The last time I wrote about telehealth, I noted that there remained substantial room for growth. While that remains the case, telehealth has been rapidly increasing in popularity over the last several years as more technology options have become available, payers increasingly reimburse for it, and state regulations have been modernized. Increasingly, health care organizations will benefit from a formal telehealth strategy if they have not already developed one. The particular role that telehealth will play in a health care provider’s strategy and operations will vary depending on the provider’s priorities and type. Health care providers looking to develop and implement a telehealth strategy should consider several interrelated factors including service array, modality, clinical staffing, patient targeting, scheduling, and technology. (Throughout this article, I use the term ‘telehealth’ to refer to health care services delivered via electronic telecommunications technologies. While I recognize that in some contexts, a distinction is made between ‘telemedicine’ and ‘telehealth’, here I have chosen the more general ‘telehealth’ for readability.)
When developing a telehealth strategy, one of the more important factors for the provider to consider is the range of clinical services to provide via telehealth. The most common clinical services provided via telehealth are primary care, behavioral health, and dermatology. The range of possible services is largely dictated by the diagnostic requirements of the service. Basically, it is only clinically appropriate to provide those diagnostic services via telehealth that only require information that the patient can describe orally or information that can be gleaned visually by the clinician.
For primary care and dermatology, the content of the telehealth visit will be largely diagnostic, with most treatment, if appropriate, being delivered via prescription. Behavioral health visits via telehealth can include diagnosis and medication management, but may also include counseling. In cases where the telehealth is used for interprofessional communication, a much wider array of diagnostic services may be appropriate. Whatever range of services is selected, an appropriately licensed clinician should develop clinical guidelines for which types of conditions can or cannot be done through telehealth.
There are several different modalities of telehealth, including real-time consultation, store-and-forward, and remote monitoring. Real-time consultation involves a clinician providing diagnosis and/or prescribing treatment in real time using audio and/or video telecommunications technology. Store-and-forward involves the clinician being sent information and/or images and responding asynchronously via secure email or audio/video. Remote monitoring involves clinical data being sent to a clinician from an electronic monitoring device such as a digital glucometer, scale, or blood pressure cuff.
These modalities can further be subdivided depending on whether the service is being provided directly to the consumer, or whether it is being used for interprofessional communication. A typical example of direct-to-consumer telehealth might involve a patient with a sore throat initiating a telehealth consultation and receiving a diagnosis and prescription from a physician. An example of telehealth for interprofessional consultation might involve an emergency department or intensive care physician with a stroke patient in a small and/or rural hospital seeking advice from a neurologist at a larger and/or urban hospital. Small hospitals may be able to use telehealth for interprofessional consultation in this way to keep patients closer to their communities and continue to receive facility fees for them, rather than transferring them to larger/urban hospitals.
A health care provider organization considering a telehealth service line should carefully consider which clinicians will staff the service. The particular clinical staffing options available to a provider organization will vary significantly depending on the type of organization and its priorities. A solo practitioner may be able to fit telehealth consultations in between other scheduled patient visits. In larger health care provider organizations, however, such as hospitals or large group practices, the clinicians are likely to be fully utilized, which will either require re-assigning some clinicians to telehealth or using more clinicians at any given time. The particular options available will also depend on which patients are being targeted and whether the telehealth visits are scheduled or on-demand.
There are two main options for health care providers when trying to decide which patients to serve via telehealth – patients who already have a relationship with the provider, or new patients. For existing patients, telehealth may be a good option for follow-up care or scheduled appointments. Alternately, a provider may want to use a telehealth offering to increase the size of its patient panel.
Providers considering a telehealth service will also need to decide whether they are offering the service as a remote version of a typical scheduled appointment or on-demand, more like an urgent care center or emergency department. Most telemedicine services seem to be falling into the latter category (on-demand), although this is more difficult to integrate into traditional clinical workflow for a health care provider with an existing ‘brick and mortar’ operation.
There are two primary non-clinical functions that will need to be accommodated to support a telehealth service – communications and medical record-keeping. In addition, for providers who want to enable scheduled telehealth visits, a scheduling function should be included as well. There are a number of telehealth firms that provide all three of these, operating in many ways like Uber or Lyft, providing a platform for connecting clinicians with patients in an on-demand way and facilitating the communication and medical record-keeping.
At the other end of the spectrum, it is perfectly possible for a health care provider to use existing tools for all of these functions. Some providers use Skype for Business or other secure video-conferencing tools for the communication and their existing medical record-keeping and scheduling tools, whether analog or electronic.
Telehealth is clearly trending and will create competitive threats to many health care provider organizations. While it may be tempting for any health care provider organization to jump on the telehealth bandwagon, whether solo practitioner, large practice or clinic, or hospital, it is important to carefully consider a number of clinical, operational, and strategic factors prior to doing so. With the right approach, telehealth can enable a more traditional ‘brick and mortar’ health care provider organization to hedge against competition from ‘digital only’ telehealth platforms, complement existing clinical activities, and increase revenue.