Home Care Technology Association of America
TEN STEPS to building a successful telehealth program
By Daniel L. Cosentino
  1. Define Success
  2. Segment Your Population
  3. Dedicate a Telehealth Leader
  4. Employ Proven Protocols
  5. Staff Efficiently
  6. “Test-drive” the Telehealth System
  7. Use a Service Agreement
  8. Integrate with Clinical Systems
  9. Market Your Success
  10. Be Proactive

Telehealth can improve clinical outcomes, focus clinical resources, and differentiate your home care agency. The ten steps that follow provide a framework to create a successful telehealth program.

1. DEFINE SUCCESS

The first step in establishing a telehealth program or reinvigorating your existing program is to develop a measurable definition of success. Establishing metrics can provide visibility on key operating aspects of your program, and will let you see what´s working and what needs work.

Reduce Acute Care Hospitalizations Telehealth can improve clinical outcomes and further enhance the home care value proposition. One way to do this is to measure your agency´s acute care hospitalization rates for telehealth vs. non-telehealth populations. Segment data into 30 day increments (30d, 31-60d, 61-90d, and 91+d) and compare your results to national, state, and regional benchmarks. According to the recent study, Re hospitalizations Among Patients in the Medicare Fee-for-Service Program, 19.6 percent of Medicare beneficiaries who have been discharged from a hospital were re hospitalized within 30 days. The estimated cost to Medicare of unplanned re hospitalizations in 2004 was $17.4 billion. A key finding of this study was that a safe transition from a hospital to the community requires care that centers on the patient and transcends organizational boundaries. In the care transition process, telehealth has proven to be a useful tool for many home care agencies. Telehealth enables agencies to communicate objective, patient-centric data, and proactively adjust care plans to reduce acute care hospitalizations.

Focus Clinical Resources Telehealth can assist in identifying patients in greatest need of home care services each day. It can tell you precisely which patient needs a home care visit and how their condition has changed. It is important to integrate telehealth into your visit scheduling program to focus clinical resources where they can have the greatest impact on outcomes. You can then measure visits that are scheduled from telehealth alerts vs. those that originate from your pre-determined care plan. Many agencies front load visits during the first few weeks of care and then arrange subsequent visits based on telehealth alert data. This integrated, proactive scheduling strategy is one more way to reduce re hospitalizations.

Increase Referrals The value of telehealth can be demonstrated to referring physicians by providing them with timely, objective clinical data. Daily vital sign and symptom data are integral when making medication and care plan adjustments. When referring physicians see these additional telehealth services, referrals will increase as their confidence level rises. What they ultimately see is the home care agency delivering high quality, proactive care. An agency can track how frequently telehealth is requested on the physician referral or discharge orders.

2. Segment Your Population

Up to this point, most programs have used a “one-telehealth- device-fits-all” approach. To deliver telehealth more cost effectively, consider segmenting the population to match a patient´s disease condition with a primary vital sign. Prepare a list of disease states, vital sign monitoring, and device types needed. Many home care patients need multiple vital signs monitored (weight, blood pressure, oxygen saturation, blood glucose), but others may benefit from monitoring only one or two vital signs each day.

Segmenting a population with targeted vital sign monitoring is a great way to lower your average telehealth device expense, allowing you to deploy telehealth services to a broader population and reach more patients in your daily census.

3. Dedicate a Telehealth Leader

Every telehealth program needs a dedicated operations leader. Look for an individual with a combination of clinical and operational skills who can direct internal resources. Depending on the size of your telehealth program, this may not require a full-time person. Key responsibilities include:

  • Establishing telehealth policies;
  • Facilitating program implementation;
  • Identifying patients;
  • Monitoring daily alerts;
  • Managing device utilization; and
  • Preparing management reports.

To foster success, the leader should have executive visibility and promote key milestones of the telehealth program.

4. Employ Proven Protocols

Established telehealth companies offer robust training programs that include proven best practice models of success. Work with a telehealth vendor to incorporate clinical protocols into the daily telemanagement process. These should include:

  • Patient identification;
  • Device selection criteria;
  • Vital sign parameters;
  • Daily patient management;
  • Compliance; and
  • Installation /deinstallation.

Protocols need to be clearly written and version controlled; pertinent staff members should complete training and competency exams. Many telehealth vendors offer on-line resources to support on-going training needs.

5. Staff Efficiently

Determining clinical staffing requirements and nurse-to telehealth patient ratio is one of the most important operating cost factors. Advanced telehealth systems support greater than 250 patients for every one nurse. The cost for a program that staffs one full-time telehealth nurse per 200 patients is $27/ month, compared to $54/month for programs with a lower ratio of 1:100.

There are several types of staffing models to consider (i.e. centralized vs. decentralized monitoring). It´s usually more efficient to use a centralized model where a focused nurse or team of nurses are processing telehealth data and distributing interventions to field staff.

If an organization cannot dedicate appropriate resources, some telehealth vendors can provide supplemental clinical call center services. By visiting a professional telehealth nurse call center, you can learn about the practices employed to achieve high operating efficiencies. An advanced telehealth software system will help you reach superior operating levels.

6. “Test -drive” the Telehealth System

Don´t settle for a quick sales demonstration of a telehealth system. It is best to try the actual telehealth software application and devices to validate that it meets your needs. Telehealth systems should be comprehensive workflow tools, not just simple alerting programs. A few simple questions to ask:

  • Is the clinical software flexible and comprehensive?
  • Is it an “exception based” system or do you need to review every patient´s data every day?
  • What reports are offered?
  • What access is available to the raw data?
  • What administrative role control is offered?
  • Are the devices easy to set-up and use?
  • Does the device “speak” to the patient?
  • Do devices offer messaging or are they just vital sign gathering systems?
  • Do they require batteries?
  • What device connectivity options are offered?
  • Who is responsible for product issues and troubleshooting?

7. Use a Service Agreement

In today´s rapidly evolving technology market, consider using a service agreement (similar to a rental), instead of purchasing a telehealth system. There´s no capital outlay and your long-term interests are more directly aligned with your telehealth provider. A service agreement can also provide a flexible “ramp-up period” so you´re not paying for devices that haven´t been deployed. Many early adopters of telehealth who purchased equipment have since switched to a service model because of these advantages. Integrate with Clinical Systems It is important to diagram the workflow and data processes when designing a telehealth program. Look for opportunities to integrate telehealth with your enterprise EMR or Point of Care software application. Many companies offer an HL7 based interface to exchange data. As biometric data and symptomatic triage markers are received by the telehealth system, this information can be shared with other enterprise systems.

If possible, seek a system that offers bi-directional data exchange. Encourage collaboration between your enterprise software and telehealth vendor to optimize the benefits of both systems into an integrated platform.

9. Market Your Success

We´ve already mentioned the importance of measuring outcomes. The results can be distilled in a white paper to share with referral sources, showing the improved clinical outcomes that telehealth has brought to your patient population. You may want to consider partnering with a physician champion to help author and validate these outcomes.

Presenting chronic care telehealth management outcomes at local hospitals, community centers, and regional and national home care meetings will raise awareness of your agency. Publishing hard data will set your home care agency apart from others that can only offer fuzzy, anecdotal, or undocumented results. Be Proactive Telehealth is an important tool to showcase home care´s value proposition to the health care system. Now is the time to build a solid chronic care management program with proven outcomes.

10. Be prepared and proactive.

If a shared incentives reimbursement program materializes that rewards reduced readmissions, your agency will be well positioned to benefit. Your agency will be able to deliver proven, measurable, care management services.

Those who wait to address the readmission problem or those who are assembling chronic care programs after the fact, will be years behind most sophisticated home care organizations that are making technology investments today. The adoption of telehealth will ensure your home care agency delivers value and remains at the forefront of our rapidly evolving health care system for many years to come.

References:

1. Jencks, S.F., et al. Re hospitalizations among Patients in the Medicare Fee-for-Service Program, New England Journal of Medicine 2009;360:1418-28.

About the Author:

Daniel L. Cosentino, MBA, is CEO and president of Cardiocom®. Cardiocom, the Experts in TelehealthSM, is an award-winning leader in innovative home telehealth solutions. Founded in 1997, Cardiocom develops, manufactures and markets its own telehealth devices for heart failure, diabetes, hypertension, COPD, asthma and other chronic conditions. Cardiocom´s clients include some of the most respected home health groups, health plans, hospitals, physician groups, and coordinated care companies in the nation. Through these established relationships, Cardiocom improves the lives of thousands of people each day. For more information on Cardiocom and its services, call 888-243- 8881 or visit www.cardiocom.com.

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