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    DIY Telemedicine

     

    Learn Tech requirements

    James F. Bush, MD, FACP, an internist serving as the Wyoming Medicaid medical director and chairman of the Wyoming Telehealth Consortium, says most EHR vendors offer telemedicine functions that bring together the video, audio and documentation components with little or no need for additional integration requirements. However, he and others say physicians could find that their EHR’s telemedicine functions might not offer all the features they want, in which case they’ll need to explore options from other vendors.

    Health IT leaders say that while each practice needs to evaluate vendors based on the criteria specific to their practice needs, some common questions to ask when deciding on which one to choose would be: 

    • How the patient will interact with the provider; for example, are they more likely to use a mobile phone or a computer?
    • How will the practice capture and process payment for the visit? 
    • How does the software capture information from the patient?
    • How easy is it for the practice to incorporate clinical guidelines and recommendations?
    • Does the system support the requirements for telemedicine that are specific to the state in which the practice resides?
    • How easy is it for the practice to document the visit using the platform, and how is that documentation integrated into the patient EHR?
    • What ancillary services, such as marketing materials to give to patients, does the platform provide to ensure success?

     

    They also advise selecting platforms that are HIPAA-compliant instead of using consumer services (such as Skype) or technologies offered to businesses that don’t have the same level of security requirements as healthcare. Waldren reminds practices to ask vendors for verification that they’re HIPAA-compliant.

    Tennant advises physicians to seek out colleagues in similar-sized practices who have implemented telemedicine to ask about their experiences and the technologies they use. He suggests visiting the practice to observe telemedicine in action.

     

    Hardware requirements

    The good news is, most physicians won’t need significant hardware investments. 

    “For the vast majority of telemedicine, the commercial consumer-level products are more than adequate,” Waldren says, noting that the cameras in desktops and laptops offer sufficiently high resolution.

    Physicians also should have headsets to ensure adequate sound quality and more privacy than the speaker functions embedded in laptops and desktops generally offer, health IT experts say.

    Additionally, “you want to make sure your internet connection is fast enough to support video,” Sharp says, adding that physicians can test their connection using a free consumer platform (such as Skype) to see if their system works smoothly or if the video snags or crashes their computers (thus indicating the need for an upgrade).

     

    Adjust practice workflow

    Practices need to consider how telemedicine will fit into their services. That includes:

    Determining whether the procedures for checking in and treating patients for telemedicine visits will mirror the workflow of in-office visits or whether the workflow needs to be tweaked; for example, practices might opt to have their non-physician staff gather needed information from patients at the start of the telemedicine visit as they do for in-office visits. Or practices could decide to have patients electronically enter information prior to their appointment.

    Determining whether, and where, they can add automation and patient-entered information into the process.

    Determining whether physicians will be the only ones to conduct telemedicine visits, and if not, under what circumstances other team members may conduct those visits.

    Bush recommends training at least one point person for telehealth, with responsibilities for scheduling the appointments and sending out the appointment notices with the links or details on how to join the video visit. Related to that, physicians need to determine whether they’ll use telemedicine to handle urgent calls.

    Experts also advise practices to consider how telemedicine will fit into the practice schedule. Sharp says some practices carve out blocks of time during their schedules for telehealth visits rather than having telemedicine services available at all times.

    Practices need to consider their typical office rhythms and patient demands, such as whether they get a flood of appointment requests on Monday morning that could be handled more efficiently via telemedicine.

    Sharp adds that practices piloting telehealth might consider planning only for a few hours weekly to test how well it works rather than starting with large blocks of time. They also need to determine, based on their patients’ needs and practice experience, how much time to allot for these visits.

     

    Market & measure success

    A practice can work through all these questions before implementing telemedicine only to find that it isn’t well-received by patients. A practice might not see a return on its investment—at least not in the short run.

    But physicians shouldn’t abandon telemedicine in such circumstances, experts say, but rather use the experience to evaluate how to better promote the service to patients and to refine their pricing.

    Telemedicine can help practices be more efficient, and thus more profitable, as well as provide supplemental income to physicians. However, health IT experts don’t see it as a lucrative endeavor.

    Still, practices offering telemedicine should seek to maximize the value of their investments, and that means letting patients know that it’s available, Waldren says.

    “You’re going to have to market it to your patients and explain what they can and can’t do, so think about a marketing campaign,” he says.

    The campaign should do more than simply say the service is available, Waldren adds. It should let patients know why it’s available, when it’s offered, and for what conditions. 

    At the same time, physicians should determine from the start what a successful telemedicine program should look like for their practice so they can establish metrics to judge their efforts as they get under way.

    Physicians could establish objectives around improved financials, patient convenience, provider satisfaction rates, and/or patient outcomes. Whatever the anticipated benefits, Waldren says physicians should set how and when to measure progress in each area to determine if they’re succeeding with their telemedicine program. 

    He adds, “You want to check in frequently enough to make sure you’re making progress.” 

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