Any telehealth program, no matter the organization’s size, staffing structure, or patient demographics, is meant to be a system that will engage patients in their own care, empower them to improve lifestyle habits, and take more control in managing their condition(s). In working to achieve these goals, the question becomes: what are some practical steps that healthcare providers can take at the beginning of a telehealth enrollment to increase patient engagement in the short-term and patient empowerment in the long-term?
Operating with a Clearly Defined Eligibility Criteria
Before launching a telehealth program, it is crucial to define sound eligibility criteria and periodically refine the criteria based on practical experience. Telehealth is not a one-size-fits-all solution; in order to avoid wasting resources, the program should be tailored to respond to the needs of patients based on cognitive/physical abilities, home environment, social determinants, caregiver support, and the patient’s willingness to consistently and thoroughly participate.
The organization will want to be sure that patients selected for the telehealth program are those who would benefit most. Using an EMR’s algorithmic risk assessments, LACE scores, or Strategic Healthcare Programs’ hospitalization risk levels, a successful program will focus on enrolling moderately at-risk patients who can still be helped to integrate new lifestyle strategies for self-management rather than high-risk patients whose cognitive and/or physical conditions likely cannot be improved via telehealth.
The Critical Nature of the Installation Visit
In addition to a sound set of eligibility criteria, emphasis should be placed on a well-considered protocol for introducing a patient to the program. Once an appropriate patient has been identified, the quality of results that the patient and clinical team achieve hinges on the quality of the patient’s very first telehealth experience: the more clearly patients understand what the program is, why they are being selected, and how the system works, the more likely they will be to reach their goals and the program as a whole will be to succeed. There are a few key aspects to consider towards enhancing a patient’s engagement with the program.
Caregiver Engagement: Whenever possible, schedule the installation visit at a time when a caregiver is available to receive the same introduction to the program and instructions for equipment use as the patient. This will decrease any patient anxiety about having to learn a new type of technology and strengthen the network of stakeholders who are committed to the patient’s success. Furthermore, both the patient and the program will benefit greatly if the caregiver has a way to remotely check the patient’s daily telehealth adherence and communicate with the patient. These two aspects of caregiver involvement increase the patient’s accountability in staying adherent to the program and decrease the amount of non-clinical adherence-related outreach that an agency needs to perform.
Staffing for Installation Visits: There are two ways to approach telehealth equipment installation, each with its own set of pros and cons: either A) a clinician can conduct the installation, or B) a non-clinical installer can initiate a patient’s enrollment in telehealth. With the first model, clinically-trained staff are qualified to answer medical questions and provide education at a higher level than most per diem installers. However, from a program-specific education perspective, it can be more difficult to keep a full team of nursing staff trained on how to do a telehealth setup as opposed to teaching one or more installers how to do it. In either case, creating an installation checklist will help ensure consistency and quality of installations.
By designating a non-clinical installer, an agency can benefit by allowing its clinical staff to remain focused on their clinical work. The installer is able to take the necessary time with a new telehealth patient, having already honed the specific language needed to not only walk the patient through use of the equipment but, also importantly, frame the program’s objectives and drive home the organization’s message without feeling pressed for time on a tight visiting schedule.
As Travis Tomulty, Regional Care Transitions and Telehealth Manager for Eden Health explains, “If you’re conducting the installation without believing in the program, or you’re rushing the setup and education process, patients will immediately be able to tell and will probably not be as successful as they could be under better installation circumstances.” It is also good practice to provide the patient with a clear and succinct packet of important information about the program, including the best ways to communicate with the telehealth team, how to record metrics, and agency-specific details. Many successful programs have taken this informational material a step further by creating a custom “intro to telehealth” video that patients can watch during the installation visit.
When you consider the clinical versus non-clinical installer methods from a financial perspective, determining which approach is more cost-effective depends on a variety of agency-specific details, including travel time and costs within the service area, size of patient census, and number of telehealth patient enrollments. It can be argued that it’s cheaper to go with clinical installers since no additional staffing is required. However, installation visits conducted by non-clinical per diem staff can reflect increased productivity in the clinical team’s capacity to care for more patients
Video Calling: After explaining the telehealth system and helping the patient to record his or her initial readings, another best practice is to introduce the patient to virtual visits during the installation. The installer should prepare the patient to participate in a video call, then contact the main office to have an onsite clinician initiate the video call. Given the numerous benefits of video conference capabilities between clinicians and patients including visually-based symptom triage, patient condition education and anxiety reduction, and agency cost-avoidance opportunities, it is a good idea to introduce patients to the concept of video calling at the outset of the patient’s enrollment, so that he or she can know what it looks like to receive a video call and what it feels like to be involved in one. Conducting the first video visit while the installer (and ideally a caregiver) is with the patient helps to ease any concerns. This also frees the clinician placing the call to focus on addressing program goals and compliance expectations, receiving the patient’s feedback about personal goals and questions, and reinforcing the virtual visit as a way to make the patient’s care as convenient and comfortable as possible.
As Sarah Foley, RN, BSN and Director of Marketing for the Visiting Nurses of the Lower Valley succinctly puts it, telehealth services help to “build a partnership” among many stakeholders, not least of whom is the patient. Having clear criteria and proper protocols in place before and during the installation visit will help ensure the strength of that partnership, increasing the likelihood that the patient will take the program as seriously as his or her clinicians and caregivers expect.