Telehealth Toolkit

This toolkit is designed to help libraries implement telehealth programs that are relevant and valuable to their communities. Whether you are a rural library hoping to provide services that are geographically out of reach for your patrons or an urban library trying to create a safe and private space for mental health visits, this toolkit provides you with the information and resources you need to get started.

Questions about this toolkit? Contact the ICfL Digital Skills Library Consultant Chelsea Summerlin (chelsea.summerlin@libraries.idaho.gov).

Introduction

Due to the rural nature of Idaho, many communities lack sufficient medical and mental health care services to meet the needs of their residents. For many rural Idahoans, as well as those belonging to historically underserved groups, accessing these services requires long wait times for a local provider (if they exist) or traveling a long distance both ways to reach a clinic or hospital. Vulnerable populations, such as the elderly or disabled, have additional hurdles seeking health care due to a lack of independence or the ability to transport themselves to appointments.

These barriers can ultimately lead some Idaho residents to choose not to seek services like mental health care, preventative check-ups, or support for managing chronic conditions such as diabetes.

Connecting patients and doctors through telehealth is one way to overcome these barriers. While some patients may be able to access telehealth services from their home, others may lack sufficient internet speeds, may not have appropriate devices, may not have enough digital literacy skills, or may lack privacy or a quiet space within their home. Libraries can help bridge this gap by providing a safe, private, reliable location to access telehealth services with staff who can help patients use the technology. As highly trusted and well-connected institutions within their community, libraries are a perfect place to build or expand a community’s telehealth infrastructure.

Libraries, health care partners, and patrons should have a clear understanding of each other’s roles in providing telehealth access at the library. This will ensure a positive working relationship and a good experience for everyone. In general, the role of the library is to provide a safe, private, welcoming, and functional space with staff who can help navigate technology. It is the patient’s responsibility to secure a provider and communicate with that provider to schedule appointments. The role of the health care provider is to provide medical care and a secure platform through which to connect.

Roles of Healthcare Providers, Patrons, and Library Staff

Healthcare Provider

• Schedule the telehealth appointment.
• Reserve the telehealth space at the library (this could be done by either the provider or the patient, depending on the situation).
• Provide access to the appointment via a secure platform (e.g., a Zoom link sent by email).
• Provide medical advice, diagnosis, care, and answer medical questions.
• Provide support for using technology and navigating digital interfaces and meeting platforms.

Patron

• Schedule the telehealth appointment.
• Reserve the telehealth space at the library (this could be done by either the provider or the patient, depending on the situation).

Library Staff

• Provide clear instructions about how to reserve the space and when it is available.
• Accept and manage bookings and ensure the availability of the space for those who have reserved it.
• Create and maintain the space, including privacy barriers, furniture, and technology.
• Provide support for using technology and navigating digital interfaces and meeting platforms.

What is Telehealth?

The American Telemedicine Association (ATA) defines telemedicine as: “The delivery of any healthcare service or transmission of wellness information using telecommunications technology.” Closely associated with telemedicine is the term “telehealth,” which is often used to encompass a broader definition of remote health care that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, and nursing call centers are all considered part of telemedicine and telehealth.

Essentially, telehealth is health care provided at a distance, in real time, using technology. Libraries should understand that telehealth is health care provided by a licensed medical practitioner. The role of a library is to provide an access point to this service. Library staff may support digital navigation and technology support, but they are not expected to, nor should they attempt to, provide medical advice, counseling, or other services.

Please see the glossary for definitions of common telehealth terms.

Healthcare Landscape for Idaho

This video provides an overview of the health care landscapes in Idaho. It includes background information about the different types of hospitals and health care centers and shows how to navigate these systems to create community partnerships.

When libraries offer telehealth access points in their facilities, they become important links between their patrons and the health care system. However, most library staff are not experts when it comes to the health care system or the health care landscape in their communities. Libraries that build positive and cooperative relationships with health care providers will have more success. For this reason, it is helpful for library staff to understand the health care system at a high level as they navigate these relationships.

Although all health care organizations have a mission to prevent and intervene in patient health, the ways in which they do so and the ways in which they are paid for their services depend on the type of organization they are.

Often, physicians in rural areas have fewer resources, both financial and technological, which results in struggles to keep up with technological advances that larger organizations in urban settings may have access to. Federal or state funding can help aid in improving access to services.

Below is a list of common health care service providers:

• Hospital: A facility that provides 24-hour medically monitored care to patients.
• Health Care Clinic: A facility where patients seek health care services and leave when their appointment is over.
• Public Health and Public Health Districts: Public health is a division of the Department of Health and Welfare, and it develops and provides funding for statewide initiatives related to health care. Federal funds that come into the Division of Public Health are often passed through to the local public health districts.
• Crisis Centers: A facility where someone who is experiencing a crisis can go to receive care, such as for a mental health or substance abuse crisis.
• Health Care Payers: Companies or organizations that pay for health care services. These include the Centers for Medicaid and Medicare, as well as commercial insurance.

How to Connect with Healthcare Services

By offering a telehealth space, libraries will be a connection point for library patrons and their health care providers. Reach out to your local service providers and let them know about your telehealth space. Often, local Emergency Management Systems (EMS) coordinators or your local fire departments can be a good point of contact to help you connect to other health care systems.

If you don’t know individuals who work in your local hospitals or clinics, reach out to your local public health district and ask for connections to those systems. Local public health districts have many connections to the health care providers in your area and are eager to help make those connections.

Unless you know a medical provider personally, trying to get a hold of them can be challenging. Medical providers spend the majority of their working hours treating patients. The best way to let medical offices know about your telehealth space is to talk directly to the office manager. Office managers are the key to providing information to all staff in the clinic, including the physicians.

When navigating hospital systems in a rural area, these organizations are typically smaller, so you may have access to individuals like the CEO, the chief medical officer, or the chief operating officer. Often, these individuals can connect you with the rest of the hospital system so that you can talk about your telehealth space and share any fliers or advertising materials.  

When contacting emergency departments, connect with the lead nurse or the charge nurse. These individuals share information with the rest of their team on a regular basis and can promote the presence of a telehealth space for any prescribed follow-up services.

Telehealth Technology Considerations

One of the most challenging aspects of managing a telehealth space is understanding the technology components that are required. For telehealth to be effective, both the patient and the provider must be able to clearly see and hear one another. Achieving a clear connection requires good internet access and appropriate, up-to-date technology.  This section will outline many of these considerations, but it may not be comprehensive depending on the space or limitations of your facility. Please reach out when you are uncertain or need clarification for installing a specific piece of equipment or technology.

Technology and Equipment Room Set-Up

A room setup for virtual meetings should contain a few key features to ensure a clear connection, good productivity, and best use.​ Necessary items include:

• Video camera
• Speakers or headphones
• Microphone
• Computer monitors
• Computer
• Internet
• Proper sound treatment
• Proper lighting
• Neutral wall colors and minimal décor

Video Camera

There are many video camera set ups. However, the easiest plug-and-play device is a USB webcam that connects directly to the computer via a cable. Most cameras now come with a “privacy screen” that allows you to slide a cover over the camera. It is recommended to use a camera that supports a minimum of 720p resolution, as anything under this will not provide adequate quality. It is also best practice to use the same brands for as many of your devices as possible to reduce compatibility issues.

Speakers, Headphones, and Microphones

External speakers and microphones have the benefit of being hands-free and easy to clean. However, they have some setbacks. External devices can pick up background noise, are harder to set up, can cause an echo, and may require extra steps to ensure patron privacy. Headphones are easy to set up, offer a more private experience, and often come with a built-in microphone. However, they can be hard to clean and will have more wear and tear.

Environmental Considerations and Sound Treatments

Often, rooms used or repurposed for telehealth fail to consider how sound and visual backgrounds affect the space. For example, empty rooms naturally echo, and cluttered and busy walls behind a user can be distracting. There are multiple ways to reduce noise and background distractions. You can reduce noise by having:

• Carpets and rugs
• ​Noise-dampening panels, canvas-style paintings, or cloth tapestries
• Upholstered furniture
• White noise machines placed outside a door

Broadband Internet

To provide telehealth connections, all computers need high-speed connectivity. It is recommended to have 100 Mbps for every eight devices being used, as one device will consume roughly 10-20 Mbps for an average telehealth scenario. You can check each device’s network speed and connection stability by using a speed test. Libraries with additional questions about broadband internet speeds or set up are welcome to contact the ICfL’s Library Technology Consultant.

Policy and Administrative Recommendations

Libraries should ensure that their public policies, as well as their internal procedures, cover the use and maintenance of the telehealth space. These documents should include information that clarifies expectations and allows staff and the public to use the space safely and fairly. Any policies or procedures put in place for the telehealth space should be consistent with other reservable or private spaces within the library (such as meeting rooms, study rooms, etc.).

Most public libraries offer telehealth access through a multi-purpose space that is also used for activities such as study, video calls, or private virtual meetings. In these cases, the policy and procedures should consider the multiple uses and needs for the space.

Below are topics that should be considered for inclusion in your library’s public-facing policies. The specific criteria included in each library’s policy will depend on the unique circumstances of that library and the preference of the board.  In general, a public policy should not get “into the weeds,” and should be general enough to allow staff to adapt and change their procedures as needed to carry out day-to-day operations. The policy should be specific enough that staff can use it to enforce expectations and behaviors with patrons using the space. 

• What are acceptable uses for the space, including what types of uses are allowed or not allowed? At the very least, this should include a statement that the space may not be used to conduct any activity that is illegal in the state of Idaho.
• Who is allowed to use the space? For example, are children under 10 allowed to use the space without being accompanied by an adult? Is more than one person allowed into the space at the same time? Are there any exceptions to these rules?
• When is the space available or not available? For example, some libraries may have their telehealth access point set up in a space that is also used for other functions. Make sure your policy outlines when the space is available for private uses, such as telehealth. This statement does not need to include specific days and times, but should generally address things like whether preference is given to the space for library activities, if the space is not available during community classes, etc.
• How do patrons get access to the space? Are reservations required? Must reservations be made in advance, or is the room open to walk-in traffic if it is not already in use? Although your policy doesn’t need to specify the details about how to reserve the space, it should at least outline the expectations or requirements for reserving the space.
• Under what circumstances will library staff intercede or remove access to the space? For example, do library staff have the right to interrupt a meeting if they believe patron or staff safety or health is at risk? Do staff have the right to interrupt or deny a reservation if they believe the space is being used for an illegal activity?

Libraries with additional policy questions are encouraged to reach out to their attorney.

Below are topics the library should consider including in its procedure manual. The procedure manual (or similar document) is used internally by staff to ensure consistent operations and to guide the day-to-day duties of staff. The specific criteria included in each library’s procedure manual will depend on the unique circumstances of that library. Procedures should be specific enough to allow staff to fulfill their duties or provide back-up support when other staff are not available. The procedure manual should include adequately detailed process instructions and responsible parties for the following:

• Scheduling the space.
• Cleaning the space (including a cleaning schedule for various equipment).
• Checking patrons in or out of the space (if applicable).
• How to use the various technologies in the space. At a minimum, how to turn on the equipment and how to ensure that the microphone, camera, and speakers are functioning properly.
• What to do if a patron asks for help in using the space or its technology.
• Whom to contact if there are technology problems, and some common troubleshooting tips.
• What to do in an emergency (quick reference provided below).

Patron Educational Materials

There are various materials a library may consider having available for patrons using a telehealth space. Below are general examples. Please consult an attorney to ensure documentation meets the threshold of legal considerations and risk minimization.

Liability Waiver

• A liability waiver is a legal document that a person who participates in an activity may sign to acknowledge the risks involved in their participation. By doing so, the company attempts to remove legal liability from the business or person responsible for the activity.
• Liability documentation may be in the form of a wall poster, online form, or physical document signed upon arrival by patrons.

Self-Guided Materials

Patrons will have various levels of comfort with telehealth appointments and technology. It is recommended to have self-guidance materials available. Below are some examples:

• What to Expect from a Telehealth Visit
• Patient Telehealth Checklist
• How To Prep for Your Telehealth Appointment
• Getting Patients Set Up with Telehealth Technology
• Getting Started with Telehealth

How to Handle an Onsite Emergency

Libraries should expect to encounter a few medical or mental health emergencies related to their telehealth space. Having a plan in place ensures the safety of your patrons experiencing the emergency, as well as the other patrons at the library at the time of the emergency. The responsibility of the library falls within the Good Samaritan Law guidelines.

Good Samaritan Law Guidelines

ID Code § 5-330 states that people rendering good-faith aid or medical attention at the scene of an accident or emergency shall not be held responsible for civil damages. Any library employee or patron who attempts to help a person in a mental health or medical emergency will not be held liable for the outcome of that emergency.

One caveat to this law is that if a person intentionally engages in care/treatment that is beyond their training, scope of knowledge, or known to cause additional injury or death, the Good Samaritan clause for immunity would be inapplicable.

In Case of Emergency

Do:

• In the case of a medical or patron safety emergency, direct a nearby person to call 911 or call yourself.
• Keep eyes on the individual to continuously monitor their condition.
• Ask if any patrons present are trained medical professionals.
• If the individual is breathing and responsive, speak to the individual and gather as much information as possible to relay back to the 911 dispatcher.
• Follow all 911 dispatcher instructions.
• If the person is not breathing, begin CPR if you or another nearby person has been trained. If there is no one present with CPR training, move the person into the recovery position.
• Remain aware of contact with bodily fluids.
• If the person is experiencing a mental health emergency and is responsive, contact 988 and allow the individual to speak with the crisis specialist. If the person is unresponsive, contact 911.

Don’t

• Don’t wait to call 911 until after you have collected information.
• Don’t engage in medical interventions that you have not been trained in.
• Don’t attempt to drive someone to a medical clinic or hospital.
• If the person recovers, don’t attempt to physically or otherwise restrain someone until emergency responders arrive. It’s okay to encourage the individual to wait to be checked out.
• Don’t immediately leave the scene once emergency responders arrive. Remain present to convey whatever information you have about the individual.

Local Emergency Contact Numbers

If your library has a provider that consistently provides telehealth services, it is best practice to equip them with the local emergency numbers. If your healthcare provider is outside your county, calling 911 will connect them to their local emergency center. If they’re calling for a patron, the call will need to be transferred to the emergency office covering the area where your library is located.

Mental Health Crisis Centers

In addition to 988, Idaho offers help for individuals facing a mental health crisis through the use of regional crisis centers. Per the Health and Welfare website, crisis centers provide emergency substance use disorder and mental health services for adults 18 and older.

Crisis centers are a place for adults to go for help if they are experiencing a behavioral health crisis, such as suicidal thoughts or withdrawal from drugs. They receive a bed, food, and services from mental health professionals.

All services are provided without charge to patients in need. Referrals and connections are made to appropriate community resources. Clients may remain at the facility for up to 23 hours and 59 minutes, but most people get the help they need in less time. Services provided include a 24-hour hotline, detox services, and crisis intervention and prevention.

Scheduling Recommendations

A major consideration of a successful library telehealth program is how a patron schedules time in the space. This is also the area of the biggest risk for a HIPAA violation.

Pros and Cons

Phone, in person, or email booking

• Con: Administration is heavy on library staff.
• Con: Limited to scheduling during business hours.
• Pro: Certain patrons may feel more comfortable with analog methods rather than electronic scheduling.
• Pro: No additional software scheduling costs/fees.

Online booking platform

• Con: May be difficult for some patrons to navigate an online booking platform.
• Con: May have extra cost associated with purchased or integrated software.
• Pro: Potentially less of an administration burden on the library staff.
• Pro: Patrons can self-schedule at their convenience regardless of the library’s business hours.

Considerations

• What current workflow is being used to schedule meeting spaces in your library?
• What is efficient about this method? What is inefficient?
  • What are the man-hour costs to schedule spaces over the course of a month?
  • Are there consistent problems with double booking or losing reservations?
  • What is the process for a patron to use the space after reserving it?
• If your library uses an electronic scheduling system, can this system/software be used for the telehealth space?
• If using multiple methods, ensure the library’s scheduling methods are synced together to prevent double booking.
• If the space is solely advertised and used as a telehealth room, please follow HIPAA guidelines.
  • The scheduling process should limit or avoid collecting any information that is considered Patient Health Information. This includes the patient’s full name, date of birth, address, health care patient ID numbers, or other unique identifiers.
  • Any information should be limited to library staff knowledge only. For example, do not post a printed pod/room schedule on the door for all other patrons to see.
  • Best practice is to limit the personal information to only what is necessary.
  • Best practice is to frequently delete records you no longer need. Consider creating a records retention schedule for your bookable spaces.
  • Please consult a HIPAA expert for further information.
• If the space being used for telehealth is advertised and used as a multi-purpose space with general video conference capabilities, then it doesn’t need to follow HIPAA regulations.
  • Best practice is to limit the personal information collected in the scheduling process to only what is necessary.
  • You may post a printed schedule on the door, but consider using the patron’s first name and last initial to respect the patron’s privacy.
• You may need additional time between appointments for the following:
  • Time for a patron to sign in and prepare for their telehealth appointment.
  • Time to clean and sanitize the space in between patrons.
  • Time in case an appointment runs late.

Media Kit

Download and print the files below to help spread the word about telehealth resources in your community.

Printable Resources

Digital Resources

The following digital resources can be used on your digital platforms, including your website and social media.

Would you bring your roommates to your doctor’s appointments?

You wouldn’t bring your roommates to your doctor’s appointment, so why bring them to your telehealth appointment? Reserve a private booth at your local library. This short video is perfect for marketing on mobile devices with an eye towards younger audiences. Download Video.

Slides and Images

The following slides can be used on your website, social media, and digital reader boards to let your community know about your telehealth site.

Don’t Let Slow Internet Disrupt Your Next Telehealth Connection

Click on an image to download it. Each image is 1080x1080px.

Take Your Next Telehealth Appointment at Your Library

Click on an image to download it. Each image is 1920x1080px.

Resources

Telehealth Best Practices and Toolkits

• Telehealth Guidance for Providers Section
• Telehealth Guidance for Patient Section
• Northwest Regional Telehealth Resource Center Tools and Resources
• American Telemedicine Association (Membership Required)
• Counseling Compact Toolkit

Learning Opportunities

• Telebehavioral Health 201 Series (Free CEUs)
• Northwest Regional Telehealth Resource Center Trainings
• Digital Navigation Toolkit
• Digital Skills Training Toolkit
• Idaho Digital Access Workbook

Telehealth Organizations

• Telehealth Gov
• Northwest Regional Telehealth Resource Center
• American Telemedicine Association

Other Resources

• 211 Idaho Care Line
• FindHelpIdaho.org
• List of Idaho State Services
• LGBT National Hotline: (888) 843-4564
• Trevor Lifeline (for LGBTQ+ Youth): (866) 488-7386
• Trans Lifeline: (877) 565-8860
• Veterans Crisis Line: (800) 273-8255 and press 1
• National Domestic Violence Hotline: (800) 799−7233 | text “START” to 88788
• Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline: (800) 662-4357

Glossary

• Distant site: The location where the distant provider is housed and offering health information or treatment by remote means.
• HIPAA: The Health Insurance Portability and Accountability Act (HIPAA) establishes federal standards protecting sensitive health information from disclosure without a patient’s consent.
• Latency: Any delay in transmission of the picture or audio in a telehealth visit. It can create awkward interruptions or long pauses.
• Originating site: The location of the patient when telehealth is used, whether at home, in an office, at a local primary care, or mental health clinic.
• Patient portal: A secure internet sign-on that allows patients to contact their provider, review medical tests and records, access health education materials, and seek appointments. Most provider networks develop a patient portal before they move to full video appointments.
• Peer-to-peer telehealth: Providers talking to each other over a video link, often for specialists to offer education to general providers or consult on individual cases.
• Peripheral medical devices: Measurement or monitoring devices that plug into, for example, a tablet computer providing a video link. The peripherals can be stethoscopes, blood pressure cuffs, audiology tools, or a pulse oximeter, among others.
• Real-time: Usually refers to a live videoconference with the patient, where the provider and patient can see each other and can interact nearly as they would in a face-to-face encounter.
• Store-and-forward: Uploading a patient record or a digital photo for a distant provider to review at another time.
• Telehealth: The delivery and exchange of health information, education, patient encounters, and provider consultations through any technology other than traditional face-to-face office visits.
• Telehealth Clinical Technician (TCT): A designated job category with alternative titles in provider organizations. The TCT works at the patient’s end of the telehealth link, handling the cameras or other technology, educating the patient, and following the remote provider’s instructions to gather information, among other duties.
• Telehome care: Home technology that is quickly moving beyond monitoring and straight to video visits using the patient’s own smartphone, tablet computer, or desktop with a camera. The “visits” must be routed through the provider’s security or encryption systems for patient privacy. 
• Telemedicine, telepsychiatry, and telemental health: Telemedicine refers to the delivery and exchange of physical medicine through technology. Telemental health is an emerging term meant to cover mental health access through technology, whether by patient appointments on video link, telephone consultations, or other means. Telepsychiatry is a subset of telemental health, indicating the presence of a psychiatric MD and any accompanying prescription drug management or inpatient hospital requirements.
• Telemonitoring: A more passive form of telehealth than a live video appointment. It often involves providing a homebound patient with tools to record and transmit important health information, such as blood pressure, blood sugar levels, or weight, to a central case manager.
• Telepresence: Using a robot camera or other remotely controlled health tool to make a diagnosis or assessment of a patient over long distances.