In this article I’m going to discuss the basic framework to implement a sustainable telehealth program. Every organization is different so this framework will provide you with the building blocks you need to create a sustaining telehealth program.
Understanding telehealth and its modalities is a vital step to offering telehealth services at your organization. All four modalities can be used or a combination of them to suit your businesses needs.
Four Modalities of Telehealth
Live Video: The first is live video between the specialist and the patient. This allows for a two-way conversation and allows both the patient and specialist to be engaged and communicating.
Store and Forward: The second is the store-and-forward model. This modality was used back in the 90’s and allows for images to be taken, stored and then transmitted electronically. This is a model to allow the sharing of x-rays and other images for the specialist.
Remote Patient Monitoring (RPM): The third modality is remote patient monitoring (RPM), which is used when a patient is released to go home and the primary care provider (PCP) can continue to monitor the health of their patient.
Mobile Health: The fourth and last modality is the mobile health or mHealth. mHealth is utilizing tablets, smartphones and other mobile devices to improve both access to healthcare and patient engagement.
Tips to Telehealth Planning
- Hire a Telehealth Program Manager right away and empower them to be a decision-maker. The sooner you hire them the better your program will be.
- When going into the planning phase ensure both your IT and Finance departments are at the table to help define the full scope of this new program.
- Don’t throw a ton of money at the latest gadget. Start small and keep your scope controllable so you can stay within budget.
- Next complete an internal analysis on your organization including technology, location and referral data. The data is the driver here and will guide you to your telehealth services priorities. Remember data is everything. Once you have identified your first service or services you want to implement telehealth with, monitor and report on all successes and challenges.
- Practice good project management controls while in the implementation phase and always monitor and report to your leadership the success and challenges. The ultimate goal here is to provide your patients with better and more effective care.
Hiring a Telehealth Program Manager
First and foremost, before you start planning your telehealth program, I highly recommend that you hire a Telehealth Program Manager (TPM). Your new TPM will need authorization to make decisions about the program. If you hire a TPM before you start planning then he or she can develop the telehealth program from scratch, which is always more cost effective.
Job duties for a Telehealth Program Manager include but are not limited to the following:
- Manages, oversees and facilitates all clinical, technical, business and regulatory activities for the telehealth program.
- Leads the development of ongoing services and expansion of telehealth services.
- Identifies budgetary source(s) of funding for each project and develops project plans for telehealth opportunities.
There are many more job duties for the Telehealth Program Manager, but the most important thing I want to impart to you is that the TPM must be empowered to make decisions within the organization.
Analyzing Before Implementing
The next step in your telehealth journey is to perform an internal analysis of the organization. The analysis should consist of the following items:
- Inventory any existing telehealth equipment, if any.
- Identify existing space for the use of telehealth.
- Review and make recommendations for network circuits.
- Identify and review specialty referral data.
This is a high level view of the analysis and each of the bulleted items have more detail involved.
If your organization has attempted to implement a telehealth program in the past and was unsuccessful, you may be able to reuse that equipment.
The space needed for a patient and either a medical assistant (MA) or PCP will need to be identified and reviewed. This review will need input from the MA and PCP because they will be using this new program and the space. Also, having their input will allow you to get their buy-in for the new telehealth program.
Get Everyone Involved
You will also need to get your Information Technology (IT) department involved. I would highly suggest you get them involved on day one of the planning phase. The sooner the IT department is involved the better off your organization will be. If you have to upgrade hardware or software it can consume your resources, including time and staffing. Plus ordering an upgrade to your network circuits can take significant time.
Speaking of technology, there are a huge number of telehealth vendors that can assist your organization’s needs for technology and education. A word of caution with regards to vendors. They are needed and can be a great partner for you and your organization. However, there are vendors out there that will try and talk you into to purchasing a five-figure or higher device to use for telehealth.
Most organizations have limited funds to use for implementing new programs, so start small and plan for expansion. Do not purchase anything that cannot be expanded or upgraded, as it will cost you more in the long run.
Your Finance department should also be involved in the planning phase on day one. Your organization will want to get paid for telehealth services rendered and the Finance department has to figure out how to get this accomplished. This can be complicated and you will want them to have processes and policies in place before going live with the telehealth program.
When data gathering your referral data, be sure to start with an inventory of what and how referrals your organization makes. Once you have that information, dive a bit deeper into the numbers to find out if, for example, Dermatology is your top referral or is it used the most because the PCP is pushing that service due to lack of understanding of rashes. It does happen.
Once you have identified your referral data, you can identify your top priorities for telehealth. It could be Ophthalmology or Dermatology or something completely different. The point is your data will tell you what services you want to start with for the telehealth program.
Also, another big push is happening as we speak with Behavioral Health (BH) telehealth. If your organization has a BH program then ignore this part but if it doesn’t, implementing a BH program within your healthcare organization is a great way to add value to your organization and increase your revenues.
Sustaining Telehealth Within Your Organization
The sustaining piece to a successful telehealth program is going to be the funding from your telehealth services. Be sure to thoroughly review your contracts for both the specialists and the insurance providers. Your insurance providers may have their own opinions on what your priorities should be. Understanding your referral data will help you keep your priorities straight.
One identified issue you will come across is how to get the data from the specialist into your electronic health record (EHR). You have a number of options to choose from:
- As part of your agreement with a specialist, have them input the data into your EHR.
- Develop an interface between the specialist’s EHR and your EHR.
- Manually enter the data.
- Fax and scan the data.
This framework should help guide you in the implementation of a sustainable and successful telehealth program within your organization.
If your organization has already implemented a telehealth program, tell me about it in the comments. I’d love to hear what worked and didn’t work for your business.