Patient-Centered Care

How Telehealth Programs Can Evolve to Meet Patient Demands

An expert from Avera Health, one of the largest and best-known telehealth organizations in the nation, weighs in on how to lay the groundwork for a successful virtual care practice.

John Parks

John Parks is the director of business development at Avera eCARE, the telehealth branch of Sioux Falls, S.D.-based Avera Health.

There are more than a few reasons why hospitals across the country choose to implement telemedicine. For some, telehealth can provide a board-certified emergency physician for consultation in the event they need to perform an infrequent procedure. Others rely on telemedicine to support providers, delivering a better work-life balance to clinicians. Many opt for virtual consults with the aim of keeping care local, avoiding unnecessary transfers and offering specialized services.

Whatever the reason, telemedicine is much more than a connection between a provider and a patient; it has the potential to save workforces, communities and, most important, patient lives. And the sooner hospitals grasp the idea that this care delivery innovation can be a powerful way to tackle their goals and challenges, the better off they will be.

What Is Telemedicine?

Several terms — telemedicine, telehealth, virtual care, e-health — are used to describe the real-time, two-way interactive communication between the patient and the physician or provider at a distant site.

The broad definition of telemedicine typically does not account for the additional hospital-focused benefits, such as:

assisting in recruiting and retaining providers
collegial consults with bedside physicians and nurses
on-call support and assistance with nursing documentation
access to tertiary-level hospital services

Simply put, telemedicine, done properly will look different depending on where it is deployed in the hospital and can be a solution for many issues that hospitals face.

VIDEO: See how telehealth is moving care closer to the patient.

Rural Care Facilities: The Ideal Use Case for Telemedicine

Rural communities rely on their local physicians and providers for virtually all of their healthcare needs, and yet those providers have few colleagues to turn to for a quick consult. One of the most challenging parts of the job can be emergency room coverage. Rural hospitals typically staff emergency departments with an on-call, offsite provider who may take 20 to 30 minutes to arrive at the hospital. The two nurses staffing the building at night will manage these patients with standing orders or phone orders while they await physician arrival. Many rural physicians experience few critical encounters each year, making unpredictable and time-sensitive situations that much more stressful.

Tele-emergency care, designed with the end-user experience in mind, can offer rural stakeholders the consistent, reliable and easy-to-use services they require to augment emergency care. The last things the teams at the rural hospitals need when dealing with a trauma is difficulty in getting technology to work or waiting for a physician to be available. The equipment’s ease of use is vital, but consistent and secure video access also impacts successful adoption.

When the team and technology align to form a great service offering, amazing things can happen for remote hospitals. A hospital in Wagner, S.D., for example, tapped Avera eCARE emergency and hospitalist services alongside their unique staffing model to increase the average daily census and improve Hospital Consumer Assessment of Healthcare Providers and System scores while significantly decreasing overall costs for the hospital.

How to Create a Virtual Healthcare Delivery Model

Those looking to develop a telemedicine program should begin by listening to the needs of practicing clinicians with the aim of tapping telemedicine to augment care delivery. With this practice, Avera eCARE now provides services in over 420 hospitals around the country over the past 25 years. Born as a virtual care option for Avera Health’s internal customers, the eCARE program has grown to include several sustainable telemedicine programs geared toward addressing workforce issues, extending expertise to underserved populations and reducing total cost of care by treating patients in the most appropriate setting.

Based on demand from the marketplace, Avera eCARE has expanded hospital-focused offerings for intensive care units, emergency rooms, pharmacies, hospitalists, behavioral health departments and specialty clinics. In each case, the setting had an impact on how the services were designed and developed.

With the ER offering, for example, one of the main priorities was to make sure communication was clear and consistent, which could be achieved by a direct point-to-point connection. A second critical consideration was ease of use, to allow the clinical team at remote hospitals to keep their hands on the patient instead of fiddling with devices. To enable that, we created a system that requires just one touch from the nursing team — the push of a red button on the wall — after that, everything is handled from the telemedicine hub; for example, Polycom Cameras’ pan, tilt and zoom capabilities are controlled via the telemedicine hub and not by the clinicians.

It should be noted that the ER service is designed dramatically differently from the other Avera eCARE services, some of which use remote monitoring equipment, mobile carts or proprietary software programs to fit the needs of the service line. There is no single technology solution for all settings.

INFOGRAPHIC: Are telehealth offerings meeting patient expectations?

3 Early Considerations for a Sustainable Telehealth Program

Certain decisions need to be made early on when creating a sustainable telemedicine program. Here are three considerations healthcare and IT teams should take into account when building out a telehealth program:

1. Will a specific team be identified to lead the program?

Defining a department to oversee and execute responsibilities is vital in the implementation and overall success of the program. Lack of a dedicated team can result in a duplication of efforts, variability in systems and processes, and limited resources to develop, design and distribute telemedicine across the system.

2. Understand the existing culture and behavior of the users

Identifying change management needs early is important to successful technology adoption. The specific reason for lack of adoption may not be related to technology, but to how virtual providers interact with the end user. Excellent customer service is essential; fostering relationships and trust between patients and providers can make or break a program.

3. Evaluate technology for functionality, technical issues and user error

To uncover technical or design problems in advance of a launch, IT teams should gather technology requirements up front. Those efforts can help to keep costs and labor for telehealth implementations in check by preventing multiple implementations, reducing time spent troubleshooting or patching technical glitches. Moreover, it can help teams to focus on providing a better user experience, rather than fighting with technical glitches.

For each telehealth offering, IT teams should identify, in advance, industry standards and benchmarks for video quality and security, including network uptime and video latency, jitter and packet loss. Other technical recommendations include standardizing technology, establishing customer service resolution protocols for technology issues, and developing a plan to measure and report HIPAA security compliance.

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