Comprehensive Index: A Pioneering Telehealth Approach to Eating Disorder Care

Strict adherence to Arizona Revised Statutes § 36‑3601 et seq., ensuring informed consent, valid patient‑provider relationships, and RN scope of practice within telehealth parameters.

Evidence‑based algorithm (APA‑aligned) determining appropriateness for telehealth; excludes medically unstable patients requiring inpatient care.

Agreement between Hannah Thompson, RN, and Dr. Salazar defines supervision, task delegation, and emergency protocols; ensures coordinated, accountable care.

RN‑led nutritional counseling and meal support services covered within Arizona RN scope, supporting innovative service delivery.

Telehealth protocol for FBT integrates parent coaching and family systems interventions for adolescent eating disorders.

Guidelines for therapeutic boundaries, disclosure, and maintaining the therapeutic frame in home‑based telecare.

Rigorous confidentiality for comorbid SUD, specialized consents for digital communication, and privacy protections.

Clear pathways to PHP/inpatient when remote vitals or symptoms indicate instability needing rapid intervention.

OpenTelemed credentialing validates RN licensure, eating‑disorder certifications, and telehealth competencies. CQI monitors weight restoration, readmissions, and patient satisfaction to continuously refine care.

HIPAA‑compliant multi‑party video with RN, RD, family participation; protected under OpenTelemed BAA.

• Stable high‑quality sessions, multi‑device support
• End‑to‑end encryption verification at start

Bluetooth BodyTrax scales send weight to EHR; patients are shielded from numbers while clinicians monitor accurately.

HRV, resting HR, SpO₂ tracking with FDA‑cleared devices for metabolic stress and recovery markers.

Pre‑ and post‑meal photos support nutritional assessment without requiring real‑time supervision.

Interactive meal plans, recipe exchange, and food logs via shared screen tools.

Consent and configuration for step count and active minutes via Fitbit, Apple Health, etc., to detect compulsive movement.

Correlates movement with nutritional intake and recovery indicators for informed adjustments.

Modifies treatment plans based on objective activity and clinical findings.

Automatic fallback to audio‑only and secure messaging for rural Arizona patients to sustain access.

With consent, meal support sessions may be recorded for supervision and skills optimization; supported across phones, tablets, computers.

Telehealth administration of the Eating Disorder Examination (EDE) and SCID‑5 establishes accurate diagnoses and informs planning. ICD‑10 references: F50.00 Anorexia Nervosa (unspecified), F50.2 Bulimia Nervosa, F50.8 Binge Eating Disorder, F50.9 Eating Disorder NOS.

Detailed interview covers diet history, food rules, fear foods, binge/purge patterns, and supplements to form individualized nutritional rehabilitation plans. Evaluates patterns, timing, preferences/aversions, and emotional context of eating.

1. Remote Vital Sign Assessment Protocol: Patient training for orthostatic HR and BP using standardized home kits.
2. Laboratory Coordination: Quest/LabCorp orders for CBC, CMP, Mg/Phos, ESR, EKG with electronic results.
3. Co‑morbidity Screening: PHQ‑9, GAD‑7, PCL‑5, and OCD screening tools.

• SDOH Screening: Food insecurity, finances, kitchen access, environmental factors.
• Motivational Interviewing: Readiness via Stages of Change to tailor interventions.
• Family System Assessment: For adolescents, evaluate dynamics, communication, caregiver capacity.

Mechanical Eating Protocol: Structured timing and consistency, prioritizing mechanical consumption over hunger/fullness cues initially to support neurobiological recovery. Plate‑by‑Plate® Tele‑adaptation: Real‑time visual guidance for balanced meals via video and screen‑sharing.

Scheduled support during challenging meals/snacks using distraction, emotion regulation, and motivational interviewing to build confidence.

1. Mindful re‑introduction of hunger, satiety, taste awareness as recovery progresses.
2. Digital weekly meal planning, grocery lists, and recipe exchange.
3. Psychoeducation on energy needs, macronutrients, starvation physiology, and re‑feeding.

1. Assessment: Identify/categorize anxiety‑provoking foods.
2. Hierarchy Development: Graduated exposure list.
3. Systematic Exposure: Guided sessions with coping skills in real time.
4. Integration: Incorporate challenged foods into regular plans and generalize skills.

• Supplementation: Evidence‑based oral supplements (Ensure/Boost), electrolyte protocols tailored to status.
• Virtual Cooking Sessions: Live skill‑building to reduce anxiety around food prep.
• Post‑Meal Support (60–90 min): Manage urges to purge/compensate after meals.

• Re‑feeding Syndrome Risk: Monitor edema, rapid weight gain, electrolyte shifts via remote labs for high‑risk transitions.
• Vital Sign Trend Analysis: Weekly orthostatic vitals and resting HR as objective stability indicators.
• Collaborative Medication Management: With Dr. Salazar for SSRIs (Fluoxetine in Bulimia), Olanzapine (Anorexia), Vyvanse (BED); CPT 99211 (RN), 99213–99215 (MD E/M).

Evidence‑based taper with medical monitoring, hydration support, and vigilance for rebound edema or complications.

• Video assessment for lanugo, acrocyanosis, parotid swelling, Russell’s sign using high‑definition video.
• Secure collaboration with PCPs and specialists; clear referral criteria to higher level of care when needed.

• Bone Density: Coordinate DEXA scheduling and orders for remote patients.
• GI Symptom Management: Functional GI symptoms during re‑feeding (constipation, bloating, early satiety) addressed with evidence‑based guidance.
• Hormonal Status: Track return of menses as a key indicator of metabolic recovery.

Normalization of GI and hormonal function guides treatment intensity and marks true physiologic healing.

• CBT‑E: Enhanced transdiagnostic CBT tailored for telehealth while preserving fidelity.
• DBT Skills Coaching: Distress tolerance, emotion regulation, mindfulness, interpersonal effectiveness for ED‑related urges/triggers.

ERP: Target body checking, compulsive weighing, specific food fears using the home environment for authentic exposure and generalization.

• Body Image Exposure (mirrors, fitted clothing)
• Cognitive Remediation Therapy (CRT) via screen‑shared exercises

• CFT: Build self‑compassion, reduce self‑criticism for food/body concerns.
• ACT: Defusion and values work via digital whiteboards for psychological flexibility.
• Virtual gentle movement groups; digital food‑mood journaling; family therapy via telehealth.

• Recovery Record: FDA‑cleared PDT for tracking meals, emotions, urges; clinician dashboard access.
• HRV Biofeedback: HeartMath devices for anxiety regulation before/during/after meals.

• Virtual support groups (process and skills‑based)
• Gamified recovery challenges (feared foods, variety, timing)
• Asynchronous patient video check‑ins for continuity

• EMA: Smartphone prompts capture urges, dissatisfaction, triggers in real time for unbiased insights.
• AI‑Predictive Alerts: Analyze logs, weight trends, EMA to flag relapse risk; Digital Recipe Library: curated meal ideas to reduce planning anxiety.

• Unified dashboard overlays intake, weight trends, mood, activity on a single timeline.
• Wearable integration checks for compulsive exercise; energy balance algorithms align intake with expenditure.
• Longitudinal trends support relapse prediction and optimal intervention timing.

Virtual team conferences unite: 1) Patient, 2) Primary RN & MD, 3) RD & Therapist, 4) Family & PCP, 5) Specialists & community resources — aligning goals and optimizing outcomes.

• RD Coordination: Specialized meal planning and MNT delivery; consistent with overall goals.
• Therapist Coordination: Share goals, progress notes, clinical observations securely.

1. Regular Case Review: Efficacy, side effects, dose optimization with Dr. Salazar.
2. Medication Management: Coordinate psychotropics and adapt therapy to med effects.

• School Reintegration: Tele‑meetings for 504 plans and recovery‑aligned academic supports.
• Family Workshops: Neurobiology and strategies to support recovery, avoid pitfalls.
• Role Clarity: RD creates meal plans; RN provides support, coaching, medical monitoring.

• Managed transitions from inpatient/PHP to telehealth step‑down, preserving gains.
• Arizona provider networks for in‑person needs, labs, and emergencies.
• Crisis resources and inpatient ED facility access when safety requires intensity.

• Use modifier 95 and Place of Service 02 for all telehealth encounters.
• RN‑led monitoring (weight/vitals) billed via CPT 99211 for established patients.

• Psychotherapy 90832–90837 where within RN scope and competency; group and family tele‑therapy included.
• Care management: 99484 (BHI), 99490 (chronic care) for non‑face‑to‑face coordination.
• RPM: 99453 setup, 99454 data collection, 99458 interpretation.

Note: H&B coverage varies; prior auth may be required. MNT codes available when RN holds CNSC, increasing reimbursement for specialized nutrition interventions.

1. RTM: 98975, 98976, 98977, 98980, 98981 for CBT engagement/food log tracking and app utilization.
2. Medical Necessity: Document complexity, comorbidities, and risk to support billed level and telehealth modality.
3. Payer Navigation: Nuances across Medicare, AHCCCS, and commercial plans; ED‑specific limitations and prior auth.

• EDE‑Q: Quarterly measure of restraint, eating, weight, and shape concern.
• CIA: Psychosocial impairment specific to ED features, beyond symptom reduction.

• Weight restoration velocity and goal maintenance tracking.
• Frequency of objective binges, purging, and compensatory behaviors.
• BSQ (Body Shape Questionnaire); BAS‑2 (Body Appreciation Scale); RCQ (Readiness for Change); WAI (Working Alliance Inventory).

KPIs include treatment retention, weight goal achievement, reduced higher‑level‑of‑care admissions, and patient satisfaction via Telehealth Usability Questionnaire (TUQ).

• Ongoing credentials: CEDRN; continued training in CBT‑E and FBT.
• Systematic outcome tracking for potential publication to advance telehealth evidence base.
• Protocol/technology innovation for accessibility across Arizona and beyond; professional collaboration via conferences and organizations.

This program sets new standards for telehealth ED treatment, joining advanced technology with evidence‑based care to improve access and outcomes statewide.