1 Evidence-Based Telehealth Network Program_Data Dictionar

Evidence-Based Telehealth Network
Program
(EB TNP)
Performance Improvement
Measurement System
(PIMS)

Data Dictionary
August 2022

TABLE OF CONTENTS
Introduction .................................................................................................................................. 3
Configure Sites for this Reporting Period ...................................................................................... 3
Select Specialty Areas for this Reporting Period ........................................................................... 5
Select Settings for this Reporting Period ..................................................................................... 11
Configure this Reporting Period .................................................................................................. 13
Form 1: Priorities ........................................................................................................................ 14
Form 2: Originating and Distant Sites.......................................................................................... 14
Form 3: Specialties and Services, by Site ..................................................................................... 15
Form 4: Volume of Services, by Site and Specialty ...................................................................... 16
Form 5: Patient Travel Miles Saved ............................................................................................. 17
Form 6: Other Uses of the Telehealth Network .......................................................................... 19
Form 7: Diabetes ......................................................................................................................... 21
Form 8: Mental Health ................................................................................................................ 22

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Introduction
The following document provides an overview of the Performance Improvement Measurement
Systems (PIMS) data and forms required for reporting for the 2021-2026 Evidence-Based
Telehealth Network Program (EB TNP). It includes each form required for PIMS reporting,
including an overview of that form, additional information or guidance on the data to be
reported, and includes screenshots as well as tables to show examples of the data fields.
Configure Sites for this Reporting Period
In this form, you will see listed all the sites that were active during your previous reporting
period for the EB TNP grant. Simply specify which of the sites remained active during the
current reporting period and add any new sites. If this is your first reporting period, you will
need to list all active sites.
Indicate the sites in which you had activity during this reporting period. Only sites that are
eligible for and receiving EB TNP funding should be included.
For the purposes of this grant program, rural is defined as all counties that are not designated
as parts of metropolitan areas (MAs) by the Office of Management and Budget (OMB). In
addition, we use Rural Urban Commuting Area Codes (RUCAs) to designate rural areas within
MAs. This rural definition can be accessed at
https://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx. If the county is not entirely
rural or urban, follow the link for “Check Rural Health Grants Eligibility by Address” to
determine if a specific site qualifies as rural based on its specific census tract within an
otherwise urban county.
Originating (or spoke) sites are the sites where a patient is located and receiving care. Distant
(or hub) sites are the sites where the specialist is located and working.
When you are finished entering in data, click "Add" to add it to the table. Then click the "Save"
button to move to the next screen. See screenshots and table below for data fields requested
for each site.

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Data fields for EB TNP sites
Site Name:
Street Address:
City/Town:
County:
State:
Zip Code:
Originating or Distant Site (O/D):
Rural or Urban Site (R/U):
HPSA:
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MUA:
HCPN:
Primary Taxonomy:
NPI (Site):
EIN (if non-profit):
Site URL:

Select Specialty Areas for this Reporting Period
In this form, you will indicate the medical specialties and services provided via telehealth via
your EB TNP program. Indicate the specialties for which you had activity during this reporting
period. Only specialties that are eligible for and receiving EB TNP funding should be included.
You will see all the specialties listed, with those from your last reporting period checked; you
can remove checks to inactivate specialties you no longer offer or add checks beside new
specialties you have recently begun to offer. Please try to use the existing categories if possible,
using the catch-all ‘other’ category for small numbers in other specialties that don’t fit into
existing categories. If you require a Specialty which is not available on this list, please contact
the HRSA Project Officer for your grant.
Check the box in the left-most column to indicate each of the specialties/services in which you
had activity during this reporting period. If you leave this box unchecked, it will be recorded as
inactive and that specialty will not appear on any subsequent forms. When you are done, click
“Save” and you will be navigated to the Select Settings page. See screenshot along with a list of
selection options and definitions below.

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Specialties: Selection Menu & Definitions
The following is a list of medical specialties and services provided through telehealth:
• Allergy/Rheumatology/Immunology – Rheumatology: A subspecialty of internal
medicine concerned with the study of inflammatory or degenerative processes and
metabolic derangement of connective tissue structures which pertain to a variety of

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musculoskeletal disorders, such as arthritis. 1 Immunology: A medical specialty
concerned with the hypersensitivity of the individual to foreign substances and
protection from the resultant infection or disorder. 2
Cardiology (includes CHF) – A branch of medicine that specializes in diagnosing and
treating diseases of the heart, blood vessels, and circulatory system. These diseases
include coronary artery disease, heart rhythm problems, and heart failure. 3
Cardiovascular Surgery - Surgery performed on the heart or blood vessels. 4
Chronic Disease Counseling (diabetes, cardiac rehab, etc.) – Provision of education,
counseling, and other resources to support improved outcomes for individuals with
chronic conditions and/or recovery post-procedure or treatment.
Clinical Pharmacology - The branch of pharmacology that deals directly with the
effectiveness and safety of drugs in humans. 5
Dentistry - The profession concerned with the teeth, oral cavity, and associated
structures, and the diagnosis and treatment of their diseases including prevention and
the restoration of defective and missing tissue. 6
Dermatology - A medical specialty concerned with the skin, its structure, functions,
diseases, and treatment. 7
Diabetes Clinical Services – Diabetes care and support provided in a clinic setting. May
include insulin therapy; diabetes management education; support from a registered
dietitian and diabetes educator; and access to eye, kidney, and foot specialists. 8
Emergency Medicine - The branch of medicine concerned with the evaluation and initial
treatment of urgent and emergent medical problems, such as those caused by
accidents, trauma, sudden illness, poisoning, or disasters. Emergency medical care can
be provided at the hospital or at sites outside the medical facility. 9
Endocrinology Clinical Services - A branch of medicine that specializes in diagnosing and
treating disorders of the endocrine system, which includes the glands and organs that
make hormones. These disorders include diabetes, infertility, and thyroid, adrenal, and
pituitary gland problems. 10
ENT (including surgery) – ENT (or otolaryngology) is a medical specialty which is focused
on the ears, nose, and throat. Medical and surgical procedures focus on the ear (ear
infections, balance disorders, ear noise (tinnitus), nerve pain, and facial and cranial
nerve disorders); nose (diagnose, manage and treat allergies, sinusitis, smell disorders,
polyps, and nasal obstruction); throat (managing diseases of the larynx (voice box) and
the upper aero-digestive tract or esophagus); and head and neck (treat infectious

1

https://www.online-medical-dictionary.org/definitions-r/rheumatology.html
https://www.online-medical-dictionary.org/definitions-a/allergy-and-immunology.html
3
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cardiology
4
https://www.online-medical-dictionary.org/definitions-c/cardiovascular-surgical-procedures.html
5
https://www.online-medical-dictionary.org/definitions-p/pharmacology-clinical.html
6
https://www.online-medical-dictionary.org/definitions-d/dentistry.html
7
https://www.online-medical-dictionary.org/definitions-d/dermatology.html
8
https://www.mayoclinic.org/diseases-conditions/diabetes/care-at-mayo-clinic/mac-20371457
9
https://www.online-medical-dictionary.org/definitions-e/emergency-medicine.html
10
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/endocrinology
2

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diseases, both benign and malignant (cancerous) tumors, facial trauma, and
deformities). 11
Gastroenterology - A subspecialty of internal medicine concerned with the study of the
physiology and diseases of the digestive system and related structures (esophagus, liver,
gallbladder, and pancreas). 12
General Surgery - The branch of surgery that covers the main areas of surgical
treatment. General surgeons treat diseases of the abdomen, breast, head and neck,
blood vessels, and digestive tract. They also manage care of patients who have been
injured or who have deformities or other conditions that need surgery. 13
Genetics - The study of genes and heredity. Heredity is the passing of genetic
information and traits (such as eye color and an increased chance of getting a certain
disease) from parents to offspring. 14
Geriatrics - The branch of medicine concerned with the physiological and pathological
aspects of the aged, including the clinical problems of senescence and senility. 15
Hematology - A subspecialty of internal medicine concerned with morphology,
physiology, and pathology of the blood and blood-forming tissues. 16
Home Health - Home health care is a wide range of health care services that can be
given in your home for an illness or injury. Home health care is usually less expensive,
more convenient, and just as effective as care you get in a hospital or skilled nursing
facility (SNF). 17
o Examples of skilled home health services include:
o Wound care for pressure sores or a surgical wound
o Patient and caregiver education
o Intravenous or nutrition therapy
o Injections
o Monitoring serious illness and unstable health status
Hospice Services - A special way of caring for people who are terminally ill. Hospice care
involves a team-oriented approach that addresses the medical, physical, social,
emotional, and spiritual needs of the patient.
Infectious Disease - An illness caused by an infectious agent or its toxins that occurs
through the direct or indirect transmission of the infectious agent or its products from
an infected individual or via an animal, vector or the inanimate environment to a
susceptible animal or human host. 18 Examples of infectious diseases include COVID-19,
influenza, HIV/AIDS, hepatitis, measles, meningococcal disease, and diphtheria.
Intensive Care Unit Services - An intensive care unit (ICU) provides the critical care and
life support for acutely ill and injured patients. ICU teams are multi-disciplinary, made

11

https://www.entcolumbia.org/about-us/what-otolaryngology
https://www.online-medical-dictionary.org/definitions-g/gastroenterology.html
13
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/general-surgery
14
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/genetics
15
https://www.online-medical-dictionary.org/definitions-g/geriatrics.html
16
https://www.online-medical-dictionary.org/definitions-h/hematology.html
17
https://www.medicare.gov/what-medicare-covers/whats-home-health-care
18
https://www.online-medical-dictionary.org/definitions-c/communicable-diseases.html
12

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up of highly skilled intensive care nurses, doctors and specialists trained in providing
critical care for patients with a variety of medical, surgical and trauma conditions. Some
hospital ICUs specialize in providing care for particular health conditions or injuries
including: major trauma, severe burns, respiratory failure, organ transplants, complex
spinal surgery, and cardiothoracic surgery. 19
Mental/Behavioral Health Counseling – Behavioral/mental health counseling is a
distinct profession with national standards for education, training, and clinical practice.
Clinical behavioral/mental health counselors are highly skilled professionals who provide
flexible, consumer-oriented therapy. They combine traditional psychotherapy with a
practical, problem-solving approach that creates a dynamic and efficient path for
change and problem resolution. Services may include assessment and diagnosis,
psychotherapy, treatment planning and utilization review, brief and solution-focused
therapy, alcoholism and substance use disorder treatment, psychoeducational and
prevention programs, and crisis management. 20
Neonatology - A subspecialty of Pediatrics concerned with the newborn infant. 21
Nephrology - A subspecialty of internal medicine concerned with the anatomy,
physiology, and pathology of the kidney. 22
Neurology - A medical specialty concerned with the study of the structures, functions,
and diseases of the nervous system. 23
Obstetrics/Gynecology – Obstetrics: A medical-surgical specialty concerned with
management and care of women during pregnancy, parturition, and the puerperium. 24
Gynecology: A medical-surgical specialty concerned with the physiology and disorders
primarily of the female genital tract, as well as female endocrinology and reproductive
physiology. 25
Oncology - A branch of medicine that specializes in the diagnosis and treatment of
cancer. It includes medical oncology (the use of chemotherapy, hormone therapy, and
other drugs to treat cancer), radiation oncology (the use of radiation therapy to treat
cancer), and surgical oncology (the use of surgery and other procedures to treat
cancer). 26
Orthopedics (including surgery) - A surgical specialty which utilizes medical, surgical,
and physical methods to treat and correct deformities, diseases, and injuries to the
skeletal system, its articulations, and associated structures. 27
Other
Pathology - A specialty concerned with the nature and cause of disease as expressed by

19

https://healthywa.wa.gov.au/Articles/F_I/Intensive-care-units-ICUs
https://amhca.site-ym.com/page/facts
21
https://www.online-medical-dictionary.org/definitions-n/neonatology.html
22
https://www.online-medical-dictionary.org/definitions-n/nephrology.htmlneur
23
https://www.online-medical-dictionary.org/definitions-n/neurology.html
24
https://www.online-medical-dictionary.org/definitions-o/obstetrics.html
25
https://www.online-medical-dictionary.org/definitions-g/gynecology.html
26
https://www.cancer.gov/publications/dictionaries/cancer-terms/search/oncology/?searchMode=Begins
27
https://www.online-medical-dictionary.org/definitions-o/orthopedics.html
20

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changes in cellular or tissue structure and function caused by the disease process. 28
Pediatrics - Pediatrics is the specialty of medical science concerned with the physical,
mental, and social health of children from birth to young adulthood. Pediatric care
encompasses a broad spectrum of health services ranging from preventive health care
to the diagnosis and treatment of acute and chronic diseases. 29
Physiatry/Physical Medicine - Physical medicine and rehabilitation (PM&R), also known
as physiatry or rehabilitation medicine, aims to enhance and restore functional ability
and quality of life to those with physical impairments or disabilities affecting the brain,
spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. 30
Physical Therapy - A branch of rehabilitative health that uses specially designed
exercises and equipment to help patients regain or improve their physical abilities.
Abbreviated PT. PT is appropriate for many types of patients, from infants born with
musculoskeletal birth defects, to adults suffering from sciatica or the after effects of
injury or surgery, to elderly post-stroke patients. 31
Plastic Surgery - The branch of surgery concerned with restoration, reconstruction, or
improvement of defective, damaged, or missing structures. 32
Primary Care (adult) - Primary health care is a whole-of-society approach to health and
well-being centered on the needs and preferences of individuals, families, and
communities. It addresses the broader determinants of health and focuses on the
comprehensive and interrelated aspects of physical, mental and social health and
wellbeing. It provides whole-person care for health needs throughout the lifespan, not
just for a set of specific diseases. Primary health care ensures people receive
comprehensive care - ranging from promotion and prevention to treatment,
rehabilitation and palliative care - as close as feasible to people’s everyday
environment. 33
Psychiatry - Psychiatry is the branch of medicine focused on the diagnosis, treatment,
and prevention of mental, emotional and behavioral disorders. 34
Pulmonology - A branch of medicine that specializes in diagnosing and treating diseases
of the lungs and other parts of the respiratory system. These diseases include asthma,
emphysema, tuberculosis, and pneumonia. 35
Radiology - The use of radiation (such as x-rays) or other imaging technologies (such as
ultrasound and magnetic resonance imaging) to diagnose or treat disease. 36
Rehabilitation - Restoration of human functions to the maximum degree possible in a
person or persons suffering from disease or injury. 37

28

https://www.online-medical-dictionary.org/definitions-p/pathology.html
https://pediatrics.aappublications.org/content/135/4/780physiatry
30
https://www.aapmr.org/about-physiatry/about-physical-medicine-rehabilitation
31
https://www.medicinenet.com/script/main/art.asp?articlekey=11885
32
https://www.online-medical-dictionary.org/definitions-s/surgery-plastic.html
33
https://www.who.int/news-room/fact-sheets/detail/primary-health-care
34
https://www.psychiatry.org/patients-families/what-is-psychiatry-menu
35
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pulmonology
36
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/radiology
37
https://www.online-medical-dictionary.org/definitions-r/rehabilitation.html
29

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Speech Therapy - Treatment for individuals with speech defects and disorders that
involves counseling and use of various exercises and aids to help the development of
new speech habits. 38
Substance Use Disorder Services – Services provided to address the impacts of
substance use. They might include inpatient treatment, residential programs, partial
hospitalization or day treatment, outpatient and intensive outpatient programs, and
methadone clinics (also called opioid treatment programs). 39
Surgical Specialties (other)

Select Settings for this Reporting Period
In this form, you will define the settings where patients received telehealth care via your EB
TNP program. Indicate the Settings for which you had activity during this reporting period.
Only settings that are eligible for and receiving EB TNP funding should be included. If you
require a setting which is not available on this list, please contact the HRSA Project Officer for
your grant.
Check the box in the left-most column to indicate all the patient settings in which you had
activity during this reporting period. If you leave the box unchecked, that setting will be
recorded as inactive and will not appear in subsequent forms. When you are done, click ‘Save’
and you will be navigated to the Configure report period page. See screenshot along with a
list of selection options and definitions below.

38
39

https://www.online-medical-dictionary.org/definitions-s/speech-therapy.html
https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4126.pdf

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Settings: Selection Menu & Definitions
• Clinic (including RHC): A clinic means a building or portion of a building
containing offices or facilities for providing medical, dental, or behavioral
health services for outpatients. 40
• Community Health Center (including FQHCs): community-based
and patient-directed organizations that deliver comprehensive, culturally
competent, high-quality primary health care services. Health centers also
often integrate access to pharmacy, mental health, substance use disorder,
and oral health services in areas where economic, geographic, or cultural
barriers limit access to affordable health care services. Health centers deliver
care to the Nation’s most vulnerable individuals and families, including
people experiencing homelessness, agricultural workers, residents of public
housing, and the Nation’s veterans. 41
• Health Care Provider in Private Practice: A professional business (such as
that of a doctor) that is not controlled or paid for by the government or a
larger company (such as a hospital). 42
• Higher Education Institution: Higher-educational institutions include not
only universities and colleges but also various professional schools that
provide preparation in such fields as law, theology, medicine, business,
music, and art. Higher education also includes teacher-training schools,
junior colleges, and institutes of technology. 43
• Home Health Service Provider: Home health care is a wide range of health
care services that can be given in your home for an illness or injury. 44
• Hospital (including CAH): An institution where the sick or injured are given
medical or surgical care. 45
• Local Health Department: The National Association of County and City
Health Officials (NACCHO), in collaboration with the Centers for Disease
Control and Prevention (CDC), defines a local health department as "an
administrative or service unit of local or state government, concerned with
health, and carrying some responsibility for the health of a jurisdiction
smaller than the state." 46
• Local or Regional Emergency Health Care Provider: An emergency medical
technician, paramedic, or first responder authorized under 16 Del.C. Ch 97. 47
40

https://www.lawinsider.com/dictionary/medical-clinic
https://bphc.hrsa.gov/about/what-is-a-health-center/index.html
42
https://www.merriam-webster.com/dictionary/private%20practice
43
https://www.britannica.com/topic/higher-education
44
https://www.medicare.gov/what-medicare-covers/whats-home-health-care
45
https://www.merriam-webster.com/dictionary/hospital
46
https://www.encyclopedia.com/education/encyclopedias-almanacs-transcripts-and-maps/state-and-local-healthdepartments
47
https://www.lawinsider.com/dictionary/emergency-careprovider#:~:text=Emergency%20care%20provider%20means%20an,responder%20authorized%20under%2016%20D
el.
41

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Long Term Care Provider: Long-term care involves a variety of services
designed to meet a person's health or personal care needs during a short or
long period of time. These services help people live as independently and
safely as possible when they can no longer perform everyday activities on
their own. 48
Oral Health Provider: Providers that focus on the health of the teeth, gums, and the
entire oral-facial system that allows us to smile, speak, and chew. This includes dentists,
dental assistants, dental hygienists, and dental specialists.
Other
Other Publicly Funded Health or Social Service Agency: Examples include
Area Agencies on Aging, county mental health departments, communitybased youth programs, homeless shelters, job training agencies, etc.
Outpatient Mental Health Service Provider/Facility: Outpatient mental
health facility: A facility that primarily provides ambulatory clients/patients
with less than 24-hour outpatient mental health services for generally less
than 3 hours at a single visit. Services are provided on an individual, group or
family basis, usually in a clinic or similar facility. 49
School Based Health Center: School-based health centers (SBHCs) provide
elementary, middle, and high school students a variety of health care
services on school premises or at offsite centers linked to schools. Teams of
nurses, nurse practitioners, and physicians often provide primary and
preventive care along with mental health care; reproductive health services
may be offered in middle and high schools, as allowed by district policy and
state law. 50

Configure this Reporting Period
This form contains ‘Are all Setup Options listed on the left menu complete?’ question. 'Save'
this form by selecting 'Yes' for 'Are all Setup Options listed on the left menu complete?'
question to display all the forms under Grantee Data Entry on the left menu. The forms under
the Grantee Data Entry will not be displayed when selected 'No' for this question.

48

https://www.nia.nih.gov/health/what-long-term-care
https://info.nmhss.org/Definitions/index.asp#:~:text=Outpatient%20mental%20health%20facility%3A%20A,a%20c
linic%20or%20similar%20facility.
50
https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/schoolbased-health-centers
49

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Form 1: Priorities
Complete form below. Only sites that are eligible for and receiving EB TNP funding
should be included.

Services provided during reporting period
Did you provide services to patients in any of the following categories because of any EB TNP
funding during this reporting period?
Yes
Mental Health
Substance Abuse Treatment

No

Form 2: Originating and Distant Sites
Complete Form 1: Priorities before inputting data in this form. Only sites that are eligible for
and receiving EB TNP funding should be included.

List of Selected Sites and Settings (Modify the list of sites and/or settings if needed)
Site Name

[grantee
generated
list]

Street
City/Town County State Zip
Originating Rural or
Address
Code or Distant
Urban
Site (O/D) Site
(R/U)

Setting

[choose from
menu]

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[grantee
generated
list]

[choose from
menu]

Number of Each Type of Site in this Reporting Period
Originating Sites
Distant Sites

[#] auto-populate
[#] auto-populate

Form 3: Specialties and Services, by Site
Complete Form 2: Originating and Distant Sites before inputting data in this form.
Only sites and specialties that are eligible for and receiving EB TNP funding should be
included.

List of Sites/List of Specialties (Modify the list of sites and/or specialties if needed)
Originating Site

Specialty(s) actively available at
this site through telehealth

Was specialty available in your
community prior to this EB TNP
funding?
Yes/No
Yes/No

[grantee generated
site]

[choose from menu]
[choose from menu]

[grantee generated
site]

[choose from menu]

Yes/No

[choose from menu]

Yes/No

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Number of sites that have access to [specialty from configure report] services
where access did not exist in your community prior to this EB TNP funding*

[#] autopopulate

*For each specialty listed in the configure report, it will tally the number of sites that now have
access to that specialty as a result of EB TNP funding where that access did not previously exist.
Form 4: Volume of Services, by Site and Specialty
Complete Form 3. Specialties and Services, by Site before inputting data in this form. Only
unique patients seen and encounters occurring as the result of receiving EB TNP funding should
be included.
Real-Time Encounters are encounters that are live, two-way interactions between a person and
a provider using audiovisual telecommunications technology. Store-and-Forward Encounters,
also called asynchronous, are the transmission of health information through digital images or
pre-recorded videos through electronic communication to a practitioner who uses the
information to make an evaluation.
Enter ‘0’ if there is no data to report.

Originating Site

Setting

Specialty

[grantee
generated list]

[grantee
generated
list]
[grantee
generated
list]

[grantee
generated
list]
[grantee
generated
list]

[grantee
generated list]

Unique Number of
Patients Real-Time
Encounters

Total Number of Unique Patients Served because of EB TNP funding
Total Number of Encounters because of EB TNP funding

Number of Total
Store-anEncounters
Forward
Encounters

[#] auto- populate
[#] auto-populate
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Definitions
Unique Patient: If a patient is seen by an eligible provider more than once during the
reporting period, then for purposes of measurement that patient is only counted once
for the measure. 51
Real-time encounters: Are encounters that are live, two-way interactions between a
person and a provider using audiovisual telecommunications technology.
Store-and-forward encounters (i.e., asynchronous): Are the transmission of health
information through digital images or pre-recorded videos through electronic
communication to a practitioner who uses the information to make an evaluation.
Form 5: Patient Travel Miles Saved
Complete Form 4: Volume of Services, by Site and Specialty before inputting data in this form.
Only sites and specialties that are eligible for and receiving EB TNP funding should be included.
For group sessions/clinics, each patient should be counted separately, as each would have had
to travel for these sessions.

51

https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/2013DefinitionEP_9_Record_Smoking_Status.pdf

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Originating
Site

Specialty

[grantee
generated
list]
[grantee
generated
list]

[grantee
generated
list]
[grantee
generated
list]

Name of
location
where
patient
would have
been
referred in
absence of
telehealth

Distance
Between
Originating
(patient)
Site to the
location
where the
patient
would have
been
referred in
the absence
of
telehealth
(Miles)

Miles
Roundtrip

Total
Encounters

Miles
Saved

Total Miles Saved

Definitions
Distance: Grantees might use a standard, online mapping application such as
Google Maps or Mapquest to calculate the distance between the originating site at
which patients receive services through TNGP and the locations where they would
have been referred for each specialty in the absence of TNGP.
Total Encounters: The total number of patient encounters for that originating site
and specialty.
Miles Saved: The number of total patient encounters multiplied by distance in
miles between sites (X 2) between the originating site and referral location for each
specialty service.
• Calculation: Miles X Encounters X 2 = Miles Saved

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Example:

Originating
Site

Specialty

Name of
location
where
patient
would have
been
referred in
absence of
telehealth

Clinic A
Clinic B

Diabetes
Diabetes
Behavioral
Health
Behavioral
Health

Hospital A
Hospital A

Clinic A
Clinic C

Total Miles Saved

Distance
Between
Originating
(patient) Site
to the
location
where the
patient
would have
been
referred in
the absence
of telehealth
(Miles)

Miles
Roundtrip

Total
Encounters

Miles
Saved

37
43

74
86

11
13

814
1,118

Hospital B

29

58

21

1,218

Hospital B

33

66

17

1,122

4,272

Form 6: Other Uses of the Telehealth Network
Complete Form 5: Patient Travel Miles Saved before inputting data in this form.
Provide required data in the tables below. Enter ‘0’ if there is no data to report. Enter ‘DK’ if ‘Total
Number of People’ is unknown.

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Categories
Administrative Meetings
Distance Learning
Other – Specify:

Number of Sessions

Definitions
Administrative Meetings: Administrative meetings might include meetings conducted to
operate the care site that might otherwise have required staff to travel to a “home office.”
Distance Learning: The incorporation of video and audio technologies, allowing students to
"attend" classes and training sessions that are being presented at a remote location. Distance
learning systems are usually interactive and are a tool in the delivery of training and education
to widely dispersed students, or in instances in which the instructor cannot travel to the
student's site. 52
Formal and Informal Education

Total Number
of Sessions

Total Number of
People

Formal Education
Informal Education
Definitions
Formal Education: Sessions that are used to fulfill formal education, licensure, or certification
requirements. Typical characteristics of formal education may include well defined learning
goals/objectives, structured curriculum, and/or established assessment criteria.
Informal Education: Sessions that are used to meet regulatory practice requirements, as well as
supervision/advice requested by remote practitioners.

52

FORHP/OAT 2020 TNGP Notice of Funding Opportunity, p.47

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Form 7: Diabetes
Complete Form 6: Other Uses of the Telehealth Network before inputting data in this form.
Only patients seen and encounters occurring as a result of receiving EB TNP funding should be
included. Provide required data in the tables below.
Enter ‘0’ if there is no data to report.

Number of unduplicated patients with diabetes
served for at least three months during the
reporting period
Number of patients with diabetes (who
received services for at least three months
during the reporting period) whose most
recent Hemoglobin A1c (HbA1c) level is 7.0%
or less.
Number of patients with diabetes (who received
services for at least three months during the
reporting period) whose most recent
Hemoglobin A1c (HbA1c) level is between 7.1%
and 9.0%.
Number of patients with diabetes (who
received services for at least three months
during the reporting period) whose most recent
Hemoglobin A1c (HbA1c) level during the
measurement year was greater than 9.0% (poor
control), or if an HbA1c test was not done
during the reporting period.

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Form 8: Mental Health
Complete Form 7: Diabetes before inputting data in this form. Only patients seen and
encounters occurring as a result of receiving EB TNP funding should be included. Provide
required data in the tables below.
Enter ‘0’ if there is no data to report.

Number of sites that have access to mental
health services where access did not exist prior
to the EB TNP grant
Number of sites that have access to mental
health services for pediatric and adolescent
populations where access not exist prior to the
EB TNP grant
Number of sites that have access to mental
health services for adult populations where
access did not exist prior to the EB TNP grant

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