Partnership HealthPlan of California ACCESS to econsult SERVICES Statement of Interest CONTENTS PAGE Introduction --------------------------------------------------------------------------------------------------- 1 History --------------------------------------------------------------------------------------------------------- 1 Specialties -------------------------------------------------------------------------------------------------- 1 Training or Technical Assistance ----------------------------------------------------------------------- 2 Eligibility ------------------------------------------------------------------------------------------------------- 2 Application ------------------------------------------------------------------------------------------------- 3-6
PART I: PROGRAM DESCRIPTION INTRODUCTION Partnership HealthPlan of California (PHC) is pleased to announce that we have retained Safety Net Connect (SNC) to provide econsult services to Primary care Physicians (PCP) across our network. PCP s will have the ability to request specialty consults using econsult for a variety of adult patient specialties. HISTORY Over the last 8 years, SNC and its partners have provided a multitude of successful and nationally recognized web based healthcare solutions that serve the underserved and Safety Net populations. econsult is SNC s web-based system, allowing PCP s and specialists to securely share health information and discuss patient care. This unique approach expands the capabilities and definition of telehealth, providing faster access to specialty care while allowing patients to receive specialty care in their primary care office or medical home. SPECIALTIES (Subject To Specialist Availability) Specialties currently available through econsult: Breast Health Dermatology Endocrinology Gastroenterology Infectious Disease Neurology Orthopedics Otolaryngology/ENT Rheumatology Urology Additional specialties may be added in the near future, please use the above list for the purposes of this application. FOR QUESTIONS PLEASE CONTACT: econsult@partnershiphp.org PAGE 1 OF 6
TRAINING OR TECHNICAL ASSISTANCE The SNC Professional Services team along with PHC will collaborate with you to plan and manage the implementation process in the use of econsult. The implementation plan will include step by step tasks, resources necessary, and a training plan outline if needed. ELIGIBILITY Eligible: Medi-Cal Members; Patients 21 years and older. NOT Eligible: California Children Services (CCS), private insurance in our region, FOR QUESTIONS PLEASE CONTACT: econsult@partnershiphp.org PAGE 2 OF 6
APPLICATION AND QUESTIONNAIRE NAME OF PCP ORGANIZATION: ADDRESS: STATE: CITY: ZIP: NAME OF CONTACT PERSON: E-MAIL: PHONE NUMBER: NUMBER OF CAPITATED PARTNERSHIP HEALTHPLAN PATIENTS: PROGRAM CONTACTS OFFICE MGR. OR EQUIVALENT: MEDICAL DIRECTOR: *econsult COORDINATOR: IT STAFF MEMBER: EMAIL: EMAIL: EMAIL: EMAIL: *This staff person will be the main contact for the program 1. If you would like to be considered for this program, tell us why you are interested, and why you believe your site would be a good selection for this program. FOR QUESTIONS PLEASE CONTACT: econsult@partnershiphp.org PAGE 3 OF 6
EQUIPMENT 1. Which operating system/s are currently installed on computers to be used? Windows 8 Windows 2003 Windows 7 Windows 2010 Windows Vista Linux Windows NT Mac Windows XP Other 2. What type of internet connection does your site use? Dial-up Satellite DSL T-1 or T-3 Cable Modem Internet2 Broadband or Fiber-Optic Other 3. Can the internet browser on computers used by clinical and referral staff be updated to minimum requirements (Internet Explorer 10 / Mozilla Firefox 40.02) or above? 4. What type of network configuration does your site use? LAN Local Area Network WLAN Wireless Local Area Network WAN Wide Area Network VPN Virtual Private Network Other 5. Are there any limitations or restrictions for uploading documents, ie: photos, attachments, files & etc. onto computers?, Please Describe: 6. Are there any limitations or restriction for scanning capabilities?, Please Describe: 7. Do providers & staff members who will use econsult have proper internet access? ALL have internet access. ONLY Providers Only STAFF Members 8. Do providers & staff members who will use econsult have their own email? ALL have email addresses. ONLY Providers Only STAFF Members FOR QUESTIONS PLEASE CONTACT: econsult@partnershiphp.org PAGE 4 OF 6
9. Will providers & staff members be able to access and utilize WebEx for training? ALL can access WebEx. ONLY Providers Only STAFF Members 10. How many computers will be available for training purposes? 11. What is the status of your site s EHR implementation? Selecting a system In the process of implementing a system: Currently live on a system: System Go Live Date System Go Live Date 12. Does your site use any other health information technology? None Clinical Decision Support (Electronic Resources for providers) Consumer Health Informatics (Electronic resources for patients) CPOE (Computerized provider order entry) Disease Registries Electronic Health Records Electronic Labs e-prescribing Personal health record Remote patient monitoring Telemedicine (Physical & Psychological treatments at a distance) Other TRAINING 13. Will any IT Staff be available for any assistance needed on the day of your site s econsult training? 14. Will computers be available for every user during econsult training? 15. Where will the computers be located for econsult training? Lunch Room Conference Room Exam Rooms Doctor s offices Portable Other: 16. Will the computers used for econsult training have access to your organization s email? 17. Is there a projector available to use for training? FOR QUESTIONS PLEASE CONTACT: econsult@partnershiphp.org PAGE 5 OF 6
SPECIALTY SERVICES Please select the service/s of interest. NOTE: Specialties listed below are subject to availability. Please refer to the current list of available specialties on page one of application. SPECIALTY ESTIMATED # PATIENTS PER SERVICE SPECIALTY ESTIMATED # PATIENTS PER SERVICE Cardiology Dermatology Diabetes Endocrinology Gastroenterology Gynecology Hematology Hepatology HIV Services Infectious Disease Nephrology Neurology Orthopedics Pulmonology Occupational Therapy Oncology Ophthalmology/Optometry Otolaryngology/ENT Physical Medicine & Rehab Physical Therapy Podiatry Rheumatology Speech Therapy Urology Breast Health Pain Management FOR QUESTIONS PLEASE CONTACT: econsult@partnershiphp.org PAGE 6 OF 6