Five Challenges of Telehealth Implementation in Large Health Systems
Abena Ansah-Yeboah  |  January 21, 2018
Telehealth, defined broadly as an array of digital technologies used to conduct activities of healthcare[1], continues to attract the interest of large e-health systems that seek to reap the potential benefits of improved workflow, better clinical outcomes, and reduced costs offered by telecommunication services. Technologies such as video conferencing platforms, mobile health (mHealth) apps, and wearable devices (e.g. Apple Watch, FitBit, etc.), leverage the prevalent use of electronics amongst Americans to allow for remote patient monitoring (RPM) to securely collect, transmit, and evaluate patient data without the obstacles of distance and limited accessibility. The adoption of a new digital platform by a health system typically begins with a pilot, which can take anywhere from six months to one-and-half years to plan and execute[2]. However, once these pilots show success in clinical and financial outcomes, they are often not implemented into a given hospital’s IT system. What factors constitute to the disconnect in transitioning between pilot and full-scale implementation for telehealth platforms and how can they be addressed? Insight from electronic health (e-health) teams at four large health systems — Emory Healthcare, Jefferson Health, Massachusetts General Hospital, and Michigan Medicine — describing their nuanced experiences implementing telehealth initiatives was summarized into a list of the five most common challenges and effective solutions.
1. Engaging Leaders
  • CHALLENGE: Executives have varied opinions on the alignment of telehealth with their health system’s strategic vision and how much to financially allocate towards resources for expansion.
  • SOLUTION: E-health teams must prioritize presenting tangible results during the early piloting period to health executives that clearly demonstrate how telehealth initiatives can advance the health system’s mission. This can be done by proving how the initiative can:
    • Expand coverage of providers
    • Boost physician productivity
    • Improve patient access and experience
    • Reduce wait times and clinic congestion
    • Integrate easily into existing health infrastructure
2. Prioritizing Initiatives
  • CHALLENGE: E-health teams can easily be overwhelmed with a large volume of different telehealth initiative requests by interested clinical departments.
  • SOLUTION: Create a framework of guiding principles that assesses and prioritizes each successful pilot across a standard set of domains to determine which telehealth initiative to devote time and resources. For example, the following four domains could be used rank each initiative and determine its suitability for a given health system:
    • Alignment with hospital priorities
    • Magnitude of impact
    • Resource requirement for implementation
    • Readiness of hospital, department, or team for program
3. Engaging Physicians and Staff Team
  • CHALLENGE: Some clinicians and administration members may view telehealth implementation as a disruption to their current clinical practices and workflow.
  • SOLUTION: E-health teams should develop tactful strategies that persuade staff to advocate for telehealth expansion and promote buy-in. This can be achieved by doing the following:
    • Designating telehealth champions at each staff level (i.e. executives, clinicians, nurses, and clerical staff) that encourages employees to model the behavior of their colleagues.
    • Allowing clinicians to identify specific areas in which their practice could benefit from telehealth, and molding the rollout and application of the program to fit their needs.
    • Incentivizing staff members who are engaged in telehealth initiatives with opportunities, title promotions, and/or financial rewards.
4. Enrolling & Educating Patients
  • CHALLENGE: Newness and unfamiliarity of telehealth programs can result in poor enrollment and engagement across a heterogeneous patient population.
  • SOLUTION: Patients must be educated about the general value and technical components of telehealth in order to make adoption easy and user-friendly. The following methods could be used to minimize patient confusion and encourage telehealth use:
    • Creating an interactive, user-friendly website.
    • Mirrorring online processes (e.g. scheduling, reminders, cancellations) to in-person processes.
    • Designating a telehealth coordinator to assist patients with questions and/or concerns about the telehealth program or device.
5. Evaluating Outcomes
  • CHALLENGE: Proving return on investment to health executives poses great difficulty with poor evaluation of outcomes.
  • SOLUTION: E-health teams should create specified areas that telehealth outcomes can be measured within. The National Quality Forum published a framework that outlined the following four domains upon to base outcome evaluation:
    • Access to care
    • Financial impact and cost
    • Experience
    • Effectiveness
    Consistent review of important metrics and execution of quality improvement (e.g. conducting physician and patient interviews to gain direct feedback on experience with the software and/or devices) is also essential to proving the value of telehealth initiatives by demonstrating that positive outcomes can lead to investment returns.