8 Best Practices in Telemedicine

When the Supreme Court upheld the Patient Protection and Affordable Care Act in June, a great deal of uncertainty around the future development and adoption of telemedicine lifted. According to the American Telemedicine Association, the ruling will accelerate the deployment rate of telemedicine as well as other remote healthcare technologies. These technologies are important elements of managed and accountable care, medical homes and care coordination; therefore, upholding the PPACA encourages providers to pursue telemedicine to improve care, reduce costs and increase access.

However, embracing and implementing telemedicine is sometimes easier said than done. Here are eight best practices for successfully implementing and managing telemedicine programs.

1. Create an implementation committee. An internal implementation committee can guide the integration of telemedicine services with current hospital operations while keeping costs down. When a hospital has an internal committee, the need for meetings with third-party consultants may be less. According to Kevin Abel, CEO of Lake Chelan (Wash.) Community Hospital, a hospital should create an implementation committee of not just of IT staff or hospital staff but also of physicians.

"You need everyone's input and assistance for the best outcomes," says Mr. Abel. "You should also include clinical staff in the design and implementation. Adding telemedicine to a hospital needs to be an enterprise-wide effort."

2. Encourage collaboration with local organizations. One of the biggest challenges in developing, implementing and using telemedicine networks is encouraging different healthcare organizations to work together. However, it is a best practice that could greatly benefit a telemedicine network.

"In today's healthcare market everyone is protective of their services and their patients," says Doug Lawrence, MSM, PMP, manager of telemedicine at IU Health in Indianapolis. "For example, organizations can be protective of the patient images they periodically store on a cloud system."

For telemedicine to best live up to its potential, a network should extend to rural areas and potentially across communities, counties or entire states. If healthcare organizations do not collaborate to set up a network, the benefits of telemedicine may be harder to introduce to patients in rural areas. "It has to be a collaborative effort with other healthcare organizations across the state to benefit the patients," says Mr. Lawrence. "It is really important to make sure you have developed a solution or program that is not totally self-servicing. It can't just be for your organization's benefit — that doesn't work."

3. Set appropriate goals. Both Mr. Abel and Ross Hurd, CIO of LCCH, attribute the success of LCCH's radiology telemedicine service to clear and appropriate goals. LCCH's overall goal was to improve patient care through better access to specialists, In order to meet this goal, its telemedicine committee intially focused on funding rather then securing infrastructure for a network. However, the committee members soon realized that most rural hospitals — where the telemedicine would be most useful — did not have the network infrastructure to support remote consults from radiologists. Before LCCH could utilize the grant, a system had to be designed to freely route studies between each hospital.

Mr. Hurd had to build a network to connect members and the outside hospitals.
"It took a little backtracking and redesign time, but the project continued and is still widely used," says Mr. Hurd.

If the committee had begun with the goal of creating a network, instead of receiving funding, Mr. Hurd may have avoided backtracking and redesigning.

4. Find and apply for grants.
It is not breaking news that telemedicine services struggle to spread. The reimbursement for hospitals is just not there. In order to fund telemedicine projects, Mr. Lawrence recommends finding and applying for technology grants.

Even though requirements for reimbursement may be increasing, payors still prefer to reimburse for live interactions between patients and physicians, says Mr. Lawrence. While this gives hospitals and providers a big challenge to overcome, there are other ways to support the services financially.

"Most of the hospitals [that use our telemedicine services] are not in the [IU Health] network," says Mr. Lawrence. "By working with the Indiana Rural Health Association, we were able to secure grant money [for telemedicine services to extend to those facilities]."

The IHRA is a non-profit corporation developed to improve the health of all the state's rural citizens. There are also rural health associations in 35 other states such as Alabama, California, Colorado, Delaware, Georgia, Hawaii, Idaho, Kentucky and Maryland. These associations and other organizations, such as the U.S. Department of Agriculture, have provided grants for telemedicine projects.

5. Build community support. Mr. Abel believes success in telemedicine comes from the community around the hospital. If the community is not comfortable with telemedicine, they may not be willing to use it for their visits with physicians. All the time and effort put into the program could prove futile.

LCCH received strong community support for one of its telemedicine services — digital mammography — before the service was fully implemented. When the service was available, LCCH had already educated the community, made them aware of how local mammograms would change and what the value of the digital version would be. The community adopted the digital service with more vigor, and LCCH could continue to afford the service due to the high level of activity it saw — 528 studies — a large number by rural hospital standards.

6. Conduct training drills with staff, but make it easy. Mr. Hurd recommends training clinical staff on the telemedicine services so they are informed and are confident operating the devices, such as the video monitors and video-conferencing software.

"Create simple, clear instructions for the training. When the clinical staff is given time to practice, later issues are more resolvable. Real-time in the hospital is time sensitive so avoiding mistakes is crucial," says Mr. Hurd. "I also recommend training without the IT staff present. They will not be there in real time. It is best to train in as real of situations as possible."

The equipment should be easy to turn on, easy to operate, and the support number for problems or malfunctions should be clearly posted if not memorized by staff.

"From a technological and clinical standpoint, the clinical staff needs to know the protocol forwards and backwards before they are placed in high-stress situations with the high-tech equipment," says Mr. Lawrence. "The telemedicine operation needs to be as simple as possible. Merely turning on the monitor and flipping one switch is the best."

7. Hold roundtable meetings and site visits. Site visits and roundtable meetings help to ensure that technical problems and human errors are accounted for as best as possible. IU Health held quarterly round table meetings with all the sites involved in the telemedicine network.

"We learned about interesting things such as the high-stress situations in which clinical staff use the telemedicine equipment," says Mr. Lawrence. "We found we would need clear protocol and training for managing stressful situations and family members while operating the high-tech equipment."

In order for site visits to inform telemedicine implementation, Mr. Lawrence recommends the following questions:

• What kind of wireless capability does the facility have?
• What kind of connectivity can the facility receive?
• How are the rooms set up?
• Where can the equipment be stored safely?

8. Practice for disaster scenarios. It is important for hospitals to test telemedicine services under various disaster situations. LCCH practices mock drills randomly throughout the year to determine if the clinical staff is current in knowledge and training to utilize all the telehealth and telemedicine equipment.  LCCH also conducts once-a-year disaster training to prepare for scenarios such as system breakdowns, Internet disruptions or natural disasters.

"As [a] service becomes more electronic — more telemedicine-based — it is important to go through scenarios. What if you cannot access the hospital's server? If you have to access the back-up system, what will change? You have to prepare for these scenarios so they are not debilitating in real-time," says Mr. Hurd.

You cannot prevent disasters or technological issues, but as Mr. Hurd says, you can prepare for them by practicing. "Practice is neither expensive nor difficult. It could save your hospital's telemedicine services down the road."

More Articles on Telemedicine:

HIT in 2013: 2 Areas to Watch
11 Missouri Hospitals Receive $262k in Grants for Telemedicine
ICU Telemedicine: Do Costs Outweigh Benefits?

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