A couple of weeks ago at the ATA Fall Forum conference, I participated on an industry panel titled, “Telemedicine & Chronic Care – What Does the Evidence Show? A Review of Findings from Scientific Studies.” The distinguished panel commented on the findings of Dr. Rashid Bashshur’s thorough studies on telemedicine and chronic care.
This is an extremely hot topic for healthcare systems as the number of chronic patients is on the rise. Due to many demographic and lifestyle reasons, chronic care is topping 70 percent of the healthcare expenditure and is expected to increase.
As the vendor representative on the panel, I provided commentary specific to the operational aspects of setting up a telemedicine program designed to help manage chronic care. To do this successfully, here are my two main recommendations:
1. Think BIG!
Many of the programs established for chronic care management only covered a few hundreds or thousands of patients, and many of them were experimental and short-lived. It’s hard to examine the real impact on the quality of care and associated costs without such programs being mass deployed. Moving forward, in order for such programs to succeed, they should be designed accordingly, with the ability to scale and cover thousands or even tens of thousands of patients. Here are some of the considerations:
- Commercial sustainability – Analyze what the cost of adding a new patient to the program would be, and the expected return on investment. Be sure to confirm the commitment of the investment source. I have seen quite a few programs die when the grant that was used to start it dried up.
- Measure criteria of success – It’s important to define the criteria of success and related measurements to assure that the program stays on track.
- Training and adoption – Prepare a training program for your staff as well as for patients. Don’t rely solely on a few enthusiastic champions to provide ad hoc guidance to all users and patients. Last I checked, they generally don’t teach how to properly sit and engage in front of a webcam during medical school.
- Network design – Scalability is one of the most crucial factors to a telemedicine deployment. Design a scalable network topology with multiple datacenters, and one that is easily upgradable. My recommendation? Bet big on software.
- Technical support – The user experience is ultimately the key to adoption. Go with an intuitive user interface that minimizes the support required to onboard new clinicians and patients. Think about how many people you would need to staff at your helpdesk if your solution is difficult to learn and use.
2. Think FLEXIBLE!
We have witnessed that telehealth leads to behavioral change. You should design your service to be flexible and accommodate such change, while having the capability to adapt to different workflows.
One example that I like to use is from a Vidyo customer in the Netherlands that provides online telepsychiatry services. When visiting them a couple of months ago, they told me that when they introduced their telemedicine solution, the whole pattern of interaction between their therapists and patents changed. Instead of having one hour, pre-scheduled sessions with the therapist, patients are now moving to much shorter, more frequent ad-hoc sessions of about ten minutes each. They contact their therapists when they are actually in need of immediate consultation, not when the sessions are scheduled. This makes the service much more effective while also saving time for the providers, who can see patients at a moment when care is critical resulting in significantly improved patient outcomes.
Lastly, when designing a patient-facing telemedicine service, the healthcare system needs to prepare to adopt workflows that will undoubtedly change over time. When choosing a platform to enable the telemedicine service, it should provide the flexibility to address a number of different scenarios, such as adjusting scheduled meetings to ad-hoc, changing capacities and patterns of usage, and adopting new medical and consumer devices that integrate with other essential peripheral medical processes like Electronic Health Records (EHRs).
Have you successfully deployed a telemedicine solution to manage chronic care? What other considerations would you recommend?