Occupational therapy outcomes achievable through telehealth include: facilitation of occupational performance participation in ADLs and IADLs health and wellness role competence well-being quality of life occupational justice
Studies have described the use of telehealth in areas that are of concern to occupational therapy, such as: evaluation and consultative services for cognitive screening orthopedic (hand) assessment lymphedema assessment wheelchair prescription home assessment adaptive equipment prescription and home modification ergonomic assessment
The following assessments to be reliable when administered remotely through telehealth: The Montreal Cognitive Assessment The Mini-Mental State Exam The Functional Reach Test and European Stroke Scale The Kohlman Evaluation of Living Skills Canadian Occupational Performance Measure The Timed Up and Go Test The FIM Jamar Dynamometer Preston Pinch Gauge Nine-Hole Peg Test Unified Parkinson's Disease Rating Scale The Ergonomic Assessment Tool for Arthritis
In some cases, an ____________, such as a caregiver or other health professional, may be used to relay assessment tool measurements or other measures (e.g., environmental, wheelchair and seating) to the remote therapist during the evaluation process. in- person assistant
When using a telehealth model for conducting an evaluation, occupational therapists must consider: the client's health care needs client's preference access to technology ability to measure outcomes
Practitioners should adhere to all __________ and requirements when administering assessments
If assessment materials or the administration protocol requires ____________ when used via telehealth, this should be documented and factored into the scoring and interpretation of the assessment copyright laws modification
certain requirements imposed by individual state regulations such as that a practitioner be physically located in the _________ as the client to use telehealth technologies denies access to services and specialists unavailable to the client same state
Similarly, a requirement that a client must first be seen _________ by the practitioner before receiving services via telehealth is not appropriate and should be determined by the practitioner based on clinical reasoning and ethical judgment in person
A telehealth model of service delivery may be used for providing interventions that are _________, _________, or __________ in nature preventative habilitative rehabilitative
In addition, teleconsultation may be used to conduct home safety and _____________, prevention and wellness services , _________ consultation, consultation for patients undergoing total hip and total knee replacement, and to facilitate support groups for people with ______________ home modification evaluations ergonomic chronic conditions
In the area of pediatrics, teleconsultation has been used to treat children with complex pediatric ___________, facilitate coordination and motor control in children with ______, support school-based services for children with complex medical needs, and provide occupation-based coaching for ________ of young children with autism feeding disorders CP caregivers
_____________, or remote patient monitoring (RPM), is commonly used in the medical model for chronic disease management and involves the transmission of a client's vital signs (e.g., blood pressure, heart rate, oxygen levels) and other health data (e.g., blood sugar levels, weight, ADL performance, fall events) for review by a clinician to assure more timely monitoring.
This type of monitoring can prevent health crises, emergency department use, and __________ and can promote health and wellness. telemonitoring hospitalization
It is the professional and ethical responsibility of occupational therapy practitioners to provide services only within each practitioner's level of __________ and ___________ competence scope of practice
Due to the intimate nature of some occupational therapy services (e.g., interventions related to dressing, bathing, toileting), special consideration should be made to avoid _______ of the client on camera in an undressed or otherwise compromised state exposure
American Telemedicine Association's "_________________" outlines important administrative, clinical, technical, and ethical principles associated with the use of telehealth principles in delivering telerehabilitation services
Practitioners should have a working knowledge of the _________-, software, and other elements of the technology they are using and have technical support personnel available should problems arise hardware
Telehealth may be used while adhering to ______________ guidelines to support students and practitioners working in isolated or rural area Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services, OT Code of Ethics
Factors that may affect the model of supervision and frequency of supervision include the complexity of __________, number and diversity of clients, __________ of the occupational therapist and the occupational therapy assistant, type of ___________, requirements of the practice setting, and other regulatory requirements client needs skills practice setting
Occupational therapy practitioners are to abide by ____________ and related occupational therapy regulations regarding the use of a telehealth service delivery model within occupational therapy state licensure laws
______ does not list occupational therapy practitioners as eligible providers of services delivered through telehealth. However, AOTA supports the inclusion of occupational therapy practitioners on Medicare's approved list of telehealth providers.
The U.S. Department of Defense and Veteran's Health Administration uses __________ to provide occupational therapy services as well as other telehealth programming medicare telehealth
There is a mechanism for licensure portability through a federal rule for practitioners providing services to ________. veterans
When billing occupational therapy services provided by means of telehealth, practitioners may be required to distinguish the ______________, sometimes designated with a modifier service delivery model
Opportunities for reimbursement exist through some state _________ programs; _________ companies; school districts; and ________ with individuals, agencies, and organizations. It is recommended that occupational therapy practitioners contact their state Medicaid agency or other medicaid insurance private pay
____________ technologies enable the exchange of health information in real time (i.e., live) by interactive audio and video between the patient or client and a health care provider located at a distant site
--> Software features commonly used with telehealth include screen sharing, onscreen annotation, and text chat, remote control of the client's camera to allow the occupational therapy practitioner to change the camera angle or to "zoom in" as needed synchronous
Occupational therapy practitioners using telehealth as a service delivery model must adhere to all standards and requirements for practice, including the Occupational Therapy ____________, maintain the ____________ for Occupational Therapy, and comply with federal and state regulations to ensure their competencies as practitioners and the well-being of their clients code of ethics standards of practice
What are advantages to synchronous ICT? service provision within the context where occupations naturally occur (e.g., home, work, community), minimal infrastructure requirements, and lower costs for equipment and connectivity (e.g., residential service plan, data plan)
What are disadvantages to synchronous ICT? privacy, security, and confidentiality risks; lack of infrastructure (e.g., limited access to high-speed Internet/broadband; inadequate bandwidth for connectivity) recurring expense (e.g., residential service plan, data plan) diminished sound or image quality; and technological challenges associated with end-user experience and expertise with videoconferencing technology
Telehealth applications that are _________, commonly referred to as store-and-forward data transmission, may include video clips, digital images, virtual technologies, and other forms of electronic communications --> the provider and client are not connected at the same time asynchronous
Occupational therapy practitioners providing services through telehealth technologies can take advantage of digital or _______ (mobile health) devices --> These include wearable devices (e.g., Apple Watch, Fitbit) and home devices (e.g., AMC Healthcare Console) that enable occupational therapy practitioners to monitor and subsequently provide services within varied environments mhealth
Telemonitoring technologies also enable occupational therapy practitioners to understand the real-life ________ and _____________ of the client and to plan appropriate interventions. occuaptions performance challenges
_____________ detect and respond to input or stimuli from an individual or the physical environment. --> some digital or mhealth devices (e.g., wearable devices), gaming systems, virtual reality (VR), augmented reality, the Internet of things, and sensor driven environmental and personal assistant technologies sensory technologies
Although typical use of sensor technologies does not constitute a telehealth service delivery model, live data (_________) streamed to a remote occupational therapy practitioner or recorded data (__________) used by an occupational therapy practitioner to monitor and adjust a client's course of treatment would constitute the use of sensor technologies within a telehealth service delivery model. synchronous asynchronous
______ typically refers to the use of interactive simulations created with computer hardware and software to present users with opportunities to engage in environments that appear and feel similar to real-world objects and events. VR
Practitioners can use sensor technologies within a telehealth service delivery model when providing interventions, ______________, or consulting in setting up a "__________" to increase independence and performance within various contexts home exercise programs smart home
What are examples of synchronous technology? Videoconferencing software for health care (e.g., Vsee, Zoom, Doxy.Me) - Consumer high-definition television videoconferencing - Telephone/POTS - Telehealth network with commercial videoconferencing system - Sensor technologies (with live-streaming data to remote practitioner)
When can VR be used? conducting evaluations and providing interventions. - stroke rehabilitation - assessment for client's with traumatic brain injury using virtual environments - training of users of power wheelchairs - rehabilitation for clients with Parkinson's disease and hand injuries
Low-cost _______________ (e.g., Nintendo Switch, Sony PlayStation MOVE and PlayStation Virtual Reality Platform) were not developed specifically for rehabilitation, but they offer an easy-to-setup, fun, and less-expensive alternative to the expensive VR systems. video capture gaming systems
Although typical use of ____________ does not constitute telehealth, live data (synchronous) streamed to a remote occupational therapy practitioner or recorded data (asynchronous) used by a practitioner to monitor and adjust a client's course of treatment would constitute a telehealth application of the devices. gaming systems
What are considerations of synchronous technology? Confidentiality (security, privacy) - Integrity (information protected from changes by unauthorized users) - Availability (information, services) - Cost-benefit ratio - Socioeconomic considerations - Leveraging existing infrastructure (equipment and personnel) - Technology connection requirements (e.g., broadband, T1 line) - Sound and image quality - Equipment accessibilit
What are examples of asynchronous technology? - Mobile messaging - Data from wearables or remote patient-monitoring devices - Digital images, videos, or files - Sensor technologies (with store-and-forward data to remote practitioner)
Occupational therapy practitioners should complete the following steps prior to implementing telehealth: Examine state telehealth laws and regulations that may affect the delivery of services using ICT - Explore the state occupational therapy practice act and state occupational therapy board's website for additional guidance on the use of telehealth to deliver occupational therapy services within the state - Inquire from the payer source about telehealth reimbursement and coding requirements - Confirm with malpractice insurance carrier that malpractice policy provides same coverage for services provided through ICT.
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