let s get telepractical - ncshla...let's get telepractical ncslha 2014 9 telepractice treatment...

Let's Get Telepractical NCSLHA 2014

www.mainespeechtherapy.org 1

Let’’s Get Telepractical

Nuts & Bolts Competencies Technologies

Efficacy

Michael Towey, M.A. Speech Language Pathology

Waldo County General Hospital Belfast, ME

Disclosures Financial Relationship:

The Speech Language Pathology Department at Waldo County General Hospital is an Accredited Training Program by the American Telemedicine Association and has a financial interest in providing telepractice training.

Non-Financial Relationships:

Member of Executive Committee of American Telemedicine Association Special Interest Group (Telerehabilitation)

Chair: Core Competencies Work Group: ATA.

Towey M. 2012 Speech Telepractice in Kumar S. Cohn E. Telerehabilitation. Springer (November, 2012)



Internationally: Canada Taiwan Belgium Tanzania India

Speech Therapy Telepractice Accredited Training Program



Speech Telepractcie Reach underserved clients

Reach unserved clients.

Nothin’ else better available.

Reduce travel costs.

Standard of Care

Speech Telepractice

Speech Therapy Telepractice

The opportunity to transform therapy using

the power of an interactive, content rich and

motivating Web environment that

people are using everyday.

Madden 2010



Today's patients are no longer same patients traditional therapy

was designed to treat.

Self Imposed Limits.

“Yeah, but, I have to touch the person… …telepractice won’t work for me.”



Licensure & Portability Reimbursement

Privacy & Security

Access to Technology Attitudes

Meet Red

Clinical skill video/ audio quality.

Screen capture & edited.

View for each end.

Laryngectomee evaluated & fi�ed w/HME from 350 miles away.



Cleaning & Skin Prep



Fit Base Plate

Insert HME



Outcome

  HME fi�ed in 30 minutes.

  Will be followed re: improved respiratory func�on, decreased admissions & cost.

  Licensing. Billing.

It’’s impossible to do a procedure like this without being there & ““hands on.””

Why?



Telepractice Treatment Efficacies A Standard of Care

Outcomes as good or better than the traditional “across the table model”

Curtis et al 2011

Table 2Speech Therapy Telepractice

0

10

20

30

40

50

60

70

One Level Muliple One Level Multiple One Level Multiple One Level Multiple

Speech Articulation Receptive Language Spoken/grammar Social/Pragmatics

WCGH Speech Telepractice NAT



Table 3 NOMS Outcomes Tradtional - Telepractice

0

10

20

30

40

50

60

70

One level Muliple One level Multiple One level Multiple One level Multiple

Speech Articulation Comprehension Spoken/grammar Social/Pragmatics

National NOMS WCGH Traditional WCGH Telepractice

Telepractice Delivery

Fixed In Place: Point to Point Dedicated Devices Web Based

$ $ $ $ $ $ $ $ $ $ $



Therapist device

Patient device

Others device

Web Based Portals

Web Based Portals



Feature Rich   Encryption & unique passwords   Connect any device/anywhere   HD video & VOiP   Multiple users   Screen sharing   Annotation tools   Shared internet engagement   Multiple document /video sharing   Recording   Interoperability

Combining Fixed System with a Flexible System

integrates video & Cisco WebEx™ with electronic whiteboards from

Promethean, SMART.

Web-based Telepractice

  Flexibility   Accessibility   Low cost   Authentic materials   e-tools   Connectivity   Secure



orientation



On the WEB!



Control/create their own therapy?

Access therapy 24/7.

Create powerful feedback loops.

Learning opportunities of web apps.

See what was done…everyone.

Could review/practice… again and again.

Communicate with us or

Disintermediate us!

Web Based

Not traditional therapy by video.

Does not require expensive equipment.

Where people live, work and learn.



Service Delivery Ethical Competent Legal

Getting going.

Technical Procedural

Preparation Therapeutic

Interpersonal Regulatory

Technical Platform selection.

Trouble shooting: both ends.

HIPAA, HITECH Act 2009: encryption, password protection.

Video and audio skills Armfield N. et al Clinical use of Skype: a review of the evidence base. (2012), J Telemed

TelecareApril 2012 vol. 18 no. 3 125-127 doi: 10.1258/jtt.2012.SFT101 “Nothing for or against”



Procedural

Securing permission & information.

Scheduling.

Inviting: passwords, urls, meeting numbers.

Emergency procedures

Preparation

Developing authentic digital materials.

Permissions (model releases)

Therapy planning and pre loading

Therapeutic

Lighting, distractions, camera shots.

Privacy and confidentiality.

Access materials.

Use electronic tools.

Permissions for patient/eHelper e-tools.

Managing screen.



Interpersonal

Personal appearance

Camera and tone of voice

Digital “reengagement” strategies

Knowledge of environment & setting:

Regulatory Informed consent, regulations, billing

coding (GT)

Documentation; o  Geographic o  Physical o  Lack of provider

New Rules: n  Documenting Connectivity, confidential Rx

location.

Leave Taking

Recording and editing therapy

Store forward

Converting to digital format(s) n  Feedback n  Practice n  Sharing instructions, approaches n  Storage



Policies &

Procedures

Security

Confidentiality

How to meet requirements?

  HIPAA & HITECH – Tell you what, not how.

  You decide how.

  Auditors decide if adequate.



Security & Confidentiality

“What if I have them sign off?”

Vulnerable populations.

“What if I call it patient education, do I need a license?”

Key Features

� Training of therapist. � How unique meeting numbers &

password protections are used. �  Screen placement & confidentiality of

treatment sessions. � How sessions time out. � Documentation of patient information

about telepractice.

Key Features

� P&P specifies access to work stations & telepractice.

� Administrative controls for access. �  Identifying specific individuals who are

allowed to do telepractice. � Assigning security and password

protections. � Breach notification.



Security & Confidentiality Key Features

� Policies and procedures are in place.

� There is active review of the policies.

� There is training.

� Key features are addressed.

�  Sanctions for employee violations are identified in P&P manual.

Annual Assessment Key Points documenting

1.  The review has been completed.

2.  What the findings are.

3.  What has been put in place.

4.  Demonstrates continuous/ongoing process of review and training.

Can I use…. What’s the HYPE about FREE video conferencing?



Technology consulting firms advise against SKYPE because of security & integration issues.

HIPAA Tool Kit http://scap.nist.gov/hipaa/.

Originating Site

Web Based Account Computer Web cam & Microphone Decent Broadband Digital Materials



Requirements at Receiving Site

Computer

High speed broadband

Web Cam & Microphone

e-Helper

Tech Requirements-Audio

  Built-in Microphone

  USB Microphone

  Headset

  Ear buds

Tech Requirements-Video

Logitech 9000 webcam



Tech Requirements-Mouse

Screen Capture

Camtasia $299/PC $99/Mac

Snagit $49.94 Mac & PC

Screen flow $99/Mac



Up Load

Capture à Edit à Convert



Screen Capture Video Demo

  Review screen capture   Edit   Store   Zooms   Effects   Build in quizzes   On the fly

Ah, er.. Unrehearsed.



Making Digital Materials. Google Images

Cut & paste Scanning docs

Criticism, comment, news reporting, teaching, scholarship, & research.

Permitted by copyright statute that might otherwise be infringing.

Fair Use

Fair Use Copyright Disclaimer Under Section 107 of the Copyright Act 1976



Sustainability Reduce travel cost

Force Multiplier The right therapist

right time …right therapy

Caregiver Burden Reduced no shows

Improved outcomes Value to organization NOT patient

BUT!! Coverage for SLP

FEES Registration

1.  Maryland (10/1/12) 2.  California 3.  Colorado 4.  Georgia 5.  Oregon 6.  Oklahoma 7.  Virginia 8.  Texas 9.  Hawaii 10.  Kentucky 11.  Louisiana 12.  Maine 13.  New Hampshire



The fun stuff: Telepractice is NOT

about the technology.

Effective telepractice built on relationships

Technology the portal

to relationship.

Emerging Principles of Practice Telepractice can be more than just an

extension of traditional speech therapy by a video conference.

Telepractice must be comparable to on site

services.



New Rules Broader context of treatment

Need to create See patterns Add value Do things in new ways Do a few things well Scalable Valued

Sage on the Sage to

Guide by the Side Flipped Therapy Flipped Therapy

Video next: Screen Environment Therapist Jessica

Therapist has ear bud in..(Kristin child) audio is low

note use of electronic crayon for direction following, child engagement



Therapist Nathan

  With Gabe   NOTE Audio changes



Screen Environment Managing Behavior

Davis

video

Digital Materials: preparing treatment



©2008 Nathan H. Curtis, M.A., CCC-SLP

Letter B


There are a lot of letters in the alphabet that you will see.


There is one very special. It’s called Letter B.



Keeping Up With Robbie



Go Animate

Explain Wayne



Out on the web Nathan & Serena

Set up managing the virtual environment

screen sharing



Out on the web

Active content creation. Moving the sun and stars!



Out on the web

Active content creation You know she’s from Maine!

Simply amazing!

Creating authentic content

Fully engaged

Record/Save/Practice & Modify

Share with anyone/anytime

Therapist is guide

Directed toward RX goals



Maine to India to UK

Two failed attempts



Making Tea



Saying good-bye

Gabe & Nathan



Gabe & Nathan

Let’’s Get Telepractice

Clinical Competencies Technologies

Efficacy

let s get telepractical - ncshla...let's get telepractical ncslha 2014 9 telepractice treatment...

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