A Guide to Telehealth in Private Practice:

What is Telehealth?

In addition to being an excellent way for clinicians to expand their practice, Telehealth allows providers and clients to meet through live, synchronous video chat over the internet.

With Telehealth by SimplePracticeTM, you can interact with your clients remotely using any device equipped with a webcam. It’s simple to schedule appointments, conduct sessions, communicate with clients, and keep records from a single, easy-to-use platform.

TABLE OF CONTENTS

1. Getting Started
2. What to Do Before a Session
3. Conducting a Telehealth Session
4. Documenting Telehealth Services
5. Spreading the Word

PART 1

Getting Started

Know the rules

Considerable resources are available to alleviate your fears about licensing, legality, insurance, technology, training, and the other inevitable questions you may have. Specifically, get familiar with the free and easily accessible resources you can use right now like The Telehealth Resource Center, a government-funded center designed to increase the usage of Telehealth. Additional resources might be available from your licensing body and any of your affiliated professional societies.

Stay up-to-date on Telehealth laws:

• Familiarize yourself with whether your state has a parity law covering telemedicine by visiting the American Telemedicine Association (ATA)’s State Policy Center and The Center for Connected Health Policy’s (CCHP).
• Visit the Medicare Telehealth Payment Eligibility Analyzer to see what you can expect in terms of reimbursement.
• Check out our webinar on billing insurance for Telehealth here.

Is Telehealth HIPAA Compliant?

FaceTime, Skype, and other similar systems do not meet HIPAA’s standard. Telehealth by SimplePracticeTM is 100% HIPAA compliant. With SimplePractice, you can be certain that your sessions, notes, and communication are protected by HIPAAcompliant
technology.

Benefits of Telehealth

One benefit of offering video visits is that you can technically do them from anywhere, as long as you’re in a quiet, secure, and private space that complies with HIPAA guidelines. However, it’s best to have a dedicated space. This space should be free from distractions and clutter and private enough that others won’t be able to hear you discussing sensitive client information.

Some ways to prevent potential distractions include: silencing your cell phone,
confining a loud pet in another room, putting a note on your doorbell to prevent solicitors, notifying any staff members not to enter your office, closing all apps and social media, and anything else that may prevent you from providing the best possible care to your clients.

Dress professionally

Dress professionally as you would for any appointment so the client feels that a video visit is no less professional than a face-to-face appointment.

Prepare lighting

Proper lighting is also essential. Don’t sit with your back to any light source, including natural light like the sun. Instead, it helps to face the light source, which should be in front of you. If you do need to use a lamp or other artificial light, again make sure to place the lamp in front of you.

We find that LED bulbs tend to work best as an artificial light source, but take the time to test the artificial and natural sun lighting in a few different settings. During your testing, check your webcam to make sure your entire face is illuminated onscreen. This may require adjusting where you sit or setting up additional lighting.

Do: Good eye contact, professional clothing,soft light source in front, neutral wall color.

Don’t: No eye contact, casual clothing, light source behind person, in a public space.

Obtaining client consent

Before the session, determine what the policies and requirements are for your state regarding consent. The Center for Connected Health Policy (CCHP) and the American Telemedicine Association (ATA) provide overviews of current state policies.

Most states require clinicians to obtain some form of informed consent. Usually “informed” means educating the client about the possible risks of Telehealth, possible benefits of Telehealth, and alternatives to Telehealth.
You will also need to go over a client’s rights in regards to Telehealth, specifically the right to end treatment at any point.

NOTE: Written consent is standard of care. You can also obtain consent by sending the ready-to-go Telehealth consent template in SimplePractice to your client through the Client Portal. As a best practice, please review any signed documents.

SCRIPT: OBTAINING CONSENT

You: There are some potential risks to this technology, including connection failures, unauthorized access, and general technological hiccups. Computers, tablets, cell phones, web cameras, microphones, etc. can create problems if they don’t work as expected.

There are also many potential benefits. For example, you saved time and travel costs by not having to drive to my office. Based on the risks and benefits I just described, you have the option to discontinue this or any future Telehealth appointment at any time. If that is the case today, or at any point during treatment, let me know so we can make other arrangements.

Client: Okay.

You: Before we proceed, I need to get your [verbal] consent for the use of Telehealth as an acceptable mode of delivering services. Do I have your consent?

Client: Yes, I consent.

Conducting a Telehealth Session

This section covers some common state Telehealth
requirements. To help new providers feel confident and prepared for and during each session, we also included some sample language you can use to meet these requirements. Plus, we created a helpful checklist to use in your next video session.

1. Schedule through SimplePractice
   After your client has completed their intake paperwork in the Client Portal, send the link to join the Telehealth session.
   
2. Go over insurance
   At the first session, communicate to the client the information you received from their insurance company so there are no surprises.
   
3. Ask your client to “attest” to their location
   You will need clients to “attest” to their current location, and you should document this for each session.

4. Confirm client is a safe, private space
   Audio should only be loud enough so the client can be easily heard, but not loud enough that people outside the room can overhear it. There may be some cases where it’s advantageous to use headphones. A safe, private space is an important detail to keep the client’s protected health information secure. few seconds
   throughout the session. This is only to take a brief note. It doesn’t mean I’m not listening.

You: Before we continue, I want to confirm you are in a safe, private location. This is very important because I want you to be able to speak openly without having to worry that someone else is listening. Do you feel like you have enough privacy where you’re located?

5. Go over your process
   If you plan to type or handwrite notes during the session, mention this to prevent the client from thinking you are not listening.

You: You may see me look away for a few seconds throughout the session. This is only to take a brief note. It doesn’t mean I’m not listening.

6. Have a back-up plan
   Clients should be aware of what steps to take if the connection fails. Usually, the clinician and client will agree to connect by telephone if this happens.

You: I have (333) 333-3333 as your current phone number.
Is that the best number to reach you at today if we encounter connection problems?

7. Have a safety/emergency plan
   According to the Washington State Telehealth Implementation Guidebook, a safety plan is a documented process of specific steps to be followed during emergencies. It should outline exactly what will
   happen in the event of an unexpected or emergency situation.
   
   A safety plan should also identify and document the client’s physical location, emergency contact, and local police and hospital addresses and phone numbers. This information will be required if emergency services are needed. You can collect this information via the SimplePractice Client Portal, so you always have it on hand.

You: Now let’s review the safety plan in case there is an emergency. I asked you to list a person who you would like me to call in the event of an emergency. You listed [NAME] at (333) 333-3333. Is this still the person you would like me to contact? You also listed the phone number of your local police and the nearest hospital. Based on your current location at [1234 Street, City, ST], is this still true?

To address this moving forward, you can ask in the following sessions,

You: Are there any changes to your safety plan information?

PART 4

Documenting Telehealth Services

Telehealth sessions should be documented using the same
standard as if the client had been seen face-to-face. However, there are some additional things you will want to include:

1. Client’s location
2. Client’s continued agreement and satisfaction with the use of the chosen technology
3. Any technical problems that occurred during the session

The example to the right is a progress note template. Use it to begin your notes for a video appointment.

TIP: You might find it helpful to copy and paste this into your standard progress notes template in SimplePractice.

Check with an informed, local attorney who specializes in Telehealth and your licensing body to verify that all aspects of your practice are in compliance with state law.

PART 5

Spreading the Word

When it comes to marketing Telehealth to your clients, human interaction is key—make sure you are prepared to promote this feature in all communication channels. Here are some tips:

• Send clients this recruitment letter to let them know that Telehealth is now an
option.

• Download and share these Telehealth graphics for your practice from the
SimplePractice blog.

• Promote Telehealth as an option for clients on your website, in your practice
newsletter, via email, and on your social media page.

• If clients call to book or reschedule appointments, offer Telehealth as an
alternative.

• Ask current clients if they would be interested in trying Telehealth for their
next session.

• Put up signs in your waiting room to encourage people to ask about using
Telehealth.

• Make sure online booking is enabled so clients can select that option when
making an appointment.