Clinical consultation

A checklist for setting up telemedicine for contacts and cases

Checklist

1. Policies for telemedicine

• 1.a Provide a telemedicine safety net for cases and contacts who do not already have access to virtual health care for the duration of isolation and quarantine.

  • Cases and contacts will receive basic resources to support symptom monitoring, such as a digital thermometer. Some people may require symptom management advice and clinical consultation services during the isolation and quarantine periods.

• 1.b Determine eligibility for telemedicine services. (See Sample eligibility criteria for telemedicine services)

  • The telemedicine service should be available to cases and contacts without medical insurance or who do not have a regular primary care provider offering telephone or video access during the time of isolation or quarantine. Public health should not pay for telemedicine services for individuals who already have access to this type of service through their health insurance (e.g., Medicaid, Veteran’s, commercial insurance).

2. Telemedicine service provider

• Contract with a local medical care provider to provide telemedicine services for eligible COVID-19 cases and contacts. (See Template scope of work for telemedicine service provider)

  • Depending on the number of individuals needing and qualifying for this service, contracts with multiple medical care providers may be needed.

  • Some jurisdictions may have infrastructure already in place to provide telemedicine consult via a nurse triage line, for example using public health nurses with health assistants and others doing contact elicitation.

• 2.a Map medical service providers that already offer robust telemedicine services.

  • For potential service providers, assess the capacity for number of “visits,” qualifications of medical providers, costs of services, mode of services (telephone, video, mobile application chat, etc.), and language capabilities.

• 2.b Select and contract with a provider that can rapidly and effectively provide telemedicine services.

3. Linkage for cases and contacts

• Ensure the link to telemedicine services is made for contacts and cases, as appropriate.

  • Train contact tracing staff to assess a person’s eligibility for telemedicine services.

  • Contact tracing staff should provide instructions to people on accessing telemedicine based on their eligibility.

  • Consider how to make clinical services available to those without telephonic or video access (e.g., homeless population).

  • Consider including a referral process for medically complicated patients that goes beyond provision of telemedicine services.

  • For cases with potential exposures in group settings, facilities or mass gatherings, Epidemiologists (or other investigators) should make the linkage to clinical consultation services during investigations.

  • Forms and protocols used by contact tracing staff should include questions and prompts to guide this process.

Implementation Tools

• Template scope of work for telemedicine service provider

• Sample eligibility criteria for telemedicine services

• Massachusetts Medical Society: Telemedicine Vendor Options

• University of Arizona: Telemedicine & Telehealth Service Provider Directory

• American Medical Association (AMA): AMA quick guide to telemedicine in practice

• AMA: Selecting a vendor guide (except from AMA Telehealth Implementation Playbook)

• Massachusetts Medical Society: Telehealth and virtual care resource library

LIVING DOCUMENT This playbook is a dynamic, “living” document. Global knowledge pertaining to COVID-19 is rapidly evolving. Feedback and suggestions can be sent to [e-mail].