Telemedicine for Global Emergencies: Current & Future Considerations
Introduction
Telemedicine is a segment of telehealth defined as the practice of medicine via remote technology. There are 3 distinct types of telemedicine services:
Synchronous: Live discussion and delivery of health care in real time.
Asynchronous: “Store-and-forward” technique. Information collected and sent to HCP for input.
Remote Patient Monitoring: Collection & evaluation of a patient’s status (video, tests or images).
Disasters and pandemics like the coronavirus SARS-Co-V-2 not only brings telemedicine to the forefront, but present unique challenges to health care delivery. The central strategy in these emergencies is to leverage the technology consistently and reliably toward ongoing improved clinical and financial outcome
COVID-19 Telemedicine Goals:
Provide care by supporting physical distancing to keep patients and health care providers safe.
“Forward Triage” – directing patients before they leave their home
Maintain continuity of care especially chronic disease management
Considerations for Implementation:
Define the focus for each patient group (Patient Segmentation)
a. Forward Triage allows effective screening to protect patients, health care providers and
the community from exposure.
b. Coordination of testing for patient and family members
i. Who needs testing
ii. When should they get tested
iii. Where should they get testing
2. Designing the Workflow
a. Clinical:
i. Incorporate CDC & clinical risk factors & best practices
ii. Standardized screening processes
iii. Roles and responsibilities per health team member for each patient group
b. Operational: Proper documentation; patient consent; communication mechanisms (internal
& external); billing processes
c. Logistical: Workspace arrangements; appointment scheduling procedure
3. Identify Most Appropriate Technology
a. Even the simplest of technologies requires a training and support plan
b. Adoption of the appropriate technology to change care delivery is based on multiple factors
i. EHR integration
ii. Dedicated mobile app
iii. HIPAA compliance
iv. Live chat features
v. Simultaneous multi-user
vi. Documentation of notes
vii. Real time video & audio with HD quality
viii. Patient reminders
ix. Onboarding/training
c. Usability
d. Training
4. Determine success of the Implementation
a. Metrics most appropriate for assessing progress
i. Health Outcomes Data (with system to collect) - # Cases:
1. Total # interactions
2. Mitigated at home
3. Non-COVID acute exacerbations
4. Referred to testing & location
5. Admitted to hospital/ICU
ii. Patient Satisfaction Survey
iii. Financial Impact
1. # telehealth visits & types
2. # visits & amount submitted for reimbursement
3. # visits & amount paid
iv. Provider Satisfaction
v. Set clear endpoint criteria to re-evaluate and to
scale the program
5. Scaling
a. Grow smart, not fast (more is not always better)
b. Continuously improve existing program in addition to new program
c. Adjust and expand
Conclusions
Telemedicine is well on the way to become a mainstream component of our health system.
To be effective, telemedicine must be appropriately integrated into the health care service.
Advantages:
Rapidly deploy large numbers of providers
Forward Triage
Decrease risk of person-to-person contact
Minimize health delivery site overcrowding
Limitations
Clinicians willingness to adoption
Temporary regulatory relaxation – future unclear
Requires a complete telehealth strategy
Contact me to discuss any point in greater detail