> ## Documentation Index > Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt > Use this file to discover all available pages before exploring further. # CL-PM Integration Contract: Telehealth > Version: 1.1.0 Last Updated: 2026-02-22 Status: ✅ Reviewed (pre-implementation) Constitution Reference: Section 1.2 (Core Independence), Section 1.3 (Integrati… **Version:** 1.1.0 **Last Updated:** 2026-02-22 **Status:** ✅ Reviewed (pre-implementation) **Constitution Reference:** Section 1.2 (Core Independence), Section 1.3 (Integration Patterns) **Source:** CL-PM-SPEC-REVIEW Finding 5.3, Pre-Implementation Review 2026-02-22 *** ## Overview Telehealth workflows span CL and PM with overlapping data. This contract defines which core owns which data and how they integrate without direct cross-core dependencies. *** ## Ownership Boundaries | Data | Owner | Spec | Rationale | | ----------------------------- | ----- | ------------------------------------------------------------------------------------------------- | ------------------------------ | | Session platform/URL | PM-13 | `pm_telehealth_sessions` | Operational/scheduling concern | | Session status & modality | PM-13 | `pm_telehealth_sessions.session_status`, `telehealth_modality` | Session lifecycle concern | | Appointment telehealth flag | PM-03 | `pm_appointments.is_telehealth` | Scheduling concern | | Clinical documentation fields | CL-04 | `cl_progress_notes.is_telehealth`, `telehealth_modality`, `patient_location`, `provider_location` | Clinical documentation concern | | Modifier determination | PM-07 | Charge capture logic | Billing concern | | Place of Service code | PM-07 | Charge capture logic | Billing concern | *** ## Integration Flow ``` PM-03: Appointment created with is_telehealth = true ↓ PM-13: Telehealth session created, platform link generated (pm_telehealth_sessions.appointment_id → pm_appointments.id) (session_status = 'scheduled', telehealth_modality set) ↓ PM-13: Session starts → session_status = 'active' → publishes telehealth_session_started event ↓ PM-03: Encounter created when appointment starts (pm_encounters.id created) ↓ PM-13: Session ends → session_status = 'completed' → publishes telehealth_session_completed event (payload includes telehealth_modality, patient_location, provider_location) ↓ CL-04: Clinician documents visit, captures telehealth clinical fields (cl_progress_notes with is_telehealth, modality, locations) ↓ CL-04: Note finalized → clinical_note_finalized event (includes is_telehealth, telehealth_modality in payload) ↓ PM-07: Charge capture applies telehealth modifiers (95 for synchronous audio/video, FQ for audio-only, GQ for store-forward) (POS = 10 for patient at home, 02 for telehealth) ``` *** ## Telehealth Fields by Core ### PM-13: `pm_telehealth_sessions` (Operations) ``` appointment_id → pm_appointments(id) encounter_id → pm_encounters(id) -- link to encounter platform TEXT -- 'zoom' | 'doxy' | 'teams' etc. session_url TEXT session_status TEXT -- 'scheduled' | 'active' | 'completed' | 'no_show' telehealth_modality TEXT -- 'audio_video' | 'audio_only' | 'store_forward' | 'remote_monitoring' is_audio_only BOOLEAN -- DEPRECATED: use telehealth_modality. Sunset target: 2026-Q4. patient_location TEXT -- State/location of patient provider_location TEXT -- State/location of provider patient_joined_at TIMESTAMPTZ provider_joined_at TIMESTAMPTZ session_ended_at TIMESTAMPTZ duration_minutes INTEGER ``` ### CL-04: `cl_progress_notes` (Clinical Documentation) ``` is_telehealth BOOLEAN DEFAULT false telehealth_modality TEXT -- 'audio_video' | 'audio_only' | 'store_forward' | 'remote_monitoring' patient_location TEXT -- State/location of patient during session provider_location TEXT -- State/location of provider during session place_of_service TEXT -- Overrides default POS for telehealth ``` ### PM-07: Charge Capture Logic (Billing) Modifier auto-application rules based on `clinical_note_finalized` event payload: | Telehealth Modality | Modifier | POS Code | | ------------------- | -------------------- | ----------------------- | | `audio_video` | 95 | 10 (home) or 02 (other) | | `audio_only` | FQ (or 93 per payer) | 10 or 02 | | `store_forward` | GQ | 02 | *** ## Events ### PM-13 Events (New) #### `telehealth_session_started` Published when `pm_telehealth_sessions.session_status` transitions to `'active'`. ```typescript theme={null} payload: { session_id: string; appointment_id: string; encounter_id?: string; organization_id: string; telehealth_modality: 'audio_video' | 'audio_only' | 'store_forward' | 'remote_monitoring'; platform: string; } ``` #### `telehealth_session_completed` Published when `pm_telehealth_sessions.session_status` transitions to `'completed'`. ```typescript theme={null} payload: { session_id: string; appointment_id: string; encounter_id?: string; organization_id: string; telehealth_modality: 'audio_video' | 'audio_only' | 'store_forward' | 'remote_monitoring'; /** @deprecated Use `telehealth_modality` instead. Sunset target: 2026-Q4. */ is_audio_only: boolean; // backward compat for PM-07 modifier-logic.ts until migration completes patient_location?: string; provider_location?: string; duration_minutes?: number; } ``` ### Existing Event: `clinical_note_finalized` (CL-04 → PM-07) The `clinical_note_finalized` event (defined in CL-PM-ENCOUNTER-TO-BILLING.md) includes telehealth fields: ```typescript theme={null} payload: { // ... other fields is_telehealth: boolean; telehealth_modality?: 'audio_video' | 'audio_only' | 'store_forward' | 'remote_monitoring'; patient_location?: string; provider_location?: string; } ``` PM-07 uses these to determine modifiers and POS without querying CL tables directly. *** ## `pm_appointments.telehealth_url` Deprecation PM-03 Phase 1 stores a manual `telehealth_url` TEXT on `pm_appointments`. Once PM-13 is active for an organization: * **Write path:** Join links are generated into `pm_telehealth_sessions.session_url` via the edge function. * **Read path:** UI should prefer `pm_telehealth_sessions.session_url` when a linked session exists; fall back to `pm_appointments.telehealth_url` for appointments without a PM-13 session. * **Migration path:** No data migration needed. The `telehealth_url` column remains for orgs not using PM-13. * **Sunset date:** The `telehealth_url` column on `pm_appointments` will be deprecated once all organizations are migrated to PM-13. Target sunset: **2026-Q4**. After sunset, the column will be dropped in a future migration. * **Warning mechanism:** Type accessors that expose `pm_appointments.telehealth_url` MUST include `/** @deprecated Use pm_telehealth_sessions.session_url instead. Sunset: 2026-Q4. */` JSDoc annotations. Similarly, accessors exposing `is_audio_only` MUST include `/** @deprecated Use telehealth_modality instead. Sunset: 2026-Q4. */`. Runtime access without a linked PM-13 session should emit a structured warning (`deprecated_column_access: telehealth_url`) to support migration tracking. *** ## Event Registration The following events should be registered in `fw_workflow_events` for automation support: | Event Name | Channel | Registration Status | | ------------------------------ | -------------- | ------------------- | | `telehealth_session_started` | `cl_pm_events` | 📝 Planned | | `telehealth_session_completed` | `cl_pm_events` | 📝 Planned | Register in EVENT\_CONTRACTS.md under PM-13 section when implemented. *** ## Cross-Reference | Spec | Responsibility | | -------------------------- | ------------------------------------------------------------- | | PM-03 | Flags appointments as telehealth | | PM-13 | Manages telehealth platform session, publishes session events | | CL-04 | Documents clinical telehealth fields | | PM-07 | Applies telehealth billing modifiers | | CL-PM-ENCOUNTER-TO-BILLING | Event carries telehealth data from CL-04 to PM-07 |