Telemedicine is much more than two video cameras, two screens, a doctor and a patient. Telemedicine is a major change in the way healthcare is delivered, and an opportunity for healthcare provider organizations to expand the geography and range of patients they serve.
From the business point of view, there are a variety of things a hospital or health system C-suite should be prepared for when it comes to launching and maintaining telemedicine programs.
We interviewed top telehealth leaders at NewYork-Presbyterian, UPMC and Thibodaux Regional Medical Center about how they have instituted successful telemedicine tools and programs, what works well, and other considerations for healthcare business decision makers.
Many telemedicine modalities
NewYork-Presbyterian has spent the past several years developing a broad portfolio of telemedicine services.
“Creating a viable telemedicine program is both a short-term and a long-term proposition,” said Daniel Barchi, CIO at New York-Presbyterian. “It is possible, with a small team and early investment of resources, to create telemedicine capability in a specific vertical. It could be post-surgical follow-up visits for patients and surgeons, medication reconciliation video visits with a pharmacist, or urgent care emergency department video calls.”
Each of those by themselves is a discrete service that can improve quality and efficiency in that area. Creating a larger, comprehensive program involves a much greater investment of time and resources.
“Our NYP OnDemand program has more than 10 different modalities and covers facets of care from national second opinion visits with Weill Cornell Medicine and Colombia Doctors to urgent care on mobile phones from the home all the way to post-surgical follow-ups,” Barchi said.
NewYork-Presbyterian is making investments in all of these because it believes telemedicine and virtual medicine in general will make delivery of care more efficient and higher-quality in the long run, he explained. Each telemedicine modality has its own associated cost and reimbursement, and the organization is making decisions on where to put its efforts not based on net revenue but on the impact that each will have for patients, he added.
“Through our Accountable Care Network we serve hundreds of thousands of Medicare and Medicaid patients,” he said. “Our goal is to make their care high-quality and to reach into underserved neighborhoods to make primary care visits and specialty follow-ups available as necessary.”
Telemedicine allows the provider organization to extend its reach with respected physicians without having to make a capital infrastructure investment every time it wants to make another program available to patients, he added.
Identify strategic telehealth objectives
Natasa Sokolovich, executive director of telehealth at the University of Pittsburgh Medical Center, said when launching a new telemedicine program, a healthcare organization needs to identify its strategic objectives and prioritize the areas of opportunity where telemedicine services can support the mission.
“If there are areas of clinical need across the healthcare network, telemedicine may allow for better leveraging and expanding access to sub-specialists,” Sokolovich said. “Another opportunity could include better triaging patients through telemedicine-enabled provider-to-provider or provider-to-patient evaluations, which bring together experts who can quickly assess the best care path and eliminate unnecessary hospital admissions or emergency department visits.”
Once the initial areas of focus are identified, an evaluation of technology and resources should be conducted to support the short- and long-term opportunities and define the staffing and financial resource allocation needed to adequately implement, operationalize and support the services, Sokolovich stated.
Bernie Clement, CIO at Thibodaux Regional Medical Center in Thibodaux, Louisiana, believes it is more important for the C-suite to understand the organization is designing a new delivery channel.
“It is less about the technology as it is about delivering medicine via a new medium,” Clement explained. “Luckily, the C-suite is accustomed now to teleconferencing, so they have a feel for the benefits, as well as some of the communication struggles that come with being audio-visual from remote locations. Much like teleconferencing, there are situations where telemedicine will fit and others where it will not: It can’t be looked upon as a silver bullet.”
One big factor here is Thibodaux sees near-perfect alignment from all stakeholders regarding telemedicine: Everyone from payers through providers to patients understand this can be a great way to increase access while decreasing cost, Clement said.
“When you see this, risks will decrease quickly: Reimbursement will move forward, and where the money goes, vendors’ energy to continuously improve the technology will follow,” he said. “The key is to securely allow the patient and provider to feel connected to one another and follow that connection through to the post-visit workflows that complete the experience – the doctor or his nurse completing documentation and orders, the patient scheduling follow-up and payment.”
POV: Clinical leaders
From the clinical perspective, the CIO has to work carefully with their C-suite peers when it comes to moving forward with telemedicine.
The C-suite should identify key clinical leaders who will outline appropriate clinical telehealth workflows to support high-quality care delivery, said Sokolovich of the University of Pittsburgh Medical Center.
“In addition, clinical outcomes should be defined and data capture and review capabilities should be implemented to ensure clinical standards of care are followed, to evaluate clinical outcomes and patient and provider satisfaction, and to continually look for opportunities to improve the virtual process,” Sokolovich said. “In addition, having a dedicated IT support system in place for telehealth providers across the system is key to long-term success and removes the concern for equipment failure and connectivity issues that may result in virtual visit challenges.”
Regarding the clinical point of view, the bottom line is telemedicine is now medicine, said Barchi of New York-Presbyterian.
“Although technology makes it easier for physicians and patients to communicate with one another, technology does nothing to change the sacred obligation that physicians have to deliver the best care for their patients,” he explained. “Our best physician users of telemedicine are those that embrace it as a way to be more efficient themselves, to be more respectful of patients’ time, and to reach a greater number of patients.”
This does not mean compromising on quality, testing or follow-ups in any way – in fact, as New York-Presbyterian continues to build its telemedicine program, it plans for it to be a way to create a comprehensive suite of services and extend specialty consult to patients in a timely manner, Barchi explained.
“There is a perception that telemedicine is somehow different from an in-person physician practice visit when, in fact, whether the physician is seeing their patient face-to-face, following up with a phone call, or having a video visit, the key elements at play is the physician’s skill and meeting the needs of the patient,” Barchi said.
Views from the top
So for these three executives who report to C-suite leaders, how are their telemedicine programs perceived by the business decision makers at their organizations?
“Our executive leadership have been strong supporters of telemedicine at UPMC for more than a decade,” said Sokolovich of the University of Pittsburgh Medical Center. “With the initial success of tele-stroke and tele-behavioral health services, leadership recognizes the potential of telehealth in implementing new models of care that enhance the patient experience, support access to quality care regardless of geographic location, and maximize efficiencies.”
In addition, telemedicine services support the organization’s consumer-focused mission and provide “omnichannel” access to the clinical care network, Sokolovich added.
“Leadership is continually looking at ways to improve and better scale services and improve clinical outcomes,” Sokolovich said. “Through continued investments in technology, data analytics capabilities and expansion of telemedicine services, the long-term goal is to scale telemedicine to become just another extension of in-person care.”
NewYork-Presbyterian’s leaders are committed to telemedicine as a way to make clinical care delivery efficient now and in the future, Barchi said.
“It was our CEO’s vision in 2014 to create this telemedicine service, which now has more than 100,000 visits annually,” he said. “We still are in the development and growth stage of telemedicine.”
Tele-stroke has been very helpful during a time of limited local neurologist availability, said Clement of Thibodaux Regional Medical Center.
“It really helped our emergency room with treating stroke patients and benefited patient care by avoiding transportation when minutes matter,” he explained. “We see telemedicine as a solution to expand access to care without leaving the home, as well as a solution for gaining access to a specialist who may not have the patient volumes to relocate to our market.”
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