Telehealth continues to grow in popularity and demand – both patients and doctors want to use it in novel ways, including during disasters, to fight opioid addiction, and in complicated federal payment programs for hip and knee replacement surgeries. When building a telemedicine practice, providers should focus on how their telehealth services will be delivered, and make sure to consider best practices while doing so.
Click here to read the first post in this series on the basics of how to get started in telemedicine; click here to read the second, which addresses which specialties are best suited for telemedicine; and click here to read the third, which presents some pros and cons of telemedicine.
Choosing Delivery Methods
There are three major steps providers need to take when setting up their practices to add telehealth capabilities: choosing a network, the type of telehealth services you’ll offer, and your technologies.
- Choose a Network
To start using telehealth, you need to know what kinds of telehealth networks are available. There are three major types of telehealth networks:
Networked Programs: These networks connect smaller clinics (or service sites) to other smaller clinics, allowing each site to communicate with multiple other sites. This model is popular with rural clinics, which use networked programs to access specialist services from multiple different sites.
For a visual, think of these networks like a web with crossing and intersecting connections. Instead of one central hospital at the center, multiple smaller clinics create the network. According to the ATA, there are roughly 200 of these networks, with over 3,500 service sites in the United States.
Point-to-Point Connections: Point-to-point connections form networks that look like a hub and spoke. They connect multiple smaller clinics to one large hospital or healthcare facility. This model is often used to provide telemedicine services in large health systems. Smaller affiliate clinics can access specialists from a single location and don’t have to coordinate with other service locations.
Point-to-point connections are also useful for cross-practice specialty consults. For example, teleradiology services that receive images from clinics around the country often use this model.
Monitoring Centers: Monitoring centers are primarily used for telehealth services. These centers provide patients and clinicians with monitoring technology, allowing patients to record and send health information, which these centers then analyze or forward to a provider. Monitoring centers can track an amazing variety of conditions, from basic vital signs after surgery to usage data for a morphine breakthrough pump. Depending on your practice and your needs, there’s a monitoring center that can help better manage your patients’ care.
- Choose a Type of Telehealth Services
Telehealth services are defined by the systems they use and how they connect practitioners to patients. Here are the three primary types of telehealth services:
Store and Forward (Asynchronous Telemedicine): Any telehealth service where a clinician records patient data and sends (or forwards) it to another clinician is considered “store and forward.” Since providers are not communicating in real time, it’s deemed asynchronous. Store and forward technologies provide a convenient mechanism for physicians to collaborate on their own schedule. Ophthalmology, radiology and dermatology practices are frequent users of store and forward technology.
Remote Patient Monitoring: These services use remote monitoring centers to record information from patients and forward the results to clinicians. These services are great for managing complex, chronic conditions like diabetes and depression.
Real Time Telemedicine (Synchronous Telemedicine): Real time telemedicine, as the name suggests, connects patients and clinicians through live video conferencing software. Medicare-approved telemedicine relies on real time telemedicine technologies. In addition to the reimbursement benefits, real time telemedicine is a great way to manage post-op care, track medication adherence, and supplement traditional primary care.
- Choose Your Technologies
Once you’ve found a telehealth solution that fits your needs, you need three things: technology, training and software. There are three common types of telehealth technologies to choose from:
Live Video Conferencing: As you probably guessed, live video conferencing requires more than a Skype connection. To safely use and bill for telemedicine, you need a HIPAA-certified video conferencing system. Many companies provide either apps or standalone cameras and computers to facilitate video conferencing.
Specialized Email Systems: These systems are often used to store and forward telehealth services, providing a safe, encrypted and HIPAA-certified way for clinicians to share patient information.
Remote Patient Monitoring Systems: There are endless uses for patient monitoring systems and almost as many companies willing to provide them. If you have something you want to monitor, there’s likely a service ready to help. For information on patient monitoring systems, check out this helpful resource from the Center for Connected Health Policy (CCHP).
Telemedicine Best Practices
Once you’ve started your delivery of telemedicine, here are six tips and best practices to help you get the most from your telemedicine program.
- Look for Grants
Especially if you practice in an underserved community, the Health Resources & Services Administration (HRSA) and other agencies and nonprofits provide grants to help you integrate telehealth. There are also rural health associations in many states that can provide additional support.
- Create an Internal Implementation Committee
For any new program to be successful, you need buy-in from every member of your team. Creating a committee with representatives from each department in your practice will ensure a smoother telehealth rollout. Building an internal committee, especially for larger practices, lessens the need for outside support and consultants.
- Make a Space for Telemedicine
This step is crucial for anyone using live video-conferencing. Make sure you have a dedicated space to host video calls that’s clean, neat and professional. A welcoming space is key, even though your patients aren’t physically present. They will be able to see the space you’re in, after all!
- Make a Plan for Which Services You’ll Provide
Before you ever offer telehealth to a patient, you should know exactly what you can and cannot provide. This removes ambiguity for you and your patients while also streamlining reimbursement.
Start small and scale up. When beginning, only offer a few services. This way, your staff and patients aren’t overwhelmed, allowing you to troubleshoot any problems that might arise. As everyone becomes more comfortable, you can add more procedures and services to your repertoire.
- Set Measurable Goals
Sit down with your team and decide on a timeline and list of goals for your telehealth program. Decide how many patients you hope to reach, how you’ll reach them, and how you’ll measure success. Schedule check-ins throughout the process to make sure you’re achieving your goals.
- Get Specific Informed Consent From Every Patient
Some state laws require specific informed consent before using telehealth. Even if your state doesn’t, it’s a good practice and provides an opportunity for your patients to ask questions about the program. Getting informed consent for telehealth also provides an extra layer of protection for your practice and helps your patients better understand their care.
Bottom Line
Adopting telemedicine represents a serious addition to your practice’s capabilities, but it doesn’t have to be as complicated as it may seem at first. Break down the steps, plan ahead, get your whole team involved, and you’ll be teleconferencing with patients in no time. Next week in our final post of the series, we’ll take a look at some of the key compliance issues, including HIPAA, to consider when practicing telemedicine.
“Telehealth in a Nutshell.”
