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Telemedicine/ Televisit Implementation Playbook - Part 2

Telemedicine/ Televisit Implementation Playbook - Part 2

Telemedicine/ Televisit Implementation Playbook - Part 2

INTRODUCTION

Overview

This is the second installment of the Telemedicine/ Televisit Implementation Playbook. The first installment guides healthcare professionals in assessing the benefits telemedicine can bring to their practices (see "Telemedicine/ Televisit Implementation Playbook - Part 1"). This topic provides 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? and "Reimbursement for Telemedicine Services in Wound Care"For WoundReference's TeleVisit Tool, go to "TeleVisit Tool" (Video Chat Edition available in the Free Basic plan, Premium TeleVisit Tool available in Premium plans).

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 enables wound care clinicians to do more with less. 

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 a 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

How do I get started with telemedicine in my practice?

The Wound Telemedicine Wizard (Algorithm 1) will walk you through the options:

IMPLEMENTATION OVERVIEW

The actual implementation can be divided in 2 parts as listed below. This topic will focus on Part 2 (Game)

PART 2 (GAME): TELEMEDICINE IMPLEMENTATION

A step-by-step guide is provided below.

Step 7: Designing the Workflow

Important tasksKey points (how to execute task)

1. Form and engage the Implementation Team to provide input on workflow design 

The Implementation Team should include clinicians, schedulers, billers, information technology (IT) specialists, etc

2. Identify use cases for telemedicine

  • Clinician-clinician communication
  • Clinician-patient communication
3. Prioritize use cases
  • Which use case will benefit the most from telemedicine?
  • Which use case is the easiest to implement? 
  • Ideally, start with the use case that is the easiest and is likely to bring the most benefit
4. For the selected initial use case, map and document your existing workflow
  • For clinician-clinician communication: e.g. if a clinician needs a specialist's opinion on a case, how do they communicate? What are the barriers?
  • For clinician-patient communication: e.g. how does the clinician determine if a patient needs to come in for an in-person visit? What are the barriers?
5. Identify and secure resources needed for telemedicine implementation 
  • How can the telemedicine solution be smoothly integrated into clinicians' workflow? Engage the IT team and telemedicine solution vendor 
  • Which processes need to be updated? For instance: EHR workflow, communication channels, billing (see topic "Reimbursement for Telemedicine Services in Wound Care")
  • Is there enough bandwidth to perform new responsibilities? Can processes be streamlined/ automated/ outsourced? 

6. Document and disseminate the new workflow that incorporates changes across departments

Sample workflows for televisits between a provider and another provider

Sample workflows for televisits between a provider and patient

Step 8: Preparing the Care Team

Important tasks
Key points (How to execute task?)
1. Talk with your vendor about available training support   
2. Identify staff leaders who can help develop, position, and socialize training material
  • Identify local "superusers", that is, clinicians who can act as ongoing trainers for other staff 
3. Train the care team
  • Provide several options for training:
    • Large group or individual training session
    • Webinars and videos on demand
    • Brochures
4.  Provide a process/ opportunity for staff to share ongoing feedback or ideas for improvement 
  • How can staff share feedback? Talk to local superuser or vendor? 

Step 9: Partnering with the end-user/ customer (patient or requesting clinician)

Important tasksKey Points (How to execute task?)
1. Develop (or source from your vendor) a wide variety of training materials for patients or requesting clinicians, to support different learning styles
2. Identify and invite end-users (patient or requesting clinicians) who are more likely to try and use the telemedicine solution
  • Plan to introduce end-users to the program at the next time they call/ request a consultation or through direct communication (i.e., phone call, email, or direct mailer)  
  • Finalize training protocols and materials for end-users to participate in the program
  • For requesting clinicians, provide information on billing (see 'Workflows' above, and topic "Reimbursement for Telemedicine Services in Wound Care")

Step 10: Implementing the solution

Important tasks
Key Points (How to execute task?)
1. Get baseline numbers for your success metrics to compare against later  
2. Officially launch the program with eligible patients or requesting clinicians
  • Provide support during onboarding
  • Solicit feedback from staff and patients; adjust procedures as necessary  
  • Ensure you are tracking key success metrics

Step 11: Evaluating Success

Important tasks
Key Points (How to execute task?)
1. Gather data used to track your key success metrics and assess success 
  • Collect feedback from your Implementation team 
  • Determine your success by comparing these data to the pre-implementation baseline   
  • If failing to meet goals, revisit your process to identify hurdles to success;  rework and iterate as necessary  
  • If succeeding, gather compelling success metrics into an expansion proposal  
2. Consult your Implementation team to determine the program’s future  
  • Align on goals for next iteration  or phase of the program

Step 12: Scaling

Important tasksKey Points (How to execute task?)
1. Resolve any improvement opportunities identified in the initial implementation 
  • Adjust workflows to account for program growth  
  • Negotiate the next phase of your partnership with your vendor  

2. Select your next scaling prospect (i.e., new  department, more patients, etc.) 

  • Share the success of the telemedicine program throughout your organization to generate enthusiasm
  • Budget and secure financing for growth 
  • Retrain staff or train new staff to account for program growth   
  • Expand (e.g. see more patients)
  • Continue tracking key success metrics for ongoing impact

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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.
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