Author: Peyman Zand
The arrival of the coronavirus pandemic and social distancing measures has ensured that telemedicine is here to stay. Hospitals and clinics are enabling telehealth visits to their providers as quickly as possible. Some systems through expanding their existing telemedicine implementations to new sites and groups – others are moving telemedicine implementation to the number one priority. In turn, patients are embracing telemedicine options that not only help protect them today, but will mark a new level of convenience moving forward.
The advantages of rolling out telehealth infrastructure are numerous. Telemedicine is being used within the hospital walls to regulate PPE usage and create a distance between some care providers and the infected patients. Doctors and care providers are able to check in on patients remotely using Workstations on Wheels (WOW) and PDAs. And physicians are able to consult with colleagues easier which opens up the doors for much broader collaboration.
With the pandemic has arrived a tidal wave of information and new legislation – most notably the Centers for Medicare & Medicaid Services (CMS) policy changes and waivers to broaden access to telehealth services. Hospitals and health systems are working round the clock to test, treat, track and report on COVID-19 cases, prepare for the height of the curve, as well as update systems, expand the use of telemedicine, and tighten logistics around personal protection equipment and their supply chain. As part of the Coronavirus Aid, Relief and Economic Security (CARES ACT) congress included $500 million for the use of telemedicine services this week. The bill also waived some Medicare restrictions on payment for telemedicine. Some health insurers are now urging patients to use telemedicine services and giving providers and patients incentives to do this by waiving copays and other measures. In this fast evolving environment what may be lagging behind is the timely communication and the ability to reach all the patients about the availability of these expanded telemedicine services.
Although the care providers we support need critical information, tools, and supplies faster than ever, streamlined communication, robust change management and efficient governance is needed during these fast-paced deployments. There are several groups of individuals and practices involved in a telehealth rollout. From corporate senior manager to IT team members, vendors and ultimately sites that receive the products and services. Health systems are facing significant revenue impacts and unknowns – a flawed implementation, the inability to recognize revenue properly, or runaway costs will only compound the challenges to our already strained resources.
The Components of Telemedicine Implementation
Until now, the majority of US hospitals have at least partially implemented telehealth services, but widespread adoption has lagged for various issues from Medicare/insurance coverage limits, lack of broadband access in rural areas, limited interaction with the patients, to security and privacy concerns.
But the bottom line is that a telemedicine implementation involves multiple components and higher degrees of technical integration as it is expanded to new sites and groups of providers. EHR, Ambulatory solutions and the IT infrastructure in place will alter what options can be leveraged for a site or health system. Health systems must be able to bring together the skilled resources to deliver and communicate across all of these roles:
- A solid governance and project management discipline.
- Champions for physicians, nurse practitioners and care providers.
- Legal, regulatory and revenue cycle resources – can also be a provider champion, but must understand the billing challenges, requirements, and impact to revenue cycle. Focused on the consents, types of visits, and content needed for telemedicine.
- Solution architects, analysts, and trainers – expertise with architecting the telehealth systems, redesigned work processes, and training to care providers and schedulers.
- Technical resources – focused on the firewalls, networking, security and integrations needed such as Active Directory, SSO, Citrix, and the chosen EHR web interface (example: setting up Interconnect for Epic).
- EHR, Ambulatory, and third-party vendors – close coordination is needed across your telehealth platform stack, including third-party vendors for video and integrated infrastructure.
Governance Strategy for Telehealth
Proper IT governance assists with quicker decision making and avoids delays on the execution and implementation. It is an absolute necessary step for quick-turn solutions that can help your organization address the crisis. However, governance not done properly can have the exact reverse impact and bog the organization down with frivolous bureaucratic processes. In fact at times, organizations use the governance processes to slow down the demand to have the ability to scrutinize each request and queue them properly. When deploying a massive project such as rolling out telehealth to several sites in an expedited manner, there are several items to consider:
- Decisions on what platforms and systems are the right one for your environment. The tech teams can make recommendations, but the senior management needs to weigh on a number of considerations, from financial to maintenance and supportability, etc.
- How to communicate the changes to the sites and who on the sites would be the accountable individual(s) to receive the deploy systems. How will the communication be handled with departments, physicians, patients, vendors, etc.
- The work process redesign and the education and training associated with these new processes. How to communicate the changes to staff and patients both at the corporate business offices and at the site level.
- How to assure HIPAA and other compliance and security concerns. For examples, can the doctors use their own cell phones communicating with the patients in an urgent situation? How about using free online tools for video conferencing? And the list goes on.
The governance framework also needs to have local arms that can assist in both bidirectional communication but more importantly will be accountable for the proper implementation. Without proper governance in place your employees, project manager, technical, business and clinical teams will struggle to know what needs to be done, who is accountable and how to properly execute. Finally, a tracking and reporting mechanism is required to know that you are progressing on target and are appropriately reporting the status of the initiatives to the senior management and other stakeholders. These are critical in every project, but they are compulsory in fast-paced deployments. For example, organizations are already deploying digital strategies such as chatbots on the website, record-checking established patients that are eligible for telehealth to ensure they are set up properly, and increasing nurse triage over the phones. It does mean that you ensure that there is oversight for all these decisions and continuing oversight for the interdependencies, workflows and impacts of the solutions that are coming online or are operationalized. This includes considerations around:
- Contracts that will provide for an immediate need but doesn’t have favorable termination language
In conclusion, decisions made today will have a significant bearing on the future of your organization. The best COVID-19 response will come from the informed decisions made from solid governance and change management.