Telehealth, Three Ways

There are numerous ways to implement telehealth at your medical office or institution, and what works well for one facility or organization may not be the best choice for another. Different considerations, such as budget, HIPAA compliance, and ease of implementation can all play a role in how telehealth happens. Here are three of the primary options for providers that want to leverage telehealth:

Some systems, particularly large ones, want complete control over the technology so they can add, modify and deliver without any external obstacles, said Dan Bensimhon, M.D., the founder and CEO of MLS Telehealth, a telemedicine staffing company based in Greensboro, N.C.

Considerations:

• The technology can be born directly from clinician guidance at your organization.
• You can carefully shape every detail of the telehealth programs to fit your organization's needs.
• Smaller healthcare systems may not have the bandwidth to develop their own telehealth systems.
• It can be easier to partner with a company who is already a leader in this space, rather than try to reinvent the wheel. “Some of the larger healthcare organizations have tried to build their own, but with marginal success,” said Peter Antall, M.D., the chief medical offi cer of American Well, a Boston based telemedicine service provider.

One example of success: At the North County Health Services in San Diego, Calif., CMO Patrick Tellez opted to create technology pilots. “In the case of seeking solutions to the specialty care access crisis, we decided that we needed to invent our own solutions,” he said. Using financial rewards for achievements in clinical quality, NCHS reinvested these funds in technology pilots—which were designed to test the adoption of these technologies into the community medicine based primary care practice.

“These 'proof of concept' trials were designed such that we would learn something valuable and potentially publishable from our pilot irrespective of the outcomes.” The newly implemented system for telepsychiatry, remote blood pressure monitoring, and e-consulting, is off to a good start.

Some providers choose to work with existing telehealth vendors, but do so in a way the technology looks and feels as if it has been created by your brand.

Considerations:

• A lot of the technology already exists and it's cheaper than ever. “At first I thought we had to do it all ourselves,

  but now I've done a 180,” said Marc T. Zubrow, M.D., vice president for telemedicine and medical director of eCare at the University of Maryland Medical System. “We work with vendors that have an easy HIPAA-compliant platform for visual conferencing.”

• Privacy can be a factor when working with off-the-shelf products, but products that are created specifically for telehealth do not carry these concerns. “Some providers, particularly in the behavioral health space, have tried to use off-the-shelf technology like Skype or GoToMeeting, but traditionally, they are not HIPAA-certified, so there are concerns about having private patient information on servers,” Antall said. “Apple's FaceTime, for example has not been HIPAA-certified. The technology is easy to use, but following the rules is a big deal.”
• This kind of technology is constantly tested, updated, and comes with solutions to problems when they

  occur. “We chose to partner with a vendor that offers a telehealth platform that can be completely white-labeled,” said Robert Frank, M.D., the director of operations and optimization at Aurora Health Care in Milwaukee. “Resourcing requirements for build and ongoing maintenance of a telehealth platform led us in the direction of evaluating telehealth vendors that offered a complete product.”

When choosing among telehealth technologies, sometimes it's difficult to rely on just one, pushing providers to leverage a collection of services from multiple vendors.

Considerations:

• It may take time to determine which products work best, causing you to test several vendors at the onset. Robert Pearl, M.D., executive director and CEO of The Permanente Medical Group, noted his tri-state group has used several vendors over time to find the right one that works best for their use of video teleconferencing. “All video now is done over the same system, whether it is in surgery, medicine or behavioral health,” he said. “The power of video is that it solves the challenges of time and distance.”
• Working with multiple vendors can help customize what a particular program or specialty wants to do with telehealth, said Zubrow, who helps providers at the University of Maryland Medical System develop their telehealth services. “When a physician or group approaches me, I evaluate exactly what they want. Dermatologists, for instance, need a sophisticated camera that zooms in. I find the right piece of equipment at the right cost to the satisfaction of the physicians and the patients.”