Seven steps to telehealth success

By Jonathan Kaufmann, CMIO, Bayhealth Medical Center

Why do so many hospitals have closets full of dusty and unused telehealth equipment? In short, because they fail to consider the broader organizational work needed before technology can be effective. Instead, it’s the cameras, screens, mobile apps, and other telehealth equipment that come to mind when launching a project. I have seen this repeatedly as the Chief Medical Information Officer for two different organizations and have captured the seven key factors to success below. They have been observed over the past ten years and continue to serve me well in my current role at Bayhealth. Applying them will prevent your organization from wasting time, energy, and of course, not filling up another yet another closet.  

Before diving into the organizational work necessary to implement telehealth services, consider that technology to provide patient care existed long before it was widely used to do so. Radiology images were first transmitted over telephone lines in the 1940s, but teleradiology wasn’t widely adopted until the 1990s. Virtual video visits were first used in the 1990s, though it wasn’t until COVID-19 that the use skyrocketed. The reasons why can be found below.

1. Telehealth shouldn’t be thought of as a single thing to bring into your organization. Telehealth should fit a specific niche that is part of your overall organizational and IT strategy. Breaking telehealth up into projects is essential to success. For example, a project adding remote patient monitoring when chronic care management isn’t on your strategic roadmap, will fail. The technology may be great, but the overall project won’t get time, resources, or attention like those that fit the organization’s roadmap will.
   
   
2. Pick a platform to connect – Much of the buzz and advertising focuses on this. You and I receive emails, cold calls, and vendor outreach daily asking to check out a fancy new piece of telehealth technology. Cut through this noise and make sure the platform is easy to use and fits into your organization.
   
   Our organization uses a platform embedded in both our EMR and the patient’s portal for office visits. This makes connecting easy for both the clinician and the patient.
   
   Keep an eye on your overall IT strategy when choosing a platform. You may select one that is best in class for your project, but if it requires proprietary hardware or a ton of interfaces with other technology in your organization, it won’t be integrated or adopted. Imagine a busy emergency department with a different telepsychiatry cart, tele-stroke cart, and pediatrics cart. Maybe your organization can support this, but likely it would lead to confusion, lack of adoption, and patient care issues.
   
   This exact scenario played out at our organization. Now, we insist upon using our video carts rather than a vendor’s, despite losing a small amount of functionality. It was worth the trade-off to keep the workflow simple for our staff. Work with your vendors to understand your IT strategy and find ways to incorporate their platforms and services into your organization’s existing technology. If you need new hardware or software to be successful, think about future uses, so you aren’t boxed in when the next project rolls around.
   
   
3. Ensure operational support – Organizations often try to jam a project into existing workflow and staff responsibilities without much thought. Engage your administrative and office staff in the project. Without their support, the project will fail. One of the reasons virtual visits are declining at this stage of the pandemic is that organizations did not fully embrace the changes need to keep visit volume up. Did you adjust your front desk and scheduling scripts to include virtual visits as an option? Can patients request a virtual visit from your portal? If the answer to these kinds of questions is no, don’t be surprised when adoption is low or fades after launch.
   
   
4. Have a billing plan – The rules for telehealth service reimbursement are complex. They can also vary by state and payor. Having dedicated resources to help your clinicians understand documentation requirements and ensure they get paid is critical. There are whole new sets of CPT codes to learn. Clinician and coder education is a must to be successful. Patients must understand the costs on their end. For example, co-pays can vary between in-person and virtual visits.
   
   
5. Check state, national, and payor regulations – Many of the regulatory reasons for project failure have been removed or suspended due to the COVID pandemic. It is unclear how many will remain. Stay on top of these changes at both the local and national levels. One underestimated restriction is the physical location of both the patient and clinician. It seems counter-intuitive for a virtual visit, but regulation can require licensure based on where they are, not where your organization is located.
   
   
6. Make a training plan – Many organizations forget training altogether or just focus on the clinician. Don’t forget that your patients will need to be trained as well. Both groups received training on our platforms prior to go-live of virtual visits. Materials were made readily available on both our public-facing and internal websites when applicable. Standardizing your equipment and workflows helps tremendously with this. Staff and patients get accustomed to the way things work and adding new services is easier for everyone.
   
   
7. It takes two to tango. Prior to launching any telehealth service, you must clearly identify who will be the provider and who will be the recipient. It seems obvious that you need someone on either end of the technology, but I have seen instances where work begins on a project when one of the two is missing.
   
   An organization that sought to provide teledermatology services due to patient demand failed to identify a dermatologist to see the patients. Another organization with a small rural emergency department installed remote ICU monitoring equipment costing thousands of dollars, so physicians at a tertiary care center could monitor patients and identify those requiring transfer. Unfortunately, this was done without the agreement of the physicians able to provide the care. Unsurprisingly, the equipment was never used.

The seven steps above will help you avoid piles of unused equipment. You will also avoid wasted time and dollars on efforts that ultimately will fail. Telehealth is coming in almost all sectors of health care. Stay ahead of the curve with a sound strategy, good partnerships, and fully fleshed-out projects.