Electronic Health Reporter

By Robert Annas, chief operating officer, Eagle Telemedicine.

Telemedicine is a booming industry. Hundreds of companies are providing virtual physician visits via videoconferencing technology to individuals at home, at school and in the office. A segment of this market consists of companies that provide telemedicine services to hospitals, so patients can get virtual bedside care from physicians and specialists round-the-clock—a big advantage, especially in rural hospitals hit hardest by the physician shortage.

This telemedicine sector is booming, too. How is it working for hospitals?

Very well. Hospitals report they transfer fewer patients to tertiary care facilities because they have ready access to specialized expertise no matter where they are located. Physicians report they have fewer burnout issues because telemedicine doctors can cover night shifts and fill in other staffing gaps. Patients and their families report widespread satisfaction with this new model of inpatient care.

Nevertheless, there are ways to do it wrong and do it right. When a hospital or health system decides to consider telemedicine, the selection process can be a complicated one. Whether you’re dissatisfied with a current provider and considering a change or looking to start a new telemedicine program from scratch, here are three things to look for to be sure you get the telemedicine partner that is right for you.

1. Determine how care is delivered by telemedicine physicians.

Some telemedicine companies might have dozens of physicians on call across the country to serve the range of their hospital customers. The problem isn’t that they are well qualified. They probably are. The problem is that patients in those hospitals might never see the same telemedicine physician twice during their stay. How does that work?

Nurses have told us that when telemedicine companies furnish “a different doctor a day” or “a different doctor for every call,” it makes it difficult to build a long-term relationship, get to know them and drive better patient care forward. Nurses are an invaluable cog in the wheel of any hospital inpatient program. It’s best to listen to them.

Look for companies that assign a small team or “pod” of six to eight virtual physicians exclusively credentialed for a particular site. Over time, they all become an integral part of a hospital’s clinical team, deeply familiar with a hospital’s specific services, its procedures and its people. The result is more consistent, more personalized care.

This smaller team helps speed the credentialing process, easing the administrative burden for hospitals wanting to start a telemedicine program. It can be a headache credentialing a roster of physicians who might only have a few sessions with patients at the hospital. There’s little return on investment there.

2. Review technology platforms (both existing and new) to gain insight into the right fit for your facility.

Some telemedicine companies align with a particular technology platform. They often require hospitals—many of which might already have some type of telemedicine technology in use—to move to their platform. That’s not the best way to start a telemedicine program.

The best telemedicine companies don’t dictate; they adapt. Telemedicine companies should be able to integrate with a variety of EHR and third-party software platforms so that remote consultations can be automatically documented in the EHR, minimizing duplicate entry of physician notes.

Of course, telemedicine companies can recommend platforms to hospitals looking to provide telemedicine care to their patients and give valuable guidance on which ones would be the best fit for the hospital. But if a hospital already has a platform set up, it should look for a company that can run with it.

Especially for health systems implementing telemedicine programs across several hospitals, it’s best to find a provider whose physician team can smoothly transition from one site to another, one technology platform to another, so they can quickly access hospital schedules, doctors and nurses onsite or on call, as well as details about the unique operational procedures of each hospital, and securely make updates to each patient’s EHR.

3. Look for physicians with onsite experience.

Some telemedicine companies staff with family practice or internal medicine or specialty-boarded physicians who may not have been in the inpatient environment in recent years or present with little inpatient experience.

This lack of experience can contribute to continued patterns of transfers from the Emergency Department (ED). Local patient retention would be higher if more experienced physicians and/or specialists were on hand to provide telemedicine care.

Look for a company that staffs with telemedicine physicians who have had previous on-site, on-the-ground experience. With this experience, we find retained patient volume grows. Through the development of clinical workflows in collaboration with on-site clinicians and the nursing team, experienced physicians working through the telemedicine program can help hospitals retain a higher level of patient disease acuity.

This not only can result in more satisfied patients and families who don’t have to drive long distances to visit their loved one, but in hundreds of thousands of dollars in additional gross patient revenues for hometown hospitals.

The Metrics That Matter

The best telemedicine companies don’t just start your program to solve a staffing issue and move on. They’re interested in more than that—namely, what kind of metrics they will share over the long term regarding the program’s success.

The metrics could include such factors as door-to-needle time for a telestroke program, transfer reduction for a Tele-ID (infectious disease) program, or improved average daily census for a standard telehospitalist program. The telemedicine company should also offer frequent “huddles” with clinical teams onsite to pinpoint any trouble spots and fix them.

The key is to find a telemedicine company that will partner with you not just to deal with an immediate problem or crisis, but to offer a strategic, physician-led solution that improves your hospital’s overall performance.