As the use of telehealth to “provide care at a distance” is becoming a more and more acceptable mainstream service, some organizations are evaluating whether their solution for video visits is truly the one that is the best fit for their organization (and their clinicians and patients).

In this multi-part series, I will lay out the three phases and the 21+ step process that is based on our experience in helping healthcare organizations choose the best solution since 2008.

The 3 Stages of Vendor Selection

When an organization has decided to replace their existing video visit solution with a new one, there are three distinct phases that should be followed:

A. Identify the needs and define the requirements

B. Evaluate and select a vendor

C. Switch over to the new vendor

Regrettably, most organizations are mostly skipping part A (and leave it up to IT to send out a Request for Proposal, RFP to solicit bids from vendors) and also don’t pay much attention to part C (assuming/hoping/trusting that the vendor will take care of that step — or solely relying on IT (again) to “roll out” the new video visit solution).

At the end of each part I will point out the consequences of not following the process, so that if your organization decides to skip a step, at least you are doing so consciously.

Identifying the Needs & Defining the Requirements

The first part of selecting a new vendor for a video visit solution is all about truly understanding what kind of solution the organization needs now and in the future.

Regrettably, since it is a “technology solution” this step is oftentimes outsourced to the IT team which in turns oftentimes only looks at the technical and integration requirements from their perspective. Some more mature IT teams have over the past decade(s) improved their technology selection process by involving the key stakeholders, but most IT teams in smaller organizations (especially if the IT team is outsourced and mostly provides basic technical support).

From my experience of evaluating and selecting telehealth vendors, here is the “best practice” workflow to identify needs and develop requirements when selecting a new vendor for a Video Visit Solution

  1. Establish a multidisciplinary Vendor Selection Team

  2. Identify the Current Problems and develop a Future Vision

  3. Identify the specific current and future video visit services

  4. Develop the desired User Experience for clinicians and staff

  5. Develop the desired Patient and Caregiver Experience

  6. Design the desired workflows for all current and imminent video visit services

  7. Collect the technical/IT requirements

Healthcare is a Multidisciplinary Team Sport

The first step in the process is to “Establish a multidisciplinary Vendor Selection Team”. As I’ll show below, the telehealth solution for video visits will involve a multitude of users and impacts a number of stakeholders.

Here is the typical composition of a multidisciplinary team that can ensure you are selecting a vendor that meets all the needs of all of your users and stakeholders.

  1. Clinicians – at least one representative from the clinicians who will be using the new solution to delivery care at a distance via live audio/video. I.e., in a community health center that could be a primary care provider, a behavioral health provider, and a pharmacist. In a health system environment, specialty care providers may also be represented.

  2. Nurses – as I lay out in the workflow section below (step 6), part of a superb patient experience is to recreate the valuable “rooming” process we are accustomed to for in-person care.

  3. Schedulers (front office staff, patient care representatives, etc.) are at the front lines of patient communication to schedule or reschedule telehealth visits or to serve as a first line of support. While they most likely will not directly interact with the telehealth solution, they need to understand the logistics of how to communicate to the clinicians how to find their patients in a video room.

  4. IT Staff – while IT should not be leading or driving this effort (since this is more about clinical operations than a technical installation) their involvement and input is crucial to ensure appropriate support and a good technical fit of the solution. Preview: there is little to no need for “integration” unlike most IT people would like you to believe. See Step 7 below for more info.

  5. Clinical Operations Leadership – as I just mentioned, this undertaking is about redesigning and redefining the technical support for the delivery of care, albeit at a distance. With that understanding, the selection of a telehealth solution for video visits falls under the jurisdiction of the leader for clinical operations, most likely in conjunction with their clinical counterpart (CMO or CMIO, if your organization has one). This leader would also be responsible for liaising with leadership and the CFO regarding the investment and the anticipated ROI.

  6. Telehealth Operations Support – obviously if your organization already has a designated Telehealth Coordinator or even a Director of Telehealth (or similar), this person is best suited to lead this effort and should definitely have a seat at the table. If you do not have a person identified for that job, think about who would be (a) developing the clinical workflows and (b) training the clinicians on the workflows and on the new software.

If this sounds like a lot of “overhead” consider the consequences if any of the perspectives are not represented. Ultimately the clinicians and nurses are the ones using it (including the patient, who is currently not directly represented in this group), so their involvement is key. Since telehealth success is in part about good operational and technical support (including clinical training), the representation of the corresponding individuals is crucial as well.

If your organization does not already have a Telehealth Governance Team, then this group would be convening ad hoc and only probably for 4-6 of times to discuss and prioritize the various elements and make joint consensus decisions.

Where are we now and where are we headed?

Since the selection of a new Telehealth solution for video visit is about the future, a good starting point always is to assess where you are at and where you want to go.

Thus the second step in our process is to “Identify the Current Problems and develop a Future Vision”.

Obviously something prompted someone at the organization to make a push for a new solution. To get everyone on the same page and to ensure that the new solution does actually solve the current problems and meets the wishes of those currently dissatisfied, it is crucial to systematically collect, review, and prioritize those two “Yin and Yang” aspects of what’s important.

The collection of current problems starts ideally with conversations with or a survey of the clinicians using the current solution to identify the key challenges that are driving this change.

Having this knowledge is not only great for finding a solution that fits better, it also is a key input in the change management process, as you can point to the resolution of current issues as a key benefit of embracing this new solution. More about that in the last part of this series, when we talk about the roll out to all clinicians.

While griping about a solution can be cathartic (and provide bonding), we also need a perspective on the future of video visits in your organization: What is the Vision for a video visit solution that would be a great fit? What could it do? What experience would clinicians and patients have? The details of this perspective will be further refined in the next step, but it is important to “download”, especially from the executive leaders, what their vision of the future is.

If your organization already has a telehealth strategy or a digital health strategy, then the vision should be taken directly from the objectives of those strategies.

It’s all about the Service

In the third step, the goal is to “identify the specific current and future video visit services”.

What this means is to identify the numerous different scenarios how your clinicians could deliver care at a distance via live audio/video.

To give you some ideas, here’s a quick list of different common video visit services:

  • Primary Care prescheduled video visits, e.g., follow-up appointments

  • Behavioral Health prescheduled video visits for ongoing counseling

  • Site-to-site video visits where the patient presents at a different location – with or without live exam.

  • Remote Clinician video visits where the patient is in the clinic, but the clinician is remote, e.g., at home due to Covid.

  • Primary Care ad hoc video visits (same day appointments)

  • School-based, pre-scheduled primary care video visits

  • School-based ad hoc primary care visits with physical exam tools.

  • School-based counseling video visits.

  • Behavioral Health Crisis visits via video in the Emergency Department

  • Telestroke with outsourced neurologists in the Emergency Department

  • Post-discharge virtual medical reconciliation by a pharmacist.

  • Chronic Care Management video visits of patients in an RPM program.

  • etc.

Here are two articles to give you more ideas: “96 Common Video Telemedicine Scenarios” and “9 Ways to Deliver Extraordinary Care Virtually”.

The purpose of this “exercise” (typically prepared by the Telehealth Coordinator and then reviewed by the multidisciplinary Vendor Selection team) is to get a feel for how your organization is planning to use video telemedicine in the future to serve its patients better. This will help you to become clear as to the substantive, foundational “use cases” for the software solution that you want the new vendor to support flawlessly.

As we’ll see later, the vendors will share with you all the bells and whistles that they thought about (of course, all AI-enabled!) but it’s the day-to-day basics that matter most. It’s the functionality that the clinicians and patients and nurses will use 80% or 90% of the time.

As you identify what telemedicine services your are delivering now and what you want to do in the foreseeable future, this understanding will greatly enhance your ability to find and confirm a vendor that best fits your needs.

Are we there yet?

If you’ve kept track, we are on step 3 of 7 of the first phase, so, no we are not “there yet”. But this foundation of a multidisciplinary team to drive the selection of the vendor that is the best fit coupled with a documented understanding of what’s broken and what the future looks like you are already well prepared.

In the next article we will continue with the remaining four steps of systematically gathering the needs and requirements of the key stakeholders.

Have you selected a new video visit vendor in the past 2 years? I’d love to hear how you approached this undertaking and what you learned from it. Please set up a quick chat with me so I can pass on your learnings to the readers of Telehealth Tuesday.

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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.

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