Each participating provider took a slightly different approach to choosing and utilizing a telehealth or RPM system, and shared the factors that led to their success. Below is a summary of lessons learned and advice from the most recent as well as previous CAST telehealth case studies:

Communications

• Communications between telehealth nurses and coaches on the one hand, and physician on the other, is extremely important to the success of a telehealth program.
• Providing telehealth nurses and coaches access to the physician’s EHR ensures that all parties are working off of the same information and have access to the same data and each other’s notes. This also reduces the burden of documentation in two disparate systems and double entries.
• Communicate technical issues with the vendor as soon as you or end-users encounter them to increase chances of program success.   

Vendor Choice

• Choose a telehealth system that is simple, reliable, easy to use, easy to maintain and affordable to providers and patients to warrant buy-in and sustained use. Ensure the telehealth solution can easily integrate into the patient’s daily activities.
• Partner with vendors who are responsive and are willing to work with you to resolve arising technical issues quickly and effectively.
• If you choose a smaller vendor, you can mitigate risk by rolling the technology one site at a time to learn from the experience and address encountered issues, before expanding roll-out to other sites.  

Leadership and Buy-In

• Engage leaders; their engagement is key to the success of a telehealth and RPM program. It takes leadership to change behavior – and persistence to change culture.
• Engage staff; their engagement, buy-in and support are critical to a program’s success.
• Change is hard, especially when it comes to implementing a new technology that changes the way services are delivered, particularly for clinicians who have to deliver critical health care services. Patience and support from leadership are critical to overcoming these challenges. 

Enrollment

• Understand the patient population as well as internal competencies, and plan the program based on the organization’s unique needs and goals.
• Establish selection/inclusion criteria around specific conditions in which telehealth has shown efficacy.
• Focus on “super-users” who are high-risk, high-cost patient populations, at least initially.
• Ensure all patients who qualify for telehealth are assigned at the time of intake, rather than later in the care episode.
• Ask a trusted clinician to provide an introduction to telehealth. Patient telehealth program enrollment is most effective when introduced by a trusted clinician.
• Streamline the hospital and skilled nursing discharge planning process to incorporate enrollment into a telehealth program.
• Create “scripts” that clinical and non-clinical staff can use to recruit participants to reduce patient confusion and ensure consistent messaging.

Education and Training

• Work with the telehealth partner to develop a communication strategy regarding the benefits of the telehealth program for internal stakeholders and referral sources.
• Provide traditional clinical call center nurses with additional disease management education. Effective nurse communication training is vital to patient enrollment and engagement.
• Ensure that case managers and field staff understand the value of telehealth, including what is in it for them: reducing readmissions for their patients and better clinical care.
• Empower the patient with the knowledge of his or her own health readings. Patients want to be informed, active participants in their care program.
• Providing an empowering method to individuals allowing and even encouraging them to engage in self-managing their health and chronic conditions with an accessible, affordable, convenient, and accurate solution can lead to positive health outcomes.
• Offer real-time education to patients during a teachable moment. This increases self-management.
• Make sure the patient’s primary care physician is educated about the program, so they can reinforce its value when the patient visits them in the office.

Process Redesign and Improvement

• Telehealth clearly impacts the efficacy of health care delivery at every point in the care continuum, providing the opportunity to reduce readmissions and improve the quality of patient care coordination. In nursing facilities, telehealth can transform the way nurses do their work and enable continuous improvement in quality and outcomes while containing costs. Consider how telehealth will change care processes and workflows, and redesign processes to take advantage of telehealth data in driving efficiencies and ongoing process improvements.
• When selecting a telehealth solution, take the integration of telehealth data into the electronic health record (EHR), which is not straightforward, into account. Partner with a vendor who not only implements interoperability standards, but is willing to work with others, like the EHR vendor.
• When deciding to embark upon or grow a telehealth program, it is very important to consider how remote patient monitoring fits into the clinician’s workflow.
• The technology does not substitute, but supplement the personal touch, training, and expertise the clinicians provide.
• Work with the telehealth partner to establish a clinical program design that will have maximum clinical and financial impact.
• Make sure you have a process in place and measures to evaluate your programs success.
• Telehealth technology is an enabling tool, not an end unto itself; focus on patient services versus telehealth equipment. Improving wound care or chronic disease management is a quality initiative, not an information technology initiative.
• Telemonitoring alone does not improve outcomes unless it is accompanied by an effective and active care management programs, including interdisciplinary services aimed at eliminating root causes of problems to alleviate them and reduce risk factors. Such services may include transportation, home visits, home care or home delivery of medications, for example.
• Multi-pronged approach may be necessary for some non-adherent patients who ignore telehealth nurse’s advice to seek medical attention; such approaches may entail proactive outreach to the physician or family member.
• The connection between the clinical staff and the patient is critical to the success of the telehealth program. Integrate visits to the home into the clinical program to reinforce the importance of using the telehealth equipment to the patient.
• Share clinical outcome data with all applicable practitioners across the full care continuum. Analyze the data, along with the financial data, to validate system cost savings, and report regularly to the physician group and senior leadership.
• Establish physician pro re nata (PRN), as needed, orders for telehealth patients to maximize efficiency of monitoring.
• If managing the telehealth inventory, make sure to apply an organized approach to inventory management including signing the equipment in and out. Make sure the telehealth system allows inventory to easily move between patients. Ask telehealth partners for a process to effectively manage the equipment.
• Involve all stakeholders from the very beginning, such as hospital physicians and nurse practitioners, to ensure buy-in and ownership of the program. The success of integrated and coordinated care hinges upon having robust response protocols, frequent communications, and most of all equally-robust industrial-grade enabling technology.

Financial Data Matter

• Understand your return on investment (ROI), collect and analyze the data that will demonstrate ROI.
• Develop business partner relationships.
• Partnership/collaboration with the organization’s chief financial officer is important to collect and analyze financial data.

Planning and Looking Ahead

• Plan to expand the program to a larger number of patients. Take into account the possibility of linking projects into partnerships with payers, hospitals, Patient-Centered Medical Homes and accountable care organizations (ACO).
• As health care organizations work to form integrated delivery networks or become ACOs in order to leverage a more streamlined health care model, the system-wide embrace of telehealth solutions as a communication bridge for the patient discharge process, can (quite literally) be the missing link.

 

For more details, please check the individual Telehealth/RPM Case Studies.