Enterprise Adoption of Telehealth: An Academic Medical Center's Experience Utilizing the Telehealth Service Implementation Model.

There are numerous challenges to developing and sustaining successful telehealth services and a paucity of guiding frameworks to inform telehealth strategy, design, and ongoing operations. The framework Telehealth Service Implementation Model (TSIM)™ was developed to provide a guiding telehealth framework that enables grassroots innovations and accounts for the many factors and domains necessary for successful telehealth service development, implementation, and sustainment. TSIM includes six phases: (1) Pipeline, (2) Strategy, (3) Development, (4) Implementation, (5) Operations, and (6) Continuous Quality Improvement. TSIM provides common terminology for improved team coordination, checkpoints, and milestones to facilitate scaling telehealth services, and a process to get stalled services back on track. TSIM provides an invaluable framework to assist organizations in developing a strategic vision for telehealth services, designing telehealth services enabled for success, and monitoring for high quality and high reliability.

Preliminary Development of Value Scorecards as ICU Telemedicine Evaluation Tools.

EXECUTIVE SUMMARY: Intensive care unit (ICU) telemedicine has grown exponentially to the point that approximately 10% of U.S. hospitals use such programs. However, no studies have focused on strategic decision tools in the context of rural hospitals. We applied the pervasive balanced scorecard framework and used a sequential, mixed methods design with qualitative and quantitative data sources. We then triangulated them to generate value scorecards for four rural South Carolina hospitals. Four domains, each with numerous components, were identified and compiled to create a composite value scorecard. Domains and numbers of components included organizational (n = 10), clinical (n = 5), financial (n = 8), and strategic (n = 3) effects of ICU telemedicine. When weighting each component within domains and then comparing across hospitals, we identified substantial variation in the relative value derived from ICU telemedicine. Our novel, multidimensional value scorecard could be prospectively applied by hospitals seeking a structured approach to decision-making for ICU telemedicine investments.

Leveraging health system telehealth and informatics infrastructure to create a continuum of services for COVID-19 screening, testing, and treatment.

OBJECTIVES: We describe our approach in using health information technology to provide a continuum of services during the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 challenges and needs required health systems to rapidly redesign the delivery of care. MATERIALS AND METHODS: Our health system deployed 4 COVID-19 telehealth programs and 4 biomedical informatics innovations to screen and care for COVID-19 patients. Using programmatic and electronic health record data, we describe the implementation and initial utilization. RESULTS: Through collaboration across multidisciplinary teams and strategic planning, 4 telehealth program initiatives have been deployed in response to COVID-19: virtual urgent care screening, remote patient monitoring for COVID-19-positive patients, continuous virtual monitoring to reduce workforce risk and utilization of personal protective equipment, and the transition of outpatient care to telehealth. Biomedical informatics was integral to our institutional response in supporting clinical care through new and reconfigured technologies. Through linking the telehealth systems and the electronic health record, we have the ability to monitor and track patients through a continuum of COVID-19 services. DISCUSSION: COVID-19 has facilitated the rapid expansion and utilization of telehealth and health informatics services. We anticipate that patients and providers will view enhanced telehealth services as an essential aspect of the healthcare system. Continuation of telehealth payment models at the federal and private levels will be a key factor in whether this new uptake is sustained. CONCLUSIONS: There are substantial benefits in utilizing telehealth during the COVID-19, including the ability to rapidly scale the number of patients being screened and providing continuity of care.

Utilization of Outpatient Telehealth Services in Parity and Nonparity States 2010-2015.

Background and Introduction: Telehealth is a promising approach to improving healthcare access and quality. While coverage for telehealthcare has expanded, reimbursement remains one of the biggest barriers to provider adoption. Thirty-four states and the District of Columbia have enacted parity legislation requiring private insurance companies to provide some level of reimbursement coverage for telehealth services. MATERIALS AND METHODS: The purpose of this article is to describe the trends in telehealth utilization from 2010 to 2015 for privately insured patients. Using a nationally representative sample of patient data from the 2010-2015 Truven® MarketScan Commercial Claims dataset, we examine the change over time in the utilization of outpatient telehealth visits between states enacting parity legislation and those who do not. RESULTS: We found the states with parity laws saw significant increases in the number of outpatient telehealth visits. Controlling for year, the odds of receiving a telehealth visit in a parity state were 29.8% greater than in a nonparity state (p < 0.0001). DISCUSSION AND CONCLUSION: Telehealth remains a small percentage of all outpatient private health insurance claims. Enactment of telehealth parity legislation is related to significant increases in the utilization of telehealth outpatient services. Further expansion of private telehealth insurance coverage may encourage increased utilization of telehealth services. However, telehealth reimbursement coverage varies greatly across parity states. Future examination of the impact of individual state-level policy options on telehealth utilization is warranted.