In addition to provider training, an information technology representative who can administer technical support as needed must be selected for both the provider and remote locations. Technologic complications can make TMH implementation much more challenging. 12 As such, it is important to assure that both the veteran and the provider have the necessary TMH equipment. The selected communication device must be compatible with the technology requirements at the provider and remote facilities. 12
In addition to designated technical support, the VISN TMH coordinator needs to have point-of-contact information for those who can assist with each site’s telehealth services and address the demand for EBP for PTSD or other desired services. After this information has been obtained, relationships must be developed and maintained with local leadership at each site, associated telehealth coordinators, and evidence-based therapy coordinators.
After contact has been established with remote facilities and the demand for services has been determined, there are several agreements and procedures to put in place before starting TMH services. An initial step is to develop a MOU agreement between the VISN TMH center and remote
sites that allows providers’ credentials and privileges to be shared. Also, it is important to establish a service agreement that outlines the procedures for staff at the remote site. This agreement includes checking in veterans, setting up the TMH rooms, transferring homework to VISN TMH providers, and connecting with the VISN TMH provider. In addition to service agreements, emergency procedures must be in place to ensure the safety of the veterans and the staff. 24
After these agreements have been completed, the VISN TMH providers will have to complete request forms to obtain access to the Computerized Patient Record System at the remote facilities, which then must be approved by the Information Security Officer at that site. This is separate from the request at the provider’s site. 12 It is essential to have points of contact for questions regarding this process. In order to facilitate referrals for TMH, electronic interfacility consult requests must be developed. Local staff need to collaborate with VISN TMH staff to ensure that the consult addresses the referral facilities need to meet the appropriate requirements.
Before the initiation of TMH services, each TMH provider has to establish clinics for scheduling appointments and obtaining workload credit. Program support assistants at the provider and remote sites must work together to ensure clinics are established correctly. This collaboration is essential for coding of visits and clinic mapping. After the clinics are “built,” appointment times will be set up based on the availability of the provider, support staff, and rooms at the remote site for the TMH session.
Once a consult is initiated, the VISN TMH EBP coordinator will review the consult and the veteran’s chart to ensure initial inclusion/exclusion criteria are met before accepting or canceling the consult. If the consult is accepted, a VISN TMH provider is assigned to the case and contacts the veteran to discuss the referral and (if the veteran is appropriate and interested) initiate services at the closest CBOC or at home. The VISN TMH regional center staff enter the appointment time for the veteran at both facility sites. The VISN TMH provider also coordinates with the CBOC staff to ensure that the veteran is checked in to the appointment and is provided with any questionnaires and necessary homework.