Guide: Telemedicine benefits held back by lack of reimbursements
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SAN JOSE, CA -- Experts convened on a panel at the American Telemedicine Association's (ATA) 2012 annual meeting didn't just talk about technology driving telehealth projects, but workflow, too. While setting up a telemedicine implementation, it's important to purchase gear that will survive the upgrades for several years -- but just as important to consider the people using the gear, too.
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The panel, in a room packed with attendees, closely followed presentations from Brendan Purdy, RN, telehealth manager for University Health Network in Toronto; Susan Goran, operations director for MaineHealth VitalNetwork; and Julie Cherry, RN, director of clinical development at Care Innovations, a joint Intel-GE venture.
Judging from the heavy attendance and volume of follow-up questions, it appears that many traditional hospitals are at least examining the feasibility of new telemedicine projects. One reason for this may be that telemedicine often puts specialty and subspecialty physicians before a wider audience of patients via live high-definition video feeds to places like nursing homes, primary care physician offices and other hospitals.
Among the advice they offered to CIOs and clinical leaders designing telehealth pilot projects:
- Planning trumps technology choice in importance, Cherry said, adding that poor planning "absolutely" will guarantee poor results, possibly failure -- even if you choose excellent gear.
- Along those same lines, don't expect technology to be the panacea for pre-existing workflow issues; solve them first with a detailed workflow analysis and problem-solving session. It's possible that features built into a new technology (such as better interoperability between two information systems) can help solve existing workflow issues -- but create a detailed implementation plan to make it work.
Seven weeks is not an adequate amount of time for people to get through the change process…they were coming at us with pitchforks.
Susan Goran, operations director, MaineHealth VitalNetwork
- Physician champions are essential to the success of a telemedicine project. As are multidisciplinary planning teams that include clinical, IT and administrative representatives. The hard part for you as the team leader? Explaining "what's in it for you" to the satisfaction of the various factions, because they often have conflicting wants and needs -- especially in the realms of funding versus care incentives.
- In the planning stages, it's crucial to identifying which patients (and where) will be best served by a telehealth service. That way, the provider can concentrate its resources on creating the most efficient, cost-effective rollout of the service. That means someone with deep knowledge of patient data needs to sit on the planning team, and contribute from the earliest stages.
- Bring up -- and resolve -- physician licensure issues early on. Purdy said that one stakeholder in his health system's outpatient thrombosis telemedicine project had asked to extend it to the remote territory of Nunavut. This discussion sparked the creation of a whole workflow to ensure practitioners were credentialed to treat patients in Nunavut and all the other provinces to which they extended their services.
- Get your own scheduling system. Physicians constantly are changing their schedules, and some (especially specialists) practice for more than one provider, which means their master schedule isn't likely governed by one hospital -- but rather, by their iPhones. A telemedicine service should have its own scheduling system, and the physicians can sync their own software to it -- not vice-versa.
- Measure the telemedicine implementation's progress toward quality goals, but start measuring after at least six months of service. If you can keep the bean counters and clinical wolves off your doorstep, wait a full year. It's going to take that long to train staff, stand up the service and get practitioners into the swing of the workflow -- and practicing the most effective care. At that point, you can get accurate quality measures and go ahead and upgrade patient care and documentation processes with an eye toward improving quality.
Goran said that Maine Medical Center -- a 606-bed tertiary care center at which MaineHealth launched a tele-ICU -- was required to do a survey measuring its progress seven weeks after launch. "Don't do that," said Goran. At that point the organization didn't need a survey to show physicians and nurses were unhappy with the implementation process but they went ahead and did it, anyway, with more than 60% indicating a negative (or worse) experience using the tele-ICU. "You're going to want to shoot yourself. Seven weeks is not an adequate amount of time for people to get through the change process…they were coming at us with pitchforks."
The happy ending? Seven years later with the same survey, 95% of practitioners indicated a positive -- or better -- experience with MaineHealth's tele-ICU.