Children's Hospital Colorado

Telemedicine Resources for Primary Care Providers During the COVID-19 Crisis

As primary care providers (PCPs) are impacted by the COVID-19 pandemic, we want to help with the unique challenges you're facing. To help you work through operational concerns regarding the health and safety of your patients and staff, services for patients, telehealth functionality, personal protective equipment (PPE) and more, Children's Hospital Colorado has collected these resources to guide you in implementing telemedicine services.

Colorado standard telehealth regulations and requirements

Telehealth platforms must be HIPAA compliant and secure for sharing of patient information (temporarily modified March 17, 2020 for COVID-19). Platforms must have more than simply technical encryption and must satisfy requirements set by the HIPAA and HITECH acts.

  • Any storage of electronic PHI by a third-party or telehealth vendor requires a BAA – many telehealth platforms offer this document during the implementation process, including DoxyMe, Zoom for Healthcare, SnapMD, Spruce, etc.

The use of telehealth services in Colorado requires providers to obtain all first-time patient's written consent before a telehealth visit occurs.

  • Required consent can be electronic for many payers, and in some cases (current CMS modifications) can be verbal. Please check with your specific vendor for more information.
  • Several telehealth platforms reviewed by Children's Colorado provide options for informed consent by patients. When using telehealth communications, providers must ensure that each patient and family agrees to the use of telehealth services, and notify them that the use of these third-party applications potentially introduces privacy risks to their information.
  • Use all privacy mode and encryption features available in these applications.

As of January 2017, Colorado has a full parity law covering the state, meaning that all private payers are required to reimburse live telemedicine visits as they would in-person visits.

All regulations are based on the location of the patient, not the location of the provider. When working with patients across state lines, new state licenses are generally needed but specific details can be found through the Interstate Medical Licensure Compact. Colorado Medical Board Policies also highlight telehealth requirements for providers.

Read our entire Telehealth Reference Guide (last updated March 19, 2020) for the most up-to-date information on recent regulatory and legislative changes, billing requirements and more.

Tips for successful telemedicine visits

Children's Colorado has curated advice and recommendations to assist you with what questions to ask during telehealth appointments, and how to connect with patients and families during these virtual visits.

It's up to each provider to gather enough data to make appropriate and defensible medical decisions. If this is not possible with telemedicine, please do not use telemedicine for appointments.

  • You do not have to duplicate your usual in-person exam approach. It's ok to get creative.
  • Do not provide telehealth when a patient or parent is driving.

Important factors to consider for home video visits:

  • Does the patient or family have access to the internet and a computer or mobile device?
  • Do you have the need to collect any vitals?
    • What is the patient/family's ability to obtain necessary vital sign data?
  • Do you have a need for in-person testing?
  • Does the patient need a physical exam?
  • Is the patient verbal or non-verbal?
    • It's easier when your patient is verbal, but this is not essential.
  • What is the patient/family dynamic?
    • It's more difficult to control the patient's home environment, but this may allow a better understanding of the home situation.

Try to follow as much of your "normal" routine during the appointment to make the patient and family feel comfortable.

  • Keep a HIPAA-compliant workspace. Assure an uncluttered view from where you are positioned.
  • Position your camera close to the screen of your computer to minimize distractions.
    • Be aware of lighting so the patient and family can still see your face and expressions.
    • If there is a glare on your end or the patient/family's end, try closing any blinds, adjusting the camera angle or moving around lamps.
  • Assure there are no disruptions during the visit. If there is background noise or activity on the patient/family end, let them know it's keeping you from fully focusing on their care.
  • Introduce everyone in range of the microphone from your side. This is especially important for off-camera attendees.
  • Verify the patient using two patient identifiers at the beginning of the visit.
    • Full name and date of birth
  • Ask the patient and family to introduce everyone in their room. This is especially important if anyone is off camera at their location.
    • Pediatric patients must be with the parent to bill for the appointment (unless the child doesn't need to be there for similar in-person care).
  • Stay attentive and do not cover your camera or mute your microphone at any time during the appointment.
    • Make eye contact with your camera, not the patient's eyes.
    • Be aware of typing noise as typing can be loud if the microphone is close to the keyboard.
    • It's ok to advise they may hear you typing but you want to accurately document the information you are receiving.

It's difficult to change your habits and conduct a physical exam virtually, but we recognize some patients might require this type of appointment.

  1. Ensure the patient is comfortable with everyone in the room, particularly if clothing will need to be removed during the exam. Ask others to leave when appropriate.
  2. Confirm privacy in the room and reduce any glare. Ask for window blinds to be closed before beginning the visit.
  3. Explain the video visit is not recorded and it cannot be posted anywhere.
  4. Split the patient history and physical exam into distinct parts due to conversation and participation.
  5. Talk the patient/parent through the exam and engage cooperation from them both.
    • Acknowledge and confirm the exam will feel different than an in-person exam.
    • Ask the patient and their parent to shine a light, move closer to the camera or farther away, remove objects in the way of your view, speak more loudly, etc.
    • Direct them to remove clothing as necessary, and remember to tell them when it is ok to put their clothing back on.
  6. Tell the patient and their parent how to do exam maneuvers you would usually perform, encouraging their participation.
    • For example, how to palpate for pain, perform range of motion maneuvers and describe landmarks you use in clinic to find the right location for an exam component, such as ribs or pelvic bone.
  7. Watch carefully, and ask your patient or their parent/guardian to repeat anything questionable.
  8. Verbalize what you think you are seeing, allowing the patient and their parent/guardian to clarify as needed.
  9. Refer to scheduling an in-person care appointment if the video exam is not adequate for medical decision-making.

Additional telemedicine resources for PCPs