Before putting pen to paper this week and adding to the outpouring of commentary on all things telehealth, it was important to pivot a bit on perspective if I was to offer anything new. I, too, was growing weary of reading and hearing the same “everything you should know about telehealth” themes from various industry newsfeeds, webinars and even the state and federal regulatory bodies.
In fairness, given the COVID-19 virus, the avalanche of redundant information and industry insight regarding all things telehealth is essential as we try to fit these unconventional options into our already complex patient access platforms. And even though we find ourselves in the midst of another crisis inducing, IT retrofit exercise, there is no doubt that what we are doing is unprecedented.
Implementing virtual visit solutions in a “by the seat of our pants” mode has been a very different experience for provider organizations that have a telehealth strategic plan and program in place versus those that do not. To give this some perspective, in speaking last week with a premier virtual visit (direct-to-consumer) vendor, it was interesting to hear that due to the hundreds of calls they were getting from prospective customers, they developed a strategy to help guide customers to the most appropriate short-term virtual visit solutions. They grouped organizations by their level of telehealth preparedness:
- The “We get it” group – organizations who already have a virtual visit platform, are able to immediately increase virtual visit volumes with only workflow adjustments, and have completed the strategy necessary to deploy a comprehensive telehealth program for the long term. They are looking for COVID-19 specific triage tools.
- The “We are on the learning and planning path” group – organizations who do not have a virtual visit platform in place, but are closing in on finalizing a strategy necessary to deploy a comprehensive telehealth program for the long term. They are looking for a short-term virtual visit solution that may continue as a part of their long-term plan.
- The “We have nothing” group – organizations who do not have a virtual visit platform in place with no planning of any kind for building a long-term telehealth strategy but are now looking for a short-term virtual visit solution.
This was a clever way for the vendor to quickly determine the most appropriate virtual visit solution to sell but it also shed light as an indicator of something else. The organizations in the second and third groups are facing the inevitability of incorporating this short-term virtual visit tool as a potentially permanent option in the patient access space. They are also faced with building a strategy around a comprehensive telehealth program for the long term. Given the current inertia around telehealth, these organizations can no longer delay doing that.
So, in thinking about what these organizations can do to get started on a comprehensive long-term plan, here are a few things that have hit home with our clients in helping them to build a stable program foundation, enable expediency and establish transparency:
1. Conduct a comprehensive telehealth education session for senior executives and clinical leaders
It is vital to establish a collective high-level understanding of the different telehealth modalities, reimbursement complexities, industry trends, vendor variety, return and value on investment and operational and technical considerations. Without this understanding, top down support for telehealth will be very difficult to maintain. This also helps leadership figure out their best approach for purchasing and inform decisions that require transparency, discipline and control. For example, should their purchase be:
- A “bright shiny object” – a telehealth solution that has already captured the organization’s attention with the anticipation that a problem will present as a perfect fit
- Made via a holistic vetting of the problem where telehealth was one out of multiple solutions considered
2. Establish as much structure as possible at the very beginning
Determine a telehealth program owner to prevent the program from becoming a special project, “hot potato” that is tossed around the C-Suite. Establish a steering committee with membership geared toward advocacy for the provider and patient. Activate memberships with local and national telehealth forums in order to stay current with industry trends and updates. Complete an inventory of the telehealth solutions already in place at your organization and then find out what the local competition is doing with telehealth (include retailers). Chances are that they have already done the work to determine the telehealth components that best meet the needs of the community. Consider duplicating what they have implemented.
3. Set the stage for defining the organization’s telehealth goals
Start with a healthy mix of the organizational goals and improvement ideas where a telehealth solution might make sense. Gather the operational details around these ideas to prepare for eventual vetting against a set of criteria that serves to determine viability and the likelihood of achieving a defined goal.
4. Conduct a cursory industry market analysis on a few of these ideas
An improvement idea using telehealth may check all the boxes from an internal perspective but could look very different when looked at from a community or industry success and failure perspective.
At the same time, be aware that challenges associated with deploying telehealth initiatives are primarily due to changes required with culture and behavior and not with technology. Major adjustments to people and processes will require empathy and clear, concise communication. Here are a few examples of those challenges with some anecdotal thoughts on how to change your thinking around them:
1. Telehealth returns us to a “best of breed” state
Virtual visits, remote monitoring and provider consultations are all examples of telehealth activities occurring in both the inpatient and outpatient setting and in just about every service line. Therefore, vendor response to the market demand is a variety of disparate tools that focus on a specific telehealth modality, for use in a specific care setting, within a specific service line and with a consumer, a provider or both as an end user. One-size will never fit all in a telehealth world.
Change your thinking: After living in a “best of suite” EHR world for so long, let’s be honest, best of breed feels scary but it may be the best fit.
2. Expand the telehealth program beyond the inpatient arena
Many organizations have long since launched inpatient-focused telehealth solutions such as teleICU, and teleStroke and continue to focus their telehealth programs on the expansion of these initiatives because it is a proven telehealth modality that sits on very solid ground. Telehealth planning in the outpatient arena has likely been delayed or even excluded as a strategic component as direct-to-consumer telehealth has not seen the year over year increase in consumer demand and, given the involvement of the patient in using the technology, is the antithesis of being on solid ground.
Change your thinking: For many provider organizations, the COVID-19 crisis has ignited the demand for direct-to-consumer modalities and, consequently, a plan for offering patients this capability. Embrace this immediately because there is no going back.
3. A disruptive change in how care is delivered
In just about every way possible, consumer-facing industries are making things easy for their customers while access to healthcare continues to lag far behind in terms of things being anywhere close to easy. Provider organizations must be disruptive in their advocacy of making access easier for the healthcare consumer via telehealth.
Change your thinking: If the organization continues to treat their brick and mortar physician offices as sacred ground, there will be very little inertia for change. Plan telehealth disruptions carefully and transition at a pace that is tolerable for providers and for patients.
As John League stated in last weeks’ Advisory Board webinar (March 26, 2020), we are currently taking part in a “national demonstration” of telehealth given the need to immediately transition from in-person appointments to virtual visits. Time will tell but there is little doubt that this experience has given telehealth, especially in the ambulatory space, a defined spot on every provider organization’s strategic planning board and strategic planning for the long-term is now inevitable.
Karen M. Marhefka, DHA, MHA, RHIA, is a telehealth strategist, health information management executive, healthcare operations leader and director, Provider business unit at emids. As an industry veteran, Dr. Marhefka has 30+ years of comprehensive and progressive leadership experience in large healthcare systems that include academic and non-academic, for-profit and not for-profit, ambulatory and large group practice organizations. She possess the rare combination of being a seasoned healthcare operations executive and an information systems and management officer. She is passionate about using technology and information to improve the patient and provider experience. Be sure to connect with her on LinkedIn.