How Teladoc Health approaches clinical quality, meets hospital virtual care needs

As vice president of quality and innovation for hospital and health systems at Teladoc Health, Shayan Vyas, MD, ensures the telehealth provider exceeds health system clients' expectations when it comes to delivering quality virtual care.

While Teladoc sets its own standards for health quality, Dr. Vyas believes it is important to work with the telehealth provider's hospital and health system clients to not only meet their needs and understand their different perspectives of healthcare but also help them improve their grasp on virtual care delivery.

"We do a lot of hand holding," Dr. Vyas said. "We meet with our clients often and really share our bread and butter of how we practice virtual medicine which helps let our partners incorporate their medical practice virtually."

Here, Dr. Vyas discusses how Teladoc builds client relationships focused on maintaining high quality standards as well as some of the most important factors hospitals and health systems must consider around physician workflows and clinical quality.

Editor's note: Responses have been lightly edited for clarity and length.

Question: How did you initially become involved in the telehealth space?

Dr. Shayan Vyas: Before joining Teladoc, I started a large telehealth program across the east coast. This was a path that was previously untaken, and telehealth has since become much more common and accepted.

Q: As VP of quality and innovation for hospitals and health systems, what are some of your goals and priorities at Teladoc?

SV: No. 1 is making sure that when our clients use the Teladoc Health service for their telehealth needs, that the quality is up to their level. We keep high standards, but our clients have different needs; they have a different perspective of quality and a different perspective of healthcare. Working with our clients to ensure we continue to strive for excellence in health quality and also understand their needs and culture is one of our top priorities.

Q: How do you establish that relationship with clients and anticipate their telehealth needs?

SV: When developing relationships with our clients, we start with what everyone is concerned about — antibiotic stewardship as well as corticosteroids stewardship. We believe that we're doing a really good job with trying to ensure we prescribe antibiotics, or corticosteroids, only when most appropriate in the virtual setting. However, because virtual care is still new to our partners, they need to understand how treatment is prescribed without touching a patient or having the patient physically in front of them. Because we see more patients than other telehealth companies — we have tremendous experience. This experience is a tremendous responsibility. We review our protocols and guidelines with our partners and help educate them on how telehealth is delivered virtually at scale and help them understand how the art of medicine is transferred to the art of virtual medicine. Working with clients one on one helps them grasp how similar our protocols and values really are to theirs and that our guidelines are up to the highest standards of medicine.

Q: What are some initiatives Teladoc has taken around clinical quality and telehealth?

SV: I've previously worked with multiple competitive telehealth companies as a client and they all have a certain lack of transparency when it comes to virtual care and their own providers. With our platform, our clients own the data. When patients enter their virtual platform and regardless of their providers or our physician see them — they also own the data and can run analytics on all the data. Regardless of who the provider is, whether it is a Teladoc provider, the clients' own provider or their network provider, all the data exists in their instance of the platform. When you allow your partners to experience this level of transparency in medical care, they see and trust your quality. This level of transparency doesn't exist with others in our playing field.

We work with our clients so they can see how their data compares to ours. For example, if there's any questions about antibiotic stewardship with their physicians, clients can look at their physicians' averages of how they're treating patients in comparison to Teladoc. When it comes to licensed platforms and hospitals themselves providing healthcare virtually, the most important factor is for the health system's quality and metrics to stay on their platform. At Teladoc, our clients get to see exactly how we draw certain conclusions when it comes to diagnosing and prescribing, and it's completely transparent.

Q: How do you assure physician quality on Teladoc's platform?

SV: We look at quality on our platforms unanimously. When physicians prescribe antibiotics, we look at what we set as the standard that the physician needs to ask, document and ascertain from patients. What information needs to be there when it comes to making a diagnosis of a medical illness virtually? When physicians prescribe antibiotics, they must qualify within our protocols and our guidelines. And overall from a scale perspective, physicians are observed not only by the antibiotic or diagnosis but down to the specific cases over time. We also marry multiple related diagnoses and the individual's antibiotic prescribing habits altogether. We don't necessarily track a general antibiotic prescribing rate because that doesn't make sense in any medical setting. We look at what was prescribed, why and then we compare that against all the peers within the Teladoc network, as well as to what the national or published standards are.

We have a higher standard for quality than what has been traditionally published in peer review journals because we believe there is some difference between virtual care and in-person visits, and we want to make sure we are providing the highest level of care virtually. Those antibiotic quality measures are taken very seriously so every time a physician prescribes on our platform, they are aware of the quality protocols that are behind it as well as the standard metrics that we have and how they're doing compared to their peers. This allows physicians to see how other physicians are prescribing on a certain disease or prescribing different antibiotics compared to their peers across the country on the Teladoc platform. It really kind of gives them a gut check that they're either prescribing higher or lower than their peers and that they need to improve. We do provide coaching for the physicians and peer-to-peer reviews; we have medical directors and physicians within the Teladoc network that will reach out to our physicians and connect with them and try to understand their perspective and coach them along so they can learn how we look at this.

Q: When looking at a telehealth platform, what are some factors health systems should consider regarding workflows around clinical quality?

SV: First, for a telehealth program to be successful from not only a clinical quality standard, but even financially — telehealth needs to have executive sponsorship, program design is critical (cost) and operational and marketing. Additionally, telehealth must be aligned with your organizational goals. Telehealth is not a niche; it is really transforming traditional in-person medical services into a host of virtual medical care services and creating a new front door for their medical services.

Another key aspect that's important to invest in is the proper infrastructure for telehealth, including EMR integration. I have advocated over the past decade that telehealth must be integrated into one's EMR to truly create a seamless workflow. Today, we are integrating in multiple EMRs transferring data, such as bidirectional data transfer, to ensure a seamless workflow. Having executive level leadership, medical leadership and technology integrations — telehealth can easily replicate existing clinical quality programs and are very successful at improving access, decreasing cost and attracting more patients. As we continue to grow through EMR integrations and our acquisition of InTouch Health, we are very committed to unsurprised quality and developing long-term relationships with our clients. We are transforming how people access healthcare around the world.

More articles on telehealth:
The future of telehealth: 2 hospital execs share their predictions
U of Mississippi partners with state for pediatric telehealth program
Intermountain extends telehealth services to cancer patients at Utah hospital

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