Managing change in today’s ambulatory clinics is a full-time job. Many of us admit to a certain level of battle fatigue; from shifting politics in Washington that affect reimbursement, to new clinical breakthroughs in our practice specialty, to technology disruption – today’s doctors and medical practices are constantly forced to react to changes in the healthcare landscape.
In the face of constant change and as our healthcare paradigm is shifting from volume to value, it’s sometimes difficult to consider taking on new technology that isn’t mandated by payers, the government, or other healthcare regulatory bodies. Even if that technology has proven to cut costs and improve outcomes in the patients they serve.
As the OrthoLive team travels the country speaking to clinical professionals about the need for telehealth, we have first-hand experience in the kind of heel-dragging some doctors express when faced with a voluntary and proactive shift to telemedicine in the small practice. In fact, physician reluctance is the number one barrier to telehealth in the small practice, despite the fact that the majority of hospital competitors are successfully using these tools.
Sometimes what holds us back is simply a lack of understanding of the roadmap necessary to enact change. In the case of telemedicine adoption, there is now a standardized set of best practices that we can learn from to improve rollout of these tools.
This article will review standard metrics for a telehealth rollout, based on the California Telemedicine and eHealth Center’s recommended guidelines for the successful implementation of telehealth.
CTEC’s Roadmap for Telehealth Implementation
The California Telemedicine and eHealth Center (CTEC), now called the California Telehealth Resource Center (CTRC) is part of The National Consortium of Telehealth Resource Centers. The goal of these organizations is to improve access to care for rural communities through the use of telehealth. Many of these state-specific organizations have been around a decade or more, extending access and improving patient care quality to some of our most vulnerable rural communities.
CTEC published the Telehealth Program Developer Kit in 2012 as a way to provide an actionable roadmap for any healthcare entity seeking to roll out telemedicine. While the kit was created to provide an “implementation methodology developed for the state’s largest telehealth provider, the California Department of Corrections.” However, today the tenets it shares still provide a baseline for a telemedicine rollout regardless of the care delivery mechanisms.
The document breaks out telehealth implementation into three segments:
- Assessment and definition of the telehealth program.
- Development and planning.
- Implementation and monitoring.
The document points out that these steps are fluid, stating, “in actual practice the steps blend together into one process,” but that the tool was designed for customization based on program application. They also point out that the steps vary in intensity based on the scope of the telehealth project and even the size of the practice.
Here are the necessary steps, by category for road mapping your own telehealth project.
Understanding the business case for your telehealth initiative will improve the focus of the deliverable, how it should be launched, and how it will impact the market. This process should include:
- Understanding how telehealth will improve the lives of patients and the bottom line of your practice.
- Defining the types of services that fall under your telehealth offering.
- Documenting how the service will be delivered.
Crucial questions to ask during this planning stage include:
- What unmet need will telehealth fulfill for you, your team, and the patients frequenting your practice?
- What types of treatment modalities are best suited for telehealth?
- What is the payer mix of your target audience?
- What market or competitive factors should you consider?
- What are the internal and external barriers to offering telehealth?
At this stage it is particularly crucial to seek the buy-in from providers. As knowledge workers, they must understand the “why” behind the new service line. Without this buy-in, any technology roll-out will struggle or fail.
Planning and Development
The planning phase takes data from the needs assessment and creates timelines and task lists necessary to launch and maintain the telehealth program. This includes:
- Defining the tasks necessary to test, deploy and operate the telehealth service line.
- Map out who will perform these tasks.
- Determine the hours necessary to complete the tasks and creating an implementation timeline.
- Discuss and create the materials necessary to market the program to your target patient base.
Some of the best questions to ask during the planning and development phase include:
- What are the step-by-step workflows necessary to market, book appointments, and provide care via telehealth technology?
- How will the features of the chosen technology vendor support these tasks?
- What on-site technology or clinical preparation must be established to launch your first telemedicine visit?
- What are the costs of launching and what are your projected cost savings goals?
- What is your communication strategy for marketing this service?
- What type of training will need to occur?
- How will risk be identified and mitigated?
These simple steps are necessary for implementation of your telehealth service line. When considering go-live with telehealth, part of the process must include benchmarking the service offering to determine its success. When considering a telehealth deployment it is necessary to consider if the go-live is a “big bang” or full rollout, or if implementation will be incremental. When discussing the metrics for telehealth, consider:
- What utilization metrics will you track and what is your goal?
- How will you track quality outcomes?
- How will you track patient satisfaction?
- How and who will track the data?
- What is the process for program review and any changes in how the service is delivered, including how it is marketed to patients?
Defining the objectives and goals of the service line offering will ensure the success of your telehealth program. The CTEC guide is an interesting tool to help clinicians determine their readiness for a telehealth application. But the authors wisely suggest that providers reap the benefits of telehealth only when they have the fortitude to handle the workflow change:
Telehealth offers healthcare organizations new and effective systems for delivering healthcare and, in many instances, allows organizations to reach far beyond current service offerings and think creatively about delivery models. Implementing a telehealth program is an organizational change, and like all change it’s about people. Technology is a cornerstone of telehealth programs; however, successfully implementation requires the ability to manage change.
OrthoLive is standing by to help your orthopedic practice roadmap and implement telehealth. Contact us to get started.