In previous posts, we’ve discussed the strategic challenges of gaining consensus among hospital leadership to start a telemedicine program. Part I and Part II covered hurdles such as the crisis-planning mindset and fear of change. In Part III, we address the tactical challenges involved in laying the foundation for a successful telemedicine program.
So…the powers-that-be have given the green light for a telemedicine program at your hospital. What happens next? Remember that starting a telemedicine program requires preparation. It’s not just about “plugging in.”
Everyone on the same page. A technology-focused conference call is always a good starting point to make sure clinical and technical teams are in sync. When implementing a new telemedicine program, Eagle’s technical team completes a “discovery call” with your hospital’s tech team to discuss IT platforms and connection requirements. We also discuss the hospital’s Electronic Medical Records (EMR) platform, as our physicians document within our partner hospital’s EMR.
Platform basics. With Eagle Telemedicine, the technology platform provider is the hospital’s choice. We consider ourselves “equipment agnostic,” but Eagle has experience with several companies that provide the equipment and technology that support our telemedicine physician teams. Eagle does recommend a platform capable of “always on” technology with a track record of 98 percent uptime or better to achieve top performance.
Hospitals must also be able to connect to the internet via broadband networks that support the required data transfer. For security purposes, many technology providers now recommend transferring video data through a secure connection to a “cloud” that the remote physicians connect to via a secure Virtual Private Network (VPN). Under this approach, there is no clinical data stored on any remote computers.
Other basics for a sound technical platform include “cloud” redundancies and fail-overs; FDA and HIPAA compliance; ease of use; online diagnostic capability with strong technical support; 128-bit (or higher) Advanced Encryption Standard (AES) encryption and optimized video quality by dynamically adjusting bandwidth.
Diagnostic equipment. Some hospitals choose to use handheld tablets for patient consults, and those might work in certain settings. However, many of our physicians prefer a larger screen—19 to 24 inches. This allows them to show the patient and the clinical team a slide or X-ray in a picture format and still maintain an on-screen face-to-face connection. Additionally, the cart should be equipped with a 10x zoom camera so the telemedicine physicians are able to zoom in during pupillary exams and assess swelling, infection or other trouble points.
Based on our experience of more than 20,000 ER and inpatient encounters per year across our 10 medical specialties offered, we have found that an e-stethoscope is the only peripheral scope needed for inpatient telemedicine exams. Though e-stethoscope technology is ever changing, our physicians largely still prefer a direct connection between the e-stethoscope and the cart, as opposed to a Bluetooth connection.
Communication basics. A secure HIPAA-compliant texting platform such as TigerText is essential for communication between clinical staff and the telemedicine providers. It should be noted that according to Joint Commission Standards, secure texts are not able to be used to send orders but they can be a helpful tool for triaging patients and assisting telemedicine physicians prioritize urgency and order of return calls.
Assessing specialty services and sustainability
If you’re looking for TeleHospitalists to fill your most basic inpatient needs, then the cost benefits compared with hiring full-time staff or paying the often exorbitant locum-tenens fees are clear. However, if your hospital is considering offering specialty services, it may be slightly more complex to determine if they are right for you.
Contribution margin. If you find, for example, that your community sorely needs a stroke treatment program and that local neurologists are scarce, you can use our new calculator feature to help determine whether a TeleStroke program would be financially viable for your hospital to implement. You might find the incremental revenue to be quite attractive, and the savings in brain tissue and neurons to be incalculable!
Hospital capabilities. A hospital must also assess its clinical capabilities in order to meet its vision. You should assess the skills of your clinical staff, shift by shift, and whether they are the right fit for supporting various telespecialty programs. This assessment will determine what kind of patients you can keep at your facility and if any additional clinical support is needed.
Once you’ve decided on the type of program you want to offer and selected your technology platforms and equipment, what next?
At Eagle, our 10 years of telemedicine experience has helped us get the implementation process down pat. Our implementation team will design custom workflows for your hospital’s patient scenarios, including direct admission processes, regional transfers, ED admissions and rapid-response situations. Before your telemedicine program “go-live” date, Eagle will host a mock session including a simulated patient exam to make sure everyone is comfortable with the new technology.
The key to success is collaboration and respect among the remote and the onsite team. We utilize a decade of best practices to ensure a seamless start-up for your hospital’s new telemedicine program. With Eagle, implementation doesn’t have to be another hurdle.