| Key Term | Definition | Examples and References |
| Appointment Wait Time | Refers to the time (in days) patients must wait before they can see a health care provider for an appointment. | |
| Community-Based Organization | As defined by the HHS Office of the Secretary for Preparedness and Response, community-based organizations (CBOs) are public or private not-for-profit resource hubs that provide specific services to the community or targeted population within the community. CBOs include but are not limited to aging and disability networks, community health centers, childcare providers, home visiting programs, state domestic violence coalitions and local domestic violence shelters and programs, adult protective services programs, homeless services providers, and food banks that work to address the health and social needs of populations. | |
| Consumer Assessment of Healthcare Providers and Systems (or CAHPS) Clinical & Group Adult Visit Survey 4.0 (beta) | The Agency for Healthcare Research and Quality (AHRQ) identifies CAHPS as an AHRQ program that began in 1995. Its purpose is to advance scientific understanding of patient experience with healthcare (ahrq.gov). | CAHPS Clinician & Group Adult Visit Survey 4.0 (beta) (ahrq.gov) |
| Countable Visit | A documented in-person or virtual live video and/or audio (synchronous, real time) interaction between a patient and a licensed or credentialed provider who exercises his/her independent, professional judgment in the provision of services to the patient. | |
| Ethnicity | Self-reported patient ethnicity (Hispanic or Latina/o or Not Hispanic/Latina/o). | |
| Face-to-Face (In-Person) Health Visit | Documented, in-person, face-to-face contact between a patient and a provider who exercises objective judgment in the provision of services to the patient. To be included as a visit, services rendered must be documented in the patient’s record. | |
| Limited English Proficient (LEP) | Describes individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English. | |
| Medical Insurance | Patient's primary medical insurance (Medicare, Medicaid/Children's Health Insurance Program (CHIP)/other public insurance, private insurance). | |
| Patient | A person who has at least one in-person or virtual encounter or countable visit in the last 12 months. | |
| Patient Encounter | An in-person or virtual interaction between an awardee health center and a patient for the purposes of health care. | |
| Patient Visit (Or Countable Visit) | A documented in-person or virtual live video and/or audio (synchronous, real time) interaction between a patient and a licensed or credentialed provider who exercises his/her independent, professional judgment in the provision of services to the patient. | |
| Race | Self-reported patient race (Asian, Native Hawaiian, Black, African American, White, More than one race). | |
| Reporting Period (Also referred to as "6-month Reporting Period") | Reporting Period refers to the four specified 6-month time frames for OVC data collection. |
Reporting Period 1 of 4 :3/1/2022 to 8/31/2022 Reporting Period 2 of 4: 9/1/2022 to 2/28/2023 Reporting Period 3 of 4: 3/1/2023 to 8/31/2023 Reporting Period 4 of 4: 9/1/2023 to 2/28/2024 |
| Special Populations | Migratory and seasonal agricultural workers, homeless populations, residents of public housing, patients from school-based health centers, veterans, and populations with limited English proficiency. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| Telehealth | The use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health, and health administration. | |
| Telemedicine | Telemedicine is a subset of telehealth services referring to remote clinical services. | |
| UDS Service Categories | Medical care services, dental services, mental health services, substance use disorder services, other professional services, vision services, enabling services, pharmacy personnel, other programs and services, quality improvement staff, total facility and non-clinical support staff. | See the the most recent Uniform Data System Reporting Manual. |
| UDS Service Categories for Countable Visits | Includes medical care, dental, mental health, substance use disorder, vision, other professional services, enabling services. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Dental Services | Personnel include general dental practitioners, oral surgeons, periodontists, endodontists, dental hygienists, dental therapists, dental assistants and advanced dental practice assistants, dental technicians, dental aides, and dental students (including hygienists students). | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Enabling Services | Personnel include case managers, case/referral coordinators, patient advocates, social workers, public health nurses, home health nurses, visiting nurses, registered nurses, licensed practical nurses/licensed vocational nurses, family planning counselors, health educators, outreach workers, patient transportation coordinators, drivers (including mobile van drivers), benefits assistance workers, pharmacy assistance program eligibility workers, eligibility workers, patient navigators, patient advocates, registration clerks, certified assisters, interpreters, translators, community health workers, community health advisors or representatives, lay health advocates, promotoras, and other enabling services personnel. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Medical Care Services | Personnel include family practitioners, general practitioners, internists, obstetricians/gynecologists, pediatricians, licensed medical residents, allergists, cardiologists, dermatologists, endocrinologists, orthopedists, surgeons, urologists, other physician specialists and sub-specialists, nurse practitioners, physician assistants, certified nurse midwives, clinical nurse specialists, public health nurses, home health nurses, visiting nurses, registered nurses, licensed practical nurses/licensed vocational nurses, nurse emergency medical services/nurse emergency medical technicians, nurses aides/assistants (certified and uncertified), clinic aides/medical assistants (certified and uncertified medical technologists), unlicensed interns and residents, EMT/EMS personnel, pathologists, medical technologists, laboratory technicians, laboratory assistants, phlebotomists, radiologists, X-ray technologists, X-ray technicians, radiology assistants and ultrasound technicians. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Mental Health Services | Personnel include psychiatrists, psychologists, clinical and psychiatric social workers, family therapists, psychiatric nurse practitioners, psychiatric and mental health nurses, and unlicensed mental health providers, including trainees (interns or residents), and "certified" personnel. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Other Professional Services | Personnel include audiologists, acupuncturists, chiropractors, community health aides and practitioners, herbalists, massage therapists, naturopaths, registered dietitians (including nutritionists/dietitians), occupational therapists, podiatrists, physical therapists, respiratory therapists, speech therapists/pathologists, and traditional healers. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Other Programs and Services | Personnel include WIC workers, Head Start workers, housing assistance workers, child care workers, food bank/meal delivery workers, employment/educational counselors, exercise trainers/fitness trainer personnel, adult day care and frail elderly support personnel. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Pharmacy Personnel | Personnel include pharmacists, clinical pharmacists, pharmacy technicians, pharmacist assistants, and pharmacy clerks. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Quality Improvement Staff | Personnel include quality improvement (QI) nurses, QI technicians, QI data specialists, statisticians and analysts, quality assurance/quality improvement and HIT/EHR design and operation personnel. | |
| UDS Service Category: Substance Use Disorder Services | Personnel include unlicensed substance use disorder providers, including trainees (interns or residents), and "certified" personnel, alcohol and drug abuse counselors, and RN counselors. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Total Facility and Non-Clinical Support Staff |
Personnel include project directors, chief executive officers/executive directors, chief financial officers/fiscal officers, chief information officers, chief medical officers, secretaries/administrative assistants, administrators, directors of planning and evaluation, clerk typists, personnel directors, receptionists, directors of marketing, marketing representatives, enrollment/service representatives, finance directors, accountants, bookkeepers, billing clerks, cashiers, data entry clerks, directors of data processing, programmers, IT help desk technicians, janitors/custodians, security guards, groundskeepers, equipment maintenance personnel, housekeeping personnel, medical and dental team clerks, medical and dental team secretaries, medical and dental appointment clerks, medical and dental patient health records clerks, patient health records supervisors, patient health records technicians, patient health records clerks, patient health records transcriptionists, and appointments clerks. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| UDS Service Category: Vision Services | Personnel include ophthalmologists, optometrists, ophthalmologist/optometric assistants, ophthalmologist/optometric aides, and ophthalmologist/optometric technicians. | See the the most recent Uniform Data System Reporting Manual, Appendix A. |
| Virtual Care Encounter | A virtual interaction between an awardee health center and a patient for the purposes of health care. May include but is not limited to virtual care visits. | |
| Virtual Care Type: Asynchronous Store and Forward (Store and Forward Telehealth, Asynchronous Telehealth) | Definition: Use of technology for the electronic transmission of medical information for remote evaluation, such as x-rays, sonograms, other digital images, data derived from questionnaires, and pre-recorded audio and/or videos that are not real-time interactions. Key Components: • Not real time (asynchronous). • Use of technology to electronically transmit x-rays, sonograms, other digital images, data derived from questionnaires, and pre-recorded audio and/or videos. • Includes evaluation by a provider, which is defined as interpretation and follow-up. • Includes e-consults: interprofessional provider to provider consultations that involve assessment and management services provided by a consultative physician, including report to the patient's treating/requesting physician or other qualified healthcare professional. • Guidance note: Medical information may be submitted by a patient and transmitted to a provider for remote evaluation, or transmitted provider to provider for remote evaluation. • Guidance note: Medical information may include data derived from questionnaires. Technology: Any technology that can electronically transmit x-rays, sonograms, other digital images, data derived from questionnaires, and pre-recorded audio and/or videos. |
Examples of provider to provider asynchronous store and forward: • Secure emails with photos or videos of patient examination. • Sending patient x-rays or other images to provider for evaluation. Examples of patient to provider asynchronous store and forward: • Youth completing a mental health assessment screener and sending to pediatrician through a patient portal. • Email or text messages with follow-up instructions or confirmations (HHS). |
| Virtual Care Type: Mobile Health (mHealth) | Definition: Use of technologies, like smartphone and tablet apps, that enable patients to capture or track personal health, fitness, or wellness information, or to access general health education materials, independent of an interaction with a health care provider, AND do not meet the FDA definition of a device. Key Components: • Does not meet the FDA definition of a device. • Used to capture or track personal health, fitness, or wellness data. • Used to access general-purpose health education (e.g., tutorials, training videos, articles, info on accessing services etc.). • Independent of an interaction with a health care provider. Guidance note: a provider could suggest an app. Technology: Smart phone or tablet applications (apps) NOT meeting the definition of an FDA defined device. (FDA: https://www.fda.gov/industry/regulated-products/medical-device-overview#What%20is%20a%20medical%20device). |
Examples of mHealth: • Sleep tracker • Fitness tracker • Calmness app • Step counter Examples that are NOT mHealth: • Smart phone or tablet applications (apps) that are used as an accessory to FDA defined “device” used for remote patient monitoring (e.g., an app for a continuous glucose monitor or an app that collects blood pressure data from a self-monitoring device). • Automatic push notifications/reminders [see Other Asynchronous Services]. |
| Virtual Care Type: Other Asynchronous Services | Definition: Includes any other asynchronous virtual care types not described in the categories above. | Examples of other asynchronous services: • Chatbot interactions that simulate human interaction. • Asynchronous portal, email, or text messaging for general health promotion, disease prevention, promotion of health services, and/to provide care access information. • Use of automatic reminders. • Use of push notifications. |
| Virtual Care Type: Remote Patient Monitoring (RPM, remote monitoring, remote physiologic monitoring, remote therapeutic monitoring, RTM) | Definition: Using a specific technology device to collect and transmit medical patient data such as vital signs, pulse, and blood pressure from patients in one location (typically a home) to health care providers in a different location for monitoring and evaluation. Key Components: • Can be synchronous or asynchronous. • Instrument or monitoring tool collecting patient data must meet the FDA definition of a device (see FDA link in Technology section below). Guidance question: Based on clinical judgement, would a Qualified Health Professional consider this a device? • Device must be prescribed or recommended by a provider and documented in the patient health record. Guidance note: Remote patient monitoring can be furnished/provided by other Qualified Health Professionals under the general supervision of a provider. (Note: the recommendation does need to be documented.) • Data must be able to be digitally uploaded or transferred (automatically) to a secure location where the data is available for analysis and interpretation by a Provider or other Qualified Health Professional. • Provider or other Qualified Health Professional uses the data to understand the patient’s status and/or develop a care plan (i.e., Remote Monitoring is an integral part of the patient’s care plan). Technology: Use of a technology that meets the FDA definition of a device, "Intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment, or prevention of disease" (https://www.fda.gov/industry/regulated-products/medical-device-overview#What%20is%20a%20medical%20device). *Guidance note: Includes smartphone or tablet application (apps) that are used as an accessory to a FDA defined “device” for remote patient monitoring (e.g., an app for a continuous glucose monitor or an app that collects blood pressure data from a self-monitoring device)". |
Examples of Remote Patient Monitoring: • Flash glucose monitor • Continuous glucose monitor (CGM) • Blood pressure monitor • Oximetry monitor • Pacemakers • Telemetry monitor (when automatically collected) • Remote Therapeutic Monitoring (e.g., inhaler that records use) Examples that are NOT Remote Patient Monitoring: • Patient independently chooses or receives a suggestion to use a Fitness tracker app (e.g. My Fitness Pal), but the app use does NOT meet the criteria for remote patient monitoring. |
| Virtual Care Type: Synchronous Real-time Telehealth - Audio-Only (Audio-only visits) |
Definition: Use of a two-way, interactive audio-only technology, such as a telephone for “live” or real-time interactions between a patient and provider. Key Components: • Live or real-time interaction. • Interaction is between patient and provider. • Evaluation/management and remote clinical services that meet the UDS definition of telemedicine. Technology: Telephone or other audio-only technology. |
Examples of audio-only synchronous real-time telehealth: • Audio only calls to confirm instructions (HHS). |
| Virtual Care Type: Synchronous Real-Time Telehealth Video (Live video) |
Definition: Use of a two-way video technology or other HIPAA compliant video connection to conduct a “live” or real-time interactive visit between a patient and provider. Key Components: • Live or real-time interaction. • Evaluation/management or remote clinical services that meet the UDS definition of telemedicine. Technology: Video (i.e., integrated video/audio conferencing technology) or other HIPAA compliant video connection. |
Examples of video-based synchronous real-time telehealth: • Video calls with remote physician to share progress or check on healing (HHS). |
| Virtual Care Types | 1. Synchronous Real-time Telehealth - Audio-Only (Audio-only visits) 2. Synchronous Real-Time Telehealth Video (Live video) 3. Asynchronous Store and Forward (Store and Forward Telehealth, Asynchronous Telehealth) 4. Remote Patient Monitoring (RPM, remote monitoring, remote physiologic monitoring, remote therapeutic monitoring, RTM) 5. Mobile health (mHealth) 6. Other Asynchronous Services |
|
| Virtual Care Visit | Virtual (telemedicine/telehealth) contact between a patient and a licensed or credentialed provider who exercises his/her independent, professional judgment in the provision of services to the patient. Virtual visits must be provided using interactive, synchronous audio and/or video telecommunication systems that permit real-time communication between the provider and a patient. Virtual visits should use codes that will result in accurate identification of virtual visits. These include telehealth-specific codes with the CPT or Healthcare Common Procedure Coding System (HCPCS) codes such as G0071, G0406-G0408, G0425-G0427, G2025, modifier “.95,” or Place of Service code “02” to identify virtual visits. |
See the the most recent Uniform Data System Reporting Manual. |
| Reporting Guidance Summary BMR Table Template Titles, Instructions and Guidance |
| Table 1: Number of Unique Health Center Patients with Countable Visits |
| Instructions: Enter the number of health center patients with countable visits for each visit type.Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 2: Number of Unique Health Center Patients with Countable Visits by Service Category |
| Instructions: Enter the number of health center patients with countable visits for each visit type by service category. Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 3: Number of Countable Visits by Service Category |
| Instructions: Enter the number of countable visits during for each visit type by service category.Enter '0' to indicate there are 0 to 5 visits to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 4: Number of Health Center Patients with Virtual Care Encounters During the Reporting Period |
| Instructions: Enter the number of health center patients with at least one specified virtual care encounter during the reporting period.^ Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 5: Number of Health Center Patients with Virtual Care Encounters During the Reporting Period, by Service Category |
| Instructions: Enter the number of health center patients with at least one specified virtual care encounter during the reporting period by service category.^ If applicable: Include health center patients with virtual encounters even if they do not have a countable visit.Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 6: Number of Health Center Patients with Virtual Care Visits or Encounters During the Reporting Period by Race and Hispanic or Latino/a Ethnicity |
| Instructions: Enter the number of health center patients with at least one specified visit or encounter during the reporting month by patient race and Hispanic or Latino/a ethnicity. Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 7: Number of Health Center Patients with Virtual Care Visits or Encounters During the Reporting Period by Patient Special and Other Populations |
| Instructions: Enter the number of health center patients with at least one specified visit or encounter during the reporting period across health center patient special or other populations. Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 8: Number of Health Center Patients with Virtual Care Visits or Encounters During the Reporting Period by Patient Medical Insurance Type |
| Instructions: Enter the number of health center patients with at least one specified visit or encounter during the reporting period by health center patient primary medical insurance type as of their most recent visit during the calendar year.^Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 9: Number of Health Center Patients with Virtual Care Visits or Encounters During the Reporting Period by Patient Age |
| Instructions: Enter the number or health center patients with at least one specified visit or encounter during the reporting period for each of the indicated health center patient age ranges.^Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 10: Number of Health Center Patients with Countable Visits by In-Person or Virtual Care Types and Quality of Care Screening Completion (Select 3 Measures) |
| Instructions: Select three Quality of Care screening measures to report in rows a to j. Rows a to g provide a list of possible screening measures to choose from. Rows h to j provide cells to write in one or more different Quality of Care screening measure(s) monitored by your health center. Enter the number of health center patients who received specified in-person or virtual care during the 6-month reporting period AND ALSO completed selected quality of care screening measures. Only include health center patients with a "countable visit" during the 6-month reporting period.^Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. See "Guidance for Tables 10 and 11" tab for additional instructions |
| Table 11: Number of Health Center Patients with Countable Visits by In-Person or Virtual Care Types and Health Outcome Measures Achievement (Select 1 Measure) |
| Instructions: Select at least one Health Outcome measure to report in rows a to d. Rows a and b provide a list of possible health outcome measures to choose from. Rows c and d provide cells to write-in a different Health Outcome measure(s) monitored by your health center. Enter the number of health center patients who received specified in-person or virtual care during the 6-month reporting period AND ALSO completed selected Health Outcome measure. Only include health center patients with a countable visit during the 6-month reporting period.^Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. See "Guidance for Tables 10 and 11" tab for additional instructions |
| Table 12: Health Center Patient Overall Rating of Most Recent Countable Visit (Optional) |
| Instructions: Enter the mean patient rating from the most recent countable visit.^ |
| Table 13: Health Center Patients Who Reported Receiving Instructions for Synchronous Video Virtual Care Visit (Optional) |
| Instructions: Enter the applicable number of health center patients. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. |
| Table 14: Overall Health Center Staffing |
| Instructions: Enter the total number of FTEs per UDS Service Category for the entire health center for this reporting period. Include FTEs for in-person and/or virtual care.Enter '0' to indicate there are no FTEs to report for a cell. |
| Table 15: FTE Virtual Care Training For the Entire Health Center |
| Instructions: Follow the instructions provided for each item. |
| Table 16: Virtual Care Claims Reimbursement Changes |
| Instructions: Select 'Yes' or 'No' for each item, and provide additional comments in Column B. |
| Table 17: Virtual Care Claims Submitted Versus Reimbursed by Virtual Care Types |
| Err:508 |
| Table 18: Virtual Care Claims Submitted Versus Reimbursed by Patient Primary Medical Insurance Type |
| Instructions: Enter the median appointment wait time in days during the 6-month reporting period for each UDS Service Category or 'n/a' if not applicable. |
| Table 19: Median Appointment Wait Time by Service Category |
| Instructions: Enter the median appointment wait time in days during the 6-month reporting period for each UDS Service Category or 'n/a' if not applicable. |
| Table 20: Median Appointment Wait Time by Visit Type |
| Instructions: Enter the median appointment wait time in days during the 6-month reporting period for each visit type or 'n/a' if not applicable. |
| Table 21: Virtual Care Strategic Deployment Self-Assessment Model Instrument |
| Instructions: We recommend that at least two members of your OVC project team complete the self-assessment. Each team member should complete the assessment individually, then come together to discuss and arrive at consensus responses. For items a. through j., read the "Virtual Care Strategic Deployment Leadership Category and Dimensions" in Column A and the corresponding "Maturity Assessment Question" in Column B. Identify a maturity level (basic, foundational, or advanced) that best fits your health center during the 6-month reporting period based on the descriptions in Column D "Possible Health Center Maturity Level Scores and Descriptions". Enter 'X' in the appropriate field in Column C. Select only one maturity level per item. In Column E, you may provide additional details on your health center's maturity level score based on the prompts. |
| Share Additional Information |
| Grant recipients may use this tab to submit any additional information, comments, or data findings not requested in other areas of the template. For example, if your health center has a definable program for a specific patient population through the OVC grant, please report related data for OVC-specific telehealth visits and any other relevant information in the Share Additional Information tab. |
| Reporting Guidance for Table 10 Quality of Care Screening Measures and Table 11 Health Outcomes Measures |
| Important Considerations |
| Tables 10 and 11 from the Biannual Measures Report template (BMR) include Quality of Care and Health Outcome measure names and descriptions from the most recent Uniform Data Service (UDS) Manual. To access detailed measure specifications, refer to the applicable UDS Manual and Program Assistance Letters (PALs). (Link to PAL: https://bphc.hrsa.gov/data-reporting/uds-training-and-technical-assistance/uniform-data-system-uds-program-assistance-letters) In reporting data for these selected measures using the BMR, please note that ALL measure Exclusions/Exceptions, Specification Guidance, and UDS Reporting Considerations described in the applicable UDS Manual and PAL apply. The two major differences in Quality of Care and Health Outcome measure reporting in the BMR are as follows: 1. Reporting period: For the BMR, health centers will only report for a 6-month reporting period. (Note: The BMR also uses the term "reporting period" instead of "measurement period".) 2. Virtual care type: For the BMR, health centers will report measure numerators and denominators by virtual care type. |
| Key Terms Referenced in Measurement Descriptions |
| • Denominator: Captures patients who fit the detailed criteria described for inclusion in the specific measure to be evaluated. • Numerator: Captures patients (from the denominator) that meet the criteria for the specified measure. • Denominator Exclusions: Identifies patients not to be considered for the measure and who are removed from the denominator before determining if numerator criteria are met. • Denominator Exceptions: Identifies patients who meet denominator criteria but do not meet numerator criteria and meet any of the exceptions listed for the measure and are removed from the denominator. • Specification Guidance: CMS measure guidance that assists with understanding and implementing electronc clinical quality measures (eCQMs). • UDS (OVC) Reporting Considerations: Describes Additional BPHC requirements and guidance that must be applied to the specific measure and that may differ from or expand on the eCQM specifications. |
| Step-by-Step Example Using the Table 10 UDS Breast Cancer Screening Quality of Care Measure |
| Measure Description |
| Percentage of women 50*–74 years of age who had a mammogram to screen for breast cancer in the 27 months prior to the end of the measurement period. (*Note: Use 51 as the initial age to include in assessment. See UDS Reporting Considerations for further detail.) |
| Calculate the Denominators and Numerators as follows: |
| Denominator: Column A |
| The number of women 51 through 73 years of age with a medical visit during the 6-month reporting period^ |
| • Note: the 6-month time period differs from the UDS manual. |
| • See birthdate guidance in the UDS manual. |
| Denominator: Columns B, C, D, E, F, G, H |
| The number of women reported in Column A, who received the following virtual care type during the 6-month reporting period: |
| • Column B: at least one Face-to-Face (In-person) visit during the 6-month reporting period^ |
| • Column C: at least one Synchronous/Live Audio Only virtual visit during the 6-month reporting period^ |
| • Column D: at least one Synchronous/Live Video virtual visit during the 6-month reporting period^ |
| • Column E: with at least one Asynchronous Store and Forward encounter during the 6-month reporting period^ |
| • Column F: with at least one Remote Monitoring encounter during the 6-month reporting period^ |
| • Column G: with at least one Mobile Health (mHealth) encounter during the 6-month reporting period^ |
| • Column H: with at least one Other Asynchronous Technology encounter during the 6-month reporting period^ |
| Numerator: Column A |
| Women with one or more mammograms during the 27 months prior to the end of the reporting period. |
| • Note: the 6-month time period differs from the UDS manual. |
| Numerator: Columns B, C, D, E, F, G, H |
| The number of women reported in Column A who received the following virtual care type: |
| • Column B: at least one Face-to-Face (In-person) visit during the 6-month reporting period^ |
| • Column C: at least one Synchronous/Live Audio Only virtual visit during the 6-month reporting period^ |
| • Column D: at least one Synchronous/Live Video virtual visit during the 6-month reporting period^ |
| • Column E: with at least one Asynchronous Store and Forward encounter during the 6-month reporting period^ |
| • Column F: with at least one Remote Monitoring encounter during the 6-month reporting period^ |
| • Column G: with at least one Mobile Health (mHealth) encounter during the 6-month reporting period^ |
| • Column H: with at least one Other Asynchronous Technology encounter during the 6-month reporting period^ |
| Additional Resources |
| Uniform Data System (UDS) Training and Technical Assistance: Clinical Care available at link: https://bphc.hrsa.gov/data-reporting/uds-training-and-technical-assistance/clinical-care |
| For measure information relevant to clinical measure reporting and virtual care, see "Telehealth Impact on 2022 Uniform Data System (UDS) Clinical Measure Reporting" available at link: https://bphc.hrsa.gov/sites/default/files/bphc/data-reporting/telehealth-impact-uds.pdf |
| (Note: More recent documentation may be available at the UDS technical assistance link) |
| ^See Terms and Definitions tab |
| Biannual Measures Report – Optimizing Virtual Care (OVC) | ||
| Grant Recipient Information (Please complete below) | ||
| Grant Recipient Organization Name | OVC Grant Number | Reporting Period* (Please indicate if this submission is for Reporting Period 1, 2, 3 or 4. See the table below for guidance) |
| *Reporting Period refers to the time period for data collection. | ||
| Reporting Period Guidance | ||
| Reporting Period* | Data Collection Months | Data Submission due to HRSA |
| Reporting Period 1 | Mar 2022 Apr 2022 May 2022 Jun 2022 Jul 2022 Aug 2022 |
10/5/2022 |
| Reporting Period 2 | Sep 2022 Oct 2022 Nov 2022 Dec 2022 Jan 2023 Feb 2023 |
4/5/2023 |
| Reporting Period 3 | Mar 2023 Apr 2023 May 2023 Jun 2023 Jul 2023 Aug 2023 |
10/5/2023 |
| Reporting Period 4 | Sep 2023 Oct 2023 Nov 2023 Dec 2023 Jan 2024 Feb 2024 |
4/5/2024 |
| Table 1: Number of Unique Health Center Patients with Countable Visits | ||||||
| Purpose: Information in this table will be used to better understand variations in the number of health center patients with countable visits across care types. | ||||||
| Instructions: Enter the number of health center patients with countable visits for each visit type. | ||||||
| Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. | ||||||
| To support patient privacy, do not enter patient counts fewer than 6 patients. | ||||||
| Health Center Patients | A. Total number of unique health center patients with at least one countable visit during the 12 months prior to the last day of the reporting period^ | B. Total number of unique health center patients with at least one countable visit during the 6-month reporting period^ | C. Number of unique health center patients with at least one Face-to-Face (in-person) visit during the 6-month reporting period^ | D. Number of unique health center patients with at least one Synchronous Live Audio Only OR Synchronous Live Video virtual visit during the 6-month reporting period^ | E. Number of unique health center patients with at least one Synchronous Live Audio Only virtual visit during the 6-month reporting period^ |
F. Number of unique health center patients with at least one Synchronous Live Video virtual visit during the 6-month reporting period^ |
| All health center patients | ||||||
| ^See the Terms and Definitions tab for countable visit and care type definitions. | ||||||
| Table 1 Additional Comments (300 Word Max, enter 'n/a' if no comments) |
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| Table 2: Number of Unique Health Center Patients with Countable Visits by Service Category | ||||||
| Purpose: Information in this table will be used to better understand variation in the number of health center patients with countable vists across service categories. | ||||||
| Instructions: Enter the number of health center patients with countable visits for each visit type by service category. | ||||||
| Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. | ||||||
| To support patient privacy, do not enter patient counts fewer than 6 patients. | ||||||
| UDS Service Category^ | A. Total number of unique health center patients with at least one countable visit during the 12 months prior to the last day of the reporting period^ | B. Total number of unique health center patients with at least one countable visit during the 6-month reporting period^ | C. Number of unique health center patients with at least one Face-to-Face (in-person) visit during the 6-month reporting period^ | D. Number of unique health center patients with at least one Synchronous Live Audio Only OR Synchronous Live Video virtual visit during the 6-month reporting period^ | E. Number of unique health center patients with at least one Synchronous Live Audio Only virtual visit during the 6-month reporting period^ |
F. Number of unique health center patients with at least one Synchronous Live Video virtual visit during the 6-month reporting period^ |
| a. Medical^ | ||||||
| b. Dental^ | ||||||
| c. Mental Health^ | ||||||
| d. Substance Use Disorder^ | ||||||
| e. Other Professional Services^ | ||||||
| f. Vision^ | ||||||
| g. Enabling Services^ | ||||||
| ^See the Terms and Definitions tab for countable visit, UDS Service Category, and care type definitions. | ||||||
| Table 2 Additional Comments (300 Word Max, enter 'n/a' if no comments) |
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| Table 3: Number of Countable Visits by Service Category | ||||||
| Purpose: Information in this table will be used to better understand variation in health center patients' countable visits across service categories. | ||||||
| Instructions: Enter the number of countable visits during for each visit type by service category. | ||||||
| Enter '0' to indicate there are 0 to 5 visits to report for a cell. | ||||||
| To support patient privacy, do not enter patient counts fewer than 6 patients. | ||||||
| UDS Service Category^ | A. Total number of countable visits during the 12 months prior to the last day of the reporting period^ | B. Total number of countable visits during the 6-month reporting period^ | C. Number of Face-to-Face (in-person) visits during the 6-month reporting period^ | D. Number of Synchronous Live Audio Only virtual visits during the 6-month reporting period^ |
E. Number of Synchronous Live Video virtual visits during the 6-month reporting period^ | |
| a. Medical^ | ||||||
| b. Dental^ | ||||||
| c. Mental Health^ | ||||||
| d. Substance Use Disorder^ | ||||||
| e. Other Professional Services^ | ||||||
| f. Vision^ | ||||||
| g. Enabling Services^ | ||||||
| h. Total Number of Countable Visits During the Reporting Period (Sum a to g) | ||||||
| ^See the Terms and Definitions tab for countable visit, UDS Service Category, and care type definitions. | ||||||
| Table 3 Additional Comments (300 Word Max, enter 'n/a' if no comments) |
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| Table 10: Number of Health Center Patients with Countable Visits by In-Person or Virtual Care Types and Quality of Care Screening Completion (Select 3 Measures) | ||||||||
| Purpose: Information in this table will be used to better understand variations in use of in-person or virtual care types for patients who completed quality of care screenings. | ||||||||
| Instructions: Select three Quality of Care screening measures to report in rows a to j. Rows a to g provide a list of possible screening measures to choose from. Rows h to j provide cells to write in one or more different Quality of Care screening measure(s) monitored by your health center. | ||||||||
| Enter the number of health center patients who received specified in-person or virtual care during the 6-month reporting period AND ALSO completed selected quality of care screening measures. Only include health center patients with a "countable visit" during the 6-month reporting period.^ | ||||||||
| Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. | ||||||||
| To support patient privacy, do not enter patient counts fewer than 6 patients. | ||||||||
| See "Guidance for Tables 10 and 11" tab for additional instructions | ||||||||
| Quality of Care Screening Measures (CMS eCQM ID ) (Select 3 measures to complete) |
A. Number of unique health center patients with a medical visit during the 6-month reporting period | B. Number of unique health center patients with at least one Face-to-Face (In-person) visit during the 6-month reporting period^ | C. Number of unique health center patients with at least one Synchronous/Live Audio Only virtual visit during the 6-month reporting period^ |
D. Number of unique health center patients with at least one Synchronous/Live Video virtual visit during the 6-month reporting period^ |
E. Number of unique health center patients with at least one Asynchronous Store and Forward encounter during the 6-month reporting period^ | F. Number of unique health center patients with at least one Remote Monitoring encounter during the 6-month reporting period^ | G. Number of unique health center patients with at least one Mobile Health (mHealth) encounter during the 6-month reporting period^ | H. Number of unique health center patients with at least one Other Asynchronous Technology encounter during the 6-month reporting period^ |
| a. Breast Cancer Screening: (CMS125v10) (See the most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) |
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| a.1. Denominator: Women 51-73 years of age with a medical visit during the reporting period | ||||||||
| a.2. Numerator: Women with one or more mammograms during the 27 months prior to the end of the reporting period | ||||||||
| b. Cervical Cancer Screening (CMS124v10) (See the most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) |
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| b.1. Denominator: Women 23 through 63 years of age with a medical visit during the reporting period | ||||||||
| b.2. Numerator: Women with one or more screenings for cervical cancer. Appropriate screenings are defined by any one of the following criteria: • Cervical cytology performed during the reporting period or the 2 years prior to the reporting period for women who are at least 21 years old at the time of the test. • Cervical HPV testing performed during the reporting period or the 4 years prior to the reporting period for women who are 30 years or older at the time of the test. |
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| c. Childhood Immunization: (CMS117v10) (See the most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) |
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| c.1. Denominator: Children who turn 2 years of age during the reporting period and who had a medical visit during the reporting period | ||||||||
| c.2. Numerator: Children who have evidence showing they received recommended vaccines, had documented history of the illness, had a seropositive test result, or had an allergic reaction to the vaccine by their second birthday | ||||||||
| d. Colorectal Cancer Screening: (CMS130v10) - (See the most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) | ||||||||
| d.1. Denominator: Patients 50 through 74 years of age with a medical visit during the reporting period | ||||||||
| d.2. Numerator: Patients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one ofthe following criteria: • Fecal occult blood test (FOBT) during the reporting period • Fecal immunochemical test (FIT)-deoxyribonucleic acid (DNA) during the reporting period or the 2 years prior to the reporting period • Flexible sigmoidoscopy during the reporting period or the 4 years prior to the reporting period • Computerized tomography (CT) colonography during the reporting period or the 4 years prior to the reporting period • Colonoscopy during the reporting period or the 9 years prior to the reporting period |
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| e. Preventive Care and Screening: Screening for Depression and Follow-Up Plan: (CMS2v11) (See the most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) |
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| e.1. Denominator: Patients aged 12 years and older with at least one medical visit during the reporting period | ||||||||
| e.2. Numerator: Patients who: • were screened for depression on the date of the visit or up to 14 days prior to the date of the visit using an age-appropriate standardized tool and, • if screened positive for depression, had a follow-up plan documented on the date of the visit. |
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| f. Depression Remission at Twelve Months: (CMS159v10) (See the most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) |
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| f.1. Denominator: Patients aged 12 years and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 or PHQ-9 modified for teens (PHQ-9M) score greater than 9 during the index event between [see dates] and at least one medical visit during the reporting period | ||||||||
| f.2. Numerator: Patients who achieved remission at 12 months as demonstrated by the most recent 12 month (+/- 60 days) PHQ-9 or PHQ-9M score of less than 5 | ||||||||
| g. HIV Screening: (CMS349v4) (See most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) |
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| g.1. Denominator: Patients aged 15 through 65 years of age at the start of the reporting period and with at least one outpatient medical visit during the reporting period | ||||||||
| g.2. Numerator: Patients with documentation of an HIV test performed on or after their 15th birthday and before their 66th birthday | ||||||||
| h. Other Screening Measure (Write in): _________________ | ||||||||
| h.1. Denominator: Other (Write In) _________________ | ||||||||
| h.2. Numerator: (Write in) _________________ | ||||||||
| i. Other Screening Measure (Write in): _________________ | ||||||||
| i.1. Denominator: (Write in) _________________ | ||||||||
| i.2. Numerator: (Write in) _________________ | ||||||||
| j. Other Screening Measure (Write in): _________________ | ||||||||
| j.1. Denominator: (Write in) _________________ | ||||||||
| j.2. Numerator: (Write in) _________________ | ||||||||
| ^See the Terms and Definitions tab | ||||||||
| Table 10 Comments: (300 Word Max, enter 'n/a' if no comments) |
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| Table 11: Number of Health Center Patients with Countable Visits by In-Person or Virtual Care Types and Health Outcome Measures Achievement (Select 1 Measure) | ||||||||
| Purpose: Information in this table will be used to better understand variations in use of in-person or virtual care types for patients with specified health outcomes. | ||||||||
| Instructions: Select at least one Health Outcome measure to report in rows a to d. Rows a and b provide a list of possible health outcome measures to choose from. Rows c and d provide cells to write-in a different Health Outcome measure(s) monitored by your health center. | ||||||||
| Enter the number of health center patients who received specified in-person or virtual care during the 6-month reporting period AND ALSO completed selected Health Outcome measure. Only include health center patients with a countable visit during the 6-month reporting period.^ | ||||||||
| Count each health center patient only one time per cell. Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. | ||||||||
| To support patient privacy, do not enter patient counts fewer than 6 patients. | ||||||||
| See "Guidance for Tables 10 and 11" tab for additional instructions | ||||||||
| Health Outcomes Measures (Select at least 1 measure below to complete) |
A. Number of unique health center patients with a medical visit during the 6-month reporting period | B. Number of unique health center patients with at least one Face-to-Face (In-person) visit during the 6-month reporting period^ | C. Number of unique health center patients with at least one Synchronous/Live Audio Only virtual visit during the 6-month reporting period^ |
D. Number of unique health center patients with at least one Synchronous/Live Video virtual visit during the 6-month reporting period^ |
E. Number of unique health center patients with at least one Asynchronous Store and Forward encounter during the 6-month reporting period^ | F. Number of unique health center patients with at least one Remote Monitoring encounter during the 6-month reporting period^ | G. Number of unique health center patients with at least one Mobile Health (mHealth) encounter during the 6-month reporting period^ | H. Number of unique health center patients with at least one Other Asynchronous Technology encounter during the 6-month reporting period^ |
| a. Controlling High Blood Pressure: (CMS165v10) (See most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) |
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| a.1. Denominator: Patients 18 through 84 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first 6 months of the reporting period with a medical visit during the reporting period | ||||||||
| a.2. Numerator: Patients whose most recent blood pressure is adequately controlled (systolic blood pressure less than 140 mmHg and diastolic blood pressure less than 90 mmHg) during the reporting period (Must also meet denominator criteria) | ||||||||
| b. Diabetes Hemoglobin A1c (HbA1c) Poor Control: (CMS122v10) (See most recent UDS Manual for denominator exclusions/exceptions, specification guidance, and reporting considerations) |
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| b.1. Denominator: Patients 18 through 74 years of age with diabetes with a medical visit during the reporting period | ||||||||
| b.2. Numerator: Patients whose most recent HbA1c level performed during the reporting period was greater than 9.0%, or was missing, or was not performed during the reporting period | ||||||||
| c. Other Outcome Measure (Write in): _________________ | ||||||||
| c.1. Denominator: (Write in) __________________________ | ||||||||
| c.2. Numerator: (Write In): ______________________ | ||||||||
| d. Other Outcome Measure (Write in): _________________ | ||||||||
| d.1. Denominator: (Write in) __________________________ | ||||||||
| d.2. Numerator: (Write In): ______________________ | ||||||||
| ^See the Terms and Definitions tab | ||||||||
| Table 11 Comments: (300 Word Max, enter 'n/a' if no comments) |
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| Table 12: Health Center Patient Overall Rating of Most Recent Countable Visit (Optional) | ||||||||
| (Optional: Applicable only for health centers that implement the CAHPS Clinical and Group Visit Adult 4.0 (beta) Survey) | ||||||||
| Purpose: Information in this table will be used to examine variation in patient ratings of in-person and virtual visits. | ||||||||
| Instructions: Enter the mean patient rating from the most recent countable visit.^ | ||||||||
| Patient CAHPS Survey Respondents | A. Mean patient rating of most recent visit (Range 0 to 10) (Refer to CAHPS Survey Item 21: "Using any number 0 to 10, where 0 is the worst visit possible and 10 is the best visit possible, what number would you use to rate your most recent visit?" |
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| a. All Patients who responded to item 21 of the CAHPS Clinical and Group Survey and Instructions Adult 4.0 (beta) | ||||||||
| b. Patients with most recent visit with provider in person | ||||||||
| c. Patients with most recent visit with provider by phone | ||||||||
| d. Patients with most recent visit with provider by video visit | ||||||||
| Note: If your health center did not administer the CAHPS survey, but collected similar virtual care patient satisfaction data using a comparable survey please report the survey name, questions, response options, and response data in the Share Additional Data tab. | ||||||||
| ^ See the Terms and Definitions tab for countable visit definition | ||||||||
| Table 12 Comments: (300 Word Max, enter 'n/a' if no comments) |
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| Table 13: Health Center Patients Who Reported Receiving Instructions for Synchronous Video Virtual Care Visit (Optional) | ||||||||
| (Optional: Applicable only for health centers that implement the CAHPS Clinical and Group Visit Adult 4.0 (beta) Survey) | ||||||||
| Purpose: Information in this table will be used to examine variation in instructions provided to patients. | ||||||||
| Instructions: Enter the applicable number of health center patients. | ||||||||
| Enter '0' to indicate there are 0 to 5 health center patients to report for a cell. To support patient privacy, do not enter patient counts fewer than 6 patients. | ||||||||
| Patients CAHPS Survey Respondents | A. Number of patients who completed the CAHPS Clinical and Group Survey and Instructions Adult 4.0 (beta) | B. Number of patients who reported last visit was synchronous, video virtual care visit | C. Number of patients who responded (1-Yes) to item 6*: "Did you need instructions from this provider’s office about how to use video for this visit?" of the CAHPS Clinical and Group Survey and Instructions Adult 4.0 (beta) | D. Adults who responded (1-Yes) to item 7: "Did this provider's office give you all the instructions you needed to use video for this visit?" | ||||
| a. Health Center Patients | ||||||||
| Note: If your health center did not administer the CAHPS survey, but collected similar virtual care patient satisfaction data using a comparable survey please report the survey name, questions, response options, and response data in the Share Additional Information tab. | ||||||||
| Table 13 Comments: (300 Word Max, enter 'n/a' if no comments) |
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| Table 21: Virtual Care Strategic Deployment Self-Assessment Model Instrument | ||||
| Purpose: Information from OVC awardees' self- assessments will be used to identify topics for future coaching sessions or Technical Assistance through your HRSA Project Officer. | ||||
| Instructions: We recommend that at least two members of your OVC project team complete the self-assessment. Each team member should complete the assessment individually, then come together to discuss and arrive at consensus responses. | ||||
| For items a. through j., read the "Virtual Care Strategic Deployment Leadership Category and Dimensions" in Column A and the corresponding "Maturity Assessment Question" in Column B. |
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| Identify a maturity level (basic, foundational, or advanced) that best fits your health center during the 6-month reporting period based on the descriptions in Column D "Possible Health Center Maturity Level Scores and Descriptions". Enter 'X' in the appropriate field in Column C. | ||||
| Select only one maturity level per item. In Column E, you may provide additional details on your health center's maturity level score based on the prompts. | ||||
| Enter the roles of the OVC project team members completing the assessment. Use semicolons to separate multiple individuals: | (Team Member Roles): | |||
| A. Virtual Care Strategic Deployment Leadership Category and Dimension | B. Maturity Assessment Question | C. Enter 'X' to select the appropriate maturity level | D. Possible Health Center Maturity Level and Descriptions | E. Additional Comments (Optional, enter 'n/a' if no response) What factors contribute to this assessment? What additional resources, if any, does your health center need to support this category? What recommendations do you have for other health centers? |
| Basic-Level Maturity • Leaders leverage virtual care as a short-term, tactical response to a crisis (e.g., the COVID-19 pandemic). • Approaches to virtual care are locally defined and fragmented across departments. • Leaders rely on existing infrastructure and resources to address the shift to virtual care. |
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| a. Leadership | How would you describe your health center leaders' commitment to immediate and long-term adoption of virtual care operations? | Foundational-Level Maturity • Leaders support a more permanent virtual care deployment plan that integrates telehealth into standard care operations. • Board and enterprise leaders allocate sufficient resources and staff to meet the demands of the new virtual care environment. |
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| Advanced-Level Maturity • Virtual care is incorporated into and is a specifically identified tool to support the broader health center strategic priorities and goals. • A virtual care strategic plan, approved by senior leaders, guides all virtual care operations, equitable approaches to care delivery and investment strategies. |
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| Basic-Level Maturity • Oversight of virtual care falls to existing in-person care oversight processes. • Existing operational governance structures remain unchanged and there are no new operational or clinical quality oversight processes put in place specifically for virtual care processes. |
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| b. Governance | How would you describe your health center leaders' commitment to a permanent health center-wide virtual care governance/strategic oversight structure? |
Foundational-Level Maturity • A virtual care governance structure is established health center-wide. • Virtual care structure, process and outcome metrics are defined, tracked, and acted upon. • Virtual care governing bodies include all levels of staff (e.g., senior leaders, front-line workers) from across departments (e.g., quality improvement, IT, ambulatory care). |
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| Advanced-Level Maturity • Virtual care governance structures include patients and caregivers from under-resourced communities that represents the patient population served. • Success measures for virtual care processes and outcomes are aligned with health center goals and community needs to address health inequities. |
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| Basic-Level Maturity • Synchronous and asynchronous "use-what-we-have" devices are used to support virtual care operations. • Different solutions exist throughout the health center and with the home-based workforce. • Departments purchase hardware and software to fill in gaps without regard for health center-wide consistency. |
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| c. Technology Platforms: Virtual Care Devices | How successfully has your health center met the hardware and software support needs of providers, staff and patients for the desired synchronous and asynchronous virtual care operations? | Foundational-Level Maturity • The health center plans for and begins purchasing common hardware and software solutions across the enterprise in support of their virtual care operational needs. • Hardware and software consistency leads to greater acceptance of virtual care operations. • Virtual care hardware and software quality and options are standardized for the home-based workforce. |
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| Advanced-Level Maturity • Virtual care supporting hardware and software options balance the need for common platforms with consistent support and maintenance and the desire for newer "competitive edge" options. • User friendliness and staff acceptance increases dramatically with existing workforce devices (e.g., smartphones, mobile devices, home computers, laptops). • Privacy and security are consistently high across all available devices. • Consistently branded and professional patient-facing video platforms and virtual backgrounds are provided to the home-based workforce. |
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| Basic-Level Maturity • Technical support mode is "use or adapt the tech support team we have". • Technical support staff work from home and in-person as the environment dictates. • Portions of the technical support staff begin to retrain to support virtual care technologies. |
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| d. Technology Platforms: Technology Support | How successfully has your health center met the technical support needs of providers, staff and patients for the desired synchronous and asynchronous virtual care operations? | Foundational-Level Maturity • Technology support functions are reorganized to more permanently meet the needs of the new virtual care environment. • Leaders and technical support staff specifically trained in virtual care technologies are hired. • Resources are researched, purchased, and allocated that specifically support home-based staff needs (e.g., dual screens, special cameras, etc.). • Technical support staff may join pre-telehealth visit workflows to help staff and patients prepare for proper virtual care connection. • Just-in-time short-term contract support is used where appropriate to remain nimble as the virtual care operational environment unfolds. |
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| Advanced-Level Maturity • IT departments consider new health center structures that respond more nimbly to emerging virtual care business processes and technology support needs. • Decentralized virtual care "coordinator" functions may embed into operational departments. • The technical support staff provide support for home- and community-based virtual care connection centers to reduce barriers to access for vulnerable populations. |
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| Basic-Level Maturity Response • Security and privacy protocols and staff training continue in pre-pandemic format and do not include any additional processes specific to new virtual care operational risks. • Awareness of potential security and privacy threats specific to increased use of virtual care technologies is low. • "Crisis reaction" deployment of telehealth platforms rely on the data and security protections organic to off-the-shelf third-party vendor products. |
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| e. Technology Platforms: Cybersecurity Support | How would you describe your health center's cybersecurity infrastructure protections, user protocols, and training necessary to counter existing and emerging cybersecurity threats? | Foundational-Level Maturity Response • Cybersecurity harm reduction efforts cover broad infrastructure threats and are not typically targeted to unique virtual care risks; focus mainly on extending protection for HIPAA compliance into the various virtual care settings; rely on in-house expertise; and rely on external data exchanges and brokers of data to provide their own cybersecurity protections. • Awareness of HIPAA, privacy, and cyber-security threats specific to virtual care operations relies on in-house expertise; risk reduction measures are often reactive, are slow to be put in place and are only moderately successful at increasing protection from unique virtual care cybersecurity risks. |
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| Advanced-Level Maturity • Cybersecurity harm reduction efforts are targeted to virtual care risk; have audit processes and training in place to enhance HIPAA, privacy, and security compliance and cybersecurity protection; cover all technology infrastructure, data exchange platforms, medical devices and user processes; engage external cybersecurity expertise; and protect processes across all virtual care operational settings. • In-house IT team and external stakeholders partner to increase awareness of and anticipate the unique HIPAA, privacy and cybersecurity threats emerging across virtual care and technology exchange platforms; target threats specific to virtual care operations; have rapid-response risk mitigation procedures in place; assure that health information exchanges, external brokers of data and connected medical devices have high levels of cybersecurity in place; and train users regularly on measures to avoid these risks. • IT infrastructure and data storage processes incorporate redundant and backup procedures and to minimize the impact of technology or data exchange down times and/or "bad actor" strikes. • Health center-wide standards for virtual care technologies are established to improve users'/patients' level of trust to address privacy and security protection concerns. |
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| Basic-Level Maturity • Standards of care continue in crisis-response mode. • Focus is on primarily keeping patients, providers and staff safe - and only conducting visits in-person within existing public health protocols. Providers are accepting care delivery limitations and attempting the most complete care possible given their crisis-response context. • Care is typically characterized by limited-to-no vital signs collection, limited care team coordination, and "doing-the-best-care-we-can-in-the-given-situation." |
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| f. Virtual Care Operations: Operational and Clinical Standards | At your health center, to what degree has virtual care functioned with the same or better care and operational quality standards as in-person care? | Foundational-Level Maturity • Virtual care quality standards aim for equal or better care quality compared to in-person care. • Virtual care workflows link to all necessary integrated team-based care team and admin processes (e.g. registration, intake, remote patient monitoring, vital signs collection, etc.). • Quality improvement oversight and structure, process, and outcome measures integrate virtual care operations. • Protocols are formalized to appropriately triage patients to in-person or virtual care options and to take into account patient preference. • Telecommuting protocols for staff and providers are standardized to create consistent well-being, connectivity quality, and care quality. • The patient portal becomes a viable and user-friendly pathway for patient-facing pre-visit and post-visit administration functions including eligibility screening, pre-visit surveys, check-in, linking to virtual care visit, post-visit follow-up, and completion of all billing processes. • Permanent, safe and appropriate diagnostic, care and counseling options leverage virtual care advantages in select specialty areas (e.g. specialty care, physical therapy, behavioral health, etc.). • Care teams prioritize moving communication, counseling, and remote monitoring of chronic conditions to virtual care when and where it can produce better patient outcomes. |
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| Advanced-Level Maturity • Quality of care, patient experience, and provider satisfaction are reimagined and optimized through a mix of virtual, hybrid and in-person care options. • The culture of the health center embraces virtual care as a viable option for optimal care where medically indicated and desired by the patient. • Virtual care includes fully EHR-integrated real-time information access leading to high-quality, caring, individualized, culturally appropriate, safe, private, and secure processes that patients trust. • New quality improvement oversight processes are developed and deployed to provide unique virtual care-specific measures on the impact of virtual care operations on care and business operations quality. • Federal requirements for price transparency and access to care notes are integrated into virtual care processes (e.g. patient portal functionality). • Business functions such as automatic eligibility screening, HR functions, licensure, and reimbursement/payor relations move seamless to online processes where possible. |
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| Basic-Level Maturity • Crisis-response virtual care processes are in place as a response to the pandemic and they continue to reflect less than optimal training, usability, and access for providers and staff. • Providers and staff often just simply moved old workflows into the virtual care processes when possible and truncated or eliminated those workflows not feasible in their crisis virtual care setting. |
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| g. Virtual Care Operations: Provider/Staff Engagement | At your health center, how proficient are providers and staff in using virtual care tools in terms of access (hardware, software, connectivity, setting, language), training, usability, and coordination across teams? | Foundational-Level Maturity • Virtual care operations provide a seamless patient visit flow that is perceived by both provider/staff and patients as equal or better than previous in-person only processes (e.g., advanced team-based workflows provide more "in-person"-like handoffs and communications between interpreters, front desk, care team members, navigators and eligibility/billing functions). • Providers and staff are engaged in quality improvement assessment and improvement cycles for continuous improvement of their virtual care operations and the integration of those operations into both hybrid and in-person care settings. |
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| Advanced-Level Maturity • The health center actively engages in reimagining care across all professions and all types of patient needs and creates virtual care services that maximize care efficiency and quality but also improves health and care experience outcomes beyond that experienced by both patients and provider/staff in previous in-person only operations. • Provider and staff wellbeing are specifically taken into account when determining the optimal care setting choices. • Regular feedback processes (including virtual feedback) measure provider/staff satisfaction with and usability of virtual care. • Remote-only primary care providers and "Telespecialists" are considered to enhance care operations and support the health center's mission. Medical specialists who practice solely in virtual care settings could include specialty care providers, behavioral health, and physical therapists. |
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| Basic-Level Maturity • A large sub-set of patients continue to engage healthcare in a crisis response mode and are still avoiding in-person care for anything other than emergency care. • Patients experience uneven success in using virtual care services due to lack of awareness of virtual care modes of communication and how to access them. • Virtual care is mostly provided through publicly available and free online applications (e.g.; Zoom and FaceTime) and telephone. • Patients receive text messages, emails and/or patient portal messages that provide a link to their virtual care visit. |
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| h. Virtual Care Operations: Patient and Family Engagement | At your health center, how proficient or engaged are patients, families, and caregivers in virtual care in terms of access (hardware, software, connectivity, setting, language), digital health literacy, and use? | Foundational-Level Maturity • Patients are aware of the options for accessing virtual care and are getting more comfortable with care delivered through virtual care processes. • Patients are regularly screened for digital access and virtual care interface skills. • Regular feedback processes (including virtual feedback) measure patient satisfaction with virtual care. • Advanced team-based workflows provide more "in-person"-like handoffs and communications between medical assistants, nurses, and physicians. • Basic vital signs collection processes are coordinated where reliable through manual patient self-assessment. • Policies and procedures are put in place to help caregivers and family members link into virtual care processes as easily as the patient can. |
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| Advanced-Level Maturity • Patients are aware of the options for accessing virtual care and are getting more comfortable with care delivered through virtual care processes. • Patients are regularly screened for digital access and virtual care interface skills. • Regular feedback processes (including virtual feedback) measure patient satisfaction with virtual care. • Advanced team-based workflows provide more "in-person"-like handoffs and communications between medical assistants, nurses, and physicians. • Basic vital sign collection processes are coordinated where reliable through manual patient self-assessment. • Policies and procedures are put in place to help caregivers and family members link into virtual care processes as easily as the patient can. |
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| Basic-Level Maturity • The health center continues using existing disparities tracking processes. • The health center does not analyze data to provide insights into potential inequity in how virtual care impacts access to health care across different patient populations. • The health center does not work with patients to identify areas of inequities that can be negatively or positively influenced by increased use of virtual care. |
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| i. Health Equity: Awareness | How successful has your health center been in creating awareness of varying levels of access to and uptake of virtual care in their patient population and the impact of virtual care on inequities in access, care, experience, and outcomes? | Foundational-Level Maturity • Virtual care governance and health center resource allocation processes prioritize the collection of information on health equity in virtual care operations. • The health center proactively screens patients on access to and skills (e.g., digital health literacy) necessary to use virtual care. • Virtual care access, use, and health equity outcomes measures are collected and categorized by vulnerable population, broken down by demographics, and that information is disseminated across the health center (e.g., via dashboard or regular reporting). |
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| Advanced-Level Maturity • The health center engages in de-identified information exchanges that help the health center and the community track the determinants of inequitable access to virtual care. • Information is regularly shared internally within the system and externally in the community about the impact of virtual care operations on health equity to inform strategies to close care gaps for vulnerable populations. |
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| Basic-Level Maturity • The health center does not attempt any new processes to help those who are not able to equitably access virtual care. |
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| j. Health Equity: Action | At your health center, to what degree are virtual care processes intentionally designed to create equitable access to care and reduce health disparities in the population served? | Foundational-Level Maturity • The health center prioritizes and allocates resources to existing projects that have the potential to decrease health inequities caused by virtual care processes. • Evidence-based processes are in place to reduce health inequities in the use of virtual care such as: virtual interpreter services; non-English device instructions and prompts; programs to connect to caregivers/family who help bridge communication divides; and, prioritization of health center actions that increase patient trust and more equitable use of virtual care. |
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| Advanced-Level Maturity • Equity-focused strategies to address barriers to access to virtual care are incorporated into the broader health center strategic priorities and goals. • The health center continually seeks out and funds new and emerging projects that leverage emerging virtual care technologies to decrease health inequities. • Partnerships with community-based health centers are formed to understand and address upstream determinants of equitable use of and outcomes from virtual care (e.g., telecommunications literacy programs, virtual interpretation/language access resources, broadband for low-income populations, and access to low-cost smart devices or computers. |
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| Citation: Meyers, JF. (2021) Virtual Care Strategic and Tactical Deployment Maturity Self-Assessment Model. Oakland, CA: The California Health Care Safety Net Institute | ||||
| This document presents a model adapted from the Virtual Care Strategic and Tactical Deployment Maturity Self-Assessment Model authored by Jim Meyers, DrPH under funding from the California Health Care Safety Net Institute. |
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