Telemedicine/ Televisit Implementation Playbook - Part 1

Last updated on 1/14/21 | First published on 10/31/19 | Literature review current through Mar. 2024 [cite]

Authors: Kye Evans D.O., Elaine Horibe Song MD, PhD, MBA, Jeff Mize RRT, CHT, UHMSADS, Tiffany Hamm BSN, RN, CWS, ACHRN, UHMSADS, Amy Smith JD, RN, PHN, Topic editors: Cathy Milne APRN, MSN, CWOCN-AP, Scott A. Robinson MD, more...

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 clarification on 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

Step 1: Identifying a Need for Telemedicine Solutions
Step 2: Forming the Team
Step 3: Defining Success
Step 4: Evaluating the Vendor
Step 5: Making the Case
Step 6: Contracting

Part 2 (Game): Telemedicine Implementation - focus on interprofessional internet consultations (see "Telemedicine/ Televisit Implementation Playbook - Part 2")

Step 7: Designing the Workflow
Step 8: Preparing the Care Team
Step 9: Partnering with the end-user/customer
Step 10: Implementing the solution
Step 11: Evaluating Success
Step 12: Scaling

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 tasks	Key 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 tasks	Key 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 tasks	Key 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

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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

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

Topic 1435 Version 1.0

Telemedicine/ Televisit Implementation Playbook - Part 1

Telemedicine/ Televisit Implementation Playbook - Part 1

INTRODUCTION

Background

About this Playbook

IMPLEMENTATION OVERVIEW

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

Step 1: Identifying a Need for Telemedicine Solutions

Step 2: Forming a Team

Step 3: Defining Success

Step 4: Evaluating the Vendor

Step 5: Making the Case

Step 6: Contracting

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