Frequently Asked Questions | AHRQ Safety Program for Telemedicine

Program Benefits, Structure, and Overview
Eligibility
Joining the Program
Data Collection
Data Use and Privacy
Educational Content

Program Benefits, Structure, and Overview

What are the benefits of participating?

The Agency for Healthcare Research and Quality (AHRQ) Safety Program for Telemedicine: Improving Antibiotic Use team will work closely with your practice staff to develop or enhance the approaches your practice takes to optimize appropriate antibiotic prescribing for patients seen over telemedicine. Telemedicine offers unique challenges to the appropriate prescribing of antibiotics, such as limitations to the physical exam. As part of this program, your practice will learn and implement strategies to improve antibiotic decision making for patients seen over telemedicine and to reduce patient harm.

Using evidence-based, practical implementation strategies, we can help members of your practice expand their knowledge of appropriate use of antibiotics and implement improvements in the diagnosis and treatment of infectious syndromes over telemedicine. As part of this program, practices will strengthen their teamwork, patient safety culture, and ability to communicate with colleagues, patients, and families about antibiotic prescribing.

This program offers access to renowned physician subject matter experts in antibiotic use and the science of patient safety and quality improvement in real-world settings. Your practice will have access to these experts through one-on-one technical assistance, coaching, and ongoing education.

Practices participating in a prior similar AHRQ-funded program saw a 9% decrease in antibiotic prescribing overall and a 15% decrease in prescribing for acute respiratory infections.

By participating, your practice will—

Learn evidence-based strategies from nationally renowned experts in telemedicine diagnosis and antibiotic prescribing
Gain dedicated access to free expert consultation
Providers will receive continuing education units (CEUs), continuing medical education (CME) credits, and Maintenance of Certification (MOC) points
Improve efficiency, using approaches such as scripting for live and patient portal interactions
Improve patient safety and reduce harm from antibiotic side effects
Improve patient satisfaction and communication with your patients and their families around appropriate antibiotic use
Improve performance on antibiotic-related quality measures such as Healthcare Effectiveness Data and Information Set (HEDIS) measures for bronchitis/bronchiolitis, upper respiratory infections, and pharyngitis, and meet Merit-based Incentive Payment System (MIPS) criteria from CMS

Can participants earn continuing education credits/points through this program?

The program is offering credit via the American Medical Association (AMA), American Nurses Credentialing Center (ANCC), American Board of Internal Medicine (ABIM) Maintenance of Certification (MOC), American Academy of Physician Associates (AAPA), and Interprofessional Continuing Education (IPCE). To earn credits/points, participants will need to attend live webinars, review recorded program webinars, or review slides and scripts for webinars. Participants will then be asked to complete a short quiz to demonstrate their comprehension and claim their credits/points on CME University.

Physicians participating in the program are eligible for American Board of Internal Medicine MOC Part 4 Points (ABIM MOC Part IV). The program will provide additional information about MOC Part 4 Points after the program commences and will assist physicians in claiming these credits.

What is the timeline for the program?

The program runs for 18-months, beginning in June 2024. Key dates include:

Enrollment form deadline: May 23, 2024
Commitment Form submission deadline: May 31, 2024
Participate in the program: June 2024 through November 2025
Submit practice data: June 2024 through November 2025

What is required of our practice to participate in the program?

Expected activities include the following:

Participate in regular webinars (about 20 minutes each). Participants will receive monthly training via webinars, which are both held live and posted online for self-paced learning. Webinars will be offered at varying times so that staff can participate at a time convenient for them.
Check-in with an Implementation Adviser. Each practice will be paired with an Implementation Adviser, a quality improvement expert who will provide technical assistance in implementing practice changes, help troubleshoot challenges, and support data collection through monthly check-in meetings.
Participate in optional office hours. Optionally attend live “office hours” with program staff and subject matter experts to ask questions and learn from peers.
Determine and implement approaches to improve antibiotic use. Using approaches discussed in the webinars, practices will form Antibiotic Use teams and develop and implement strategies to improve antibiotic decision making in their practice.
Collect and review data. Practices will be asked to complete several surveys throughout the program. Practices will also be asked to extract and submit antibiotic prescribing data from the EHR.

Who should be on the team for the program?

The team could consist of physicians (M.D., D.O.), including residents and fellows, advanced practice providers (P.A., A.P.N.), clinical support staff (R.N., L.P.N., M.A.), pharmacists (Pharm.D., RPh), and schedulers or other front desk staff. One or more people within the team will facilitate data collection and submission at your practice.

I am a telehealth provider who does not work with a regular team of other clinicians or staff. Can I still participate?

If you are physician providing telemedicine services but do not work as part of a team (i.e., you are a contractor or employee of a virtual-first or direct-to-consumer company) you can participate in this program as an individual clinician. The program’s educational content will still be applicable to your practice.

How much time will the program take our staff?

We anticipate that the team lead will need to spend two hours per month on the AHRQ Safety Program for Telemedicine: Improving Antibiotic Use, participating in webinars, office hours, and team meetings. Administrative leads may also need to devote an additional one hour each month to collect, submit, and review data. Other practice members may need to spend 30 minutes per month on the activities.

Who is sponsoring the program?

This program is funded and guided by the Agency for Healthcare Research and Quality (AHRQ), which is part of the U.S. Department of Health and Human Services. NORC at the University of Chicago is conducting the work in collaboration with Johns Hopkins Medicine.

What is antibiotic stewardship?

Antibiotic stewardship refers to the coordinated efforts to improve the use of antibiotics by promoting the selection of the optimal antibiotic regimen, dose, duration of therapy, and route of administration, when antibiotics are needed. Successful stewardship of antibiotics leads to decreased harm related to antibiotics such as Clostridioides difficile infection and other adverse events like rashes, yeast infections, and antibiotic-associated diarrhea.

I’ve participated/heard of the prior AHRQ safety program for antibiotic use in ambulatory care. How is this program different?

This program utilizes lessons learned from the prior program and has significant adaptation and enhancement of previously developed content to accommodate telemedicine delivery. In particular, content describing management of patients over telemedicine is a major focus. Additionally, it includes new modules such as diagnosing and managing sexually transmitted infections (STIs), COVID-19, diarrhea, and a primer on which antibiotics cover which organisms. Moreover, it assists clinicians with managing infectious disease concerns in the absence of a traditional physical examination.

Eligibility

Who is eligible to participate?

This program is looking to recruit ambulatory and primary care facilities, as well as direct-to-consumer and virtual first telemedicine practices across the United States. Practices must offer telehealth in their practice with video-based telemedicine capabilities, as well as utilize electronic health records (EHR). Practices can offer care exclusively via telemedicine or via a mix of in-person and telemedicine visits.

Eligibility

Practices

Eligible Practices

Primary care practices (including internal medicine, family medicine, and pediatrics)
Direct-to-consumer, virtual first, and other telemedicine practices
Community-based health clinics (e.g., Federally Qualified Health Centers or FQHCs)
Urgent care clinics
Student health clinics
Outpatient specialty practices that provide primary care (e.g., gynecology)
Retail clinics
Employee health clinics

Ineligible Practices

Outpatient specialty clinics that do not provide primary care
Ambulatory surgery centers

What are examples of specialty practices excluded from this program?

Specialty practices that are not eligible for this program include pharmacies, dentistry, dermatology, occupational health, surgery centers, diagnostic laboratories, and dialysis centers.

How does the program define telemedicine?

This program defines telemedicine as any synchronous (i.e., “live”) communication between a provider and a patient regarding their care. This includes videoconferencing and telephone calls in which patient care is discussed. Asynchronous methods of communication, such as exchanges of messages in a patient portal, are not considered telemedicine for this program.

Additionally, practices should use videoconferencing for at least a portion of their telemedicine visits. Practices that solely use audio-only methods (e.g., telephone calls) to conduct telemedicine visits are not eligible. This refers to both practices with a brick-and-mortar location and direct-to-consumer/virtual first practices that enroll.

My practice has multiple locations/facilities. Does each location have to enroll separately?

If your practice has multiple locations/facilities, each location will need to enroll separately to participate in the program. If you represent a health system or a consortium of healthcare practices and would like assistance to enroll multiple practices, please contact us at safetyprogram4telemedicine@norc.org.

My practice does not have a physical location. What would constitute a practice for this program?

If your practice does not have a physical location, a group of clinicians and staff that work together closely as a virtual practice should enroll as a practice. If your practice does not have a physical location and there are not groups of clinicians and staff that work together closely, each individual clinician should enroll as a practice.

Would this program be of benefit to a pharmacy? Or is it specifically targeted towards the ambulatory care practices?

We are enrolling ambulatory care practices, not pharmacies.

My practice is owned or operated under a pharmacy. Can I still enroll?

If your practice is a practice on its own and meets the additional eligibility criteria, you are eligible to enroll.

My practice does not currently have an electronic health record (EHR). Are we still eligible to enroll in the program?

Facilities must have an electronic health record to enroll as it will be difficult to collect required data by hand.

Joining the Program

How do I join the program?

To join the program, complete the online enrollment form available at https://safetyprogram4telemedicine.org/page/join-the-program

The deadline to enroll is May 23, 2024.

How many practices will participate in the program?

The program aims to recruit up to 500 practices across the United States.

What does it cost for our practice to participate in the program?

There is no cost to participate. Participating practices will not receive any payment for participation.

What materials do I need to complete before the program begins?

You need to complete the online enrollment form and a Commitment Form, which will need to be signed by practice leaders.

Do we need IRB approval to participate?

Johns Hopkins Armstrong Institute for Patient Safety and Quality Institutional Review Board (IRB) has determined this program is not human subjects research and therefore exempt (Johns Hopkins IRB #IRB00338433). This program does not involve human subjects research, so no IRB approval is required. Your practice should be able to frame this program as a quality improvement study. If your practice requires an IRB submission for informational purposes, we will be glad to help you as needed.

Can my facility drop out of the program if we find it isn’t working for our organization or we experience significant unplanned events?

Yes. We will work with you to address any unplanned events that may occur. But we understand that circumstances change and can impact participation.

Data Collection

What data will be collected from our practice?

During the program, participating practices will be asked to engage in data collection activities to help understand the program’s impact on practice culture and prescribing patterns. Practice leads will be asked to complete three surveys at the beginning and/or end of the program; practice staff will be asked to complete two surveys. Quarterly, practices will be asked to submit antibiotic prescribing data extracted from the electronic health record (EHR). Finally, participants may elect to participate in optional (voluntary) interviews at the end of the program.

How will practice data be submitted?

Your practice will submit data through the program’s website via structured online forms. You will need to access your practice’s electronic health record (EHR) data to extract and submit antibiotic prescribing data.

What antibiotic prescribing data are required from the EHR?

Antibiotic prescribing data will include: 1) total antibiotic prescriptions per 100 respiratory tract infection telemedicine visits, and 2) antibiotic prescriptions per 100 antibiotic-inappropriate acute respiratory tract infection telemedicine visits. Both of these measures will be collected monthly from June 2024 through November 2025 and will be requested quarterly. The program staff will be available to assist in understanding how to collect this data from the EHR.

Data Use and Privacy

Is a data use agreement (DUA) required to participate in the program?

No, a DUA is not required for participation in the program. The data are being collected both for program assessment purposes and as a tool for each practice’s own quality improvement efforts. Each practice should use the data it collects to evaluate its antibiotic use. NORC at the University of Chicago and Johns Hopkins University, the program implementers, will use the collected data to assess the adoption and effectiveness of the program overall.

Since the program only requests deidentified information and does not request any protected health information (PHI), program participation does not require a data use agreement. However, if your practice determines that it still needs a DUA to define the transaction, we can provide a template for your review.

Will participating practices have to provide PHI about their patients?

The program only requests de-identified information; it does not request any PHI.

For what purpose will the data be used?

The program is collecting data as a tool for quality improvement efforts and program assessment purposes. Each practice should use the data it collects to evaluate its antibiotic use. NORC at the University of Chicago and Johns Hopkins University will use the collected data to assess the adoption and effectiveness of the program overall. The program is collecting only de-identified data and will not identify any individually participating practices.

Where specifically will our data be shared, and will it be “published” with our practice identifiers?

The program only collects de-identified data. Your data will be aggregated and anonymized by NORC at the University of Chicago, the program implementers, and then shared only with partners Johns Hopkins University and AHRQ. Individual practices will not be identified.

How will submitted data be managed?

The data will be stored on NORC at the University of Chicago’s secure server, and only NORC at the University of Chicago staff will be authorized to access the data.

Educational Content

What will the educational webinars discuss?

The webinars will focus on: 1) how to develop and improve antibiotic use in the telemedicine environment in your practice; 2) best practices for the diagnosis and treatment of infectious syndromes over telemedicine; and (3) strategies to communicate with colleagues, patients, and families about antibiotic prescribing. Educational webinars may cover the following topics:

Interventions to promote teamwork, communication, patient safety culture, and behavior change among telemedicine practice team members
Approaches to identify and mitigate obstacles that can cause patient harm such as navigating antibiotic allergies
Approaches to ensure all patients receive consistent evidence-based care via telemedicine

In addition to webinars, the program may provide additional tools and resources to support implementation, such as patient portal message scripts and discussion guides

Who should participate in the webinars?

Any participating providers and available members of your Antibiotic Use team should attend webinars, ideally including the designated administrative lead and at least one clinical staff person. Content will also be available on-demand through the program website for asynchronous review.

Are in-person meetings required?

This program does not require any in-person meetings. All program content will be delivered via webinars and eLearning modules. Meetings and communications with the program team (e.g., monthly check-ins with Implementation Advisers, office hours with experts) will be held virtually over conference calls, video calls, or email. Internal meetings with team members in your practice may be held in person or virtually.