We’ve talked a lot about the benefits of telehealth over the past year. There are more than three decades of data showing the positive effects of using digital telecommunications technology to provide patient care. Some of the positive telehealth outcomes we’ve seen over the years include:
- Improving access to care for patients in rural areas.
- Receiving medical treatment before a patient becomes critical.
- Using the technology to monitor chronic care conditions.
- A decrease in hospital readmissions.
- Reduced travel costs for patients.
- To improve the lives of elderly patients at home.
- To provide clinical care for workers comp cases and on the job site.
- Improving clinical continuity and care coordination.
- A reduction in overhead costs for clinical providers.
There is also evidence that telehealth can improve provider efficiency and productivity. Telehealth can also improve the lives of physicians struggling with burnout; OrthoLive offers a telehealth network of clinical providers that can serve as locum tenens, giving orthopedists a much-needed break.
Telehealth holds promise, too, for the reduction in chronic care conditions in a specific patient population, for example, with diabetics or patients recovering from a cardiac event.
We know that medical specialists are in short supply, but in the coming years even family practice physician availability will fall short of demand as the aging Baby Boomer population puts more strain on our overburdened healthcare safety net. As costs spiral upward, telehealth can help both with the provider shortage and simultaneously reduce costs.
If these are all the benefits, then why has telehealth been slow to catch on both with consumers and with some clinicians? What are some of the challenges to implementing telehealth technology no matter how the services are implemented – and how can we overcome them?
Defining and Overcoming Telehealth Challenges
The Agency for Healthcare Research and Quality (AHRQ) released their study on provider outcomes, tracking more than $260 million in funding they awarded since 2004 for healthcare IT and telehealth initiatives. The goal of this large grantor was to fund IT projects “to support planning, implementation, and evaluation of various information technologies that were intended to improve the quality, safety, and efficiency of healthcare delivery.” AHRQ grantees implement telehealth programs all over the United States. Typically these programs sought to connect rural clinics and facilities with larger urban hospital counterparts in order to provide access to specialty care in rural communities. The programs used telehealth in a variety of ways, including:
- Provider-to-provider communication with the patient present.
- Provider-to-provider communication without the patient present.
- Telemonitoring or remote monitoring of patients.
- Healthcare education.
While the way they used telehealth was diverse, they all experienced implementation challenges over the past decade but found ways to overcome them. Some of the challenges, solutions, and lessons learned they reported included:
- Security and interoperability presented challenges for these providers, because disparate healthcare organizations were required to communicate information. To overcome these issues, grantees coordinated common security technologies, including firewalls and encryption, while sharing and maintaining security protocols. This required cooperation between different healthcare providers and the coordination of departments beyond IT. The report pointed out, “Changing organizational policies requires buy-in from organization leaders who understand the value of telehealth for providers and patients.”
- Image resolution and video quality requires significant bandwidth. Providers reported low-resolution video was less-than-adequate for healthcare applications. The providers recommend introducing telehealth in pilot projects in order to work out these kinks. However, it should be noted that the study encompassed the years 2004 through 2014, and bandwidth, as well as the resolution and quality of digital video cameras, have greatly improved today.
- Technical support that is efficient and cost-effective is a requisite for these programs. For the academic facilities, internal technology departments provided technical support. Rural healthcare programs had fewer resources and many times technical support was provided by a consultant our third-party vendor. This was an expensive undertaking several years ago, that has been mitigated over time with more user-friendly applications.
- Organizational culture changes as part of any telehealth services offering. Gaining the buy-in of stakeholders is imperative in any new service line. Yet the grantees found that because patients saw many different providers within a healthcare organization, telehealth helped facilitate a team-centric approach that lent itself to coordinated care. The challenge of coordinating care improves with telehealth, because it eliminates geographic distances that stymie communication between providers and the providers and their patients. The study said, “Telehealth supports and enhances team-based care by connecting providers remotely to foster collaboration and health information exchange.”
- Provider retention in rural areas is often a significant challenge. Rural doctors can feel isolated and may seek a more urban practice. Interestingly, the study found that telehealth had a side benefit of connecting rural providers with their peers from other hospitals in both urban and rural settings. One project funded by AHRQ developed a telehealth-driven learning network for doctors and other clinicians. The project surveyed network participants and found that the clinicians felt more confidence when treating complex and chronic diseases. They also reported higher job satisfaction. Prior to implementing telehealth, some of these providers had to drive up to 100 miles to participate in healthcare learning events and networking activities. After implementing the telehealth learning network, grantees reported lower turnover among doctors, nurses, and other clinical providers. The study reported:
The investigators learned that the practice staff enjoyed interacting with peers at other practices and felt connected to their profession in a way they had not prior to the implementation of the telehealth network.
Keeping in mind that this study monitored programs dating back more than 10 years; telehealth solutions and the technology used are constantly improving along with digital software and hardware. Security measures, in particular, have improved, along with cloud technology and the speed of our digital connectivity.
With that said, the AHRQ findings were particularly interesting because they came directly from the providers that implemented telehealth programs. We can learn a tremendous amount from these case studies in our own telehealth practices.
OrthoLive works every day with clinicians utilizing telemedicine service lines to improve patient care. Talk to us about the challenges you’re experiencing with an existing service line, or about implementing a new virtual service for your patients.