / 1-855-765-6995 [Spanish]. 
    • Xfinity Nationwide WiFi Hotspot Access.  Go to http://wifi.xfinity.com/#find-a- hotspot to find a hotspot near you. 
    • CenturyLink’s COVID-19 Response. For the next 60 days, CenturyLink is committed to waiving late fees and not terminating a residential or small business customer’s service due to financial circumstances associated with COVID-19. They are also suspending data usage limits for consumer customers during this time period due to COVID-19. 

    Other Supports
    • EveryoneOn offers  a search engine by zip code that helps families identify low-cost internet options, computers, etc. near them. This website is also available in Spanish. Check it out at www.everyoneon.org. 
    • PCs for People offers eligible families and tax-exempt 501(c)3 organizations with computers, computer repair, internet services and learning resources. To learn more visit https://www.pcsforpeople.org/. 
    • Lifeline is a federal program that lowers the monthly cost of either phone or internet services. Due to COVID-19, Lifeline has temporarily waived usage requirements and general de-enrollment procedures until May 29, 2020. To get Lifeline, find a company near you. 

     

  • HIPPA Requirements for Telehealth

    Visit HHS.gov for more information. For a printable version, click HERE.
     

    Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency

    The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) is responsible for enforcing certain regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act, to protect the privacy and security of protected health information, namely the HIPAA Privacy, Security and Breach Notification Rules (the HIPAA Rules). 

    During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies.  Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules. 

    OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.  This notification is effective immediately. 

    A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients.  OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency.  This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.

    For example, a covered health care provider in the exercise of their professional judgement may request to examine a patient exhibiting COVID- 19 symptoms, using a video chat application connecting the provider’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation.  Likewise, a covered health care provider may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions. 

    Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.  Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. 

    Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers.

    Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products.  The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA.

    • Skype for Business / Microsoft Teams
    • Updox
    • VSee
    • Zoom for Healthcare
    • Doxy.me
    • Google G Suite Hangouts Meet
    • Cisco Webex Meetings / Webex Teams
    • Amazon Chime
    • GoToMeeting
    • Spruce Health Care Messenger


    Note: OCR has not reviewed the BAAs offered by these vendors, and this list does not constitute an endorsement, certification, or recommendation of specific technology, software, applications, or products. There may be other technology vendors that offer HIPAA-compliant video communication products that will enter into a HIPAA BAA with a covered entity.  Further, OCR does not endorse any of the applications that allow for video chats listed above.

    Under this Notice, however, OCR will not impose penalties against covered health care providers for the lack of a BAA with video communication vendors or any other noncompliance with the HIPAA Rules that relates to the good faith provision of telehealth services during the COVID-19 nationwide public health emergency. 

    OCR has published a bulletin advising covered entities of further flexibilities available to them as well as obligations that remain in effect under HIPAA as they respond to crises or emergencies at https://www.hhs.gov/sites/default/files/february-2020-hipaa-and-novel-coronavirus.pdf - PDF.

    Guidance on BAAs, including sample BAA provisions, is available at https://www.hhs.gov/hipaa/for-professionals/covered-entities/sample-business-associate-agreement-provisions/index.html.

    Additional information about HIPAA Security Rule safeguards is available at https://www.hhs.gov/hipaa/for-professionals/security/guidance/index.html.

    HealthIT.gov has technical assistance on telehealth at https://www.healthit.gov/telehealth.

    • Cyber Security Tips

      Cyber Security

      Cyber threats and associated malicious acts through phishing, ransomware, malware, and hacking are geared toward tricking the unsuspecting user and acquiring access to their work computer and/or personal information. Attackers are expected to try to take advantage of employees working from home and will be attempting to trick them into taking actions (clicking links, phishing, responding to request) intended to hack your information. Now is the time to be vigilant and protect your information. 

      • Be even more vigilant and skeptical of unsolicited email and watch for phishing attacks.
      • Be wary when opening emails and do not click on links from people you do not know.
      • Do not provide agency or personal information in response to an email, pop-up webpage, or other communication you did not initiate.

      General Security
      • Make sure that the information on your screen is not visible by others in your home and lock your computer when you walk away from it.
      • Similarly, ensure that work discussions cannot be easily heard by others in your home (i.e. shut the door). Use a headset, if available, rather than speakerphone.
      • Do not allow others, including family members or roommates, to use your work computer.
      • Avoid using public computers and/or public wi-fi to access, process, store, or transmit data.
      • Do not permit others to have access to sensitive or confidential work information, e.g. computer or hard copy.
      • Store records at home in a secure manner, a private, closed, and locked place if possible, i.e. locked cabinet.
      • If transporting documents from your work location, do not leave documents visible and/or accessible in your vehicle. Lock them in your trunk if you must make a stop between your office and your home.  Treat them as you would a laptop.
      • Do not share work passwords with others in your household.
      • Use complex password or an easy-to-remember passphrase.
      • When transporting your laptop from your work location to a remote location, do not leave it visible and accessible in your vehicle. Lock it in your trunk if you must make a stop between your office and your home.
      • Conduct virtual visits that ensure privacy of the participant.  Find a secure location in your home where you will not be interrupted or allow others at home to see or hear your visit.
    Resources have been identified to guide programs and professionals as they implement new service delivery models utilizing available technology.

    The following best practices were identified by Child Trends. 

    Research-supported technological outreach strategies:
    • Video calls. Many states are allowing providers to use video calls to parents to address families’ needs for support. Parents as Teachers has partnered with the University of Southern California to test the use of video calls to offer home visiting services; preliminary research shows high rates of parent satisfaction. While video calls are a great way to reach families, not all families will be able to take advantage, and providers can support families through other means.
    • Texting and messaging apps. Telehealth may also include providing supports using texting or messaging services, and some research finds that these technologies enhance the effectiveness of programs. 
    • Online content. Telehealth may also involve providing relevant information online. Some parenting programs that typically offer information to parents in a group-based setting have offered online versions of their programs to reduce barriers to access, finding that outcomes were the same for in-person and web participation. Programs that use online content for parents have found that online versions of parent support can improve outcomes for families and for children. Parent engagement with online content can be strengthened when providers check in with parents about the content and reinforce ideas.

    Providers may need to adjust typical service delivery strategies to best recognize and meet the needs of families. For example:
    • Families and providers need technology support. When using video conferencing, technology glitches may affect the quality of interactions with families. Programs should provide support to both staff and parents to troubleshoot problems. Not all families will have regular access to web-supported devices for virtual visits (although some providers are offering open access to wifi during the crisis), so programs should provide a range of telehealth support.
    • Providers must be even more attentive to privacy concerns than usual during virtual visits, particularly around challenging topics such as depression or intimate partner violence. For example, a parent’s risk is potentially amplified given that they or other family members may be in close contact with an abuser who is also practicing social distancing. Providers must be able to communicate with other practitioners who have expertise in these difficult topics and can provide additional services to families—both of which can be done remotely.

    While the field is learning how to best implement telehealth, programs can also adapt strategies from traditional home visiting as they move to virtual visits during the COVID-19 crisis.
    • Good communication skills remain important to engage with families. To communicate well using video, providers should set up equipment to allow eye contact with the family to strengthen rapport. They should minimize distractions such as background noise and think carefully about what is in their background (for example, choose a blank wall as a backdrop).
    • Support to parents extends beyond the home visit. Programs can text to check in on parents or reinforce content between meetings. Texting to support parents can increase their overall engagement in the program.
    • It’s important to create day and time boundaries for communication with families. Since telehealth technology is available around the clock, providers must be supported by programs to clearly set expectations and boundaries when they engage with families.