Secure HIPAA Compliant Telehealth

Introduction to Secure HIPAA Compliant Telehealth

Medical professionals have had to adapt to social distancing with the help of proven and new technologies. Due to the unexpected and escalated timeline of necessary adaptation, many professionals are still uncertain about proper protocol, which formats of Telehealth such as audio-only or live videoconference, to use for what services, and how exactly to have secure HIPAA compliant Telehealth while providing the necessary clinical services and healthcare connections.

It is essential to explore the differences between telehealth services and telemedicine. While there is some significant overlap, telemedicine strictly involves remote clinical services. (1) Telehealth covers a lot more ground and can be used to describe anything from remote medical services to non-clinical communications like training or managerial meetings. Due to the broad scope of telehealth services, it is vital to make sure that confidentiality is maintained.

Covid-19 has created a unique situation for healthcare programs around the globe. Providers have scrambled to find alternatives to the in-person appointment, and that left little time to vet the different applications being used for things like HIPAA compliance. Now that it has become apparent that secure HIPAA compliant Telehealth is here to stay for the foreseeable future, the best choices must be made for telemedicine.

How to provide that while still allowing for the level of connection needed for a given service can be tricky. Thankfully, there are a lot of tech companies working overtime to ensure that healthcare services become available for everyone in an accessible and that is secure HIPAA compliant Telehealth way. For more information, check out “HIPAA Compliance Tips for Telehealth.”

There are a lot more options today than there were even six months ago. However, with all these new options comes the need to learn how to navigate technologies that may still have bugs or unexpected disadvantages. Thankfully, companies like DRexly Health have dedicated teams working to create the most confidential service possible with various formats available to accommodate multiple needs. (2)

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Available Secure HIPAA CompliantTelehealth Formats

Over the last decade, Telehealth has started finding its way into the mainstream consciousness. Phone apps offering direct contact with medical professionals and live chats with nurses or doctors have become almost commonplace for patients that live in remote areas or who do not have access to transportation. Now that it has become a necessity for nearly all healthcare to take place via telecommunication, this has highlighted some of the benefits and disadvantages of the platforms. We will give a brief description of the four most used telehealth formats. (3)

• Live Videoconferencing

Perhaps the most known form of Telehealth is the two-way live video call that allows face-to-face connection between the healthcare providers and patients. This type of communication is probably the most important to meet the standards of being a secure HIPAA compliant Telehealth platform.  Afterall, we are talking about patient and doctoro talking about sensitive issues related to the Patient Health Information (PHI).  This form of Telemedicine began mostly to communicate effectively with people who lived in rural areas or those unable to attend appointments physically. Today they are an excellent way to assess patients visually instead of relying on them to describe their current physical or emotional state over the phone.

There are live video conferencing options for laptops, tablets, smartphones, and desktop computers, which means that almost every patient can access it in some way. It can be entirely secure though many people are unfamiliar with the protocol for video conferencing even though it is the most used. Many times, this means that both healthcare providers and patients must undergo a brief introduction to video etiquette.

• Asynchronous

Often called store-and-forward, this is a video that was previously recorded and stored by the healthcare provider to be forwarded as needed to a recipient. Often it is accompanied by additional digital documentation such as notes and test results. This format is most used to share patient information between doctors and specialists. Now that Covid-19 has made Telehealth, the current standard store-and-forward can be used for other things such as medical, educational materials. 



• Remote Patient Monitoring

Many people are familiar with one form of remote patient monitoring (RPM), which is the medical alert button that most seniors wear in case of falls or accidents. RPMs are devices that will monitor patients’ vitals to a degree. They are most used for elderly patients, but now that social distancing and self-isolation are implemented, they can be used in certain instances to monitor people who are sick but not sick enough to require hospitalization.

• Mobile Health

These are the thousands of healthcare centered apps currently available on the market for smart devices. They come with chat, video, file sharing, and audio options. Some of them are strictly confidential, while others are more open and do not adhere to any HIPAA guidelines. A clinician looks for a secure HIPAA compliant Telehealth platform that offers the ability for patients to be connected via a device other than just their personal computer.  Patient telehealth platforms beyond the computer is the norm rather than the exception today.  Providers should expect to be able to connect to their patients via computer, iPad, and smartphone devices for their healthcare.  For more in-depth information on virtual care, see Guide to Telehealth.

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How Telehealth Struggles to Maintain Confidentiality

One of the hardest parts of maintaining confidentiality with Telehealth is the lack of control over how the recipient chooses to act. In-person it is easier to make sure conversations take place in a private environment. Over the phone, video, or chat, there is no way to control that. It can be impossible to know if the person you are speaking with is alone or in a room full of other people that will hear whatever is said.

There are a few ways to try and ensure privacy. Requiring headphones to be used can help keep at least one side of the conversation unheard by anyone else present. Also, for store-and-forward information, unless there are locks in place to prevent unwanted viewers, it is always possible that information will be copied and forwarded to another location or person without the knowledge of the healthcare provider.

Whenever the internet or a phone line is involved in treatment, communications can be intercepted unless strict security guidelines are adhered to by the medium or application chosen by the healthcare provider. That is why it is vital to select your telehealth subscription and apps wisely.

Telemedicine Supported Facilities

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Here are a few of the medical establishments that are currently approved to provide telemedicine information exchanges between healthcare professionals. (6) This is not an exhaustive list.

  • Private doctor’s office and additional practitioners including physician assistants, nurses, nurse-midwives, social workers, psychologists, dietitians, and nutritionists
  • Health clinics and hospitals
  • Community health and mental health centers
  • Skilled Nursing Facilities

Being accessible at a time when social distancing is vital to community health means that all these professional facilities need to have ways to communicate remotely. Secure compliant HIPAA compliant Telehealth is obviously of great concern for any physician office or health center. A few of the HIPAA gray areas include interstate communication. Several of the legal considerations include the following.

 

  • Should the healthcare provider be licensed in both the state where their practice is located and the state in which their client resides?
  • Are there significant differences in the laws of where Telehealth can take place across states lines? Are there any states that specifically disallow Telehealth for whatever reason?
  • How should billing for telemedicine be standardized? Do the same rules apply as those governing payment for in-person treatments?
  • What telehealth services require HIPAA protections?

In general, there have been various temporary emergency Executive (federal) Orders and Governor (state) Orders put in place to allow for interstate Telehealth to occur for many provider types. However, none of these relevant questions have permanent satisfactory answers at this time, and more work needs to be done by providers now to ensure HIPAA compliance in telemedicine as these interim orders expire.

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Telemedicine, Telehealth and Insurance Coverage

Lack of a standardized method of reimbursement makes telemedicine harder to implement across the board. Each state has its laws regarding insurance coverage and payment responsibility of telemedicine. Some forms of telecommunication do not fit those laws, so they are not covered. For example, in some states, asynchronous videos are not covered by Medicaid and other insurances, while live videoconferencing is covered. This murky distinction makes it harder for healthcare providers to integrate it into their standard treatment options. However, there has been substantial progress in reducing this confusion at both the Federal and Government levels.  For some insight, check out our “Telehealth Market Review 2019 & Beyond,” an analysis written prior to COVID-19 hitting the U.S the evolving Telehealth market.

There is currently no set standard for telemedicine coverage by companies. Whether or not their insurance provides is driven by either State regulations, or lack thereof or if an individual’s current plan. For example, in Florida, California, Texas, and Kentucky are just a sample of the limited number of states that have laws that required health insurance companies to consider a Telehealth visit the same as a face-to-face.  For a good summary check out this summary by the state on Center for Connect Health Policy

These disadvantages are one reason why having a secure, multi-formatted subscription membership becomes necessary. DRexly Health allows for every kind of communication currently available using security measures that keep the information confidential. The telemedicine platform also allows for payment options for patients to allow for the provider to bill insurance or the patient to pay for the visit and bill their own insurance, so there is no concern over how it can be collected at the time of service.

CMS Telehealth and Medicare Telemedicine

President Trump has expanded the ability of Centers for Medicare & Medicaid Services (CMS) to use telehealth options instead of in-person visits. This was an emergency change made due to the Covid-19 pandemic. (8) The entire face of healthcare has changed because of this pandemic. Only time will reveal what changes will stay after the crisis is over

The 1135 waiver within the emergency expansion provides a temporary ability for Medicare throughout the United States to allow for payments to cover Telehealth. The services that are covered by this waiver include Medicare healthcare visits, e-visits, and virtual check-ins. There are nuanced differences between these three options.

  • Medicare Healthcare Visits = real-time video communication between patient and practitioner. The waiver specifies that this must not be the first time they have an established provider-patient relationship before the telehealth visit.
  • Virtual Check-Ins = real-time communication through image, video, or phone calls to check in between a patient and their established provider.
  • E-Visits = patient instigated check-ins using any form of telecommunication.

These are all available through the Telehealth platforms with features that are HIPAA compliant for virtual care.  So, you can rest assured that your patients will be able to use their Medicare, Medicaid, and CHIP insurance to pay for their telehealth services.

DRexly Health Product Features

All our plans start with a secure, HIPPA compliant platform, A virtual waiting room, highest grade military encryption, secure online messaging, and more.  Take your practice entirely online with virtual waiting rooms, intake forms, and the ability for co-pays/co-insurance payments are taken before the session begins. DRexly Health allows you to provide the same level of detail and care to your patients that are unable to visit your office physically. Three main membership packages allow for seamless telehealth integration with your practice or medical facility. The product features available include the following taken from the DRexly Health features page (7)

  • Solo Practices or Medical Groups
  • Virtual Waiting Room by Provider or as a Group
  • Secure HIPAA Compliant Platform
  • Works on computer, iPad, iPhone, and Android
  • Secure online messaging
  • Secure 2-way file sharing with patient and provider
  • Walk-in appointment function
  • SMS Texting to patients for appointments
  • Custom sub-domain
  • Business Associate Agreement
  • Full Scheduling (patient can self-schedule)
  • Virtual Waiting Room by Provider or as a Group
  • Online Credit Card processing
  • Screen drop file sharing
  • Custer User Access for practice management
  • Secure Messaging
  • Scheduling reminders for both provider & patient
  • Virtual Waiting Room
  • E-Prescribing option
  • Full live customer service support
  • Ability to establish Walk-in appointment slots
  • Ability to schedule cash only visits or optional visits for patients where provider bills insurance
  • Comprehensive Business Associate Agreement (BAA)

DRexly Health Prices

There are several different pricing packages for the telehealth experience provided by DRexly Health. They cover a wide range of services, and all of them have an option for healthcare providers to demo them before committing to the monthly or yearly subscription. Below is a breakdown of the significant list available for each type of membership. (2)

DRexly QuickStart Solo and Group – This is the lowest cost option and is ideal for newer medical groups or individual practitioners. It starts at $19.99 monthly a month. Few can compete with this fantastic starting price if you are new to Telehealth and want to ease into the service. Below is a list of options provided with the QuickStart Telehealth.

  • Per Provider Monthly
  • Virtual Waiting Room by Provider or as a Group
  • Secure HIPAA Compliant
  • SMS Texting
  • Military Grade 256-bit encryption
  • Live Video/Audio
  • Secure 2-way Messaging
  • Works on Computer/iPad/iPhone/Android
  • Secure File Sharing
  • Custom Sub-Domain
  • Tutorial & Email Support
  • Ability to Screen Drop Files
  • Ability to Screen Share
  • Screen Live Annotation

White Label Enterprise – This option is highly customizable, so the desired elements will determine the cost. It is the best package for large medical centers and clinics. To find out more about pricing, you will want to reach out to the DRexly Health customer service agents. Below is the complete list of service options to choose from.

  • Multiple Provider Log-in
  • Secure HIPAA Compliant
  • Virtual Waiting Room by Provider or as a Group
  • Military Grade 256-bit encryption
  • Live Video/Audio
  • Secure 2-way Messaging
  • Works on Computer/iPad/iPhone/Android
  • Secure File Sharing
  • Custom Sub-Domain
  • Tutorial & Email Support
  • Ability to Screen Drop Files Securely
  • Ability for both patient and provider to screen share
  • Live Screen Annotation both provider and patient
  • Secure Credit Card
  • Full Scheduling System
  • SOAP Notes- Standard
  • Patient Self-Scheduling
  • Live On-Boarding
  • Live Customer Service
  • White Label Branding

The Future of Telehealth

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Telehealth and telemedicine are here to stay. Medical researchers considered it this new form of communication will become a standard part of everyday medical care. (4) Researchers at the University of California, University of Kentucky, and the University of Michigan worked together to study the viability of Telehealth and telemedicine as a part of standard care. They discovered there is “strong and consistent evidence of the feasibility of this modality of Telemedicine care. And acceptance by intended users, as well as a uniform indication of improvement in symptomology and quality of life among patients across a broad range of demographic and diagnostic groups. Similarly, positive trends are shown in terms of cost savings.” (5)

The forced mass use of Telehealth due to the Covid-19 pandemic has held up to those study results. Telehealth will continue to expand with new and innovative technologies coming into play as time progresses. Being a subscribed member of a comprehensive telehealth and telemedicine service like DRexly Health will ensure your practice stays on the cutting edge.

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