Turning to Telehealth

We all want telehealth these days.

Not many patients want to visit a clinic over the potential risk of getting infected by COVID-19.  Providers want to protect healthy patients and also reduce the spread of this disease.

Telehealth seems like a logical choice.  Technology can help in this space of healthcare, although we have to consider the business impact of moving to a telehealth strategy.

Despite what vendors claim, enabling telehealth is not just ‘flicking the switch’.  It comes with obstacles and decisions to make, before you should consider turning it on.

Here are some of my observations, and I look forward to your feedback and comments.

What is telehealth anyway?

Telehealth often refers to a broad scope of remote healthcare services, covering non-clinical services, provider training, meetings, and medical education, in addition to the regular clinical services.

These services are conducted in an online forum using technologies that your IT department has made available already or something that can be purchased for implementation.

We are of course talking about technologies to enable long-distance clinical health care, health-related education, and public health administration.

Most clinics, hospitals, health centers that explore or have implemented telehealth capabilities use technologies such as videoconferencing (Zoom, Webex, Microsoft Teams, etc.), SaaS platforms (Bluestream, Ignite+, Certintell, etc.) and of course cell phones telecommunications from your preferred wireless communications provider (AT&T, Verizon, T-mobile, etc.).

The aim is to be able to continue to deliver and service your patients base, especially during a pandemic like COVID-19, providing your patients with continuity and minimize any risk of transmitting viruses.

It is also a very powerful tool for more remote patients and rural areas, where getting to the clinic might be difficult, and some minor illnesses can be diagnosed and treated with a simple televisit by the provider.  However, that is often referred to as telemedicine … just to confuse matters 🙂

The key difference between telehealth and telemedicine is that telemedicine allows health care professionals to evaluate, diagnose and treat patients at a distance using telecommunications technology.

These days, the terminology is intermingled and people don’t really distinguish between the two services.   They both seem to fall under the umbrella of telehealth.

Telehealth Lite vs Telehealth

During my first few months in my new role with a healthcare center, I have been learning a lot more about the industry and I have had many reoccurring conversations with medical professionals, with telehealth being the center of many of these meetings.

The question is more around how and what we want to move forward with, to deliver on these services.  The initial focus is on site-to-site telehealth services, allowing our providers in any of our sites to provide services to patients visiting other sites.

During our recent adventures, and with the pandemic hitting the world, we had to expand our telehealth conversations to include alternative SaaS approaches, and this involves both telehealth lite and full-blown telehealth platforms.

Telehealth Platform

A full-blown telehealth solution is where you move the majority of your health services online, change your business processes to be a telehealth (SaaS) first strategy, transition away from traditional clinic walk-ins.

This also means that your entire care team and patient management will be part of the telehealth platform, allowing your patients to view their records online and interact with the care teams.

Your providers (doctors for us non-medical people) will move into medical exam rooms, spending large time of their day attending to patients online.  That means your providers will be part of a pool of providers, available to book, and who will see patients in rotation.

  • Waiting room time is cut from 20 mins to 0 mins as patients expect to be seen when the appointment starts

The revenue stream will change to online, which may often be less than walk-in visits, and it will raise questions of your real estate, shared services cost, technology spend, etc.

Some health care centers may see a significant drop in revenue if they change to full-blown telehealth, as their reimbursement from federal is much less for these online visits, and some not even covered.

Telehealth Lite

On the other side, the telehealth lite option will offer healthcare centers options for offering some telehealth services, for specific use cases and situations, and thereby allowing them to still focus on walk-in patient care.

Telehealth lite does not become a major shift in the business model, although you still need to consider how visits are planned and executed, as providers will need to set aside time throughout the day to provide these services.

It becomes impossible for providers to treat telehealth lite as another exam room, and just visit the room when they are available.

Patients who are booked for telehealth visits expects to be seen when the appointment starts. Providers will there need to block out this time.

Process & Change Management

For both options, process and change management is key to a successful transition or adoption of these technologies.

Technologies are easy to implement.  For years, IT departments would purchase ‘cool’ applications or gadgets, and push these out to their business users, often resulting in low adoption and limited business benefits.

Before you ask your IT department to deploy a telehealth platform, make sure we work on the requirements and objectives together.

There are no right or wrong answers in this conversation, but any decision has to be evaluated against your business model, revenue stream and technology readiness.

While the business model and revenue stream are very important, my observations are based on technology readiness given I work in IT and experience these challenges daily.

If I feel adventurous, I might explore these topics in other posts.

Are You Ready?

NOTE – findings and observations are based on my personal experience within IT over the last two decades, and may wary from your experiences.

Readiness for most technology solutions comes in three disguises; IT, internal users and customers.  In short, it covers the technology used to deliver the benefits and competitive advantage, and how our users actually interact (use) the new technology to deliver increased productivity and/or customer services.

Let’s get into some of the details:

Technology

For the telehealth topic, I’m referring to the suite of tools that are used to deliver telehealth service to our patients such as the SaaS platform, end-user tools (camera, laptop, etc.) and personal devices (tablets, smartphones, etc.).

The Platform

Unless you are planning on shifting your entire business and revenue model to virtual, I would be hesitant jumping straight on a full-blown telehealth platform.  That decision will require a lot of ground work, identifying your business objectives, change management, process changes, training and significant investment.

We opt’d for a light weight telehealth platform, which allows us to conduct quick video calls with patients, while still being able to see patients in the clinic too … if they dare.

It still require some significant process review in how you service your patient, how you plan visits, how providers set aside time to conduct these calls, and importantly, how you collect payments.

Try to pick a solution that does not need an app installed and can be executed from a browser.  It makes your life much easier when dealing with internal and external users.

Computer Tools

Thankfully a lot of the computers we’ve recently purchased come with video and microphone built-in.  The “only” configuration was to allow Chrome to use these tools when using the telehealth site.

If you are using VDI, as we do, then you will encounter additioanl setup challenges as VDI is not great at managing the video and microphone tools.

You also want to make sure that your provider uses the same device each time to avoid the common video conferencing challenges with adjusting audio settings when a call starts.

User Readiness

We have two challenges in this bucket; internal and external users.  Either comes with their own set of problems, but the internal is much easier to manage.

Internal; staff & colleagues

You can manage this population fairly easy, unless you are dealing with people who are less tech savvy given their daily work responsibilities, and some might also be a result of age and not familiar with newer online tools.

The readiness level for internal users is often down to process changes, and being comfortable with computers.

The adoption approach for any tool will determine (influence) the success criteria.  If you have opportunity to invest in training materials and other supportive documentation, then you will achieve higher results.

If you have time and capavity to offer some virtual training, then your success rate will be higher.

Basically, the more you can aid your user community, the better.

External; customers & patients

Your chances of succeeding are now determined based on your external user population technical readiness.  And, you have to accept that there is little you can do to bridge these challenges, and you just have to adapt to new playing rules.

  • WIFI; access and speed of the wireless network will impact the visual outcome.  Many families use a highly contended internet connection, and with homeschooling and streaming media, these will significantly impact the quality.
  • Computers; do they have computer and are they proficient?  Is the computer up-to-date?  Does it have the necessary plugins enabled?  Do they have camera attached?
  • Email; most tools require email or cell phone, If they don’t, you could spend a little time helping them setup an email, although this ‘eats’ into your video call
  • Age; unfortunately the older generation are often not as tech savvy which will impact their ability to start and run a telehealth session.  If they have kids or younger people in the house, they can help initiate the call.
  • Language; depending on your community and your patient mix, you might encounter language barriers and might need translation services.
  • Smartphone or Tablet; do they have an old school cell phone that is refusing to be smart?  Many telehealth platforms do require some basic level of capability such as recieving email or conduct a video call.  If they only have a basic phone (flip) then it will be limited.

Overall, your telehealth success depends on your external patients and their technical readiness.  You should expect, depending on the community you servce, a lower rate of success conducting telehalth examinations.

We have experienced roughly a 40% success rate for our patient base.


Enabling telehealth lite is doable in a short timeframe.

Full-blown telehealth platfomr requires a lot of planning and you need to seriously assess your business model to make sure it makes sense.

For either option, assess what your objectives are, ensure technology is in place to support it, and be prepared to train staff and educate patients.

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