Preparing to implement your telehealth service? What are the opportunities and challenges?

What are the opportunities and challenges?

“The success of a telehealth programme is directly proportion to the effort that goes into its planning.”

Ed Percy, Vice President of Hospital and Health Systems in Europe, the Middle East, and Africa, Teladoc Health

On 14 September 2022, the IHF’s Telehealth SIG hosted the second webinar in a series of Lunch and Learns in collaboration with Charité – Universitätsmedizin Berlin, Mayo Clinic and Teladoc Health. Across three interactive workshops, the specialist panel is providing clinical and managerial hospital executives with practical guidance on the design and implementation of sustainable acute care telehealth programmes.

Chaired by Ed Percy, Teladoc Health, the speakers sharing their expertise are: Dr Jennifer Fang (MD, MS, FAAP), the Medical Director of Mayo Clinic’s Tele-Neonatology Programme; Beth Kreofsky (MBA), Assistant Professor of Healthcare Administration and Operations Manager of Mayo Clinic’s Tele-Neonatology Programme; and Dr Björn Weiss, an Anaesthesiology and Intensive Care Consultant at Charité – Universitätsmedizin Berlin.

Building on the first workshop, which focused on matching telehealth to patient need to design a successful programme (link to write-up), this second session developed understanding of stakeholders, workflow design and programme implementation. The key considerations, and the challenges they can present, can be managed by working through four steps.

1 Identify and engage your stakeholders early in the process

The input of your stakeholders influences workflow design and facilitates successful programme implementation.

Who are your key stakeholders that need to be aware of your programme? Can they help to champion implementation?

“Successful implementation and utilization Is dependent on stakeholder engagement. You have to know who needs to be aware, to endorse, and to buy into your programme.”

Dr Jennifer Fang (MD, MS, FAAP), Medical Director of Mayo Clinic’s Tele-Neonatology Programme

Consider both the distant (hub) site and the originating (spoke) site. The list will include:

• department and division chairs
• managerial executives
• IT specialists
• physician leads
• nurse leads
• remote clinicians.

2 Design a workflow to meet your defined performance goals

The workflow should be designed to meet the performance goals, informed by your use case. Each step in the workflow should be defined, at both the hub and spoke sites, with user guides available. Your programme will be less successful if its users are not confident in the system’s performance and security features. Give special attention to technical, procedural, and personnel considerations.

• Service activation – how will staff contact and respond to the service? The teams need to know when and how to activate it.
• Technology selection – what are the technical requirements to fit patient and staff needs? It is important to include privacy and security regulations too.
• Staffing model – who will be staffing the service, and at what times? You need to define the necessary skillsets and specialisms of the programme team, assign roles and responsibilities at both the hub and spoke sites, decide the hours of availability, and the process to schedule consultations.
• Documentation – do you understand the relevant data protection regulations and policies? There will be regional compliance obligations, as well as broader regulations such as GDPR.

“In workflow design the fundamentals when selecting a telehealth product are reliability, functionality, usability, and interoperability.”

Beth Kreofsky (MBA), Assistant Professor of Healthcare Administration, Operations Manager of Mayo Clinic’s Tele-Neonatology Programme

3 Build your skilled team and pilot the programme

Before your service launches, running a small pilot will help to test the workflow, refine the process, and give everyone involved the opportunity to feel comfortable with their roles.

Arrange training for the team, clearly share the goals, and set target dates for each milestone. These will keep programme implementation moving forward at the desired pace, and include:

• selecting pilot sites (start small, with 1 to 3 sites)
• setting a realistic go-live date
• creating a timeline with gateway checks (e.g., delivery of technology, training completed).

“For a good telemedicine programme, you need well-trained staff. The staffing will be the major investment, not the technology.”

Dr Björn Weiss, Anaesthesiology and Intensive Care Consultant, Charité – Universitätsmedizin Berlin

4 Use implementation strategies that address training, feedback, and refinement

Your team should be involved in identifying implementation strategies, sharing ideas that will make it easier for the workflow to be embedded and used consistently. These strategies should cover the pre-rollout, rollout, and post-rollout periods. Allocate time for assessing performance and making adjustments so that the team has a clear focus on continuous improvement. Examples include:

• running simulation sessions on the entire workflow prior to go-live and for low-volume sites
• monitoring programme performance
• collecting and analysing user feedback.

With the right implementation strategies, you programme is heading for a successful adoption into routine practice, and this also creates opportunities for scalability. Over time, your service can expand to additional sites, and you can consider hiring dedicated administrative staff to maintain and grow it further.

Once you’ve addressed your programme implementation considerations – what next?

The third workshop in the series took place on 7 December 2022, explaining how you can demonstrate the value of telehealth and monitor its impact on patients and clinicians.

The key takeaways from sessions 1 and 3 in this series are available here: