Two years after the Covid-19 health crisis, telehealth is experiencing a renaissance in the sense that many healthcare organizations are now realizing that telehealth is not merely stop gap measure, but a viable virtual care delivery option to meet patients increasing needs and expectations.
Success in Telehealth, however, is not about picking the right technology or fretting about an integration of the telehealth solution with the EHR. Success in telehealth depends mostly on the workflows — and the training of staff on the workflows.
The seven main Telehealth Workflows (or “thworfs” for short) are:
- Telehealth Scheduling
- Telehealth Onboarding
- Telehealth Rooming
- Telehealth Visit
- Telehealth Post Visit
- Telehealth Follow Up
- Telehealth Billing
When designing telehealth-specific workflows for those 7 different areas, it is helpful to keep in mind that the same seven workflows already exist in the traditional “in-person” environment. Creating the same experience, however, when the patient is not in the clinic, is inherently more difficult, which is why the meticulous definition of each step is critical, as it is hard to correct anything that does not go according to plan on the patient’s end.
One more note before we get started: typically, we define telehealth as “delivering care at a distance” . While the seven telehealth workflows apply to a variety of different telehealth modalities, for the purpose of this article we will be focusing on the “live audio/video visit” form of telehealth.
Without further ado, here come the seven Thworfs: Timey, Newbie, Roomy, Vizzy, Posty, Folly and Billy.
1. The Scheduling Thworf (“Timey”)
It is understood that in healthcare virtually every visit has to be scheduled – including for same-day appointments or to accommodate walk-ins by fitting them into the clinician’s schedule.
The definition of a scheduling workflow should in its elementary form clarify (1) how to ensure that a telehealth visit is appropriate and (2) how the appointment on the clinician’s calendar is marked as a telehealth visit.
But even basic telehealth visits come in different flavors – e.g., televisits directly to the patient’s home or site-to-site televisits, where the patient is checking in at a distant site (where she also would have to be “roomed”). For the latter scenario, the scheduling workflow must describe how to block the appointment on the calendar of the site that will be hosting the patient.
Another innovative scheduling scenario involves patients who are calling to cancel or reschedule and offering them a telehealth visit instead.
2. The Onboarding Thworf (“Newbie”)
This workflow is a bit unique to telehealth although in traditional in-person care this would define all the steps to undertake for a new patient.
The same principle also applies to the Telehealth Onboarding Workflow, only that the patient is most likely not going to set foot into the clinic, so any paperwork needs to be completed virtually.
In addition, telehealth onboarding also applies to established (and new) patients that are doing a telehealth visit for the first time.
As the Covid-19 health crisis catapulted everyone into telehealth, we quickly established a “Telehealth TechCheck” protocol, to ensure that patients had the right technology and knew how to use it prior to their telehealth appointment. The details of that TechCheck should also be documented as part of the Onboarding Thworf.
3. The Rooming Thworf (“Roomy”)
The process describing rooming encompasses everything that occurs in the minutes prior the patient’s connection with the clinician. I.e., this typically includes at a minimum the (virtual) check-in process (“hey, I’m here and ready to see my doctor”); the collection of vitals, changes in medications, and recording of the chief complaint; and letting the clinician know that the patient is ready for their visit.
The Rooming Telehealth Workflow should also describe what happens when things don’t go according to plan — e.g., when the patient does not show up (you can call them and try to recover from the no show), or when the patient is having technical difficulties connecting (let’s get our TechCheck expert on the line), etc.
Just like with rooming in the in-person world, any challenges should be resolved as to not impact the clinician’s visit or wasting their time.
4. The Visit Thworf (“Vizzy”)
While this telehealth workflow is at the core of telehealth, it is actually the least interesting (dare I say, boring). If everything was done right in the three preceding workflows (including the Telehealth TechCheck), the visit is almost a none-event — i.e., very close to a typical in-person encounter.
The description of the workflow is typically mainly a user guide for the clinician on how to properly use the telehealth technology — how to start the visit; invite the patient from the waiting room into the visit room; share the screen; send files; text information; collect copays; ask the patient to complete a form; import information shared by the patient into the EHR; etc.