eConsult Introduction and Training Manual

Table of Contents

eConsult Basics................................................................................ 2

eConsult Referral Process................................................................ 3

eConsult Scheduling Process.......................................................... 3

Day of eConsult Appointment......................................................... 4

eConsult Equipment Training Video Unit (VSX 7000)................... 5

eConsult Equipment Training Video Unit (HDX 8000)................... 10

Troubleshooting the eConsult Equipment..................................... 15

Appendix........................................................................................... 17

eConsult Certification Requirement................................................ 19

eConsult and eNICU Website.......................................................... 20

eConsult AppointmentsAn eConsult appointment allows for patient and provider interaction through electronic communication. This communication may include videoconferencing, transmission of still images, remote monitoring of vital signs and continuing medical education.

“Originating site” refers to the location of thepatient or customer. “Specialty site” refers tothe location of the physician or other medicalprofessional.

Confidentiality and PrivacyAll personnel are required to follow the samerules and regulations for HIPAA and protectedhealth information compliance as in standardpatient encounters. Personnel at the originatingsite ensure the patient has signed routine HIPAApaperwork, just as they would for a regular officeappointment.

All documentation used for the eConsult appointment must meet the originating site’s medical record policies.

The consultation room should promote bothvisual and sound privacy for the patient.

Patient Rights• The eConsult staff will comply with the

originating site’s policies on patient rights.• The patient has the right to refuse an

appointment via eConsult technology.• The patient has the right to stop the eConsult

appointment at any time.

Infection ControlEquipment used for eConsult will be cleaned according to the referring hospital’s infection-control policies.

Equipment SafetyThe eConsult equipment at both the originating and specialty sites will be monitored for quality of service and biomedical equipment standards approved by Avera.

Quality of Service and CertificationAll participating eConsult sites will be subject to quality review of processes and documentation through the Avera certification process.

Certification is completed initially and every two years by the assigned site eConsult coordinator.

Make eConsult a Good ExperiencePlease remember:• This is an interactive video; you can be seen

and heard at any time.• Make sure the camera encompasses all

participants at your site.• There may be a slight delay when speaking or

receiving audio from the connected site.• Mute your system during non-direct patient

interactions.• Mute the microphone if the patient requests

to discuss something private during the eConsult encounter.

• Mute the microphone during stethoscope use to reduce background noise and/or distractions during the patient assessment.

The microphone is highly sensitive and can pick up even the slightest noises, which can be distracting to the physician and patient.

eConsult Basics

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The following referral process meets requirements for eConsult certification with Avera:

1. Referral is initiated and sent to originating site scheduler.

2. Originating site scheduler gathers patient information:• Patient name• Patient date of birth• Patient address• Reason for referral• Specialty provider’s name

3. Originating site scheduler ensures specialist is appropriately credentialed and privileged to provide telemedicine patient care.

4. Originating site scheduler contacts specialty site scheduler to request an eConsult appointment and shares patient information.

5. Specialty site scheduler determines if eConsult appointment is appropriate for patient diagnosis and need.

eConsult Referral Process

The following scheduling process meets requirements for eConsult certification with Avera:

1. Specialty site scheduler confirms eConsult appointment date with originating site scheduler.

2. Originating site scheduler confirms availability of eConsult room, support staff and eConsult equipment.

3. Specialty site scheduler and originating site scheduler add eConsult appointment to their electronic calendars.

4. If patient is present at originating site:• Originating site scheduler gives the

patient the specialty provider information packet with instructions to complete information and bring it to his or her eConsult appointment.

• Originating site scheduler completes

eConsult appointment sheet (Attachment A) and reviews with the patient.

5. If patient is not present at originating site:• Originating site scheduler mails the

patient the specialty provider information packet with instructions to complete information and bring it to his or her eConsult appointment.

• Originating site scheduler completes eConsult appointment sheet (Attachment A) and mails it to the patient.

6. Specialty site scheduler schedules a bridge if needed.

eConsult Scheduling Process

Originating Site Specialty Site 3

Day of eConsult Appointment

The following eConsult processes for the day of appointment meet requirements for eConsult certification with Avera:

Preparing the Patient• Patient checks in 30 minutes early.• Originating site registrar verifies patient

identity, copies insurance card and collects specialty information packet.

• Originating site registrar notifies rooming nurse that patient has arrived.

• Originating site nurse escorts patient to eConsult exam room and reviews eConsult process with patient.

• Originating site nurse completes medication reconciliation in specialist’s information packet.

• Originating site nurse takes vitals and performs nursing assessment as indicated by reason for visit.

• Originating site nurse documents vitals and other information into specialist’s information packet.

• Originating site nurse faxes all patient information from specialist’s packet to specialty provider.

• Originating site nurse prepares patient as indicated for the specific type of eConsult appointment (i.e., removes dressings). This applies to both outpatient and inpatient eConsult.

• Originating site nurse advises specialty site that faxed patient information has been sent and patient is ready for the eConsult to begin.

• Originating site nurse confirms with specialty• site that eConsult will begin on time and

advises patient accordingly.

eConsult Exam• Specialty provider initiates the eConsult call.• Specialist/patient interaction occurs.

(Originating site nurse remains in eConsult• room if appropriate.)• Specialty provider advises patient of next

steps, need for follow-up appointment and other pertinent information.

• Specialty provider documents impression and writes orders if indicated.

• eConsult exam is completed.eConsult Conclusion• Specialty site faxes provider impression and

any written orders to originating site.• Specialty provider dictates history and

prognosis and sends copy to referring provider.

• Specialty site and originating sites complete charge tickets for eConsult services and send to their individual billing departments.

Originating Site Specialty Site 4

Preset• Preset one is patient/provider.• Preset two is signage.• Preset three is exam camera and/or otoscope.• Presets four through nine are open for site

use.• Preset instructions also are located on the

screen.

To Preset Buttons1. Locate preset button at top of remote and

press it.2. Press number desired and hold down.3. Screen will note that the preset is stored.

Bridge CallsOut of Avera network: All calls need a modem. You cannot use in-band stethoscope; you must use modem stethoscope.

To schedule a nonurgernt bridged eConsult, email eConsult@avera.org. To schedule an urgent eConsult call the eConsult pager at 1 (877) 869-3302.

Point-to-Point CallsIn Avera network: All calls use in-band stethoscope.

Note• Video system and monitor must remain in

the “ON” position when not in use.• Video unit must be rebooted once a week.

eConsult Equipment Training Video Unit (VSX 7000)

To Power Up the System

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Press top right button on top of video unit.

To Place a Call

1. Go to green “Directory” button on right side of remote, point remote at monitor and press green “Directory” button.

2. Using the burgandy arrows, scroll down to site needed.

3. Press green “Call” button located at top of remote to make call.

4. Call is connected when other site is in view on the monitor.

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To get picture-in-picture, press the “PIP” blue button on the right side of remote.

Press “Preset One” to view a provider and/or patient on the screen.

During eConsult

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To activate microphone, press center button on speaker:• Red is muted.• Unlit is on.

Peripheral Equipment

• If stethoscope is needed and you are in-network, use only the TR-1/EF stethoscope.

□ At the top left on the box (TR-1/EF), plug in power cable to the outlet.

□ Plug in nine-pin cable on the right side to back of video unit.

□ If you have the chest piece, plug in on bottom left side of TR-1/EF box.

□ If you have the headset, plug in on bottom right side of TR-1/EF box.

□ Button labeled “D” (Diaphragm) top and “B” (Bell) bottom should always be set to D.

□ To adjust volume, use button labeled “Volume” on box.

• If out-of-network (bridged), you must use the modem to use the stethoscope.

□ Undo in-band nine-pin cable and attach modem nine-pin cable.

• If exam camera (AMD-2500) is needed, use “Preset Three.”

Turn power and light to “ON” position on back of camera.

Control zoom with the arrows on top of the box.

To freeze a still shot, press red button on top of box.

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• If otoscope is needed, use “Preset Three.”

Conclusion of eConsult

Press “Preset Two” to move camera to signage or logo.

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To mute, press center button of speaker until it turns red.

Press red “Hang-Up” button on remote to disconnect the call.

Preset• Preset one is patient/provider.• Preset two is signage.• Preset three is exam camera and/or otoscope.• Presets four through nine are open for site

use.• Preset instructions also are located on the

screen.

To Preset Buttons1. Locate preset button at top of remote and

press it.2. Press number desired and hold down.3. Screen will note that the preset is stored.

Bridge CallsOut of Avera network: All calls need a modem. You cannot use in-band stethoscope; you must use modem stethoscope.

To schedule a nonurgent eConsult, email eConsult@avera.org. To schedule an urgent eConsult, page (877) 869-3302

Point-to-Point CallsIn Avera network: All calls use in-band stethoscope.

Note• Video system and monitor must remain in

the “ON” position when not in use.• Video unit must be rebooted once a week.

eConsult Equipment Training Video Unit (HDX 8000)

This is where the power button is

located on this unit.

To Power Up the System

• Blue light is “ON.” □ Once powering on you will see Polycom

logo and hear music. (This may take a few minutes.)

• Yellow light is sleep mode. □ Move remote to return to “ON” mode.

• No light means power is off.

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To Place a Call

1. Go to “home” by pressing the green Directory button.

2. Locate arrow keys found in the center of the round circle buttons on remote and scroll down to the Global Directory. Press the round button in the middle of the round arrow keys to select.

3. Call is connected when other site is in view on the monitor.

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During eConsult

Press “Preset One” to view the provider and/or patient on screen.

To get picture-in-picture, press the “Display” button at the top left of the remote.

To activate microphone, press center button on speaker:• Red is muted.• Green is on.

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Peripheral Equipment

• If stethoscope is needed and you are in-network, use only the TR-1/EF stethoscope.

□ At the top left on the box (TR-1/EF) plug in power cable to the outlet.

□ Plug in nine-pin cable on the right side to back of video unit.

□ If you have the chest piece, plug in on bottom left side of TR-1/EF box.

□ If you have the headset, plug in on bottom right side of TR-1/EF box.

□ Button labeled “D” (Diaphragm) top and “B” (Bell) bottom should always be set to “D.”

□ To adjust volume, use button labeled “Volume” on box.

• If out-of-network (bridged), you must use the modem to use the stethoscope.

□ Undo in-band nine-pin cable and attach modem nine-pin cable.

• If exam camera (AMD-2500) is needed, use “Preset Three.”

Turn power and light to “ON” position on back of camera.

Control zoom with the arrows on top of the box.

To freeze a still shot, press red button on top of box.

• If otoscope is needed, use “Preset Three.”

Conclusion of eConsult

To mute, press center button of speaker until it turns red.

Press red “Hang-Up” button on remote to disconnect the call.

Press “Preset Two” to move camera to signage or logo.

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Troubleshooting the eConsult Equipment

No power to the unit: • Check to see if the unit is plugged into an active electrical outlet.

• Check that the power switch to the unit is “ON.”• Is there electrical power to the facility? Plug into

an emergency power outlet if no regular power is available.

Cannot place a call (point-to-point connections):

• Replace the call when the system becomes ready again. If unsuccessful, try next tip.

• Contact site with which you are trying to connect and ask them to reboot their system.

• If possible, have the connecting site call you.• Contact the site with which you are connecting

to make sure their system is “ON” and ready to receive calls.

• Reboot the system. Replace the call.• Try to connect via the IP address versus the

Global DirectoryNot connected to a bridge event prior to start time (bridged connections only):

• Connect to bridged sites 30 minutes in advance of an eConsult so that there is time for testing and a sound check.

• Call pager number 1 (877) 869-3302 for assistance.

Can hear sound, but no picture: • Make sure that the television is turned “ON.”• Press camera button on remote and verify main

camera is selected.• On the monitor, verify you are viewing the

proper mode. It should be “Video 1” source.• Reboot and replace call.

Can see picture, but no sound: • Ask the connected site to check that the mute button is not on.

• Try turning your volume up and down by using the “Volume” buttons.

• Check that the volume of the monitor has not been changed since last use of the equipment.

• Reboot and replace call.Cannot hear clearly from the connected site: • Have the connected site move the microphone

closer to the patient or provider.Can hear yourself repeated back to you from connected site:

• Try turning your volume down from the remote control using the “Volume” buttons.

• If you still hear yourself repeated back, ask the connecting site to move the power microphone further away from the unit.

• If you still hear yourself repeated back, ask the connecting site to turn the volume down on their unit.

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Other Technical Questions• ContacteConsult pager at 1 (877) 869-3302.

Other General Questions• Contact eConsult at econsult@avera.org.

Call drops during your session: • Wait for the “Ready” indication from the unit and replace the call (point-to-point connection).

• Page 1 (877) 869-3302 and ask to be reconnected.

Exam camera does not work: • Press “Camera” button on the remote and verify the exam camera or TV/VCR is selected.

• Check that the exam camera is plugged into a power source and the cords all are securely connected.

• Check that the cord from the exam camera is inserted properly into the videoconferencing unit.

• Verify that the power and light switches on the back of the camera are turned to the “ON” position.

• Refer to the AMD-2500 Examination Camera manual for proper setup. This manual can be found at www.avera.org/experience/ah/departments/econsult under directories and manuals.

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Appendix

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Clinic Name:

Clinic Address:

Clinic Phone:

You are scheduled for an eConsult appointment. You will see your provider over a live remoteconnection using cameras and monitors. You will be able to see and talk to your provider as if youare in the same room, just like any other provider appointment.

PLEASE BRING ALL OF THE MEDICATIONS YOU TAKE TO YOUR APPOINTMENT.

PLEASE BRING YOUR INSURANCE CARD AND A PHOTO ID TO YOUR APPOINTMENT.

Patient Name:

Provider:

Date of Appointment:

Time of Appointment: AM PM

PLEASE ARRIVE 30 MINUTES PRIOR TO THE START OF YOUR APPOINTMENT.

Special Instructions:

If you are not able to keep your appointment, please give 24-hours notice. Thank you.

Appendix A

Environment• The exam location needs to be within normal

patient exam area, such as a newborn nursery

Equipment• Thecameramustbemountedonawallor

onaneConsult-approved cart at a height appropriate for interaction with the hub.

• The camera/monitor must not face windows to decrease the potential for glare

• All cords and ports/outlets for the equipment must be labeled and connected. The port/outlet must be labeled with a port number as well as the word “VIDEO”.

• Equipment cords must be bundled and secured.

• A fax machine should be in a secure location that is in close proximity to the room but not located in the room, unless it is not disruptive to the consultation.

• A telephone should be in close proximity to the room but not located in the room. If the phone is located in the room, the phone must be silenced and not used while the patient is in the room.

• All equipment must be either currently eConsult-approved or updated within two years to become approved.

• All standard presets must be set to Avera standards.

• When not in use, equipment must be stored in a secured area, free of traffic, plugged in and turned on.

• Each unit must be rebooted one time per week.

• All equipment must pass Avera system check and biomedical certification.

• Monthly call-in for equipment check is required if eConsult equipment is not used monthly. Page Avera eCARE™ services at 1 (877) 869-3302.

Training• All staff members associated with eConsult

are required to review the eConsult training material.

eConsult Certification Requirements

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There is a website designed specifically for those participants in the eConsult and eNICU programs. Through this link you can access the following:

• Specialty site directories• Originating site directories• Patient packets• Training manual• Exam Cam AMD-2500 manual• HDX remote quick sheet• Monthly program reports• eConsult team contact information

You can access the website at www.avera.org/experience/ah/departments/econsult/index

eConsult and eNICU Website

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