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Telemedicine

How to deploy a telehealth strategy for your practice

Depending on your organization’s maturity and preparedness in addition to availability of providers, you can offer some or all of the following telehealth services. You need to consider:
1. Services you are going to offer via telehealth
2. Telehealth technology platform of choice
3. Reimbursement for services rendered
4. Clinical workflow (re)configurations

There are a few moving parts that you or your practice administrator would need to consider.

  1. Services you are going to offer via telehealth
  2. Telehealth technology platform of choice
  3. Reimbursement for services rendered
  4. Clinical workflow (re)configurations

Telemedicine services you can offer

Depending on your organization’s maturity and preparedness in addition to availability of providers, you can offer some or all of the following telehealth services.

Colon and Rectal Diseases

You can evaluate pre and postoperative patients using televisits (econsults). This allows you to offer surgical management of colorectal cancer, diverticular disease, inflammatory bowel disease as well as management of specific types of benign colorectal diseases. If medical necessity of surgery is deemed necessary, you can even offer video consults up until the day before of the actual surgery.

Dermatology

You can utilize store and forward telemedicine technology to offer remote medical care for complicated dermatology cases to others that do not have dermatology coverage. Using the right technology, images and clinical information can be transmitted to your facility for your readers to interpret and evaluate the images. The reader (your clinician) can then interpret and send their diagnosis back, with full documentation.

Mt Sinai hospitals has had success using the same with furthering education of fellows and residents as well.

Emergency Care and Trauma

Real-time video evaluation allows your trauma specialists to render timely and effective treatment for patients if they are in remote or rural areas (definition by HRSA). Your trauma specialists can offer this service as an assistance with triage and transfer decisions

Intensive Care

If your providers have the clinical workflows set up well, you can provide team-based solutions for ICU shortages at neighboring hospitals. This helps reduce ICU complication rates and therefore the length of stay as well by teaming up with bedside physicians. This service typically uses Video Conferencing equipment and technology (econsults).

Maternal-Fetal Medicine

Your providers can be made to collaborate with obstetricians and primary care physicians of at-risk, high-risk, or complicated obstetrical patients with known medical problems in pregnancy, such as seizure disorders, clotting disorders, Thyroid disease, chronic hypertension, Gestational diabetes etc. These consultations can be provided before and during pregnancy, offering collaborative approaches towards patient management recommendations. Using store and forward telemedicine platforms, you can receive patient records for review upfront and thereby triage patients to telemedicine consultation, if appropriate, based on their condition. The referring provider, local to the patient, can continue providing care to the patient while collaborating with you and your providers.

Ophthalmology

You can use two modalities for these services and therefore, offer ophthalmic consultations, testing and interpretation services, retinal screenings for diabetic retinopathy. Real time audio/visual (evisit) consultations allow you to offer your services to providers without ophthalmology coverage. Meanwhile, using a store and forward platform allows your board certified ophthalmologists / retinal specialists to offer screenings for diabetic retina disease in PCP offices.

Pathology

Whole slide imaging consults can be offered by using store and forward technologies. In this mode, the requesting physician takes whole slide digital images, uploads these images to your telemedicine portal for your physicians to interpret and revert back with the pathology report. 

Pediatrics

Pediatric physicians are not that easy to employ. If you do happen to have some on staff, you can offer televisit services for urgent, emergent, and scheduled outpatient needs of young patients. This helps tremendously with missed work and school days (the biggest reasons for no-shows)

Psychiatry

These are one of the easiest ones to administer as you can use econsults with just audio as well. Simply by using an appropriate telemedicine platform, your mental health professionals can offer telemedicine services to facilities without in-house psychiatrists

Radiology

Teleradiology has been around for a while. Typically store and forward technologies are used to offer coverage from board certified radiologists to facilities without specific radiologist coverage. This service becomes even more critical when subspecialist radiologist coverage is needed.

Remote Monitoring

This usually involves higher levels of investment in telehealth enabled devices. However, once an investment is made in such equipment, you can offer remote monitoring and care for at-home patients, for chronic care management. Usage of telehealth equipment helps to promote proactive patient self-care. These devices also help with monitoring patients’ key measures, and enabling physicians to follow their patients’ health.

Rheumatology

If you have rheumatologists on staff, you can easily utilize econsults for patients with Rheumatoid Arthritis, Psoriatic Arthritis, Osteoarthritis, Lupus, Sjogren syndrome, Vasculitis, Scleroderma, Myositis. More importantly, this also allows you to engage and manage chronic rheumatologic diseases and provide the needed follow up care.

Stroke

For this, you need to use econsult technology. This allows you to perform assessments of stroke patients and provide consults in real time about using IV TPA. Using store and forward technology, your specialists can view CT scans and help ED physicians determine candidates for acute stroke therapy, including intravenous TPA.

Surgery

Using econsult (audio visual) technology you can provide telesurgery services that are pre and post operative consultations. You can offer pre anesthesia and preoperative clearance prior to surgery. You can also offer post operative follow up care for Bariatric Surgery, Cardiothoracic Surgery, Endocrine Surgery, Foot and Ankle Surgery, Neurosurgery etc. 

Wound Care

Wound care typically uses both modalities – store and forward plus audio/visual (econsults). Your specialists can provide remote consults for patients with poorly healing wounds and also assist with review of images to reduce patient transfer rates.

Next, let’s look at the Telemedicine Technology needed for offering telehealth services


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