Virtual care aligns with strategic imperatives to improve health outcomes, enhance patient safety, and optimize the patient experience for populations with medical complexity and high healthcare needs. As a result, it will pay off if healthcare can continue the expansion of telehealth started by the COVID-19 pandemic.

One driver of successful expansion of virtual care services is open communication and collaboration with key stakeholders on important initiatives that impact the virtual care process, said Dr. Saima Aftab, vice president, strategic initiatives, at Nicklaus Children's Hospital in Miami, Florida.

Sustaining quality telehealth programs

"Stakeholders include internal and external customers, our patients, families and providers," said Aftab. "Selection of information and technology tools, video platform enhancements, and process improvement initiatives are keys to growing and sustaining quality telehealth programs. 

"The COVID-19 public health emergency flexibilities and waivers, including expanded reimbursement, were pivotal facilitators that led to the rapid scaling of virtual care services and allowed patients and providers to truly explore and adopt virtual care," she said.

While the pandemic was useful for understanding and overcoming telehealth barriers, having a defined virtual care workflow and framework in place has shown to be a best practice for a successful encounter, she noted.

"Once providers are equipped with hardware and software needs and standardized virtual care workflows are implemented, providers can focus on patient education and creating a meaningful experience," said Aftab. "Telehealth will play a pivotal role in the healthcare delivery system. The ongoing success of telemedicine will be dependent on reimbursement parity and connectivity in the form of access to high-speed internet."

To make progress, healthcare provider organizations will need telehealth data-driven and EHR-based clinical research, databases and tools, she contended.

Meaningful data, measured and analyzed

"Virtual care does not advance without meaningful data that is measured and analyzed for lessons learned on quality of care, cost and experience," she said. "Successful programs use telehealth technologies for clinical decision making, and databases and tools to further grow the program."

Nicklaus Children's Hospital developed a technology roadmap and implemented telehealth platform enhancements with a focus on interoperability and integration with its EHR. This, along with other technologies, will be used for clinical decision making.

"We are working on establishing a robust research program with core foundational infrastructure and resources," said Aftab. "We developed a dashboard to streamline data capture and support analysis of data to study health outcomes and translational clinical efforts in virtual care. 

"The objectives are to support telehealth scientific discovery and pioneering investigation, and provide a platform for researchers, physicians and all healthcare professionals to study outcomes and translational clinical efforts in telehealth," she added.

As new technologies, such as remote monitoring devices, mobile devices, sensors and others, become prevalent, technology-driven healthcare services will grow, she said.

Applying predictive analytics

"As we begin to collect and store telehealth data in a standardized format, opportunities arise to apply predictive analytics," Aftab observed. "Data collection and integration of documentation also help measure important outcomes such as improvements in access to care."

Aftab said that patient-centered technologies and techniques for advanced data sharing and visualization used to measure telehealth key performance indicators (KPIs) and effectiveness of process improvement methodologies also will be of importance.

"Patient-centric technology applications are essential to consumer adoption and creating an effective telehealth program," she said. "Telehealth is a disruptive technology that reduces costs and has the opportunity to increase quality and patient satisfaction. Patient engagement and experience, listening to the voice of the customer, must be at the forefront for scaling telehealth services."

Provider engagement also is critical, including training programs and standardized processes, which must frequently be reviewed and modulated based on feedback, she added.

User support and resources

"Telehealth user support and resources should be provided through various avenues," Aftab said. "For example, enhancements were made in the dissemination of best practices such as a new digital workplace/communication site. Sharing educational tools, manuals and guides on patient-facing websites and employee intranet also are effective strategies."

Key performance indicators related to patient and provider engagement have been critical metrics in measuring the success of telehealth services.

"These included the effectiveness of training programs and standardized processes," Aftab said. "A multidisciplinary team collaborated to ensure optimal access and facilitate a comprehensive and coordinated approach to care. More than 350 new providers in 24 pediatric specialties were trained on the telehealth platform and were engaged in virtual care.

"An important part of the process improvement journey was developing a control plan and formalized document that monitors metrics to make adjustments as needed for constant process improvement and sustainability," she continued. 

"A telehealth dashboard was developed for clinical and research data collection and application of advanced data visualization tools and techniques, which will support research initiatives and tracking of KPIs."

A control plan allows for organization-wide accountability and ensures the implementation of a meaningful virtual care program, she added.

Continuous process improvement journey

"The organization's continuous process improvement journey and goal to understand, streamline and automate processes incorporated state of the art technologies," Aftab said. "Tools included and were not limited to application programming interfaces, Erlang-C, machine learning, natural language processing, SMS text and business intelligence data analytics.

"Other KPIs measure enhancements to the telehealth platform for optimal data sharing, interoperability and data integration focused on supporting EHR-based clinical research and optimizing clinical workflows and processes."

Call Center analytics tools were developed to monitor call center metrics such as call volumes, service level and abandoned call rate.

"The formula 'Erlang-C' was used to predict call center load and determine appropriate staffing to meet service levels," she explained. "Service level goal was determined to be 80% of calls answered within 30 seconds based on industry standard, and the goal was exceeded at 97-99%. Other metrics tracked and exceeded included reduction in abandoned call rate for the call center and percent of dropped video calls."

Aftab will offer more detail during her HIMSS21 session, "Using Technologies and Data to Drive Telehealth Excellence." It's scheduled for Aug. 10, from 2-3 p.m. in Venetian Lido 3104.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
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