Telemedicine Technology Planning Questions

Most bad technology solutions are not created by bad decisions, but by bad questions.  In this post we’ll look at questions which should be part of a telemedicine technology decision making process.  For additional background on telemedicine, please refer to my previous telemedicine posts including a telemedicine overview, terminology, and technology options.  As I've said in my earlier posts, I'm not an expert in telemedicine.  I'm just passing along what I've learned as I explore this very interesting topic.

I’m going to lay out questions and considerations which you can use to facilitate your planning process.  I hope that as you read this you’ll think of many more questions nested within each area.  And that’s really the purpose of this post, to get you thinking of the right questions. 

Before making any technology decisions, it’s important to have a defined telemedicine business case and strategic need.  Technology is the means to an end, not the end itself.  If technology is selected without a defined business case and strategic need, it increases the odds of making improper and costly technology decisions. 

Not to put too fine a point on it, but technology decisions are wrapped up in general operations decisions, which are ultimately constrained by a budget.  The budget, of course, is constrained by reimbursement, whether fee-for-service or some flavor of capitation.  So figure out how much you can receive before you commit to how much you have to spend.

Information needs

What information will be received? 

What information will be sent out?

What is the quality of the information to be received and sent? 

What is the quantity of information to be received and sent?

When is the information to be received and sent?

What is the format of the information to be received and sent?

This may seem obvious, but it’s important to define information needs.  If a provider needs patient history prior to the telemedicine encounter, there needs to be someone and some process to make that happen.  If there is need for vital sign or mental state screening during the encounter, there needs to be someone and some technology to make that happen.  Maybe it’s an inexpensive fax machine, maybe it’s and EMR, maybe it’s a full-scale integrated telemedicine cart.  Whatever it is, unless information needs are clearly defined, it’s not possible to make an informed technology assessment.

Wrapped into this discussion is sharing of patient information.  This includes considerations for EMR and HIE.  If there’s a need to send out referral letters and CCD/CCR, the system will either need to handle it or there needs to be a manual process.  Volume counts here, a couple patients per day are much different than managing the process for 15 patients per day.

At some point there must be charge capture, so that will need to be considered. How does the clinical information flow to the billing clerk or CBO?

The Who

Who is the patient population? 

Who is facilitating the encounter for the patient (patient helper)? 

Who is the provider?

It’s my hope that planners will consider patient population needs.  The environment, tools, and process should create a positive patient experience.  A repainted closet entered from a busy waiting room may not be optimal for mental health patients.  A cool room with only technology devices may not be the best setting for an elderly population.

Patient population also impacts the telemedicine setting.  Ambulatory mental health patients can go to a fixed telemedicine location.  Elder care facilities may require a cart solution.  If the telehealth equipment is to be moved between facilities, then an even more mobile solution is called for.

Regarding the patient helper, if they need to attach an ECG, take vitals, or ask screening questions, they’ll need the proper clinical credentials and training.  They’ll also need aptitude and training to operate, troubleshoot, and maintain telemedicine equipment.  Finally, working with a remote provider is different than working with one shoulder to shoulder, so the patient helper will need the appropriate skills and training to be effective.

Regarding the provider, this person will need to facilitate the technology to successfully conduct a telemedicine encounter. This includes technical skill, but also skill and training on conducting a successful remote encounter.

Where

Where is the patient location?

Where is the provider location?

Does the location have adequate Internet connectivity?

Is the equipment secure?

Does the patient encounter location provide privacy and security for patient and data?

If you’re thinking of telemedicine, you’re probably already considered the care facility or setting.  But within that facility the equipment will need to be stored and secured.  The patient encounter location will need adequate privacy and security.  There will need to be a process for handling the patient and PHI before and after the encounter.  Any patient information will need to be secured and protected, which includes all pieces and parts of the telemedicine technology solution.   After all, you don’t want unauthorized people surfing the internet or playing with a camera and come across some bit of patient PHI.

It’s also important to consider where the provider will be located.  Most of the time they may be in their practice office, but will they also be available when making rounds or when otherwise out of the office?  If so, you’ll need to address a laptop or mobile solution for the provider. 

How

How is the telemedicine encounter and related information intended to be used?

This may seem basic, but will patient visits be diagnostic, follow-up, or chronic disease maintenance?  Knowing this may steer your technology decisions.  Assessing a patient’s lightheadedness differs from discussing their hypertension plan compliance.

When

When will encounters be conducted?

Will appointments be scheduled, walk-in, or on-call?

Are the patient care site, the patient helper, and the provider available for the appropriate days and time?

Typically we think of “when” in terms of scheduling method: scheduled, walk-in or on-call.  However, telemedicine presents its own set of coordination challenges.  This may not seem like a technology issue but it is.  If the remote patient location needs to be scheduled, there needs to be a way to track that.  Same goes for the patient helper and provider.  Is there shared scheduling software?  If it’s a paper schedule (a no-tech solution), who manages the schedule and coordinates the people and locations?

Conclusion

I hope these questions have provided some insight into what it takes to plan a telemedicine technology solution.  As I said at the beginning, this was intended to prompt to you think of additional questions if you’re exploring telemedicine and telemedicine technology.  If you’d like to discuss telemedicine and technology further, please feel free to reach out to me through this blog or via email.

Straight ahead,

Bob