It has been one year since New York City-based NewYork-Presbyterian rolled out telehealth services on its NYP OnDemand platform, Senior Vice President and Chief Strategy Officer Emme Deland writes in a New England Journal of Medicine Catalyst blog post.
NYP OnDemand has become a core service at the hospital since its launch in July 2016, she writes.
Here are four challenges NYP faced when developing its telehealth service.
1. Liability. Ms. Deland said the hospital reached out to its malpractice carrier to ensure its clinicians would be covered when conducting virtual appointments. Although the carrier confirmed that the hospital's clinicians would be covered if they practiced within the scope of their license, she is uncertain whether all carriers offer this type of coverage.
2. Licensure. Practice regulations vary by state, so NYP assigned a group of urgent care physicians to obtain licenses in different states. The Interstate Medical Licensure Compact provides a first step toward expediting this process, but there are still a range of hurdles, since some states place additional barriers on virtual healthcare — such as requiring an in-person visit prior to using telehealth services.
3. Reimbursement. Reimbursement is an ongoing challenge, writes Ms. Deland. The hospital offers urgent care via telehealth as a cash-pay service and focuses follow-up visits on surgical care. It decided to take on expenses associated with its inter-hospital digital consults as part of its commitment to improving patients' access to care.
4. Workflow. Remote patient monitoring was the hospital's biggest workflow concern, since clinicians "were not eager to take responsibility for responding to out-of-limit patient readings at night or on weekends," she writes. The hospital explored scheduling options, such as assigning clinicians telehealth shifts or carving out times in their schedules for telehealth visits. These approaches will continue to evolve as telehealth becomes a core component of the hospital's care delivery, Ms. Deland writes.
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