How to Scale and Optimize Your Telehealth Strategy
The US Department of Health and Human Services (HHS) defines telehealth as: the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and landline and wireless communications.
While the use of telehealth is not new, widespread adoption among healthcare providers and patients has been relatively low. And then came COVID-19.
The stories about the surge in telehealth use as a result of COVID-19 are not new. But they are remarkable. Consider that, in 2019, 11 percent of patients used telehealth, reports Mckinsey & Company . Just one year later, 76 percent of patients report a willingness to use telehealth going forward.
Healthcare providers have promoted telehealth use as a safer way to deliver acute, chronic, primary, and specialty care. They’re reporting an astonishing 50-175x increase in the number of telehealth visits from pre-COVID days. What’s more, 57 percent of providers view telehealth more favorably and 64 percent have become more comfortable using it.
In the wake of the pandemic, policymakers eased some barriers to telehealth access and expanded its use, while the Taskforce on Telehealth Policy was formed to advise policymakers on the future of telemedicine.
Clearly, telehealth is here to stay. While healthcare providers await policy changes, they’re challenged to scale existing or adopt new telehealth programs to meet patient demand.
Considerations for scaling telehealth services
Many telehealth services have been funded by one or more grant programs. But the initial technology investment is only half the battle. The ongoing costs of management and maintenance are often overlooked.
Building a sustainable telehealth program requires a holistic plan to implement, operationalize, optimize, manage, and maintain it.
In addition to establishing protocols for licensing and credentialing, the regulatory environment, clinical and operational workflows, physician and patient management, quality control and continuous improvement, and billing, consider these in your plan:
- IT infrastructure – Make sure you have the right infrastructure in place, along with connectivity options to deliver a superior experience.
- Application integration – Acquiring telehealth technology is one thing, integrating your telehealth platform with clinical and business applications—EHRs, PACS, lab systems, ERP, CRM, etc.—and managing, maintaining, and supporting them is another.
- Access – Sufficient bandwidth to transmit audio and video and access application data that allow the patient and caregiver to have a quality clinical experience.
- Cultural considerations – Even though the cost of healthcare expertise is largely the same regardless of delivery mechanism, patients may feel “underserved” with anything less than an in-person visit. Some patients—and physicians—may also lack comfortability with technology or devices used to conduct telehealth visits.
- Training – How will the telehealth sessions be scheduled? Who will train clinicians on the use of the technology? Who will train on clinical skills? Understanding the training requirements needed for different roles and implementing them into your plan is important.
Security considerations for telehealth
Growing use of telehealth and remote work means growing numbers of people who need access to healthcare providers’ networks—from telehealth practitioners to hospital employees working from home to patients to third-party contractors, payers, billing companies, and others.
At the same time, penalties for noncompliance have been eased during the pandemic, paving the way for the use of popular consumer-based videoconferencing apps in addition to HIPAA-compliant apps like Microsoft Teams and Cisco Webex for telehealth.
But just because HIPAA enforcement has been relaxed doesn’t mean that malicious actors are on holiday. The FBI continues to warn about increases in COVID-based attacks. If your organization is attacked, there will still be consequences: downtime, cost to repair, and reputational damage.
We will return to a new, potentially more regulated post-pandemic telehealth environment. So it’s important to build a solid and secure foundation for your telehealth platform now. Here are key security considerations:
Virtual Private Networks (VPNs) – While VPNs are a common and secure way to connect remotely to the corporate network, warnings about patching key vulnerabilities have largely gone unheeded for many organizations. The risk is heightened with a growing number of telehealth practitioners and work-from-home employees connecting from locations other than work.
Still, VPNs provide a secure, encrypted connection between the corporate network and the devices used by remote employees and telehealth practitioners. It delivers the same content filtering, firewall protection and other endpoint protections given to employees within the hospital or clinical setting.
Authentication – Authenticating users, especially those outside the corporate firewall, is critical. Like a passport, multifactor authentication (MFA) requires users to present 2 forms of ID when logging in to the corporate network. MFA can block over 99.9 percent of account compromise attacks, says Microsoft.
Strong access control should also be deployed, along with least privilege, a granular approach that enables administrators to provide access to a minimal number of resources for the least amount of time. Where authentication answers the “who are you?” question, access control describes what you’re able to access.
Endpoint protection and management – Healthcare organizations use a large number of Internet-enabled devices—from desktops, laptops, tablets, and smartphones to scanners, monitors, medical devices, and sensors. As endpoints are added to the corporate network, the time needed to manage them increases.
Endpoint management and unified endpoint management (UEM) ensures that each endpoint is discovered by the corporate network, and then managed via defined policies and maintained with up-to-date patches, updates, and more.
In some cases, an endpoint management tool allows work-from-home employees and telehealth practitioners to add their own devices to the platform, enabling secure access to business applications and information. This kind of solution finally enables BYOD and reduces the burden of device purchases on the healthcare organization.
Healthcare organizations can also embrace a broader BYOD strategy using mobile device management (MDM) tools.
Beyond the pandemic: Telehealth use cases
In addition to aiding physicians in screening patients who may have COVID-19 symptoms and referring them, as appropriate, telehealth can help facilitate social distancing, reduce the potential for exposure, and reduce the strain on healthcare systems.
Looking ahead, telehealth can be used for:
- Primary care – Manage common ailments—colds, flus, allergies, etc.—and keep contagious patients from coming into contact with other patients and caregivers.
- Geriatric care – Monitor and manage the health of less-than-mobile geriatric patients and enable care facilities to affordably connect their patients with their doctors, without leaving the facility.
- Chronic disease management – Manage chronic diseases—diabetes, chronic kidney diseases, heart conditions, etc.—according to an established plan of care and monitor clinical signs of chronic medical conditions (for example, blood pressure, blood glucose, heartbeat, and other remote assessments).
- Pre-op education/Post-op monitoring – Give surgical patients pre-op instructions or follow up with those who’ve already had their surgeries.
- Weight management – Provide coaching and support to help patients manage their nutrition and weight.
- Mental and behavioral health – Manage patients’ medications and help them feel more “at home” and free to discuss issues.
- Advance care planning – Provide advance care planning and counseling to patients and caregivers to document preferences if a life-threatening event or medical crisis occurs.
- Clinical training/advice – Provide education and training through peer-to-peer professional medical consultations (inpatient or outpatient) that are not locally available, particularly in rural areas.
Achieve business outcomes with the right infrastructure
When you look at more mature telehealth programs, they share some key technologies that serve as the foundation for an effective telehealth platform:
- Traditional Infrastructure (on premise or cloud) and unified communications – When properly architected, implemented, and maintained, the right infrastructure enables a quality telehealth strategy.
- Medical devices/remote patient monitoring (RPM) – Medical sensors and devices, along with RPM, are essential for effective disease prevention, diagnosis, treatment, and rehabilitation. As patients are discharged with these devices, they need to be tracked to ensure both device performance and return to the healthcare provider.
- Asset Tracking – Because mobile devices typically account for up to 95 percent of a hospital’s assets, —or about 25 percent of a healthcare organization’s annual capital expense, implementing an asset tracking solution ensures that devices are quickly located when needed and returned to the healthcare provider when completed. This is key to a cost-effective telemedicine program.
- Integration of clinical and business applications – As mentioned earlier, integrating PACs, EHRs, labs, ERP, CRM and other applications is highly recommended. Accessing this data during telemedicine sessions is critical to the overall treatment of the patient and provides a seamless patient experience. As telehealth evolves over the next few years, healthcare providers will require technology platforms to be wholly integrated for an uninterrupted flow of patient data, whether it’s an in-person visit, a telehealth session, or some other type of touchpoint.
- Security – Though HIPAA penalties have been eased during the pandemic, this will not always be the case. For telehealth to succeed, privacy and security risks must be identified and addressed as mentioned above. Having properly architected, implemented, and maintained clinical and business applications, medical and non-medical devices, software programs, and other technologies used in a telehealth consult will protect patient privacy.
- Load balancing – Particularly in times like these, load-balancing solutions can help improve application performance and delivery by prioritizing some users, devices, applications, and more over others. For example, using telehealth to address potential COVID-19 symptoms can be prioritized over lower-value applications and ensure that physicians can quickly connect and have ample bandwidth to make diagnoses. These techniques are especially useful for cloud-based applications.
A solid and secure telehealth program has ongoing maintenance and support costs that should be considered. To address this, many healthcare providers have turned to leased hardware and/or consumption-based services, where a single monthly fee not only enables access to the technology, it provides routine monitoring, maintenance, and upgrade services. These types of solutions enable healthcare IT teams to better focus on clinical innovation in support of their healthcare mission.
Logicalis: Helping you scale and optimize your telehealth program
Logicalis offers secure end-to-end on-premise, cloud, or hybrid foundational infrastructures to scale, optimize, and support your telehealth strategy. Our in-house healthcare advisors partner with industry leaders, such as Cisco, Microsoft, and others, to help you securely deliver better patient outcomes.
Leveraging your existing assets, we can integrate a unified communications and collaboration platform into your infrastructure for telehealth and remote patient monitoring, along with clinical and business applications, for a streamlined experience for patients and practitioners.
We also offer managed services so you can focus on clinical innovation, while we take care of security and management.
Mike Riley is Vice President, Healthcare & GovEd at Logicalis US, responsible for helping healthcare, government and educational organizations align their business and technology needs.