Telehealth Promises Higher Quality of Life for Rural America

It is not uncommon to find lesser access to healthcare capabilities in rural pockets of the world, and this holds true in the United States as well. A 2017 CDC report showed that death rates in rural America due to cancer are higher than urban communities. With recent changes to telehealth revenue models, and relaxed federal regulation, telehealth capabilities bring promise to areas that are hard to access service, as providers can extend their services into rural areas of states in which they are credentialed.

In June, the Federal Communications Commission (FCC) announced that it would be opening opportunities for healthcare providers to receive funding for infrastructure build-outs and improved access for patients. Funding can be used to provide clinical monitoring devices for patients's use at home, or telehealth software and hardware by providers.

Solo and small provider groups, along with large medical systems can extend their reach beyond their local zip codes. The playing field is not totally equal to all clinicians, but a specialist in Baltimore can certainly start providing telehealth services to residents in Western Maryland through the click of a mouse. The smaller practice can up with innovative billing models which still hold effective to the patient maybe even without using insurance, as they leverage lower overheads and direct personalized care. The larger provider groups benefit from the marketing economies of scale, more aggressive advertising, but are constrained by less flexible revenue models, large overhead, and the less than optimum agility to adopt solutions.

Many successful implementations have shown promise such as in the case of an oncology program in California which helped bring patients closer to caregivers especially during the brutal months of winter. The program reached accreditation by the commission on Cancer and has seen a growth of 8X over two years from 60 patients to 500 patients back in 2008.

The vendor and solution provider landscape is offering more innovation than a few years ago, and opportunities for easier access, higher value proposition and more personalized care with smarter revenue models cutting out the middle insurance broker are becoming more of a reality, especially in preventative and monitoring care. Generally speaking, patients adherence to long term is not strong, with closer engagement with their care providers the likelihood of adhering to guidelines and recommendations is much higher, leading to improved health outcomes.

Examples of telehealth solutions that are creating personalized experiences for patients through access to a stronger medical ecosystem are Siemens Healthineers, and Vianova. Standards groups such as Institute of Electrical and Electronics Engineers (IEEE) are actively working on interoperability standards for devices and data across solution providers. The IEEE P2933 work group focuses developing a framework for the clinical IoT data and device Interoperability with TIPPSS (Trust, Identity, Privacy, Protection, Safety, Security) principles. This includes wearable and other clinical IoT enabled devices and their interoperability with healthcare systems including Electronic Health Records (EHR), other clinical IoT devices, hospital devices, and future devices and connected healthcare systems.

#telehealth #patientmonitoring #P2933 #healthcare

Ayman Nassar is an industry expert in project and portfolio management with over 25 years experience in architecting business solutions through optimum alignment of technology and business to achieve meaningful results. He is also a member of IEEE P2933 helping bringing patients closer to improved quality of life through robust and seamless telehealth solutions. He can be reached at anassar@anassar.net or https://www.linkedin.com/in/aymannassar/

What is Your Telehealth Roadmap Strategy?

There is no doubt that COVID-19 has been a major catalyst in accelerating telehealth solutions. Many medical care institutions have had some flavor of telehealth prior to COVID-19. For some organizations the telehealth capability took the form of provider to provider consults. In other cases it could have been a simple portal where patients login and provide some basic information about their vitals and how they are feeling. COVID-19 however pushed the boundaries on every provider to find out ways to provide virtual encounters via video and audio remotely as both providers and patients have been quarantined and stay-home orders were in effect.

As healthcare organizations scrambled to deploy quick solutions which in some cases were not HIPAA compliant, and were far from fool-proof, leaders have to the realization of the need to operationalize the capability, as well as develop a vision for what it would look like over the short term, next 12-24 months. This need becomes of a higher need as regulations undergo some changes, compensation models innovation are occurring, and patients expect the service, not to mention potential subsequent COVID-19 waves as witnessed this morning in California as it re-enters into a State of Emergency.

So what are some considerations for a sound telehealth roadmap?

I like to break down the strategy into two distinct areas; the first is what I call the foundational phase, the second is the deployment and roll-out phase. Telehealth capabilities are more than technology. The successful realization of telehealth capabilities requires addressing culture, business rules, workflows, technology security, data analytics and operational key performance indicators (KPIs) in the clinical, revenue cycle and supporting operations areas.

Setting the foundation is the main focus of the initial component of the roadmap, and involves these activities:

1. Establishing a well-oiled enterprise portfolio management office. A group that can facilitate C-Suite discussions to define key business KPIs, and define approaches to track them on a daily basis, and view projects as investments translating delivered work into measurable value that can be translated into financial and operational metrics that the CFO and COO can appreciate and utilize. To maintain autonomy the group should have the empowerment to coach chiefs on thinking outside of their areas and think strategically. In some models the group would report to the CEO, or to all chiefs, but have autonomy to make decisions based on sound approaches and documented rules. Another common model is to have the group report to the CIO, as almost all solutions today are data-driven and technology enabled. Today's successful CIO's are those who speak in the language of the business and are empathetic with the needs of clinicians and their patients.
2. Fostering and nurturing an organizational culture of accountability, patient value proposition and organizational mission. Unfortunately, not too uncommon is many organizations in the industry suffering inefficiencies. Examples of these inefficiencies are clinician controlled organizations which tend to prioritize physician convenience over patient care reflected in scheduling rules, availability, triaging rules, decision making, patient volume accountability and documentation maintenance. Another common inefficiency is tactical leadership in the C-Suite that fails to think strategically across the organization, unable to define heat maps, or poorly identifying existing and needed business capabilities and lack of prioritization of initiatives, losing track of meaningful KPIs and creating silos. Focus should be on business rule simplification, process streamlining, capability and asset inventory, architecture documentation, and change management and enablement processes.
3. Investing in a strong supporting infrastructure represented in IT security, network and server technical capability, enterprise architecture, project management office, talent development, compliance and a legal support team. Unfortunately many healthcare organizations view their IT departments, legal team and HR recruiters as cost centers, rather than value development centers. Together these supporting teams can strategically build and support a strong value stream by weaving a strong strategy map in conjunction with the operational leaders of the organization, mainly in the clinical and revenue cycle sides. The formation of these guiding teams and the chiefs engagement directly with these teams is a key requirement for success. Chiefs shouldn't be immersed in fighting daily fires, leaving strategic growth initiatives to become second priority.

Next comes the deployment and roll-out phase which focuses on two main components

1. Problem Definition and needs analysis coupled with a visioning exercise checking its alignment to the organization's mission has proven very powerful to validate the scope of the telehealth roadmap and it's capabilities.
2. Solutioning and a strong market research of offerings, comparing off-the-shelf products and their fit to the healthcare organization's environment and configuration at a feature and use case level is the next value-add activity. This can be achieved through vendor presentations, RFPs, in person demos of well-defined use cases reflective of the organization's workflows. This piece of work should include integration concerns across vendors, and how the integration will address the organization's specific business rules and the level of adaptation of the technology to the changes in business and clinical operations.
3. Building a strong partnership model internally and externally with key stakeholders and vendors to implement the solution and telehealth capabilities under the oversight of the guiding team, utilizing the enterprise portfolio team and project management office as the internal auditors of the roll-out, providing continuous feedback and opportunities for process improvement.
4. Once these high level stages can be put into place, the problem of defining which telehealth model to deploy (virtual health, peer to peer consultations, third-party contracted services) becomes a simple task, followed by a more detailed definition of telehealth capabilities and types of clinical encounters and a roll-out plan across the various specialties or a big-bang approach.

In summary, before worrying about COTS vs inhouse implementation, or Electronic Health Record (EHR) and Practice Management (PM) embedded vs integrated solutions, or the features a doctor can perform, the organization needs to think strategically at a macro-level to build a solid foundation in an agile manner to ensure a valid business and revenue model. This will ensure a scalable roadmap that can be incrementally implemented providing value realization to both the organization and the patient, focusing on what matters and what makes the organization unique and well-positioned for longer term growth.

For more information on telehealth advisory services visit carefinitive at https://www.linkedin.com/company/68234600/admin/. Ayman Nassar is an industry expert in project and portfolio management with over 25 years experience in architecting business solutions through optimum alignment of technology and business to achieve meaningful results. He can be reached at anassar@anassar.net or https://www.linkedin.com/in/aymannassar/