Checklist: 3 key steps to develop a successful telemedicine program

Hospitals are increasing their stake in telemedicine. In a recent Foley & Lardner survey of 107 healthcare executives and providers, 76 percent indicated they either offered or planned to offer telemedicine services in the near future.

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These remote services — which comprise second opinion, inpatient specialty care or direct-to-consumer programs, among others — will likely take on an even greater role in the coming years. That's because hospital executives are pivoting toward value-based care, seeking new ways to cut costs while maintaining high-quality patient services.

"All of us are in two canoes: we're in fee-for-service and we're looking at value-based," Shayan Vyas, MD, medical director of telehealth at Jacksonville, Fla.-based Nemours Children's Health System, said during a Nov. 14 workshop at the Becker's Hospital Review 6th Annual CEO + CFO Roundtable in Chicago. "As we all jump into one canoe and head toward value-based, [telemedicine] is the way to provide care."

However, laying the groundwork for telemedicine programs — which often extend across the continuum of care and through multiple specialties — poses a unique set of challenges. Here are three steps to add to your telemedicine checklist to ensure strong patient engagement and clinician buy-in.

1. Assess patient interest

Bruce Rosenthal, MD, medical director for consumer telemedicine services at Pittsburgh-based UPMC, noted the importance of evaluating barriers patients might face to reaching existing healthcare services. "How do we bring the services that we need closer?" he said, noting distance and finances might hinder people from visiting a hospital. "There are lots of reasons people won't seek care."

Telemedicine offers a potential solution to the problem, providing populations in need with an accessible, direct-to-consumer approach to reaching care for a variety of medical needs. "When we talk about the user experience, we're talking about things that meet patients' expectations and make their lives easier," Dr. Rosenthal added.

For Dr. Vyas, an initial step to developing a telemedicine program is evaluating patient interest based on specific specialty needs. Nemours Children's Health System, for example, surveys a sample of families about their healthcare experiences and preferences each year. "Patients are demanding that they want [virtual] care," Dr. Vyas said. "Year after year on our surveys, we're seeing that trend."

In April, Nemours Children's Health System released a survey of 500 parental guardians that found respondents were most willing to use telemedicine services to treat children suffering from cold and flu (58 percent), pinkeye (51 percent) and rashes (48 percent).

2. Integrate telemedicine into existing practices — Don't partition it into its own program

A successful telemedicine program must be rooted in the "clinical best practices your organization [has] already identified," according to William Daines, MD, medical director of Intermountain Connect Care, Salt Lake City-based ‎Intermountain Healthcare's direct-to-consumer telemedicine program for urgent care. "Start with the clinical basics, and expand those into telehealth."

It's "making sure that the telemedicine is integrated to the existing practice, and not separate in its own program, [or] separate from the rest of the care that's given," said Sylvia Romm, MD, medical director at video-based telemedicine vendor American Well. This recommendation means ‎Intermountain Healthcare uses telemedicine to expand its existing services — not to introduce new ones.

"Of course, adaptations have to be made for the telehealth environment, but we thought that the care received in telehealth programs should mirror, as much as possible, the care received in person," Dr. Daines said. "A telehealth encounter should not be an accessory pathway to care that you couldn't get elsewhere in the organization."

Along with melding telemedicine with a hospital's existing care services, Peter Rasmussen, MD, medical director for distance health at Cleveland Clinic, noted remote services must be considered in conjunction with an organization's legal, marketing and finance departments. "We can't view telemedicine as a separate vertical," he emphasized.

3. Select the right clinical team

Prior to deploying a telemedicine program, hospital executives must also identify physician leaders to offer their time on the service. At Intermountain Healthcare, Dr. Daines said he seeks physicians who not only boast clinical experience in their specialty, but are also "excited about trying new things."

"In our [telemedicine] program, we really only … hire people who have demonstrated the highest degree of clinical competency," he explained. "We need people who have developed that 'spidey sense' of when something is wrong, because the patient is not right there in front of you."

For Dr. Rosenthal, the cornerstone of engaging physicians in telemedicine care is finding physicians with enthusiasm about the program. "Recruit, don't conscript," Dr. Rosenthal said of his attitude when identifying physicians for UPMC's telemedicine program.

"Ask who wants to do it, don't tell them they're going to," he added.

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