In 2019 the American Telemedicine Association declared as the tag line for their annual conference a concept that’s been long in the minds of those having been involved in telehealth for the past 20, 30 years: that “Telehealth = Healthcare”.

Which at first glance, and especially during the Covid-19 health crisis, was not as obvious at first. Prior to Covid, the introduction of telehealth was often seen as simply another healthcare IT project.

Telehealth is not a Healthcare IT Project

In healthcare IT projects, typically a need is identified (a new image management system, new business intelligence software, or even a new EMR) and the IT team peruses its vendor network, attends conferences and scours the web to find the one vendor whose solution (a) fits the IT department’s technical paradigm, (b) interfaces with (or at least play well with) the existing technologies, and (c) kind of does what the users want it to do.

A large portion of the IT team’s and the organization’s effort and time (often more than half) is expended on finding the right vendor with the best solution and negotiating the most favorable deal. Another large portion of effort is then spent on installing, configuring and training the users on the selected solution and “getting it to work” in the organization’s organically grown maze of clinical and administrative applications.

Another distinction for telehealth is that most healthcare IT solutions are either used by a small number of people (or a specialty, such as radiology or oncology) or by everyone in the organization (like an EMR or a human resources management system).

Telehealth serves healthcare’s Raison d’ĂŠtre

Telemedicine, by definition (“practicing medicine at a distance”), is different. In Telemedicine it is not first and foremost about the technology. It is about delivering care and practicing medicine – the core raison d’être (or: reason for being) of the organization.

Launching a telehealth service is about launching a new clinical service offering. Yes, it (mostly) uses the same physicians, the same staff, the same buildings and the same specialties. But it is a completely new service which requires a different approach than simply selecting and installing a new piece of software.

Telehealth is Healthcare

A Telehealth service not only involves patients and physicians, it also affects the nurses, medical assistants, schedulers, billing, legal, public relations, and (of course) the IT department.

Telehealth visits, just like any other healthcare visit, need to be scheduled, prepared, conducted, and billed. They need to be promoted and adhere to all the legal rules and regulations.

In that sense, telehealth is truly the same as traditional in-person healthcare delivery. I guess the only things telehealth does not need are wayfinding, valet parking and a patient cafeteria.

By virtue of the patient and provider being physically separated, complexities arise from keeping the workflows on both sides in sync, which is tricky since many healthcare services do not run like a car manufacturing floor. Physicians run behind due to a patient needing special attention and patients may encounter technical problems or delays of their own.

Thus, while telehealth is healthcare, it is actually, in some regards, a more complex form of care delivery; at least with challenges we have not had to deal with before.

Case Study: A rural FQHC village

I recently worked with a rural FQHC that had just launched a school-based telehealth service providing the students access to the pediatric offices 30 minutes away from the school. In the process of standardizing their service, we identified the need to define a number of workflows such as

  • schedule an ad hoc same-day appointment (e.g., determining eligibility, obtaining consent for telemedicine)
  • establishing a new patient (i.e., if the patient had not been seen before)
  • prepare for the visit with the provider (e.g., taking images and vitals before the visit)
  • conduct the telehealth visit (e.g., sending prescriptions and communication of care plans to the parents)
  • post-visit activities (e.g, completing clinical documentation on both ends, following up with parents)

Another side effect of telehealth was that initially the workflow and technology selection now required manual documentation in three different electronic medical record systems (the school’s, the pediatrician’s and the telemedicine solution’s EMR).

In the process of streamlining and optimizing the service, I enlisted the support of the following people:

  1. the billing manager (to determine eligible payors)
  2. the schedulers (to make sure the visit is set up as a telehealth visit)
  3. the legal counsel (regarding the consent form)
  4. the medical assistants in the pediatrics office (to prepare the patient record for the provider based on the school nurses’ information)
  5. the quality officer (to obtain reports on the performance of the services)
  6. the technical lead (to set up a process for technical support)
  7. the EMR specialist (to configure the EMR for telemedicine)
  8. the public relations manager (for an internal newsletter and also for their quarterly patient-facing publication)
  9. the Associate Medical Directors (to inform them of the progress and availability of telemedicine in their practices)
  10. the COO (to ensure technical and operational support)
  11. the CFO (to ensure his okay on writing off non-billable services)
  12. and the CEO (to ensure strategic support for the service to remove any possible barriers)

Every one of these people in this “FQHC village” made their contribution to ensuring that the service can run smoothly and that the students, the parents, the school nurses, the providers, the medical staff, the billing staff and the schedulers are all having a satisfying experience for each telemedicine visit.

Expand the Team and Involve All Stakeholders

As your organization is planning to expand, grow, and mature its telehealth offerings, I encourage you to cast a wide net as you put together a steering team, or a project team. In our work with clients, we recommend that such initiatives are led by a clinician and involve at a minimum representatives from the core clinical specialties, nursing, finance, operations and IT.

Because just like in raising a healthy, well-balanced child, it takes a village to nurture a telehealth program to great health!

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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.