TELEMEDICINE 101

It is becoming increasingly important that telemedicine and telehealth be integrated into our established health systems. There are 12 Telehealth Resource Centers (TRCs) across the United States that form the National Consortium of TRCs. There are two resource centers that are available to help hospitals nationally, but there are specialized TRCs that support certain regions of the United States. A map of TRCs and other telehealth resources can be found here. Telemedicine has been shown to improve health care access, reduce unnecessary patient transport, address health care provider shortage, reduce provider travel time/cost to outreach sites, reduce patient travel time and cost (outpatient), retain patients locally in their home communities, and reduce family stress.

This document serves as a guide to reinforce how important it is to implement telehealth and telemedicine options into your hospital(s), provide information on TRC services, addresses impacts of telemedicine on COVID-19, defines telemedicine terms, and sheds light on the steps needed to create the most successful telehealth program possible.

SERVICES PROVIDED BY TRCS

Because TRCs are funded by HRSA, their services are very inexpensive and often free. TRCs assist any party interested in starting a telehealth program with business models, equipment, policy templates, practice guidelines, program development, and more. Once a hospital has been assisted with gathering these supplies and resources, the hospital must implement them internally. For a Best Practices for Implementing Telehealth in Hospitals, click here.

COVID-19 AND TELEMEDICINE

There are many resources for hospitals looking to implement telemedicine during the COVID-19 pandemic. Telehealth can help address these situations by limiting exposure to infection for high-risk populations and health care workers and potentially increase patient volumes. Telehealth also holds the advantage of expanding the reach of resources and needed services into limited access communities. There are videos and toolkits that address telehealth etiquette, technology, implementation, state-specific resources, and a directory that lists telehealth providers here.

DEFINING TELEMEDICINE TERMS

The definitions below are HRSA definitions:

  • Telehealth- The use of electronic information and telecommunications technology to support long-distance clinical health care, patient and professional health-related education, public health, and health administration
  • Telemedicine- the use of electronic communication and information technologies to provide or support clinical care at a distance
    • Requirements: The appointment must be a virtual face-to-face interaction, the video must be live, interactive and encrypted, and broadband internet and videoconferencing platform must be compliant with BAA.
    • Basic Principles: provider must be licensed in the state that the patient is physically located in at the time of the appointment, may require consent of some kind, the standard of care must be the same as in-person, and the telemedicine appointments cannot be recorded
    • Preparing for the unexpected: Provide the patient with numbers to call in the case of the video or call dropping and encourage them to rejoin using the same link. Providers should keep phone numbers of IT and patient in front of them during the call. Confirm the patient’s emergency contact, and know local fire, police, and other emergency contacts in the event of an emergency.
    • Preparing for an appointment: Providers should have an opening script available (help with creating one can be found here); include- provider name, provider type (specialty), ask if you can be heard, adjust webcams or microphone if needed, confirm patient name/ date of birth/ location, ask if the patient has any questions about the privacy of the call or anything else before beginning, and get their phone number in case the call fails or link does not work.
  • Distant or Hub Site- Health Care Provider Location
  • Originating or Spoke Site- Patient Location
  • Telepresenter- Facilitates exam at originating site
  • Asynchronous or “Store and Forward”- Data transfer from one site to another
  • Remote Patient Monitoring- Uses digital devices or sensors in patients’ homes

CREATING A SUCCESSFUL TELEHEALTH PROGRAM

The most successful telehealth programs begin with an assessment. Completing an eStart assessment with TRCs is essential to the success of your program. The assessment is comprised of an organizational assessment, program development, operational support, reimbursement of telehealth equipment, equipment selection, program evaluations, and a sustainability check. A successful telehealth program can increase internal buy-in and unlock revenue streams. This telehealth program can build on existing telehealth programs hospitals may have. A telehealth program committee may be needed to help develop protocol/ policies and to determine your facility’s needs. There are several steps that can aid in this process:

  • Step 1– Bring a team together and decide what you are trying to achieve. Ideally, the team should be comprised of health care providers, other professional colleagues, clinical director, billing office, schedulers, IT, and marketing. Organizational, Workplace, and Technical Assessments are completed at this time.
  • Step 2– Decide on the type of services to be provided by preparing a preliminary program description. Decide on the type of telehealth program that best works for your application and prepare a preliminary program model description. Consider your assumptions and constraint opportunities and create high level cost estimates and written proposals for your hospital board. Reimbursement is also included in this step.
    • Decide which appointments are appropriate for Telehealth in the home. These can be conducted as Tele-Video or Telephonic. You can be reimbursed for telephonic appointments. Some examples of primary care clinical uses of telehealth are for diabetes management, hypertension, coronary artery disease, cardiac arrhythmia, end stage renal disease, hepatitis, asthma/COPD, obesity, neurodegenerative diseases, patients with treatment plans, annual wellness visits, and for video-based follow-up appointments. Decide what appointments are appropriate for Telehealth in an originating site. What peripherals will you need? Do you have everything you need? Decide which appointments must occur in person. Telehealth cannot handle everything.
  • Step 3– Develop a business case that includes a description of the need for the telemedicine program, how the proposed program aligns with the organization’s existing lines of business, the market and demand for the service, cost estimates, fiscal estimates and Return on Investment (ROI) calculations for the program, how the program will be managed and structured, and how it will be marketed and promoted.
  • Step 4– A detailed program implementation plan with protocols, guidelines, policies, and the workflow will be developed in this step. The detailed technology plan and performance monitoring plan (patient/provider satisfaction and benchmark monitoring) will also be started and completed. When considering a Technology Platform for your Telehealth program, HIPAA compliancy is imperative. HIPAA compliant videoconferencing platforms include Zoom, VSee, Vidyo, and others. HIPAA non-compliant videoconferencing platforms include personal Skype and FaceTime. The stipulations for a platform are deploy-ability, scalability, reliability, ease of use, and security and privacy.
  • Step 5– Implementation: Equipment is purchased and installed, clinical protocols are finalized, contracts are implemented, operational processes and procedures are created or revised/ communicated, staff are hired or assigned and trained, facilities are established, and all aspects of the telemedicine program are tested to ensure that the program is ready to begin delivering the targeted services using the envisioned Program model.
    • Marketing this new program is vital to ensure its use and positive impact on your hospital. Marketing the program well would include adding new notifications to your website, a new eNewsletter, brochures, local press releases, local news, and on your social media.
    • Maintaining the robustness of your telehealth program is also imperative. There are many components to the root system of these programs. Program consultation, legal and malpractice help, reimbursement, credentialing and licensing, training, quality, contracting, branding/marketing, and getting the right technology. Assessing these factors often can help assure that the program stays up-to-speed.