by Darcey Trescone, RN, BSN
COVID-19 has shed new light on the benefits of caring for patients in the home. The risk of exposure to this illness amongst our elderly and compromised populations outside of their home is high. COVID-positive patients are required to remain home, minimizing transmission to others. Our caregivers are treating these patients while utilizing PPE to mitigate their exposure, but shortages of these supplies is requiring a new way of thinking, and new care delivery procedures.
Our healthcare system, from local providers to CMS policy makers, adopted telehealth quickly due to COVID. The goal and vision for this technology, in many cases, was short-sighted as it only focused on getting through the COVID crisis. It leaves a lot of unanswered questions for how healthcare organizations will continue with this technology post-COVID. Telehealth programs saved lives across the country by allowing touch without exposure to COVID for both our patients and caregivers.
What happens next, post-COVID? Were the programs we put in place sufficient enough to continue in our regulated environment? What if another pandemic arises? What about patients with limited access to healthcare due to geographical location? Our elderly and compromised patients are susceptible to a host of other illnesses still, perhaps not as deadly to the general population but quite dangerous to compromised patients. Therefore, continued utilization and expansion of these tools will be needed.
AMD Global Telemedicine conducted a study of over 60 telemedicine companies in three different countries. During this review, they identified ten essential points and documented successful and unsuccessful approaches to each. They found it is not the equipment but the approach to each of ten points that is the determinant of success for organizations implementing telehealth.1
Successful Telehealth Programs do the Following:
1. Establish a clear vision
a. What problem are you solving? For which patients are you solving it?
b. How will you solve it with telehealth technology?
c. What results are anticipated?
d. How long will it take?
According to Thomas, "It is essential to define your goal for the program. Understanding the patient criteria for participation in your telehealth program and what you will measure is vital. Patients will get lost in the shuffle if you take a shortcut."
She continued, "It is ideal to start with the basics and then refine your telehealth monitoring program as you move forward. Tracking and monitoring progress and results will help you identify what expansion makes sense and the best plan for growth."
2. Product selection
a. Vendor stability, size, support will fit well with your vision
b. Products they offer will meet your care needs now and in the future
c. Products they offer are secure and HIPAA compliant
d. Ease of use for patients and caregivers
e. Implementation path and best practices are in place
f. Support is available during and after implementation
"Simple is what you are after, and keep in mind the device must be easy for your patients and your employees. Ideally, a BYOD model allows you to stay in touch with patients on any device they have. For patients, can they call with a one-touch button, log in quickly, big print, and is the volume loud enough. For practitioners, how much information is on one page and is easy to see. Do your homework just like when you shopped for your EMR system."
3. Build a financial plan that looks into the future
a. Start simple and expand the program later
b. Establish goals and measurements
c. Provide a plan and roadmap to success
There are initial and on-going costs associated with putting a telehealth program in place. With a lack of reimbursement for telehealth in the post-acute space, it is even more critical to ensure you are not creating an additional cost center with no realized benefit. Track and measure the benefits you anticipate. If you achieve the goal set, move forward, if not re-evaluate and tweak your program.
4. Create a convenient and effective work environment
a. Manage implementation and communication
b. Minimize disruption
c. Establish a space with all needed supplies and no noise for the visit to occur
Optimize your success with telehealth video/audio visits by establishing a comfortable, quiet area for your employee to reach out to the patient. The employee and patient must find these telehealth visits to be inviting and valuable to ensure adequate adoption of the technology. Take the time to role-play telehealth video/audio visits with your employees and their peers in these environments before launching into patient care.
5. Mainstream telemedicine into the standard care process
a. Establish protocols for telemedicine scheduling, delivery of care and documentation of the care provided (there needs to be a workflow)
b. Establish protocols for patients requiring more hands-on support/evaluation
c. Establish protocols by diagnosis type for the guidance of staff and monitoring purposes
d. Establish protocols for storage, inventory tracking, delivery and return of any required equipment
If we genuinely want to adopt telehealth in the post-acute care setting, we must utilize it with protocols in place that fit within the workflow of a visit and make it the norm in providing care. "Telehealth must be tightly integrated into the actual care delivery model to improve success and adoption," Thomas advises.
6. Plan and assure practical training and support
a. Technology readiness and testing of equipment before training
b. Train on the most straightforward utilization of the device and role play
c. Patient care with telehealth should begin close to the delivery time of training
d. Ensure adequate support, both technical and clinical, are available to employees providing patient care
Conscientious deployment of a telehealth program is critical to ensure a comfort level of both the employee and patient that encourages adoption. If utilization is difficult or not supported well, the program will fail.
7. Hire a coordinator specific for this program and identify a strong leader
a. Adopt a telehealth position for management and monitoring of the program
b. Anticipate other resources that may be needed to support this program
c. Identify a leader within the organization to oversee the program who is also able to be a cheerleader
A successful telehealth program will require focus and dedicated resources. Assigning a program of this magnitude to a current role puts the program at risk for failure. Telehealth requires a dedicated team, even if that team is small, to ensure adequate attention to how this treatment modality is deployed, measured, supported, and expanded.
8. A good project plan is valuable
a. Establish milestones and timelines for roll-out – stay focused
b. Communicate these milestones to your employees
9. Marketing is critical both in-house and outside of your organization
a. Sell your program to others and to your employees
Thomas urges, "To say you have a telehealth program is not enough. You must discuss the benefits and share the points that matter the most to your employees and your referral sources."
10. Publish your results
The most successful organizations made it a point to publish their results at least once per year. Positive outcomes in patient care that you achieve are valuable to your employees, referral sources, and patients in choosing to use your organizational telehealth program. Communicate the positive telehealth outcomes inside and outside your organization.
The technology-enhanced health care framework that includes services such as virtual visits, remote patient monitoring, and mobile healthcare has a place in our healthcare system. Value-based care, quality outcomes, and population health are still the focus of the future, and telehealth has proven to enhance the care we are delivering to achieve these mandates. We must be allowed to continue to embrace this technology.
1 Mark Vanderwerf, "10 Critical Steps for a Successful Telemedicine Program," https://www.amdtelemedicine.com/downloads/10_steps.pdf
Darcey Trescone is a Healthcare IS and Business Development Consultant in the Post-Acute Healthcare Market with a strong background working with both providers and vendors specific to Home Care and Hospice. She has worked as a home health nurse and held senior operational, product management and business development positions with various post-acute software firms, where her responsibilities included new and existing market penetration, customer retention and oversight of teams across the U.S., Canada and Australia. She can be reached at firstname.lastname@example.org.
©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. email@example.com