10 Best Practices for Implementing Telemedicine in Hospitals

Telemedicine and telehealth have the potential to increase access to care, improve quality of care and decrease costs. For instance, the American Telemedicine Association proposed legislation that would expand telemedicine and save an estimated $186 million over the next 10 years. In addition, the U.S. Department of Agriculture has devoted significant resources to the development of telemedicine, including recent grants totaling more than $30 million for telemedicine projects throughout the country. Here, several experienced hospital professionals share 10 best practices to build a successful hospital telemedicine program.

1. Conduct a market assessment. "The first step is to do an honest assessment of your capabilities and the needs [of] communities," says Tim Smith, MD, vice president of research for the Center for Innovative Care at St. Louis-based Mercy. Mercy started its telemedicine process with a community needs analysis. The executive leadership engaged the community at different events to find what healthcare services the community needed, according to Dr. Smith.

In addition to direct communication, hospitals can analyze data to assess the needs of the community. "Patient outcomes data can also be very helpful in determining what services to develop and which communities have a high need for a particular service," says Doug Lawrence, telemedicine program manager at Indianapolis-based Indiana University Health. "As an example, if a particular county in a state has poor patient outcomes for stroke and no local stroke-trained physician, developing a telestroke service to provide virtual stroke care to that county is an obvious solution."

2. Conduct a self-assessment. Hospitals need to evaluate their capabilities for providing the service lacking in the community as identified in the market assessment. "You need to be able to speak to your strengths within the service [and] match that with the needs of the community," says Aaron Bair, MD, medical director for the Center for Health and Technology at Sacramento-based UC Davis Health System. "It doesn't make sense to start down the path where the market is already saturated or you do not have specialists available. If want to do pediatric neurology, you better have a certain number of pediatric neurologists interested in providing telemedicine."

Hospitals should decide how to focus their telemedicine programs "based on an analysis of their own market, the anticipated return on investment, whether there are strong clinical champions and the goals for the organization," says Karen Rheuban, MD, medical director of the Office of Telemedicine and director of the Center for Telehealth at Charlottesville-based University of Virginia Health System. She says hospitals should also consider new regulations that may affect service delivery, such as penalties for readmissions.

Furthermore, decisions on telemedicine should be made by a multidisciplinary group of stakeholders. "It is helpful to perform a readiness assessment to determine starting points at each facility," Mr. Lawrence says. "Risk management, legal, IT, telecommunications carriers (in some instances) and clinical leadership should all be involved."

3. Align goals with the organization's mission. "Align the goals of your telehealth program with the mission of your organization," says Shelley Palumbo, chief administrative officer of the Center for Health and Technology at UC Davis Health System. This alignment will help hospital leaders develop a telemedicine program that is strategically valuable for the organization by working towards the hospital's overall goals.

"Consider and define the purpose for developing services," Mr. Lawrence says. "Is the purpose to better manage a disease state or health population within the hospital or health system, improve public health at the statewide level, [serve] as a patient satisfier reducing travel time and costs?" Defining the purpose can guide hospitals toward strategies to meet their goals.

4. Develop a timeline for implementation. Hospitals should organize implementation of a telemedicine system by creating a timeline for key stages of the project. Many factors affect the timeline, including the size of the hospital and the goals of the telemedicine program. "Ample time should be allowed for a market/needs assessment, ordering and installation of equipment, testing and troubleshooting of the equipment, training of clinical and administrative staff, conducting practice sessions with the partnering site(s) and account[ing] for any other issues that might arise during the implementation process," says Ms. Palumbo, whose center at UC Davis provides telehealth training and education. Mr. Lawrence suggests hospitals also consider time needed for credentialing, which he says say can take up to 120 days.

Less tangible factors such as support of the program by hospital leadership and buy-in from physicians should also be accounted for. "Any time you do something innovative, your timeline is going to be dictated by the level of support you have from the highest level of leadership," says Dr. Smith. "It's amazing how quickly and efficiently you can get things done when you have the support of your organization's executive leadership and when they make this a priority. You can cut months, even years off of development."

Physician leadership is also key to a streamlined implementation process. "A realistic timeline for development and deployment must be linked to provider engagement, development of institutional champions, a careful analysis of the ROI and the infrastructure needed for the program," Dr. Rheuban says.

5. Gain administrative support. Executive leadership is important not only for a tighter timeline for telemedicine, but also for accessing needed resources, gaining buy-in from physicians and encouraging patients to use the technology. "One of the advantages Mercy brings is strong executive leadership who made this a priority," Dr. Smith says. Mercy's creation of the Center for Innovative Care, which is dedicated to driving innovative projects, also helps programs like telemedicine succeed.

6. Identify clinician champions.
"On-site champions and/or leaders should be put in place to drive development and ongoing support of the service," Mr. Lawrence says. "Physician leadership is a vital component as the physician(s) have to understand and desire the benefits of providing telehealth services and drive the development of the service within the hospital." Dr. Rheuban says hospitals can encourage physician champions by sharing success stories and visiting other successful telemedicine programs to highlight the potential benefits of the program.

One benefit is that seeing patients via telemedicine can enable physicians to delegate their time more efficiently. Dr. Bair says telemedicine allows physicians to spend more time with patients who really need care and effectively manage patients who need less care. For example, physicians can view a patient on video and decide whether that patient needs intervention, potentially saving the patient from traveling to a facility only to be told to continue the current treatment, Dr. Bair says.

7. Train providers. "Training is a key component of a successful program," Ms. Palumbo says. "Telehealth technology isn't that difficult to integrate, but it doesn't eliminate the need for training. Each of our practitioners goes through a hands-on program to learn how to use the equipment prior to seeing patients via telehealth. This enables practitioners to become comfortable with the video and audio components and discuss any remaining questions or concerns," she says.

Mr. Lawrence suggests using telemedicine for planning meetings or educational conferences to familiarize providers with the technology. In addition, IU Health often sets up mock visits or test calls to "alleviate any anxiety," he says.

8. Start simple. Hospitals should begin using telemedicine for simple services before ramping up to complex services such as multi-provider calls and interventions transmitted through the technology, Dr. Bair says. For instance, hospitals can start by using telemedicine for gathering patient history and providing consultations. As programs increase in complexity they can provide services in behavioral health, neurology and endocrinology, Dr. Bair says. "[Telemedicine] is somewhat tiered — starting simple with things that are easy to approach without a lot of additional technology, then higher levels of coordinated, multi-personnel [services] with augmented exam techniques."

9. Analyze outcomes. Hospitals should track outcomes from telemedicine over time to identify any gaps in care or opportunities to expand the service. "It is imperative that health systems that implement this technology and these kinds of programs study what they're doing and report out on that," Dr. Smith says. Studying outcomes and sharing them with others will help hospitals develop additional best practices, he says.

10. Integrate telemedicine with other systems. Dr. Smith suggests integrating telemedicine with other technologies such as electronic medical records to ensure efficiency and to better understand the data. "We are fully integrating all processes to study [data] more systematically and inform improvement process and optimization," he says. While integration is difficult, benefits such as being able to quickly access population health information and having a single database for patient records makes the process worthwhile. "Ultimately you get the best outcomes and best functionality if you can tie [telemedicine and EMR] together," Dr. Smith says. "It takes a lot of work; you have to have the stomach for it. It's much easier to do disconnected work, but in the long run I think most health systems will ultimately want everything fully integrated."

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