“Implementing a telehealth program is a winding road at first. It takes a bit of patience and flexibility,
but it is well worth it, and the end of the road is satisfying for all involved.”
~ Dr. Sarita Nori, Dermatology, Atrius Health
As we participate in the ongoing “one step forward, one step back” dance currently associated with trying to pull ourselves out of the COVID-19 pandemic, independent practices struggle to balance the dual goals of bringing patients safely back into the office, while providing remote care for those who continue to remain socially distanced. The primary goal, as always, is to provide the highest level of patient care, but this must be accomplished in a manner that allows the practice itself to survive and thrive.
These are big challenges indeed, especially in these most challenging of times. As today’s version of the independent practice looks to the future, it can also gain valuable insights from lessons learned during the pandemic. One critical insight that came out of the unprecedented disruption focuses on the growing acceptance of telehealth as part of the patient care continuum. Forced into the world of telemedicine by lockdown realities, patients and practitioners alike came to realize that there are actually many benefits to be realized through telehealth:
- Providers have an increased ability to provide improved access to clinical care across a wide range of patient cohorts.
- Practices can experience reduced overhead and administrative expenses, compared to maintaining a fully staffed and equipped medical office.
- There was an increase in quality provider-patient communication opportunities.
- Improved care options for chronic care cases emerged.
- Patient satisfaction levels were maintained.
- More efficiency in the patient care process can be achieved, allowing for an increased number of visits per day.
- Removing the stress of constant in-office visits can improve the work-life balance for the medical care provider.
The question now facing the independent practice is not whether to incorporate telehealth, but rather when and how to bring it fully into the fold.
Telehealth Implementation Steps
“Telehealth is defined as the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.”
This wide-ranging definition from the Health Resources & Services Administration covers the lofty goals of what telehealth can or should be able to accomplish. Efforts to efficiently implement telehealth at the local level during the height of the pandemic, however, were often instituted on an ad hoc basis. Independent practices had to find a new way to communicate with their patient base and used whatever resources they had at hand without any real decision-making or implementation process.
For an independent practice to realize the full benefits of telehealth now, however, there must be an organized approach to making it part of everyday normal healthcare routines. Guidelines set out by the American Medical Association and other industry groups can make this process much easier. Here are the most important steps to be taken along the way:
Step One: Learn about telehealth
Telehealth is more than just calling a patient or holding a video call while trying to complete the same activities as an in-person visit. It includes patient communications and patient portals to exchange information, but also encompasses ways to improve the clinical workflow, enter information into an EHR, review patient metrics and manage data, and incorporate improved billing capabilities. There are also enhanced methods for communications with labs, medical service providers, and other medical professionals. Gather information by talking to colleagues who are already successfully using it, to get their input on what worked best for them.
Step Two: Identify your telehealth needs
Perform a brief survey of staff and patients to identify areas where telehealth will be of the most benefit in your practice. Find the biggest pain points and think about ways you can use telehealth to alleviate these situations. Focus on which solutions would provide the greatest value to your practice and identify which aspects of telehealth can most immediately achieve each goal. Other tips from the Maryland Health Care Commission include:
- Assess core readiness
- Review financial considerations
- Uncover operational challenges
Step Three: Form a telehealth implementation team
Never try to go it alone. Form a team(s) within your practice to help with the implementation process. This will provide valuable insights, and will also help to build future buy-in. You might initially include some legal and financial advice, just to make sure all the bases are covered, but they don’t have to be long-term.
Host a kickoff meeting where you reinforce the benefits of telehealth, outline the goals for your specific program, define what success will look like for your practice, and discuss the action steps required from team members. Set realistic implementation timeframes, establish key checkpoints, and schedule frequent update sessions.
Step Four: Evaluate potential vendors
Look for a vendor that can provide support across the entire digital spectrum, from electronic health records (EHR) and telehealth to practice management solutions that can help your independent practice succeed. The set-up should integrate seamlessly into your existing capabilities, and function smoothly together. Buying individual components might save money initially but could cause headaches down the road as you and your staff attempt to learn and use them in the real-life arena.
Schedule a demonstration or free trial to see what the product really looks like in action. Ask about other services that can enhance your practice administration capabilities, and look for a strong customer support philosophy, as you are building a long-term partnership.
Step Five: Refine budget and timeframe estimations
Once the vendor is chosen, and you sign a detailed contract for services, you can now refine your budget needs to include additional time for setup and training, hardware, audio/video, bandwidth or Wi-Fi requirements, and vendor payments. Lock in a timeframe for purchase, installation, training, EHR integration and patient education.
Step Six: Document your new workflow
This is your opportunity to really look at the way work flows in your practice now and adjust it so that your new telehealth process will enhance and improve practice efficiency. It may take some time to make the adjustments, and you will need to work closely with your implementation team to respond to concerns as they arise. You’ll need to:
- Assess office space and computer requirements to allow for private, secure patient conversations.
- Create a system that will efficiently integrate scheduling for in-person and telehealth appointments to make maximum use of provider time. Set designated hours to communicate consistently with your patient base, and determine which calls can be audio only, and which ones should be audio and video.
- Determine how to gather vitals and prepare for the session.
- Set office standards for any online patient communications. Designate what can and cannot be said during these conversations and through the patient portal.
- Coordinate staff responsibilities for responding to patient inquiries in a timely manner.
- Designate levels of attention for chronic care and long-term patients. Assign office staff to monitor and work with these patient cohorts.
- Design a routine which will ensure that all communications, outside consultation or hospital visit information, and test results are promptly and accurately entered into the EHR for each patient.
- Set billing and reimbursement parameters to ensure time spent in telehealth activities is promptly and accurately reimbursed.
Step Seven: Test and rollout
Begin to test your new workflow internally to work out any bugs there might be in your new system. A HIPAA Security Risk Assessment should be conducted as you begin to roll out your new technology. Now it is time to begin real-world applications with a specific group of patients who indicate their willingness to participate, and who have the computer capabilities to connect with you.
You may need to schedule in some additional time for initial appointments, as everyone becomes more comfortable with the process. Obtain feedback from your test group and share this with your implementation team to make necessary adjustments along the way. Once this group seems to function smoothly, you can start to expand to the rest of your patient base.
Step Eight: Ensure staff buy-in
It is crucial to the success of your telehealth initiative that all staff members are supportive of its implementation and are willing to support the process internally with each other and externally with patients. Include front office and support personnel that may have to deal with patient questions about telehealth. Ask your vendor if any training support is available, either in-person or online.
Identify staff members in a leadership position who will talk up telehealth with their colleagues, and who can help train those who may not catch on as quickly as others. Develop written guidelines for your procedures, talking points, and reference documents that can be easily accessed for clarification purposes. Schedule weekly “how is it going” sessions to begin, and then spread these out to quarterly as the staff becomes more familiar with the new telehealth platform. Don’t forget to perform telehealth training with new hires and include it as part of the onboarding process.
Step Nine: Create patient engagement
Of course, you want your telehealth visits to be as painless and productive for patients as possible. This will require education to inform your patients about what can be accomplished through this new outreach, and training on how to access the platform, schedule an appointment, ask questions through the portal, prepare for, and participate in a video medical appointment, and obtain post-visit instructions.
You may even want to schedule a series of in-office or online seminars for this purpose. Make sure you have the patient’s consent to provide care in this manner and let them know there are definite benefits to their overall health for engaged participation. Have a system in place where patients can easily express any concerns or suggestions they have to improve these sessions.
Step 10: Assess and address
It would be surprising to have an initiative like this go off 100 percent perfect right out of the starting block. Schedule in some time for regular assessment sessions to determine how much progress your practice is making on achieving the set telehealth goals. Identify areas of possible concern, and work with your implementation team and vendor to find ways to make sure the process stays on track.
Although this is presented as a step-by-step implementation process, it might be best for your practice to rearrange their order, or to perform several steps at the same time or overlapping with each other. After completing all the steps, though, you will find that telehealth has become an important contributor to the overall success of your independent practice.
Best Practices for Telehealth Implementation
A summary of the best practices you can follow to increase the likelihood of a successful telehealth rollout at your independent practice include:
- Set clear and consistent goals. Communicate them to all involved.
- Work closely with your staff throughout the decision-making and implementation process.
- Understand all federal, state and insurance rules regarding telehealth.
- Encourage all patients to participate fully in the telehealth process through a variety of marketing, communication, and social media outlets.
- Allow for feedback, and act on productive input received.
- Work with a technology partner who is committed to ensuring the success of a telehealth program at your practice.
Healthcare Technology Solutions Designed By and For Independent Practices
Amazing Charts was founded in 2001 by a practicing family physician to help medical practices thrive. We have grown consistently since then by creating easy-to-use solutions for delivering patient care. Today, we offer a variety of additional capabilities designed to help independent practices succeed, including Electronic Health Records, Practice Management, Billing Services, Population Health and Remote Care. Call 866-382-5932 to learn about our products, schedule a practice consultation, and learn more about telehealth pandemic lessons that can help your independent practice grow.
