As telehealth gains prominence, this article provides a comprehensive guide for organisations seeking optimal solutions. It navigates divergent definitions, the scope of telehealth, and the strategic steps to identify, prioritise, and evaluate requirements. With insights from demos and pilots, leaders can make informed decisions for effective telehealth integration.
In today's landscape, telehealth has become a familiar term among both clinicians and patients. However, its exact definition may vary. The global telehealth market showcases its diversity through various vendors offering solutions. A cursory web search reveals the top contenders and an extensive list of over 200 providers.
Telehealth1, as outlined by the U.S. Health Resources and Services Administration, employs electronic information and telecommunications technologies to enable remote clinical healthcare, health-related education for patients and professionals, public health endeavours, and administrative functions. These technologies encompass a range of tools including videoconferencing, internet connectivity, streaming media, store-and-forward imaging, as well as terrestrial and wireless communication methods.
Telehealth and telemedicine diverge in their scopes, with telehealth encompassing a more comprehensive range of remote healthcare services than telemedicine. Specifically, telemedicine pertains to remote clinical services, while telehealth encompasses a broader spectrum, incorporating non-clinical offerings like provider training, administrative meetings, continuing medical education, and clinical services.
Telehealth solutions encompass both synchronous and asynchronous modes, often integrating remote monitoring. These solutions span an extensive array of clinical specialties, ranging from general medicine, paediatrics, psychiatry, and endocrinology to rheumatology, and many others.
Telehealth can combine various medical organisations and specialties into a single virtual network, overseen by a central hub. This network may involve different physical locations, including central and remote clinics, both public and private healthcare centres, rehabilitation facilities, preventive health centres, as well as the private offices of doctors. All registered patients within these areas can be part of this network.
Alternatively, telehealth could also function as a virtual community of healthcare providers, offering assistance during disasters and humanitarian crises.
Although the fundamental functionality of telehealth remains consistent, innovative features cater to the unique needs of healthcare organisations and specific use cases. The question arises with this array of possibilities: where should one begin? While the COVID-19 pandemic accelerated Telehealth’s adoption, implementing telehealth requires a clear operational, infrastructure, and strategic plan for long-term success. Similarly, success requires a regulatory and policy environment friendly to telehealth.
Embarking on the journey to find the most suitable telehealth solution involves a deliberate approach:
Forming a dedicated project team is paramount, encompassing key stakeholders and users. This collective effort focuses on recognizing critical organisational needs and overcoming challenges. Defining metrics for success also guides and focuses the implementation strategy. Specific examples include using telehealth solutions to ensure continuity of care to address clinician shortages; to expand access to care in underserved and rural regions; to better track, contain, and treat the spread of illnesses like COVID-19; and even support displaced populations and refugees in austere environments. Throughout this stage, active involvement and backing are crucial not only from key stakeholders but also from users. Telehealth serves as a prime illustration of healthcare technology that demands a level of digital literacy from both clinicians and patients, designating them as pivotal users.
The subsequent step entails establishing the organisation's requirements. These are the conditions or capabilities necessary for solving problems or achieving objectives. Crafting a comprehensive list ensures clarity and uniformity. These requisites ensure adherence to formal documents, standards, or contracts. Organisations must compile a comprehensive list of these requirements based on their implementation requirements and expectations.
To establish these requirements effectively, organisations must engage relevant stakeholders and provide comprehensive explanations to ensure a common baseline of understanding among all participants. During this stage, an extensive list is advantageous. Here are some initial requirements to consider including:
• Synchronous, audio and video conferencing capabilities
• Asynchronous, secure messaging and chat capabilities
• Electronic scheduling features • Analytics and comprehensive reporting
• Billing, reimbursement, and online payment features
• Personalised intake forms and visit summaries
• Image and document uploads
• Existing data migration and scalability provisions
• Interoperability and security measures
• Compliance with local regulatory requirements (e.g. HIPAA in the U.S. and GDPR for the EU)
• User authentication and authorization processes
• Branding and customization options
• Language localization capabilities
• User interfaces tailored for clinicians, patients, and administrators
• Comprehensive customer service during and post-implementation, inclusive of user training, a 24/7 hotline, and technical support
• Cybersecurity requirements
Unrestricted Device Access: All users possess the flexibility to utilise diverse devices, ranging from computers to smartphones, for connecting and actively engaging in video and audioconferencing sessions, as well as exchanging vital information.
Patient Data Inclusion: Patients' data encompasses a spectrum of essential details, including general personal information, primary examination outcomes from local clinics, results of lab tests, as well as data from medical digital devices like Magnetic Resonance Imaging (MRI), Computed Tomography (CT) scans, Electrocardiography (ECG) results, and more. Including an Electronic Medical Record (EMR) that is interoperative with other systems and HL7 compliant would be ideal.
The project team can systematically categorise these requirements into segments like business, stakeholder, clinical, technological, and financial aspects for streamlined evaluation and implementation. Involving relevant stakeholders and providing clear explanations promotes a shared understanding.
Prioritising requirements demands asking pertinent questions and aligning them with the organisation's longterm goals. Employing a prioritisation matrix, which assigns weightage to different needs, aids in identifying must-haves versus nice-to-haves. Additionally, it outlines the Minimum Viable Product (MVP), representing the minimal functionality essential for a successful launch.
To thoroughly understand if the requirements mentioned earlier are met and to make a well-informed decision, the best approach is to test potential solutions or at least ask for a detailed demonstration. The main goal of this pilot phase is to confirm if the chosen solution works well for current and future telehealth needs. A patient advocate can be involved to get feedback on ease of use. They can see if the interfaces are user-friendly and if the solution works on the full range of devices like computers and tablets to smartphones and tablets.
The results from the demo and pilot phases allow for comprehensive evaluation. By assigning ratings and priority weightage to each requirement, an overall score is derived for each solution. This approach simplifies vendor comparison. Additionally, analysing detailed budget calculations, business references, and prior experience helps leadership make an informed decision.
After the initial pilot and implementation, the organisation must continue to evaluate and improve the telehealth system. This process should be circular and iterative, and feedback to the beginning to implement the lessons learned for the next round of improvements. Many frameworks exist to support this process. One example is the Plan-Do-Study-Act (PDSA) framework.
As we navigate the realm of telehealth solutions, it becomes evident that finding the right fit requires a thoughtful and strategic approach. The landscape of telehealth is vast, encompassing a diverse range of options from providers worldwide. Amidst this diversity, the importance of understanding telehealth's scope and its alignment with organisational needs cannot be overstated. These six steps, encompassing collaboration, requirement definition, strategic prioritisation, practical testing, informed evaluation, and continuous improvement, guide organisations toward telehealth solutions tailored to their unique current and future needs.
The journey to finding the right telehealth solution is intricate, and marked by collaboration, analysis, and adaptation. While the path may seem complex, the ultimate goal remains clear: to embrace telehealth as a strategic and transformative tool that caters to the diverse and evolving needs of healthcare organisations, clinicians, and patients alike. In this era of innovation, making the right choice ensures that telehealth continues to serve as a vital and seamless bridge between healthcare providers and the communities they serve. Lastly, telehealth is not the panacea of health care and there remains many ethical considerations as we all look to telehealth to solve our healthcare problems.
References:
1 What is telehealth? How is telehealth different from telemedicine? | HealthIT.gov
