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telemedicine implementation:

Solutions providers By Robert Kolodner, M.D.


elemedicine undoubtedly will be an integral part of future healthcare delivery models – in fact, it may become the predominant mode of care delivery. Also called telehealth, telemedicine allows for more eff ective and effi cient ways

for doctors and other healthcare providers to treat patients and improve health outcomes. Telemedicine is not only more convenient for patients and their caregivers, but it enables patients to receive specialty care much more quickly than traditional modes of healthcare delivery. While the opportunities for enhanced outcomes and reduced costs

are tremendous through telemedicine solutions, obstacles remain. How can providers overcome the barriers to telemedicine use, choose the right system and gauge its success? Top roadblocks to adoption and implementation include limited or

absent reimbursement for telemedicine services and resistance to make the shift from traditional face-to-face care delivery models. Progress is being made on the payment issue – more than 20 states

now require reimbursement for telemedicine use, which is resulting to a gradual increase in telemedicine use. Financial barriers will continue to melt away as payment models shift and the industry recognizes that telemedicine can result in better outcomes, reduced costs, improved access for patients and decreased hospital readmissions.

As for the cultural shift needed to implement a telemedicine solution, the IT team of an organization needs to work with clinical staff to ensure the new system integrates with the existing IT and health information infrastructure. If this does not occur, the result could be the fragment- ing of patients’ health information into isolated stovepipes. IT staff are essential to ensure the seamless exchange of patient health information. While it’s vital that IT staff and clinicians are both involved in the adoption and implementation process for telemedicine, clinicians should decide the requirements since they are the ones using it to deliver the clinical care. One approach is to fi nd and work with a clinical champion – an early adopter who sees the value of telemedicine from a cost and quality perspective – and by starting small and then growing into a more broad-scale implementation.

A telemedicine solution itself is unlikely to fi t the clinical workfl ow unless clinicians are equal participants in the prioritization, solution selec- tion and confi guration, and adoption process. T e initiative has a much higher risk of failing if IT personnel are the people driving the project.

Seek adaptable solutions Telemedicine solutions simply cannot be static. Our nation’s health-

care delivery models are constantly evolving, and our solutions must be able to adjust. Healthcare providers should choose telemedicine products that are responsive to their current and anticipated clinical workfl ows, keeping in mind that predicting these changes is a guess at best. While a specifi c telemedicine technology solution might work well today, in six months clinicians likely will want to make improvements as they gain experience and their needs advance. It is vital the products are able to adapt and change quickly – and af-

fordably – when new needs arise. It would be a costly mistake to purchase a telemedicine solution that isn’t adaptable, and IT personnel should work with their clinical staff to help their organization make the right choice.

Gauging success T e way to gauge your success depends on which telemedicine func-

tions you implement. What is your organization trying to accomplish? It might be increasing access to care, providing post-acute care or managing high-cost healthcare users. Take referral consultation telemedicine, for example. A provider may use this method to improve patient access to specialty care providers, especially those being treated in rural and underserved areas. Such care can be provided with real-time video interactions between patients in a clinic with specialists at remote locations or with a store-and-forward application that captures information and sends it to be reviewed by the specialist at a later time. Success with referral consultation may be assessed by the reduction in the time it takes for a patient to be seen by a specialist and the time it takes to resolve or manage a condition. Another example is use of home or mobile health monitoring to focus on the highest utilizers – the 5 percent of patients who account for almost 50 percent of the healthcare costs. A remote health monitoring solution is often used as an adjunct to case management in these cases. Success measures for this telemedicine function might be a decrease in ED visits or a decline in the hospitalization rate for those high utilizers. If all parties involved work as a team to overcome barriers to imple- mentation, and solution providers can continue to provide products that adapt to evolving needs, workfl ows and healthcare delivery models, our nation has the potential to greatly enhance outcomes and the health of Americans while reducing costs.


Robert Kolodner, M.D., is vice president and chief medi- c

cal offi cer, ViTel Net, and former National Coordinator for Hf

Services. HEALTH MANAGEMENT TECHNOLOGY January 2014 21 ealth IT in the Department of Health and Human

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