1. A home health care agency may provide telehomecare visits to accomplish and/or enhance patient care under circumstances when "hands-on care" is not required.
2. A physician order to integrate telehomecare into the plan of care must be obtained.
3. Video visits may be provided by RNs, social workers, LPNs, physical therapists, speech therapists, occupational therapists, nutritionists, physicians and/or nurse practitioners or others within the pre-existing scope of practice for that category o f practitioner.
4. The agency personnel providing telehomecare must document each video visit in the patient's chart.
5. All telehomecare providers listed in item #3 above must be trained and demonstrate the ability to do video visits on the technology being used by the agency.
6. In case of equipment failure an in person visit should be scheduled as soon as possible to assure adherence to plan of care.
7. The staff should demonstrate the ability to correctly use the technology and troubleshoot common problems and should have written troubleshooting guidelines to follow and a method for follow-up if problems are not quickly resolved.
8. Each state will decide if they will allow "across state line video visits".
9. Changes in video visit frequency are to be treated like changes in other parts of the plan of treatment and should be approved by the physician.
10. Agencies must provide clearly written information to patients regarding use of the equipment, in addition to in person training provided at the onset of telehomecare.
11. Patients must be given clear written instructions as to who to call in case problems arise. Patients need to be regularly informed in writing of the difference between using telehomecare and an emergency medical response system to avoid a potenti al delay in need for "911"emergency care.
12. Agencies should provide a plan of action to provide unscheduled video visits (supervisors or other staff in the office should be available if the patient case manager is absent).
13. Video visits can be incorporated into critical pathways.
14. If twenty-four hour telehomecare service is available, agencies must provide written instruction for patients to contact after-hours care providers.
15. After hours video visits coverage could be accomplished by a) on-call or after hours staff, b) call center staff, or c) emergency room staff. Arrangements for this application could be done through a remote central location.

Technology Criteria

1. The technology used should be based on the patient's clinical and functional needs. Based upon the clinical needs of the patient, many components may be included such as: a) two way interactive video, b) telephonic stethoscope, c) blood pressure a nd pulse. Other optional equipment may include oximetry, EKG, glucose meter, other medical devises, Internet capabilities, etc.
2. The equipment based at the central station should include a log-in code and password to maintain patient privacy and record security.
3. Upon installation, the telehomecare equipment should be checked for accuracy against standard devises.
4. Procedures must be written and in place to clean and maintain equipment (per agency health and safety codes and infection control standards) at installation, while in the patient's home, and on return to agency.
5. Installation kits should be developed with written instruction for the staff and should include supplies needed to assure best picture quality, e.g., small table lamp if necessary and extension cords. Supplies will be according to site and technol ogy chosen.
6. Safety instructions should be given to patients and reviewed on installation and at future times as necessary.
7. Instructions on whom to call for patient questions and concerns regarding equipment must be provided to patients and agency staff.