Seven Steps of Telehealth Planning for Program Success

1、Seven Steps of Telehealth Planning for Program Success A document to assist in the planning of telehealth and telemedicine projects for UC Health and associates.Adopted from the original document by Samuel G. Burgiss, Ph.D.· Evaluate Needs · Develop Care Services Plan · Develop Busine

2、ss Plan · Plan Technology · Train Personnel · Test Care and Technology Plans · Evaluate Outcomes Step 1: Evaluate Needs Evaluation of needs is the most critical step in telehealth planning. Decisions made in this step will affect the entire program. As a planner in the organizati

3、on, you will answer the question “Why do we need telehealth? You and your colleagues should begin by first considering the patients that you serve.Patients with chronic diseases such as diabetes and congestive heart disease are in need of almost continuous care. Medical services need to be available

4、 in their community and often in their home in order to keep their diseases under control, and to prevent exacerbation and co-morbidity. Telehealth can bring specialty healthcare services to the citizens of communities in need. The next consideration in evaluating needs is the doctors, nurses, and o

5、ther healthcare providers. Consider the following questions: If a physician, nurse, or other medical provider is providing care to a patient using telehealth, what does that clinician or nurse need to make the delivery of care effective and efficient? What information and communication does a referr

6、ing physician need? Do the clinicians travel between facilities? What if one day travel to a partner hospital could be eliminated by using telemedicine technologies such as simple videoconferencing? Providers in some organizations use telehealth technology to participate in grand rounds at medical s

7、chools and to present their cases for collaboration with faculty members. Participation in distance learning can reduce clinician isolation and increase satisfaction.The final consideration of need is for the organization. Your organization must be financially viable in order to continue providing s

8、ervices to your patients. Telehealth should not be a detriment to the financial status of the organization. It should be planned so that its return on investment to the organization will be realized.THE POINT: Identify the problem that may be solved using telehealth. Step 2: Develop a Care Services

9、Plan In developing the Care Services Plan, you should consider the needs identified in the previous step, determine which services will be offered, and how they will be delivered using telehealth. In this step you must consider the source of medical services through telehealth (who are your clinical

10、 assets), how those services will be delivered, the location of the providers, the location of the patients, and the guidelines and protocols for delivering these services. This step also includes consideration of telehealth technology features used in delivering the services, such as the quality of

11、 audio and video transmission, special instruments to view the patient, or the equipment to measure certain physiologic parameters such as ultrasound imaging. In this step, references to technology should be in terms of general features and specifications, and not in terms of specific vendors or equ

12、ipment models. For example, you might state that your patients have a high incidence of congestive heart disease which indicates the need to measure blood pressure, pulse rate, and body weight in their homes. This will need to be followed by developing protocols that include the referral of the pati

13、ent by the primary care provider, the scheduling of the telehealth examination (if real time such as videoconferencing), communication with the staff at the remote site, and the examination between the patient and the physician. All of the steps in the process should be in a written protocol that su

14、pports the patient, the referring provider, the remote clinic staff, and the local staff. These protocols should be written into your planning document and revised as the planning progresses. If you make a commitment to implement the program, these planning protocols can be revised to become approve

15、d clinical protocols. Following this process will make these protocols more mature (less likely to have errors) and will help you with planning the other steps. Developing and maintaining relationships with other health services facilities near your organization are critical to most telehealth progr

16、ams. Typically, telehealth involves bringing in services from outside your organization. Some hospitals are in alliances that include hospitals in nearby regions. Alliances could also include primary care associations, assisted living facilities, skilled nursing homes, and home care agencies. Such r

17、elationships can bring valuable assets to your organization for telehealth and other programs in the form of referrals.Developing relationships with the major employers in your region can be critical to serving the needs of their employees and to the success of your program. You can promote teleheal

18、th to employers by explaining how employees will spend less time away from work for medical services. Your organization could establish a clinic in the employers facility and use telehealth in the delivery of services. In addition, the employer may be able to influence reimbursement for services del

19、ivered by telehealth. THE POINT: Itemize what can be done given the current environment.Step 3: Develop a Business Plan and Risk AnalysisDeveloping a business plan is a critical step that is often omitted but is necessary to predicting sustainability of the program. Based on the previous two steps,

20、you should identify all possible increases and decreases in cost, increases in revenue and risk assessment that will be impacted by the telehealth program. An obvious additional cost is the technology. Though you might consider that the technology should be considered before the business plan, evalu

21、ating the business plan should be considered before technology so that you list all internal impacts on the business before obtaining more specific costs from the technology vendors. In this calculation you would consider what existing technology is already in place and how that can be leveraged.Usi

22、ng the sequence of evaluating needs, developing the care services plan, and developing the business plan will enable you to explore the technology that meets your needs rather than buying equipment and then trying to make it fit your situation. Certainly with additional passes through the planning s

23、teps and modification of these steps, improved information will be obtained and the business plan can be revised. Reductions in cost and increases in revenue are often more difficult to identify. As an example, providing continuing education to your staff at your site could result in a reduction of

24、cost and an increase in revenue. An example of cost reduction can be achieved by decreasing the travel of staff members between clinics in multi-clinic organizations to save transportation and labor costs. Reimbursement from CMS and commercial payers is complex. Based on the outcomes of Steps 1 and

25、2, identify the specific CPT codes likely generated and check with the CMS and candidate payers as to reimbursement for those services. Often, a modifier is added at the end of a code to designate it as a telemedicine encounter such as GT or U1-UD. Use caution however, to bill for these services usu

26、ally requires certain guidelines to be met such as patient and provider must be in the same state or only synchronous systems such as videoconferencing be used. Once you have identified the eligible CPT codes, outline the requirements and educate the staff.Telehealth can do something that is not oft

27、en realized It can bring you a physical patient. For example, if you have expertise at your facility such as a cath lab, consulting with a remote site may yield the decision to transfer that patient to your facility for critical care and ancillary services.If home monitoring of chronic diseases is u

28、sed, you might predict that patients would continue in your care rather than going to other facilities and estimate the resulting increases in revenue. A marketing plan should be included in the business plan. It is a part of this step since marketing typically has a cost and since the success of th

29、e marketing plan will impact utilization and revenues. This plan should include communication to leaders of the community, patients, healthcare providers, and other healthcare organizations. An organization could take the position that if grant funding will buy equipment, the organization will suppo

30、rt the operations by maintaining and using the equipment. This is not actually long-term sustainability which requires that the return on the investment be able to replace equipment when needed (e.g. after five years of use). In other words, true sustainability would mean keeping the program support

31、ed for 10 years or more. Thus, the calculated projections of expenses and revenue in the business plan should be for at least five years with the cost of the equipment amortized over three or five years. And finally, despite the Federal Government pushing for reform and healthcare technology, risks

32、remain. Clinical interventions/processes need to be evaluated from a risk-return perspective. It is important to re-visit existing malpractice policies to ensure care delivered “over the wire is covered. THE POINT: Analyze costs, revenues and risks to create sustainable business models.Step 4: Plan

33、Technology Sometimes organizations plan the technology before any of the other steps listed in this process, and occasionally the other steps are neglected. This can increase the probability that the program will fail and the equipment will be in a closet within a few years. A thorough and objective

34、 technology plan based on realistic needs, a care services plan, and a business plan (the first three steps) can increase the probability of long-term sustainability of a telehealth program. The technology planning process should begin with a review of the priorities you listed in Step 1 Evaluating

35、Needs. This includes the functions needed by the patient, the functions needed by the healthcare provider, and the functions (e.g. cost, return on investment) needed by the organization. The members of the organization should gain sufficient knowledge about telehealth technology to determine the fea

36、tures and specifications of equipment to meet their needs for clinical services and the business plan. Physicians, nurses, medical providers, clinicians, and technologists should be involved in this activity. After gaining knowledge about telehealth technology, the next step is to develop a specific

37、ation for the equipment that is needed to provide the functions and results as planned in Steps 1 through 3. This specification should include the patient operation (if applicable), provider operation, report generation, features, quality of performance, and service. An experienced person who has de

38、veloped telehealth programs and who will collaborate with the group is a valuable resource. After a specification is written, vendors can be invited for demonstrations and performance testing of their products. Some organizations require that a sample of the product be loaned to them for a period of

39、 time (e.g. two to four weeks) so that personnel can gain experience with the equipment as it would be used in the program in order to obtain the best product. For example, a nurse in the organization might use home monitoring equipment with a family member acting as the patient. Data can be transmi

40、tted and the nurse can observe the data in the “patients record. Operation by both the “patient and the nurse can be evaluated. THE POINT: The needs of the program drive the technology.Step 5: Train Personnel A plan should be developed for training personnel to prepare them for the arrival of the te

41、chnology and for its use with patients and providers. Organizations often do the obvious operational training of nurses and patients (or remote clinicians) who use the equipment while other staff members are left out of the training plan. For example, referring providers need to receive training con

42、cerning the function of the telehealth services and potential benefits to them and their patients. Administrators need to be trained concerning the services that will be offered to the patients and the benefit to the community. Other clinicians such as health educators, social workers and mental hea

43、lth providers can learn to use the equipment in order to provide consultation, education, and patient care services across distances within multi-clinic systems. THE POINT: Training must be comprehensive and include peripheral parties.Step 6: Test Care and Technology Plans The process of writing the

44、 plan and reviewing it by people with different skills improves its quality so that the probability of errors and omissions are reduced. It also needs to be tested in the implementation phase. The care and technology plans should be tested by performing a pilot program with a limited number of patie

45、nts and staff members. For example, the pilot can provide services in cardiology to one or two clinics rather than the complete plan of several specialties to several clinics. During a pilot program, much will be learned from patients, nurses, referring providers, specialty providers, and other staf

46、f members as the pilot is being implemented. This knowledge could be used to revise the clinical protocols, the business plan, and other parts of the telehealth plan. In most organizations, it is much better to learn lessons with a few patients and staff members than it is with large numbers. THE POINT: Roll out the program initially with pilots.Step 7: Evaluate Outcomes It is very helpful to think of three target beneficiaries