Many healthcare providers have been working to define and implement a telehealth strategy over the past several years. In the initiatives I’ve been involved with, this has generally been a slow march through figuring out the legal, reimbursement, compliance, and physician staffing and compensation implications. With current events, this timeline has obviously accelerated, with IT and clinical staff being tasked with standing up telehealth programs in weeks, if not days, to deal with Covid-19. Telehealth is a key tool to limit visitors at a time of overcapacity, to reduce the risk of infection spread, and to manage non-Covid-19 care when clinics are closed.
Below I outline some of the key considerations I have seen in my work with telemedicine, and what that might mean in the near term for health systems scrambling to deploy telehealth functionality as soon as possible. Here I have focused on synchronous, clinician to home-based patient communication, although launching other forms of telemedicine (clinician to clinician, virtual ICU, etc.) will have similar concerns.
For both hardware and software, there is limited time to go through assessments and procurement processes. Given the time-sensitivity, the focus should be on understanding what is available to be deployed immediately. For hardware, that may mean distributing laptops to ensure clinicians have access to camera and microphone-equipped PCs, or even redistributing hardware from training rooms. For software, this will entail understanding precisely what applications you currently have available, and what the licensing implications would be to scale up to additional users. If a new application or additional licenses are necessary, it is important to pull in legal and supply chain as soon as possible to ensure an efficient contracting process.
The technology for telehealth is relatively easy, but getting clinician, compliance, and revenue cycle leadership buy-in is not. I recommend immediately standing up a taskforce with accountability for decision making and defining policies and procedures. This group should include your IT, EMR, HIM/privacy, compliance, and physician leadership. They will be tasked with determining who is staffing the telehealth service, what the patient consent process is, patient and clinician support, and how documentation will be entered into your EMR. Since time is of the essence here, pulling this group together for a couple of long work sessions is likely the most expedient route.
TRAINING AND SUPPORT
You will need to be able to quickly and efficiently train your providers, IT help desk, and scheduling and registration staff. Reception and call center staff will need to know the basics to direct patients to online appointments. Clinicians will need tip sheets on configuring hardware, installing software, and managing appointments and documentation. Help desk staff will need to understand setup and troubleshooting, including working with “non-standard” devices as clinicians work from home. You will need basic how-tos for your patients, and coordination with your marketing and web teams to publish information and links to your telehealth service.
The version of telehealth that you roll out overnight is not likely to be the ideal model. Once your immediate telehealth service is operational at scale, your focus can turn to the longer-term view. This plan should be focused on patient and provider usability, integration with your existing patient portal and digital front door, and seamless interoperability with your EMR. Scoping out the new interfaces, services, or UI integration will allow you to plan for and allocate your team over the coming weeks. While the immediate need for Covid-19 screening is urgent, telehealth will continue to be very relevant over the coming months to allow non-Covid-19 business as usual for those with chronic conditions or requiring prescription refills.