TEN STEPS to building a successful telehealth program
By Daniel L. Cosentino
- Define Success
- Segment Your Population
- Dedicate a Telehealth Leader
- Employ Proven Protocols
- Staff Efficiently
- “Test-drive” the Telehealth System
- Use a Service Agreement
- Integrate with Clinical Systems
- Market Your Success
- 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.
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
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
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
- 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
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
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
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.
1. Jencks, S.F., et al. Re hospitalizations among Patients in the
Medicare Fee-for-Service Program, New England Journal of
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.