Many hospitals and health systems had begun forays into telehealth before the COVID-19 pandemic struck. But all were caught off guard by COVID-19 and the drastic and immediate need to implement or scale telehealth. Now, as telehealth has become a major part of care delivery, hospitals and health systems are looking for permanent solutions to replace setups hastily created at the start of the pandemic.
During a Becker's Hospital Review webinar held in December and sponsored by Amwell, telehealth experts discussed a case study and best practices for standing up a quality, integrated telehealth solution for the long term. Speakers were:
- Glenn Trippe, MD, chief medical information officer at Fisher-Titus Medical Center (Norwalk, Ohio)
- Linda Stevenson, chief information officer at Fisher-Titus Medical Center
- Daniel Eisenman, senior director of solutions engineering at Amwell
Five key insights were:
1. Quick-fix telehealth solutions many health systems turned to early in the pandemic aren't adequate for the long term. At Fisher-Titus Medical Center, the IT team cobbled together a short-term telehealth solution in one week using iPads and Microsoft software. It worked, but it was far from ideal. For example, scheduling had to be done in both the EHR and Microsoft Teams.
2. Hospitals and health systems have three key criteria for choosing a long-term telehealth solution. In Amwell's 2021 Survey of Hospital and Health System Executives, the most important factors in choosing a digital care platform were: a) the ability to fit into the existing workflow; b) high-quality video connectivity and c) reducing staff time and administrative burden.
3. Integration with existing device setups and solutions — especially the EHR — is key. A major pain point Fisher-Titus identified early on was care providers did not want to have to log in to, or toggle between, the EHR and a telehealth application, especially on two different devices. Amwell’s partnership with Cerner enabled Fisher-Titus to integration telehealth directly into the EHR, which meant providers didn’t have to log in to a different application; they simply launched the video visit from within Cerner. In addition, Amwell’s picture-in-picture window feature let providers float the patient’s video stream in a separate window overlaying the EHR window. "It really changed the process of how this was going to work," Dr. Trippe said. "It was exciting, and it reduced our costs significantly" because staff could simply use laptops instead of multiple devices.
4. One of Fisher Titus' key requirements was streamlining the pre-visit workflow and facilitating "warm handoffs." After a provisional telehealth system was in place, Fisher-Titus thought longer term. Administrators identified major pain points and defined core requirements. One requirement in selecting a long-term solution was replicating the standard in-person workflow, which involves warm handoffs between clinicians and staff. Amwell's solution allows Fisher-Titus to keep the video visit open so multiple staff and providers can come and go, much like they would during an in-person visit.
5. Picking a telehealth solution isn't the only challenge. Organizational considerations are important, too: provider and operational buy-in, executive sponsorship, planning and IT acceptance and support. Perhaps most important is having cross-functional governance. "It really is critical that the program is approached and developed as you would any other clinical program, virtual or in person," Mr. Eisenman said. "It is a compilation of departments, including our ambulatory area, medical records, our revenue cycle for the appropriate billing and coding of these visits," Ms. Stevenson said. "And I think it's made a big difference in our planning and ability to grow in telehealth."
Although telehealth volume has declined from its peak at the beginning of the pandemic, it has stabilized, showing telehealth is here to stay. Solutions exist to smooth the transition from quick-fix initial efforts to a permanent, integrated digital care platform. With best practices and a good telehealth partner, hospitals and health systems can be better equipped for their digital future.
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