This is a story about four leaders named Everybody, Somebody, Anybody and Nobody.

Once upon a time, during a big crisis, there was an important job to be done. Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it.

Soon, Somebody got angry about that, because it was Everybody’s job. Well, Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn’t do it.

It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.

While this is a funny story about the lack of responsibility and about passing the buck, it is also illustrative as to what is going on in many healthcare organizations regarding telehealth.

There are many people involved in telehealth these days, yet no one seems to be ultimately responsible for it. If the organization did not have any telehealth services before Covid-19, most organizations still do not have a designated “responsible adult”.

What does it take to lead telehealth?

I’ve said before that the launch of telehealth must be understood and organized as a launch of a new clinical service offering. You wouldn’t start a new clinical service line in your clinic or health system without assigning clinical and operational responsibility to someone, even if it’s just a part-time responsibility.

The same applies to telehealth, only that the breadth of responsibilities goes beyond clinical and operational duties. At a minimum (and it could be the same individuals) you additionally need to assign responsibility for telehealth-specific coding & billing; technology & technical support; marketing & publicity; compliance and licensing; etc.

The additional complexity with telemedicine during Covid-19 is that very few administrators have ever launched a completely new clinical service offering. There are numerous workflows to be defined — from scheduling to billing, from no-show handling to helping patients figure out the technology. There are clinical, operational, privacy, and technical policies to be written. Proper telehealth coding must be identified for each payor, with telephonic and live audio/video modalities increasing the complexity of billing.

The launch of a new clinical service, especially during a crisis, requires attention to key organizational change management principles, including proper and adequate training as well as ongoing support and supportive leadership (i.e., praise for a job well done!).

Few administrative leaders are equipped with the experience to lead the staff and the clinicians effectively through such a tremendous amount of change, let alone the skill set required to design a complete new set of workflows vs. the incremental improvements on existing processes.

So who should be in charge?

Within a typical healthcare organization of any size, there are a number of obvious and non-obvious choices.

As is often the case in healthcare, especially in times of crisis, many people simply step up to the task and get done what needs to get done. Yet that also means that there is virtually no one in charge, that the quality of the work is not being checked and there is little to no accountability.

While that was fine for the first weeks of the crisis, 3 months into it, each organization should have by now identified an official telehealth leader to bring order, structure, and accountability to this new service line.

In a best-of-class model we distinguish four areas of telehealth leadership:

  1. Executive Leadership
  2. Clinical Leadership
  3. Technical Leadership
  4. Operational Leadership
Of those four, the last one, operational leadership, is typically the key day-to-day accountability responsible for managing the launch of telehealth services, leading the continuous improvement and ensuring proper administrative and technical support. Typically this role should be able to allocate 15-20 hours a week and typically report either to the COO or to one of the primary clinical service line administrators.


Executive leadership for telehealth typically lies with the CEO or COO and clinical leadership is typically provided by the Chief Medical Officer, the Chief Medical Information Officer or a designated clinician enthusiastically supportive of telehealth. Technical leadership often falls to one or more technical leads, often including the CIO or CTO.


What’s in a Name?


While executive and technical leadership fall within the standard purview of these leaders’ responsibilities, it is important, from an organizational change management perspective, to create a separate new position for the operational leader and a formal recognition through a title for the clinical leader.


For the clinical leader, the most common title is “Medical Director Telehealth”. Depending on the seniority and experience of the chosen operational leader, titles such as “Telehealth Director”, “Telehealth Manager” or “Telehealth Coordinator” are commonly used.


Anybody can now expect Somebody to do it
With the roles in place, the delineation of responsibility is clear, and no longer can Anybody expect that Everybody does everything. With a “Telehealth Director” or “Telehealth Manager” as the quarterback, telehealth will soon improve as now things are getting done – by Somebody.

And now for a personal service announcement: We regularly serve organizations of all sizes as Interim Telehealth Program Director while the leadership is identifying, grooming or hiring an individual to fill this role permanently. During our interim time we establish all the necessary policies, procedures, training guides & key performance indicators. Once an individual is identified to assume their duties, we transition our knowledge to the new leader and provide coaching and mentorship. Let me know if you’d like to learn more what that could look like for your organization.

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Christian Milaster and his team optimize Telehealth Services for health systems and physician practices. Christian is the Founder and President of Ingenium Digital Health Advisors where he and his expert consortium partner with healthcare leaders to enable the delivery of extraordinary care.

Contact Christian by phone or text at 657-464-3648, via email, or video chat.