key: cord-0957599-fm09mmpi
authors: Bingham, Jennifer M.; Rossi, Marvin A.; Truong, Hoai-An
title: Developing and Applying a Telehealth Readiness Assessment Tool for Training Students Beyond the Pandemic
date: 2022-04-26
journal: J Am Pharm Assoc (2003)
DOI: 10.1016/j.japh.2022.04.016
sha: 25a08b704be8beccbb6c4b4511390f256ae54ad5
doc_id: 957599
cord_uid: fm09mmpi

Immediate public health interventions and solutions, including the virtual provision of patient care via telehealth, were exponentially employed in response to the COVID-19 pandemic. In response, the United States Department of Health and Human Services temporarily waived Medicare telehealth restrictions. Dramatic increases in the provision of care via telehealth were observed, beginning in March 2020. Yet, despite these changes, there was a deficit in relevant telehealth readiness assessment, resources, and training that incorporated critical elements brought forth by the pandemic. This article describes the need for and provides a telehealth readiness assessment tool as a digital health strategy for health professional students, clinicians, and organizations to be prepared for patient care engagement during and beyond the pandemic.

The COVID-19 pandemic greatly accelerated the provision and application of telehealth services that have been used in practice since the late 1950's. 1 At the onset of the pandemic, the provision of healthcare using telecommunication technology was promised to expand access to care, reduce patient and staff exposure to contagions, and reduce patient demand on health care facilities. 2 On March 6, 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. 3 In response, exponential increases in the use of telehealth were observed and telehealth restrictions were waived by the United States Department of Health provided under Section 1135 of the Social Security Act, incentivized the use of telehealth and allowed qualified providers to use telephones with audio-visual, real-time interactive communication capability; 5 as smartphones, tablets, and computers were deemed permissible with the Health Insurance Portability and Accountability Act (HIPAA) enforcement waiver. 2 The rapid switch to telehealth services contributed to positive and negative impacts regarding access for older adults, individuals with disabilities, and people living in underserved and rural areas.

The pandemic further highlighted health disparities to healthcare access and suddenly required practitioners to develop strategies to overcome barriers, including technology and broadband internet access. 6, 7 By the last week of March 2020, the Centers for Disease Prevention and Control (CDC) reported a substantial increase in the use of telehealth modalities for that week compared to the year prior. 8 As a result, the Telehealth Resource Centers announced their support of evidencebased projects as the nation shifted to telehealth and increased flexibilities in telehealth requirements continued to occur. 1 Whereas telehealth readiness tools have been shown to identify areas for improvement and deficiencies for organizations prior to telehealth implementation, 9 the urgency of the pandemic did not allow for advanced planning and resulted in a lack of telehealth readiness or the extent to which a healthcare practitioners, students, and organizations could preemptively train and prepare to participate in telehealth. 10

Prior to the pandemic, interprofessional care teams have demonstrated that telehealth has the potential to improve patient quality outcomes 11 , medication-related problems, 12 and hospital readmissions. 13 Telehealth during the pandemic, as a modality of care, was reviewed in detail by J o u r n a l P r e -p r o o f the National Committee for Quality Assurance's Taskforce on Telehealth Policy. Patient safety improved during the pandemic through telehealth as it reduced patient and practitioner exposure to contagions. 2 Telehealth also reduced the rate of no-show visits, which further reduced the potential risk of disrupted patient-provider relationships associated with greater use of high levels of care and interrupted pharmacotherapy. 14 Preliminary findings describe that telehealth contributed to better appointment attendance, improved chronic disease management, and better patient adherence to their care plan. 2 Amid dramatic increases in the provision of care via telehealth, 15 the pandemic suddenly required pharmacists, physicians, and advanced practice providers (APP) to develop strategies for organizing and managing an influx of telehealth-eligible patients previously challenged by long distances, language barriers, socio-economic status, and co-morbidities impeding access to adequate healthcare. Many clinicians found themselves unprepared for virtual provision of care.

Though tools for organizations previously existed to assist with preparation and identify opportunities and potential deficiencies, for many, the urgency of the COVID-19 response precluded carefully planned readiness process execution.

Consequently, as COVID-19 response and recovery efforts continue, it is important to revisit the value of advanced planning and telehealth readiness to supplement the professional student learning experience as healthcare professional curricula present critical opportunities for telehealth training as a digital health strategy. For example, prior to 2020, telehealth in neurology, with the exception of telestroke, was not widely available and was considered a nascent technique for delivering healthcare. 16 In the 2017-2018 academic year, 85 of 147 medical J o u r n a l P r e -p r o o f schools in the U.S. offered telehealth education, either through required or elective courses. 17 Waseh and colleagues showed that only 40% of 17 sampled medical schools across the U.S. have incorporated telehealth competencies with some form of interprofessional training. 18 Moreover, just over half of the sampled schools combined non-standardized telehealth competencies incorporating rural medicine in some form. 18 A dearth of training was also observed in pharmacy curricula, and didactic education on verbal and nonverbal communication modalities via telehealth is not an accreditation requirement. 19 Telehealth exposure during undergraduate medical clerkships and graduate education across specialties is essential for practitioners. Experiential training provides opportunities to incorporate pertinent virtual clinical examination skills, mobile health devices, and remote patient monitoring (e.g., blood pressure cuffs, stethoscopes, blood glucose meters). Given the deficit in graduate medical education on telehealth training, a longitudinal curriculum has been proposed to address this need. 20 Additionally, more programs must adopt preclinical curricula to include virtual health integration as there is a critical need for digital and/or telehealth in professional healthcare training. 21 The COVID-19 pandemic further demonstrates the need for telehealth readiness assessment tools and training as our healthcare ecosystem continues to evolve and the majority of pharmacist initiatives are now related to patient education, medication delivery, and virtual consultations. 2 The International Pharmaceutical Federation has reported a deficit of formalized training within digital health. As telehealth is only one aspect within the larger digital health universe, education and preparedness will be key for students to successfully adopt and promote new technologies as they enter practice.

Looking beyond the pandemic, practitioner telehealth readiness assessment and training can be applied in healthcare professional curricula to better prepare students to succeed when inperson care is not possible. Expanding on the application of the telehealth readiness model, a self-assessment checklist that is reflective of the current healthcare ecosystem could be utilized by healthcare professional students, clinicians, and organizations to complement telehealth competency and development protocols provided by others. 20, 22 Telehealth readiness assessment tools exist for organizations aiming to implement services; 23 ,24 yet, few have been developed with the knowledge gained post-pandemic to ensure preparedness for the provision of patient care via telehealth. In alignment with other competency tools created for medical education, 20, 22 we have included domains in Table 1 that could further enable students, clinicians, and organizations to self-assess for the following considerations: 

Despite the steep rising slope in the use of telehealth and expanded opportunities in the broader scope of digital health, there are limitations in readiness assessment and advanced training programs available to healthcare professionals and organizations to prepare them for the virtual delivery of care. While there is some educational programming available for physicians, pharmacists, students, and APPs, standardization is lacking; there is a readiness assessment gap J o u r n a l P r e -p r o o f in professional instruction and a clear national need for cross-professional digital and telehealth competencies and training to address this opportunity, overcome barriers set forth by the pandemic, and enhance virtual patient care. Furthermore, as federal, state, and local legislators are incrementally addressing licensure requirements, liability challenges, and reimbursement strategies, it is imperative that medical, pharmacy, and healthcare educational programs develop and integrate digital and telehealth into the curricula for both didactic and experiential/clinical education.

While it may be a challenge to add new curricular content, digital and telehealth should be incorporated as a standard of patient care. These programs can accelerate deployment of evolving telehealth practices and technologies by equipping future pharmacists, physicians, and APP with the sophistication necessary to practice and deliver healthcare for all populations in this rapidly changing healthcare landscape. Equally important, there should be continuing professional development opportunities, including continuing education programs and training for pharmacists, physicians, and APPs to be fully equipped for patients during future disasters and emergencies. A telehealth readiness assessment tool can provide an identified baseline need for individuals and organizations to develop and implement appropriate and relevant telehealth training programs.

In summary, COVID-19 accelerated a digital transformation. This global crisis underscored the importance of overcoming the unequitable digital divide to ensure timely access to healthcare. Thus, health care curricula and continuing professional development across all specialties must be developed and propagated, as the demand for virtual care will only increase in the foreseeable future beyond the pandemic.

J o u r n a l P r e -p r o o f

Taskforce on Telehealth Policy Findings and Recommendations

Coronavirus Aid, Relief, and Economic Security Act or the CARES Act

World Health Organization. Coronavirus Disease (COVID-19) Pandemic

1135 Waivers

COVID-19, and disparities: Policy implications

Disparities in Technology and Broadband Internet Access Across Rurality: Implications for Health and Education. Fam Community Health

Centers for Disease Control and Prevention. Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic -United States

Preparing for success: readiness models for rural telehealth

Integrating telehealth into Aboriginal healthcare: the Canadian experience

Assessing the Effect of a Telepharmacist's Recommendations During an Integrated, Interprofessional Telehealth Appointment and Their Alignment with Quality Measures

Initial Assessment of an Interprofessional Team-delivered Telehealth Program for Patients with Epilepsy

Evaluation of the Discharge Companion Program: An Interprofessional Transitions of Care Program. Presented, in part

Virtual Visits and the Future of No-Shows

Medicare Telemedicine Health Care Provider Fact Sheet

Telemedicine in neurology: Telemedicine Work Group of the American Academy of Neurology update

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Telemedicine and Medical Education in the Age of COVID

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Telehealth Competencies Across the Learning Continuum

The telehealth skills, training, and implementation project: an evaluation protocol

Telehealth Readiness Assessment Tool from the Maryland Health Care Commission

Telehealth readiness assessment tools

(1) Incorporate telehealth readiness into strategic and business plan (2) Identify key stakeholders, including local and state organizations (3) Determine baseline healthcare disparities for the community (4) Evaluate baseline relevance and urgency of the practitioner's competence and contributions via telehealth 26-50%: Practitioner has developed telehealth readiness plans and completed steps (1) to (4) above Next steps: (5) Evaluate strategic and business plan for telehealth implementation (6) Collaborate with key stakeholders, including local and state organizations (7) Assess supply and access to telehealth platforms and equipment (8) Participate and complete continuing professional development specific to telehealth (9) Identify workflow protocols and policies for telehealth implementation 51-75%: Practitioner has partially achieved readiness and completed steps (5) to (9) above Next steps: (10) Implement telehealth workflow and protocols (11) Conduct business impact and continuity analyses for reimbursement sustainability (12) J o u r n a l P r e -p r o o f