HomeVA ProstheticsVA Handbook 1173.17 - Home Telehealth Equipment Management ProceduresResponsibility of the Facility Care Coordinator

17.10. Responsibility of the Facility Care Coordinator

The facility Care Coordinator is responsible for:

a. Prescribing Authority

(1) The Prescribing Authority as outlined in this policy only applies to:

(a) CCHT programs that are designated by the OCCS. This designation is awarded to programs that have met the OCCS Conditions of Participation specified in paragraph 5.

(b) Equipment purchased to deliver routine medical care services to patients and thereby covered by VHA's medical care appropriation. If the home telehealth equipment is being provided to patients solely for research purposes and not for routine medical care, it cannot be prescribed in the manner outlined in this policy.

(2) The Clinical Practice Recommendations for the Care Coordination-Home Telehealth Program contains a memorandum which establishes the Medical Center staff authorized to prescribe home telehealth technologies. NOTE: The Prescribing Authority can be accessed at http://vaww.teamshare.va.gov/PCLO/ProstheticsPCMP/Home%20Telehealth%20Devices/CPR- TelehealthDevicesAppendixes.pdf . A copy of this memorandum is filed in the PSAS at each VA medical center.

b. Patient Needs Assessment. ?áThe Care Coordinator assesses the patient upon enrollment and assigns appropriate technology to be used in accordance with the Care Coordination Technology Assignment Algorithm established by OCCS. This algorithm is an update to the algorithm included in the Clinical Practice Recommendations for Care Coordination-Home Telehealth, Appendix F, dated March 9, 2004, and can be accessed at http://vaww.va.gov/occ/Docs/Technology_Assignment_Algorithm.pdf

c. Issuing Equipment to a Patient

(1) The patient must be provided a copy of the set up guide and installation instructions, and an informational pamphlet.

(2) The Care Coordinator enters a prosthetics consult using a locally-developed CCHT Equipment Request to include the serial number of the device issued to the patient and whether the equipment is new or refurbished. If the serial number of the device is not available, it should be annotated when the consult is closed.

(3) The item must be issued from the Prosthetic Inventory Package (PIP) to the appropriate patient, and include entering the serial number and HCPCS code of the device on the patient's VA Form 10-2319, Prosthetics Record of Patient Services.

(4) There are four options to provide the device to the patient:

(a) During the patient's visit to the clinic,

(b) During a home visit by the CCHT staff,

(c) Mailed to the patient's home, or

(d) Through contract with a durable medical equipment (DME) provider to deliver or mail.

d. Installation of Equipment. The Care Coordinator is responsible for the coordination of any device installation, until successfully completed.

(1) In-home messaging devices and stand-alone videophone devices are installed either by the Care Coordinator, or designee during a home visit or by the patient. Telemonitors must be installed by the Care Coordinator, or designee.

(2) Patients planning to install the device themselves must be trained by the Care Coordinator, or designee, (using scripted guidelines developed by the Care Coordinator) on how to install, connect, and operate the device. The Care Coordinator must educate the patient on how to use any peripheral device(s), and how to interact with the device(s), to include, as appropriate, the expectations for answering questions and completing and submitting vital sign measurements and other data. The patient must demonstrate competency in the installation and use of equipment, and any peripheral devices, which must be documented by the Care Coordinator in the patient's record.

(3) The Care Coordinator must routinely follow-up with patients who have installed the device themselves, or by a designee, either during a following home visit or by a telephone call.

(4) The Care Coordinator verifies the correct installation of in-home messaging devices or stand-alone videophones by receipt of patient data. If the device is not transmitting data within 2 workdays after the installation was completed, the Care Coordinator, or designee, must call or visit the patient's home to ensure appropriate installation.

e. Handling Equipment Failure

(1) Upon enrollment in the program, the patient is provided with a contact number for the Care Coordinator. The patient is instructed to notify the Care Coordinator, or designee, in the event of any equipment malfunction.

(2) Once notified of an equipment malfunction, the Care Coordinator, or designee, must troubleshoot the device remotely or by a telephone call to the patient. If this proves unsuccessful, the item may be replaced at the discretion of the Care Coordinator, or designee.

(3) If a replacement item is to be issued, the serial number of the non-functional unit must be replaced with the serial number of the new device in the patient record. In accordance with the Safe Medical Devices Act (SMDA), manufacturers and the FDA must be notified if the medical device:

(a) Caused or contributed to a death, serious illness or serious injury; or

(b) Malfunctioned, and there is a probability that if the malfunction were to recur, the device would cause or contribute to a death, serious injury or serious illness.

(4) The Care Coordinator, or designee, must report all unresolved equipment and/or vendor issues related to the National Contracts by using VA Form 0729, Quality Improvement Report (QIR) accessible at http://vaww.teamshare.va.gov/PCLO/ProstheticsContracts/Quality%20Improvement%20Report %20VA%20Form%200729/Forms/AllItems.aspx. This form must be forwarded through the VISN CCHT Lead to the Chief of Prosthetics for signature prior to submission to the National Acquisition Center (NAC).

f. Retrieval and Refurbishment of Equipment

(1) Patients discharged from the CCHT Program can return equipment to the issuing facility through one of the following mechanisms:

(a) Delivery to the Care Coordinator during a regular visit to the issuing VA facility, or

(b) A patient can package the equipment in the provided shipping box (NOTE: The shipping box must be disposed as part of the infection control process by the designated person.) and mail it to the Care Coordinator, or designee, or

(c) The Care Coordinator, or designated person, can pick up the equipment at the patient's home.

(2) The Care Coordinator must document the return of the device and its serial number in the patient's Computerized Patient Record System (CPRS) medical record, inform the Prosthetics office of the return, and ensure that pertinent local safety and maintenance procedures are followed for the device.

(3) The facility Prosthetics Manager, or designee, must ensure that the patient's CPRS record is updated to reflect the return of the device and that the National Prosthetic Patient Database (NPPD) is updated to reflect the return.

(4) The returned equipment must be disinfected and reprogrammed by the designated person(s) following the manufacturer's guidelines and in accordance with VISN policy. All patient data must be permanently deleted from the device.

(5) After disinfecting the equipment and verifying proper function, it is returned to inventory, where it can be re-issued to another patient.


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