Why technology isn’t the only component to telehealth success

Human factors and existing workflows are more important than fancy IT, says Judd Hollander, MD.

Healthcare organizations are increasingly looking to adopt telemedicine as a way to provide less expensive care to patients, particularly in a value-based care environment. However, providers may fail to achieve maximum benefits from the technology if they don’t take workflows and human factors into consideration.

That’s the belief of Judd Hollander, MD, associate dean for strategic health initiatives at Sidney Kimmel Medical College within Jefferson University, which includes nine-hospital Jefferson Health in Philadelphia. The organization has been adapting to a new telemedicine initiative for the past 18 months and is beginning to achieve positive results.

Now, Jefferson Health has been live on an enterprise wide, cloud-based telehealth platform, using its own physicians to conduct televisits on a 24-by-7 basis; it offers telehealth services in four states. “Most others outsource with physicians who have never been at the institution,” Hollander says. “We give you a Jefferson doctor.”

Telemedicine vendor Teledoc got the core telemedicine contract, but Jefferson Health chose to use best-of-breed vendors for ancillary products supporting neurology/stroke care, virtual rounds and scheduling visits, among other tasks. The best-of-breed strategy was selected because while Epic is the core electronic health record vendor at the three largest hospitals, decisions have not yet been made on whether the other hospitals that have merged into Jefferson Health will be transitioned to Epic.

There was a lot of overtime for the first 18 months after the telehealth system went live, he acknowledges. However, academic cycles for jobs at Jefferson Health start on July 1 when the organization can hire clinicians and right-size the staffing of the telehealth program.

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From Jefferson Health’s experience, Hollander believes that other providers moving to adopt telemedicine can get caught up in the technology and not understand the changes that come with the new tool for providing care to patients.

Above all, telehealth is not about technology but about human factors and workflows, and the strategy has to fit into current workflows—not new ones, he says. “There’s a way doctors and nurses work, and if you say ‘work differently,’ that’s not going to work.”

With telemedicine comes new capabilities, and vendors may feature esoteric capabilities to dazzle prospective customers. Don’t take the bait, he warns, “and don’t let the vendor tell you what to do.” If the bells and whistles don’t support existing workflows of the hospital or practice, they don’t matter.

Vendors certainly have product and industry expertise and often are ready to give advice, but there should be a limit to their influence, Hollander cautions. He advises healthcare organizations to ask the vendor if they will modify a system to adapt to your hospital workflows, as well as the workflows of ambulatory partners.

For Jefferson Health, that meant detailing to the vendor current workflows across the three core hospitals, affiliated hospitals and ambulatory sites.

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