CCPP Module 16, Section 1: Telecollaborative Practice Models and Platforms
MODULE 16: TECHNOLOGY, TELEHEALTH, AND DIGITAL TOOLS

Section 16.1: Telecollaborative Practice Models and Platforms

A deep dive into the world of telehealth, exploring the platforms, workflows, and “webside manner” required to deliver effective and reimbursable virtual pharmacy services.

SECTION 16.1

Telecollaborative Practice Models and Platforms

Translating Your Clinical Expertise from the Counter to the Cloud.

16.1.1 The “Why”: The Digital Transformation of Collaborative Care

For your entire career, the practice of pharmacy has been fundamentally tied to a physical location. Whether behind a community counter, in a hospital cleanroom, or at a clinic desk, your expertise has been delivered to patients who were, for the most part, physically present. The digital revolution, accelerated by necessity during the COVID-19 pandemic, has irrevocably shattered this paradigm. Telehealth is no longer a niche novelty; it is a core competency and a foundational pillar of modern healthcare delivery. For the collaborative practice pharmacist, this is not a threat—it is the single greatest opportunity for practice expansion and impact in a generation.

Why? Telehealth demolishes the geographic barriers that have traditionally limited the reach of specialized pharmacy services. A pharmacist with expertise in oncology can now co-manage a patient in a rural town hundreds of miles away. An expert in anticoagulation can adjust a warfarin dose for a homebound elderly patient without requiring them to arrange for transportation. A certified diabetes educator can conduct a comprehensive medication review and insulin pump training with a patient in another state (licensure permitting). This is the power of telecollaboration: it untethers your clinical brain from your physical location, allowing you to project your expertise to any patient, anywhere, who needs it.

However, this transition is not as simple as turning on a webcam. It requires a new set of skills, a new understanding of technology, and a new approach to patient interaction. You must become not only a clinical expert but also a proficient user of digital health platforms, a master of virtual communication (“webside manner”), and a savvy navigator of the complex regulations and reimbursement models that govern virtual care. This section is your masterclass in building that new skill set. We will deconstruct the entire telehealth ecosystem, from the foundational technologies to the practical workflows, so you can confidently and effectively translate your invaluable clinical skills from the counter to the cloud.

Pharmacist Analogy: Building a New Pharmacy Branch—in the Cloud

Imagine your health system wants you to open a new, specialized clinical pharmacy service—a “Complex Anticoagulation & Polypharmacy Clinic.” In the traditional model, this is a massive undertaking in brick-and-mortar.

The Physical Build-Out:

  • Location (The Platform): You’d need to lease or build a physical office space. Is it accessible? Does it have a waiting room? Exam rooms? Secure record storage? This is your choice of a telehealth platform.
  • Utilities & Equipment (The Tech Stack): You’d need electricity, internet, phones, computers, printers, and a validated EHR system. This is your technology infrastructure—your webcam, microphone, and secure internet connection.
  • Staffing & Workflow (The Virtual Process): You’d hire a receptionist to schedule appointments and a medical assistant to room patients and take vitals. You’d develop a paper or electronic intake form. This is your virtual patient onboarding, scheduling, and visit workflow.
  • Licensing & Compliance (The Regulations): You’d need to ensure the building is up to code, your staff is licensed, and you have protocols in place for HIPAA and physical security. This is your digital compliance with HIPAA, HITECH, and state telehealth laws.
  • Patient Interaction (The “Webside Manner”): You would train your staff on how to greet and interact with patients in a friendly, professional manner to build trust and rapport in person. This is the art of building that same trust and connection through a screen.

Building a telecollaborative practice is the exact same process, but your construction materials are digital. Your “location” is a software platform. Your “waiting room” is a virtual lobby. Your “patient intake” is an electronic form sent via a secure portal. The principles of creating a secure, efficient, and patient-centric experience are identical. You already know how a clinic is supposed to function; this module will simply teach you how to build and operate one using digital tools instead of drywall and plumbing.

16.1.2 The Telehealth Spectrum: Synchronous, Asynchronous, and Remote Patient Monitoring (RPM)

“Telehealth” is not a single, monolithic concept. It is a spectrum of care delivery models, each with unique technologies, workflows, reimbursement strategies, and clinical applications. As a collaborative pharmacist, you will likely engage in all three core modalities. Understanding their distinctions is the first step to designing and implementing effective virtual services.

Synchronous Telehealth: The Real-Time Virtual Visit

This is what most people picture when they hear “telehealth.” Synchronous care involves a real-time, interactive audio-video consultation between a provider and a patient (or between two providers). It is the digital equivalent of a face-to-face office visit.

Masterclass Table: Synchronous Telehealth for Pharmacists
Key Characteristics Prime Pharmacist Use Cases Advantages Disadvantages & Challenges
  • Real-time interaction
  • Requires both parties to be available simultaneously
  • Emulates an in-person visit
  • Typically reimbursed at rates comparable to in-person visits
  • Comprehensive Medication Reviews (CMRs)
  • Disease State Management (Diabetes, Hypertension, CHF, Asthma/COPD)
  • Anticoagulation Management (counseling, dose adjustments)
  • Transitions of Care post-discharge counseling
  • Patient education on new complex medications (e.g., biologics, anticoagulants)
  • Provider-to-provider consults
  • High level of patient engagement
  • Allows for visual cues and rapport-building
  • Can assess patient understanding and technique (e.g., inhaler, injection)
  • Meets “face-to-face” requirements for many billing codes
  • Scheduling complexity: Requires coordinating provider and patient availability.
  • Technology barrier: Requires both parties to have adequate internet, a device with a camera, and the technical literacy to use the platform.
  • “No-show” rates can still be an issue.
  • Digital Divide: Can exclude patients without reliable internet access or appropriate devices.

Asynchronous Telehealth: “Store-and-Forward” Communication

Asynchronous care involves the collection and transmission of health information (e.g., images, lab results, recorded videos, secure messages) at one point in time, and review by a provider at a later time. There is no simultaneous interaction. It is the digital equivalent of leaving a detailed voicemail or sending a secure email to your doctor.

Masterclass Table: Asynchronous Telehealth for Pharmacists
Key Characteristics Prime Pharmacist Use Cases Advantages Disadvantages & Challenges
  • Information is collected, stored, and forwarded
  • Does not require simultaneous presence of provider and patient
  • Often uses secure patient portals or messaging platforms
  • Lab result interpretation and follow-up (e.g., “Your INR is 2.8, continue current warfarin dose.”)
  • Medication refill authorizations and clarifications
  • Responding to non-urgent patient questions via secure portal message
  • E-consults: A primary care provider sends a pharmacist a detailed question about a complex patient’s regimen for review and recommendations.
  • Reviewing patient-submitted data like blood glucose logs or blood pressure readings.
  • Extreme flexibility and efficiency: Both patient and provider can engage when it is convenient for them.
  • Reduces “phone tag” and streamlines communication.
  • Creates a documented, time-stamped record of communication.
  • Lower technology barrier for the patient (can often be done from a smartphone app).
  • Limited or complex reimbursement: Billing for asynchronous work can be challenging and is less standardized than synchronous visits.
  • Lack of real-time interaction: Not suitable for urgent issues or complex conversations requiring back-and-forth dialogue.
  • Risk of miscommunication: Tone and nuance can be lost in text-based communication.
  • Potential for provider burnout if not managed with clear expectations on response times.

Remote Patient Monitoring (RPM): Data-Driven Proactive Care

RPM is a specific subset of telehealth that uses digital devices to collect and transmit physiologic data from a patient’s home to their provider’s office. This allows for continuous or frequent monitoring between visits, enabling proactive adjustments to therapy. It is the digital equivalent of having a daily vitals check without leaving your house.

Masterclass Table: Remote Patient Monitoring for Pharmacists
Key Characteristics Prime Pharmacist Use Cases Advantages Disadvantages & Challenges
  • Uses connected devices (e.g., BP cuffs, glucometers, scales)
  • Data is transmitted automatically to a clinical platform
  • Triggers alerts for out-of-range readings
  • Has specific and often lucrative reimbursement codes (CPT 99453, 99454, 99457, 99458)
  • Hypertension Management: Reviewing daily home BP readings to titrate antihypertensives.
  • Heart Failure Management: Monitoring daily weights to adjust diuretics and prevent hospitalizations.
  • Diabetes Management: Analyzing data from continuous glucose monitors (CGMs) or connected glucometers to optimize insulin regimens.
  • Asthma/COPD Management: Using connected spirometers or pulse oximeters to detect early signs of exacerbation.
  • Proactive, not reactive, care: Allows intervention before a patient becomes symptomatic.
  • Provides real-world data, not just a snapshot from an office visit.
  • High patient engagement and self-management.
  • Creates a strong, consistent revenue stream for clinical pharmacy services.
  • Logistical complexity: Requires device procurement, shipping, patient setup, and troubleshooting.
  • Data overload: Requires a dedicated workflow and staff time to review incoming data and respond to alerts.
  • Billing requirements: CPT codes for RPM have strict time and data transmission requirements (e.g., must collect data on ≥16 days per month).
  • Patient adherence to using the devices consistently.

16.1.3 The Telehealth Technology Stack: Choosing Your Digital Tools

Successfully launching a telecollaborative practice requires assembling a “technology stack”—a suite of software and hardware that work together to create a secure, efficient, and user-friendly virtual clinic. Your choices here are as critical as choosing the location and layout of a physical pharmacy. You must evaluate potential platforms based on their features, integration capabilities, security posture, and cost.

The Core Principle: Integration over Isolation

When evaluating technology, always prioritize platforms that can integrate with each other, especially with the core Electronic Health Record (EHR). A standalone telehealth platform that doesn’t “talk” to your charting and billing system creates data silos, requires duplicate data entry, and increases the risk of errors. The ideal solution is a single, unified system or a set of systems that seamlessly share data. While not always possible, this should be your guiding star.

Component 1: The Core Telehealth Platform

This is the heart of your virtual practice. It’s the software that facilitates the virtual visit itself. Platforms can be broadly categorized into two types: EHR-integrated modules and standalone solutions.

Masterclass Table: EHR-Integrated vs. Standalone Telehealth Platforms
Feature EHR-Integrated Solutions (e.g., Epic MyChart, Cerner HealtheLife) Standalone Solutions (e.g., Doxy.me, VSee, Mend)
Core Concept Telehealth functionality is a built-in module within the existing EHR system. The patient often accesses the visit through their established patient portal. A separate, third-party software dedicated solely to telehealth. It operates independently of the primary EHR.
Charting & Data Seamless. All patient data, visit notes, orders, and labs are in one unified record. No duplicate entry. Siloed. Requires the provider to have two windows open: the telehealth platform and the EHR. Notes must be copied and pasted or re-entered, increasing administrative burden and error risk.
Patient Experience Unified. Patients use a single portal (e.g., MyChart) they are already familiar with to schedule, message, and attend visits. Fragmented. Patients receive a separate link via email or text to a different website or app, which can cause confusion and trust issues (“Is this link legitimate?”).
Scheduling Integrated with the main EHR scheduling system. A visit is simply flagged as “virtual.” Requires a separate scheduling system or manual creation of visit links that are then sent to patients. Can be very cumbersome.
Cost Very High. Typically involves significant licensing fees paid by the health system to the EHR vendor. Not an option for independent practitioners. Flexible & Affordable. Many platforms offer free, HIPAA-compliant basic tiers, with paid plans scaling up based on features and number of providers. Very accessible for smaller practices.
Implementation Complex & Slow. Requires the health system’s IT department to configure and deploy the module. The individual pharmacist has no control. Simple & Fast. An individual provider can sign up and start using the platform in minutes.
Bottom Line The clinical “gold standard” for integrated care within a large health system. An excellent, accessible option for independent practices or when an integrated solution is not available, but requires strict workflows to manage data transfer.

Component 2: Essential Hardware & Peripherals

Your software is useless without the right hardware. While the requirements are not complex, investing in quality equipment pays dividends in professionalism and patient experience. This is your digital “exam room,” and it should be treated with the same level of importance.

  • Computer: A modern desktop or laptop with sufficient processing power and RAM to handle video streaming without lag. Closing all unnecessary applications before a visit is crucial.
  • Internet Connection: This is non-negotiable. A stable, high-speed broadband connection is essential. A wired Ethernet connection is always superior to Wi-Fi. A minimum of 15-20 Mbps download AND upload speed is recommended for smooth HD video.
  • Webcam: The built-in webcam on most laptops is adequate, but an external 1080p or 4K webcam provides a significantly sharper, more professional image. Good lighting is more important than an expensive camera.
  • Microphone/Headset: This is the most critical piece of hardware. Patients will forgive grainy video, but they will not tolerate poor audio. A USB headset with a dedicated microphone is the gold standard. It isolates your voice, eliminates echo and background noise, and ensures the patient can hear you clearly. Using your computer’s built-in microphone is a common amateur mistake.
  • Lighting: Position yourself facing a light source (like a window or a desk lamp with a diffuser). Never have a bright light source behind you, as it will turn you into a silhouette. A simple “ring light” is an inexpensive investment that dramatically improves video quality.

Component 3: Security & Compliance – The Digital Foundation

In a physical clinic, HIPAA compliance involves locked file cabinets, private exam rooms, and soundproof walls. In telehealth, compliance is about technology, policy, and process. This is an area where there is zero room for error.

HIPAA Compliance is NOT a Feature—It’s a Legal Contract

A telehealth platform is not “HIPAA-compliant” just because it uses encryption. To be truly compliant, the vendor must be willing to sign a Business Associate Agreement (BAA) with you or your organization. A BAA is a legally binding contract that obligates the vendor to handle Protected Health Information (PHI) according to HIPAA rules and makes them legally liable for any breaches on their end. If a vendor will not sign a BAA, you cannot use their service for patient care, period. Using non-compliant platforms like standard Skype, FaceTime, or WhatsApp for patient care is a serious violation that can result in massive fines.

Key Security Features to Demand from Your Platform
  • End-to-End Encryption (E2EE): This ensures that the video and audio stream is encrypted from the moment it leaves your device until it reaches the patient’s device. No one, not even the platform vendor, can intercept and view the contents of the visit. This is the technical standard for secure communication.
  • Access Controls: The platform must have robust systems for user authentication. This includes strong password requirements, multi-factor authentication (MFA), and role-based access (e.g., an administrator has different permissions than a clinical user).
  • Audit Logs: The system must keep a detailed, immutable log of who accessed what data and when. This is critical for investigating any potential privacy incident.
  • Secure Data Storage: Any PHI that is stored by the platform (e.g., chat messages, uploaded files) must be encrypted “at rest” on their servers.
  • Business Associate Agreement (BAA): As mentioned, this is the non-negotiable legal cornerstone of your relationship with the vendor.

16.1.4 The Virtual Workflow: From First Click to Follow-Up

Having the right technology is only half the battle. You must design a deliberate, step-by-step workflow that guides the patient seamlessly through their virtual care journey. A poorly designed workflow leads to patient confusion, missed appointments, and staff frustration. A well-designed workflow makes the technology feel invisible and allows you to focus on clinical care.

Visualized Workflow: The Patient’s Virtual Journey
1

Scheduling & Intake

Patient schedules online or via phone. They receive an automated confirmation with a link to complete digital intake forms (demographics, insurance, consent for telehealth, clinical questionnaires) via a secure portal.

2

Appointment Reminder & Tech Check

24-48 hours before the visit, an automated reminder is sent (email/SMS) containing the unique visit link and simple instructions on how to join. This message should include a link to a test page to check their camera and microphone.

3

The Virtual Visit

Patient clicks the link and enters a virtual waiting room. The pharmacist, having already reviewed the intake forms and patient chart, admits them to the secure video session to begin the consultation.

4

Post-Visit Actions

Immediately after the visit, the pharmacist completes their documentation in the EHR, sends e-prescriptions, and communicates recommendations to the primary care team. The claim for the visit is generated.

5

Patient Follow-Up

An after-visit summary is sent to the patient’s portal. Any required follow-up appointments are scheduled. Automated surveys can be sent to collect feedback on the telehealth experience.

Deep Dive: The Telehealth Consent

Before you can conduct a virtual visit, you must obtain and document the patient’s consent to receive care via telehealth. This is a critical legal and regulatory requirement. While specific requirements vary by state and payer, a robust telehealth consent form should always include:

  • Clear Explanation: A simple explanation of what telehealth is and that the consultation will be conducted via audio-video technology.
  • Voluntary Nature: A statement that the patient understands they can refuse to receive care via telehealth at any time without affecting their right to future care. They should also be informed of their option to receive in-person care.
  • Scope of Services: A description of the types of services that will be provided (e.g., medication management, counseling).
  • Privacy & Security: An acknowledgement that while the platform used is secure and HIPAA-compliant, there are inherent privacy risks with any electronic communication. The patient should be advised to conduct the call from a private location.
  • Communication Methods: Consent for communication via the telehealth platform, secure messaging, email, and/or SMS for reminders and follow-up.
  • Billing & Financial Responsibility: A statement that the virtual visit will be billed to their insurance just like an in-person visit, and that they are responsible for any copays, deductibles, or non-covered services.
  • Emergency Protocol: A clear statement that telehealth is not for emergencies and that they should call 911 or go to the nearest emergency room for any urgent medical issues.

This consent should be obtained electronically and stored as a permanent part of the patient’s medical record before the first virtual visit occurs.

16.1.5 “Webside Manner”: The Art of Building Virtual Rapport

In a physical exam room, you can rely on body language, a reassuring touch on the arm, and direct eye contact to build trust and rapport with a patient. Many of these tools are lost in a virtual setting. “Webside manner” is the deliberate practice of adapting your communication skills to the digital environment to create that same sense of connection, empathy, and trust through a screen. It is a skill that must be learned and practiced.

The Pharmacist’s Telehealth Pre-Flight Checklist

Before you click “start visit,” run through this mental checklist every single time:

  1. Your Environment: Is your background professional and free of clutter? (A neutral wall or a professional virtual background is best). Is the door closed to prevent interruptions? Have you silenced your phone and computer notifications?
  2. Your Lighting: Are you well-lit from the front? Can the patient see your face clearly?
  3. Your Framing: Is your webcam at eye level? Are you centered in the frame from the chest up? (Looking down at a laptop camera is unflattering and creates a sense of detachment).
  4. Your Audio: Is your headset plugged in and selected as the default microphone?
  5. Your Preparation: Is the patient’s EHR chart open on your screen (ideally a second monitor)? Have you reviewed their intake forms and recent notes?

Taking 30 seconds to confirm these points transforms your presentation from amateur to professional and sets the stage for a successful consultation.

Masterclass Table: Communication Techniques for the Virtual Visit
Technique Description & Rationale Good Example (What to Say/Do) Bad Example (What to Avoid)
The Tech Check & Icebreaker Start every visit by confirming the technology is working. This serves a practical purpose and acts as a natural icebreaker to get the conversation started. “Hi Mr. Smith, can you hear and see me okay? Great! I can see and hear you perfectly. Thanks so much for joining me today.” Jumping straight into clinical questions without confirming the connection is working.
Eye Contact Simulation To simulate eye contact, you must look directly into the webcam lens, not at the patient’s image on your screen. This feels unnatural at first but makes the patient feel like you are looking at them. Alternate between looking at the camera when you are speaking and looking at their image on the screen when they are speaking. Staring only at the patient’s picture on the screen, which makes it look like you are looking down and away.
Active Listening Narration In person, you can nod and use small affirmations (“mm-hmm,” “I see”) to show you are listening. On video, these can be missed or create audio feedback. Instead, verbally narrate your actions and use more explicit verbal affirmations. “Okay, thank you for sharing that. I’m making a note of that in your chart right now.” Or “What I’m hearing you say is that the new medication is making you feel dizzy about an hour after you take it. Is that correct?” Long periods of silence while you are typing. The patient may think the connection is frozen or that you are not paying attention.
Exaggerated Non-Verbals Subtle body language is lost on video. You must be more deliberate with your non-verbal cues. Use intentional head nods, a thumbs-up, and maintain an open posture. Smile more than you think you need to. When a patient confirms they are taking their medication correctly, give a clear, visible nod and a smile. Remaining static and expressionless, which can be interpreted as disinterest or disapproval.
The “Teach Back” Method This is even more critical in telehealth. After explaining a key concept (e.g., a change in an insulin dose), ask the patient to explain it back to you in their own words to ensure there was no misunderstanding due to the virtual format. “So, just to make sure we’re on the same page and I explained it clearly, can you tell me how you’re going to adjust your long-acting insulin dose starting tonight?” Simply asking “Do you have any questions?” which often elicits a “no” even when the patient is confused.
A Clear Closing End the visit with a clear summary of the plan and next steps. Verbally confirm the end of the call before disconnecting to avoid an abrupt ending. “Okay, so the plan is to increase your lisinopril to 20 mg daily. I’ll send that prescription to the pharmacy now. We’ll check in again in two weeks. Do you have any other questions for me? … No? Great! It was good to see you. Have a wonderful day. I’m going to end the call now.” Abruptly saying “Okay, bye” and clicking the “end call” button.