Setting Up a Telehospitalist Program

Written by Andrew McWilliams

Previous blog posts have tried to help you to decide whether a telehospitalist program is right for your hospital. Assuming you have decided that it is, what should your first steps be? In this post, we provide a road-map for setting up a your telehospitalist program, which includes:

  • Establishing an interdisciplinary steering committee
  • Defining program goals and metrics
  • Analyzing legal/regulatory issues
  • Determining telehospitalist impacts on hospital workflows
  • Selecting a technology platform
  • Organizing staff training
  • Developing a business plan
  • Seeking further help, if needed

Establish Interdisciplinary Steering Committee

Setting up a telehospitalist program is a complex undertaking, involving many hospital units such as clinical services, information technology, legal, and finance. One of your first steps should be to set up a cross-disciplinary committee including representatives from all involved departments, whose job it will be to steer the telehospitalist program from its inception through its implementation.

Define Program Goals and Success Criteria

One of the committee’s first tasks will be to develop a prioritized list of the goals that it wants the telehospitalist service to achieve. Examples include:

  • Reducing the burden on existing hospital personnel
  • Facilitating staff recruitment and retention
  • Improving overall quality of care at the hospital
  • Making the most efficient use of hospital resources
  • Reducing rural/urban bypass and Increasing inpatient census

The committee should also define the quantitative performance metrics and bernchmarks that will be used to demonstrate the program’s value and measure progress towards meeting its goals. Where necessary, tools should be developed to collect and analyze data on program performance.

Determine and Stay Abreast of Legal and Regulatory Developments

The legal and regulatory landscape for telehospitalist services recently has undergone, and continues to undergo, seismic shifts. These shifts impact areas such as liability, licensure, and especially, reimbursement.

Medicare has temporarily waived restrictions on reimbursements for telehealth services, including telehospitalists, for the duration of the COVID-19 pandemic, and private insurers have followed suit. While is unlikely that insurers will re-impose the same restrictions on reimbursements for telehealth services what they had before the pandemic, the committee needs to understand the present reimbursement rules in detail, as well as stay current of any changes that are being discussed.

Determine Telehospitalist Impact on Hospital Workflows

During the planning phase, it is important to identify how telehospitalist services will fit within the hospital’s workflow. The committee should identify the resources or care pathways that might be impacted by the telehospitalist program. Some workflows might need to be slightly altered, while others may need dramatic changes that require more time for design and training staff.

For example, while nurses traditionally have had to contact the on-call doctor when a patient shows signs of declining, they will assume more care management responsibilities on a telehospitalist platform. Guided by a telehospitalist at the other end of the telemedicine platform, they will be more active in a patient's care.

Select the Right Technology Platform

Selecting the right technology platform for the telehospitalist program requires careful consideration. Before evaluating alternative platforms, it is important for the committee to define the capabilities that are needed to achieve the program’s objectives in the near term, as well allow for the future growth and expansion of the effort.

Clearly articulating the technology requirements of the telehospitalist program will assist platform vendors in proposing a suitable technology solution. Minimum requirements include (but are not limited to):

  • HIPAA compliant
  • Maintains sufficient connectivity
  • Establishes minimum bandwidth needed by platform and location
  • Offers available necessary bandwidth at peak times
  • Prompt speeds for upload and download capabilities

Of course, there is the issue of cost. In addition to upfront costs, there are also ongoing costs that are a function of:

  • Warranty
  • Services
  • Upgrades

When comparing proposals, the committee should for references from similar hospitals, seeking input on each vendor’s strengths and weaknesses, and their platforms’ performance under real-world conditions.

Organize Staff Training

Staff support and buy-in will be key to the telehospitalist program’s success. An effective training program will help mitigate staff concerns about operational process changes. In particular, the committee should be sure that the staff are properly trained in using the telemedicine equipment and are comfortable with the new service. All users should be provided with camera etiquette training prior to implementation.

Develop a Business Plan

One of the committee’s core responsibilities is developing a sound business plan. The business plan should reflect the overall goals of leveraging the telehospitalist service cost-effectively to achieve the hospital’s goals. The business plan should include:

  • Description of the program
  • Program goals and objectives
  • Required investments and additional resources
  • Projected benefits
  • Cost/benefit analysis
  • Risk analysis
  • Budget, to include all expenses and revenues during implementation period and first full year of operation

The business plan should incorporate a risk analysis to identify and quantify the possible financial impacts of deviations from the baseline scenario, such as failure of the technology platform to perform as promised or major changes in reimbursement policy.

Getting Help

All of the above may seem like a tall order for a small hospital, but you should know that technical as well as financial assistance is available from sources such as the Telehealth Resource Center Program and the Telehealth Network Grant Program. These and other sources of assistance will be the focus of a future blog post.

Tags: Telehospitalist ,Services ,Hospital ,Impact ,Recruiting

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