A system-wide approach to telehealth

Telehealth has been around for decades, but it has only really gathered speed in adoption in the past five years.

On the consumer side, that’s largely because of changes to state laws and parity for reimbursements. But for many hospitals and health systems, it’s become a critical way for hospitals to expand their reach, and facilitate better outcomes—particularly in the cases of stroke treatment, the ICU, urgent care and behavioral health. In fact, according to a 2016 Avizia study, more than 63 percent of providers now use telehealth in some way.

Hospital-based telehealth, as used in a case like stroke or behavioral health, is responsible for significant improvements in specialist access, reductions in length of stay (LOS), a reduction in expected deaths—and increased savings for hospitals participating in value-based reimbursement models. Best of all, patients who have used telehealth appreciate the convenience and access to care.

Results from these use cases have been so strong that many new-to-telehealth hospitals focus only on them when implementing their own programs.

These organizations don’t see the forest for the trees.

Why take a system-wide approach?
High-acuity situations, like stroke, ICU or critical care pediatrics, are high-stakes. They’re great candidates for telehealth, but there’s a lot that goes into an implementation, like integrating with the EHR, PACS and established clinician workflow. So, it makes sense that many hospitals follow a strategy that focuses on just one use case at a time. The problem with this approach is that it sets the health system up for a more difficult telehealth expansion down the road.

There’s more to a successful telehealth program than just video consultations. A comprehensive strategy includes several ways for providers to collaborate—whether that be in-person, real-time via video, or even asynchronously via secure messaging. The mix and use of these solutions depends largely on each organization’s unique clinical culture and the needs of its patient community.

There’s also the issue of reimbursement. Often times, health systems will outsource their telehealth needs to a vendor that also provides its own physicians. While this may seem like an easy fix and a fast route to “checking the telehealth box,” according to the Wall Street Journal, these “doctor-to-doctor consultations are seldom covered by insurance.” Out-of-state licensure issues are yet another problem with outsourcing. These are just a few other factors that hospitals need to consider when setting their strategy—and the reasons why many systems choose to implement a program that makes the best use of their existing clinical resources.

Hospitals that see the most success with telehealth start with a system-wide strategy where they measure twice and cut once. This doesn’t mean a health system will implement and put a full strategy into action all at the same time, but it does give the organization an adaptable blueprint and the assurance that they’ve selected an approach and partners to accommodate changes.

Ingredients for success
Every healthcare organization is unique, but those with successful and integrated telehealth programs tend to share some common characteristics.

1. Strategic leadership: A C-suite that understands the long-range impact of telehealth, not just the near-term benefits, is key to the initial development and adherence to a strategic approach to telehealth. An enlightened team understands that telehealth is already a critical component of the next generation of care delivery. They also understand how to navigate complex reimbursement and licensure issues.

2. Clinical advocates. Even with a solid telehealth strategy and plan at the highest levels of leadership, the success of any use case implementation depends on having a clinician champion. Ultimately, the successful implementation and ongoing utilization of a telehealth program is a physician-led effort that requires understanding, ongoing education and motivation. This ensures that telehealth programs provide care that is on par or better than in-person equivalents.

3. Collaborative IT teams. Strong IT teams understand that a scalable approach to telehealth takes outside partnerships and expertise. Successful IT leaders are collaborative and have a seat at the table during the development of the system-wide strategy. They understand that innovation doesn’t happen in self-imposed vacuums. They also understand that “in house” lab projects, even if highly funded, are not taking advantage of the breadth of experience that established telehealth vendors can bring in overcoming technology and adoption issues.

Strong leadership from the top coupled with a culture of collaboration will set the right foundation. From there, providers can begin to develop a unique program that best serves their patient communities.

What could go wrong?
Unfortunately, even if a health system sets a clear vision and strategy for next generation care delivery, a telehealth program may not live up to expectations. Why? Lack of utilization, for one. For high-acuity cases, like stroke, patient education and engagement with telehealth isn’t a problem. The issue comes from physicians not understanding and using the system.

This is where physician champions come into play. If empowered, they can drive sustained excitement and education for the program.

For lower-acuity situations, like urgent care, patient utilization can be challenge. For some telehealth vendors, ROI comes from a high number of patient visits. That doesn’t always happen if healthcare organizations don’t educate their patient bases on the benefits of telehealth—and more importantly—tell them how to use it.

Allow room for iteration and feedback
Creating a thriving, system-wide telehealth program is a long game. It won’t happen overnight, nor should the development of a hospital’s strategy. But there’s a payoff for hospitals taking a holistic view on the next generation of care delivery. Encouraging stakeholders from various departments to take a seat at the table and actively participate in plan development will set the stage for a thriving program.

Planning is an iterative process. Providers must also remember that, collaborating on and implementing the technology infrastructure for a telehealth strategy is an enormous effort, but seeing ROI is another of the puzzle. Setting those goals with measurable outcomes should be a part of the long-range strategy.

Finally, hospitals should remember that when a program is successful, it’s almost always physician-led. Find and foster clinical champions, and empower them to educate and motivate others on the “what, why and how.”

Mike Baird is CEO and co-founder of Avizia, which partners with providers to deploy and power system-wide telehealth.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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