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Thinking of starting a telehealth program? Read this first

When you plan to build a telehealth program, consider these five factors, based on the experience of one healthcare organization, before committing to technologies and vendors.

BOSTON -- Since they started their telehealth program in 2003, the University of Mississippi Medical Center's Center for Telehealth has had over 500,000 patient encounters with 60,000 encounters last year alone.

For healthcare organizations planning to embark on this journey, Michael Adcock, executive director at UMMC's Center for Telehealth in Jackson, Miss., offered some advice at the mHealth + Telehealth World Congress conference.

Here are five factors to consider when creating a telehealth program:

Make sure the network can handle it

Before considering what telehealth technologies to use, a healthcare organization has to assess how much its network can handle, Adcock said.

You can't base it around a new technology; you have to base it around clinical solutions. Clinical need drives the solution. It's not the other way around.
Michael Adcockexecutive director, UMMC's Center for Telehealth

"The more data you can run through your system, [the better]," he said.

However, "all that's irrelevant, though, if you're talking about utilization," Adcock said. "From a utilization standpoint, if they're using 90 plus percent all of the time, we are not going to be able to deliver quality video services for that program."

If live audio video is a must for a telehealth program, then utilization of the network needs to be re-evaluated, he said.

"We actually prioritize the bandwidth," Adcock said. "So it takes priority over some other things that go through like Netflix or Facebook."

In addition to bandwidth, healthcare organizations also need to consider the fact that they may be interacting with systems outside their network.

"You're talking about provider services outside of just your network ... those are things you have to think about," he said. "Everybody doesn't have the same network requirements that you do; everybody doesn't have their system locked down like you might have."

Evaluate clinical need

"You start with clinical need," Adcock said. "What clinical problem are you trying to address? What clinical solution are you trying to come up with?"

Building a network or a program around the latest technology just won't work, Adcock said. "You're thinking about it all wrong."

"You can't base it around a new technology; you have to base it around clinical solutions," Adcock said. "Clinical need drives the solution. It's not the other way around, it's not about the Apple Watch, it's not about the Samsung Frontier, it's not about any of that. It's about clinical need driving the solution."

Take clinical workflow into consideration

"If you want to see a provider unhappy with what you're doing, come up with this very elaborate workflow that is completely different from when they see patients in person," Adcock said. "It will fall on its face every single time."

Even though the point of a telehealth program is to implement and use new technologies, as well as virtualize some aspects of the clinical workflow, not everything can or should be.

"We make sure that these [virtualized] workflows match the in-person workflows," he said.

Don't forget about privacy and security

With all the technology and gadgets that come with a telehealth program, Adcock reminds everyone that privacy and security are still a priority.

"We have to make sure everything is encrypted and there have been situations where there's great technology out there that should be of clinical need, but it's not encrypted so we can't use it," Adcock said. "Especially video connections, making sure that you know where those connections started and what happened during them."

Also make sure a business associate agreement (BAA) is in place, he said.

"[BAAs] are extremely important especially when you're sharing data," Adcock said. They are also important when it comes to downtime procedures.

"I know this is shocking, but technology must fail; we need to have those downtime procedures in place so that you know what to do when it goes down," he said. "So make sure those downtime procedures are in place as you're talking to your potential partners."

Choose the right vendor

Adcock said that when a healthcare organization is considering telehealth vendors, they need to take a few things in to consideration. For example, will the vendor work with the healthcare organization's EHR? Will the vendor's technology support any future projects the organization has in mind?

Adcock also urges healthcare organizations to not be afraid of a request for proposal (RFP).

"One benefit we found from an RFP: It forces not just potential vendors to know about your expectations, it forces you to know what your expectations are. It forces you to define the project ... so you know what you're looking for," Adcock said. "We've found that RFPs only work if you know exactly what you're looking for and you know what those requirements are going to be."

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