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Telemedicine/ Televisit Implementation Playbook - Part 1

Telemedicine/ Televisit Implementation Playbook - Part 1

Telemedicine/ Televisit Implementation Playbook - Part 1

INTRODUCTION

Background

The healthcare landscape has been moving from a fee-for-service to a value-based era. Payers have been implementing new reimbursement models that encourage providers to be cost-effective. Many clinicians still face a myriad of constraints that may pose an obstacle to better outcomes or increased access to wound care. Telemedicine can be a plausible option to do more with less in wound care. 

Telemedicine modalities are usually classified as:  

  • Store and forward (asynchronous): e.g., digital photographs and clinical data sent over the internet to a wound care specialist, who analyzes the data, and sends back written recommendations
  • Real-time tele-videoconferencing: e.g. live interaction/communication with a wound care specialist via a webcam 
  • Remote monitoring: e.g., provider continually monitors vital signs, glucose, etc of a patient who is at home or remote care facility  
  • Mobile health (mHealth): health care and public health information provided through mobile devices

Use cases and benefits of telemedicine in wound care include: 

  • Clinician-clinician communication: specialist provides assessment and treatment recommendations to a requesting clinician in the same or different organization. For instance:
    • Wound clinic requesting input from infectious disease provider and vice-versa 
    • Skilled nursing facility clinicians seeking consultation with remote wound care specialists
    • Remote home health wound care specialist providing recommendations to home health nurses visiting patients
    • When transitioning care, receiving facility clarifying orders/treatment plan provided by referring facility
  • Clinician-patient communication: for follow-up between in person visits of after discharge from acute care facility, to assess whether patient who is at home needs to an in-person visit

About this Playbook

The purpose of this playbook is to: 1) guide healthcare professionals in assessing the benefits telemedicine can bring to their practices, and 2) provide a pathway for implementation of telemedicine solutions. The playbook is based on the American Medical Association Digital Health Implementation Playbook [1], adapted to fit wound care clinicians' needs. For more information on telehealth, telemedicine and reimbursement, see "What is new in 2019 for Telehealth and Telemedicine?". For WoundReference's TeleVisit Tool, go to "TeleVisit Tool" (Premium plans).

IMPLEMENTATION OVERVIEW

Implementation can be divided in 2 parts: 

PART 1 (PRE-GAME): EXPLORING TELEMEDICINE AS A SOLUTION

A step-by-step guide is provided below.

Step 1: Identifying a Need for Telemedicine Solutions

Important tasksKey points (how to execute task)Reason (why execute this task?)

Solicit feedback from clinicians

Identify the biggest pain points and opportunities in communication between clinician-clinician and clinician-patient that exist in your organization. For instance, ask questions such as:
  • What areas are the barriers to communicating with other clinicians requesting input on a case and documenting the conversation?
  • What areas are the barriers to communicating with patients in between appointments?   
  • What can be done to make your job easier? E.g., having a digital solution to streamline communication and documentation
  • What are the consequences if you don’t implement telemedicine solutions?
  • To identify organizational needs and resources are adequately prioritized

Identify areas of opportunity from patients

  • Conduct satisfaction and/or experience surveys and analyze responses
  • To identify organizational needs and resources are adequately prioritized
Rank your list of pain points 
  • Analyze clinicians' and patient's input collected during the tasks above
  • To identify priorities
Identify pain points that can be alleviated with telemedicine solutions 
  • Select the highest ranking problem that, if solved, would have the greatest value to your entire organization and patients  
  • Envision the expected outcome(s) if that problem were addressed
  • To ensure telemedicine will solve a real pain point within the organization
Research telemedicine solutions/ software
  • Search for telemedicine solutions/software capable of delivering the desired outcomes. 
  • It is important to start from the pain points, and then search for solutions, and not the other way around

Step 2: Forming a Team

Important tasks
Key points (How to execute task?)
Reason (Why execute task?)
Identify the key members of your Leadership and Implementation teams 
  • Implementation Team: The team that is responsible and accountable for putting together the plan and driving the project forward day to day. 
  • Leadership: High-level decision makers who authorize key decisions, provide budgetary approval, and whose alignment is important for widescale success
  • Select the right people to ensure diverse perspective is provided
  • Having the right people will help anticipate any barriers, facilitate buy-in, minimize disruption
Define how the team members will work together
  • Outline and communicate the responsibilities and time commitment required of each team member  
  • Set up regular meetings with your Implementation team (online/in person)
  • To streamline group dynamics
Solicit input from team members
  • Some team members will likely represent end-users. Solicit feedback early on 
  • To keep focus of implementation on the end-user
Pre-seed your program intent with key members of your Leadership team  
  • Solicit input from your Leadership team 
  • To facilitate buy-in and ensure implementation is aligned with goals of the organization

Step 3: Defining Success

Important tasksKey Points (How to execute task?)Reason (Why execute task?)
Identify goals
  • Identify 3–5 goals that are most important for your entire practice or organization.
  • Relevant goals generally focus on health outcomes, improving patient experience, reducing cost and/or increasing provider satisfaction
  •   
  • Telemedicine implementation should have a positive impact on these goals
Identify desired results

Research the types of results that are feasible with the solution you are considering

  • For clinician-patient telemedicine interactions:
    • Improve patient access to care
    • Improve patient satisfaction (as patient does not need to spend resources to be physically present for a consultation)
  • For clinician-clinician telemedicine interactions:
    • Increase clinicians’ satisfaction and productivity (e.g. avoid disruptions in clinician’s schedule by reducing impromptu calls, reduce clinicians’ time spent on coordinating transportation to the clinic)
    • Improve clinical outcomes, decrease errors (e.g. requesting clinician can prepare a case so that consultant can better understand the case and provide more accurate assessment/recommendations, compared to impromptu calls)
    • Improve requesting clinician's knowledge over time
  • To be able to create metrics and measure success
Identify metrics to measure success 
  • Identify metrics
  • Set up a process to collect data and track progress against the goals 
  • Set clear endpoint criteria to re-evaluate as needed or to scale the program
  • To measure success 
Ensure each goal is S.M.A.R.T.
  • Specific: Define the goal as much as possible with no ambiguous language
  • Measurable: Is it possible to track progress and measure outcomes? 
  • Attainable: Can the goal be accomplished?
  • Relevant: Is the goal worthwhile and will it meet your needs?
  • Timely: Your goal should have a target date for completion
  • To increase probability of a goal being accomplished

Step 4: Evaluating the Vendor

Important tasks
Key Points (How to execute task?)
Reason (Why execute task?)
Research and compare potential vendors of telemedicine solutions
  • Build a Request for Proposal (RFP), clearly outlining the goals you identified in Step 3
  • Send RFPs to vendors that most closely align to your goals   
  • Review RFP responses alongside key representatives from the Leadership and Implementation teams   
  • Schedule live vendor demos with select members of the Leadership and Implementation teams 
  • Narrow your options to one or two preferred vendors to include in your pitch to leadership  

  • It is important to find vendors that offer a solution that fits your needs

Step 5: Making the Case

Important tasks
Key Points (How to execute task?)
Reason (Why execute task?)
Find your advocates
  • Identify advocates within the organization 
  • Align your implementation with organizational objectives/goals to justify why implementation of telemedicine solutions is a priority  
  • To facilitate buy-in
Research gains/ reimbursement
  • Research coding and reimbursement/payment options available
  • Estimate how much time clinicians can save with implementation
  • Assess risk and liability
  • To understand how telemedicine services will be paid/reimbursed 
Research costs
  • Estimate the budget required to obtain the resources to implement your program including vendor services, equipment, marketing, education, etc
  • To understand total implementation and maintenance costs
Calculate Return on Investment (ROI)
  • Calculate the ROI of your implementation considering the budget and value you have estimated  
  • To assess whether implementation makes financial sense
Prepare a proposal
  • Compile all necessary information in a proposal to the key decision-makers to obtain approval and resources to support your implementation
  • To make it easier for project to be approved

Step 6: Contracting

Important tasksKey Points (How to execute task?)Reason (Why execute task?)
Negotiate terms with vendor
  • What is the financial investment? 
  • Is customer support included?
  • Are any additional services needed?
  • Timeline for the current contract?
  • To understand what is being purchased
Secure any remaining approvals within your organization 
  • Work with your legal, financial, procurement, or IT teams as necessary to get the contract signed
  • To obtain approvals from groups that may be impacted by implementation

Official reprint from WoundReference® woundreference.com ©2018 Wound Reference, Inc. All Rights Reserved
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NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

REFERENCES

  1. American Medical Association. American Medical Association Digital Health Implementation Playbook . 2018;.
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