Making telemedicine work is often no easy process, but officials from Boston-based Partners HealthCare, a longtime leader in connected health, believe they've done it. So what's their secret?
Sarah Sossong, Mass General's director of telehealth, offered four guidelines for clinical adoption of telehealth:
Focus … but stay nimble. Sossong said she and her colleagues tried out every new idea during the first few years, before realizing they were trying to do too much. Now they're looking for projects that serve a specific need or solve a specific problem, she said. But they're also open to new ideas, provided they have a solid foundation under them
Don't reinvent the wheel. If an mHealth or telemedicine project changes what's already working, don't bother. Create toolkits that can be used in multiple projects across multiple departments, to streamline the process.
Align financial incentives. Sossong admits it's "really challenging" to line up those incentives, particularly when different states and the federal government reimburse for some telehealth encounters but not others. She suggested having the health system set aside a small pool of money to reimburse clinicians who, for instance, conduct virtual visits.
Make the technology disappear. Telehealth, telemedicine, mHealth and all the other terms being used these days don't refer to the technology – they refer to the connections created between doctors, consumers and other members of the health team. If the tools and toys are getting all the attention, you're missing the point. "I love my technology – I love my technology, people, but sometimes it still does feel like we're in a science fair," Sissong said.
[See also: Telehealth spurs big changes in care.]
Michael Carter, Partners HealthCare's enterprise manager of video and telemedicine systems, offered a few observations from a higher level. When looking out over the entire health system, he said, administrators should:
Integrate with something that clinicians use every day.
Make the process easy – the easier, the more likely it will be adopted into the workflow.
Understand how this affects the consumer.
Realize that the cloud is not necessarily the better option.
Expect failures and challenges and several iterations, and learn from them.
Maulik Majmudar, associate director of Mass General's Heart Center Innovation Lab, pointed out that telehealth initiatives are fighting an uphill battle these days with other system-wide projects, such as EMR
implementations or the bumpy transition from ICD-9 to ICD-10
"It's a new technology," he said. "There's a learning curve, and there are a lot of requirements of physicians nowadays."
To that end, Taylan Bozkurt, an operations and financial specialist in Mass General's Department of Surgery, advised those just launching a telehealth project to "don't let your goal blur your path to success." Make the process gradual and inclusive, he said, and don't be afraid the challenge assumptions – "stress the system but don't break the system," he said.
"Telehealth isn't a quick process improvement project," he said.
In terms of creating a curriculum for telehealth success, Majmedar pointed out that no one is teaching telehealth at the medical school level, so the industry is basically training itself. And in a nod to the many competing health networks in the field, Joseph Kvedar
, the director of Partner's HealthCare's Center for Connected Health, noted the industry is young enough that everyone can collaborate and benefit.
Kvedar added one last bit of advice. Because the industry is so new, he said, it's not easily accepted by clinicians, who have their workflows and don't want to mess with their routines. They need to be prodded – sometimes reluctantly – into telehealth.
"It's scary for clinicians," he said. "But that probably means we're in the right space."