A successful telemedicine consultation service involves a significant amount of work in several areas. It requires that the offering organization formally support the service in terms of organizational “buy in” from senior management, clinical department heads, physician and other medical specialists, as well as the legal and billing departments. The service also needs a well-trained and knowledgeable telemedicine team of sufficient skill and size to deliver the service in a high-quality and consistent manner at both the provider and patient sites. Properly designed and equipped facilities at all locations as well as sufficiently high quality telecommunications to support the doctor- patient interactions without distractions must be available. The necessary protocols must be in place to assure high-quality and consistent care delivery. Required legal agreements, business arrangements and billing procedures need to be in place to properly protect patients, providers, the organizations involved and to allow collection of reimbursements from insurance companies and other payors. Record systems must be implemented or modified to record the necessary information required by the payors. Finally, but certainly not of least importance, a plan needs to be in place to track the implementation and impact of the service for the purpose of demonstrating its clinical effectiveness, financial impact, support of the organization’s strategic plan as well as process and quality improvement.

If fortune is smiling on you, you are reading this because your organization has adopted telemedicine as one of its corporate strategies and has already established a budget to get it started and operational. In that case, you already have much of the organizational “buy in” that you need. However, in most cases getting this “buy in” is often one of the most difficult tasks to accomplish in setting up a telemedicine consultation service. Internal marketing requires both educational and political skills as well as a high level of persistence and one must be able to address the interests of a diverse set of audiences. This level of commitment is exemplified by all four of the following:

• Top management and clinical telemedicine champions
• Explicit recognition of telemedicine in the corporate strategic plan
• Dedicated resources to develop and run the program
• An identified position (box on the organizational chart) within the operational hierarchy of the organization.

A senior management champion who understands telemedicine and the benefits both for patients and for the organization that it can provide is a definite advantage, but it is seldom that one emerges unassisted. Most often, active recruitment is needed to seek out such a person. Ideally, this person will have clinical credibility; if not, a physician champion should be identified.

To recruit the champion and to convince the organization that commitment to the telemedicine service is worthwhile requires an educational effort so that all the stakeholders understand the nature of telemedicine. A sound business case is also needed for supporting the services that will be offered. The business case must clearly lay out the advantages and disadvantages of the telemedicine service and specifically identify the expected costs of providing the service along with the expected revenues and costs savings. Once this case is formulated, it is the responsibility of the champions to present this case to management in order to gain their commitment.

In organizations that are somewhat resistant or are skeptical of the benefits of telemedicine, an alternative approach may be attempted. A pilot program that tests and demonstrates the service and its benefits can be a useful. It can provide evidence about effectiveness and acceptance that can be used to build a case to senior management about committing to telemedicine as a corporate strategy.

It is usually wise to seek assistance outside the organization for help in planning and setting up a telemedicine consultation service when this is a new undertaking for the organization or when the service being contemplated is significantly different from those currently offered. For example, if an organization decides to offer a telestroke service when it has previously developed a teleradiology service, it would be to its advantage to seek outside assistance since there is a great difference between the two types of services. Outside assistance may also be necessary when there is no internal expertise in the technologies that are being contemplated for use. Finally, when starting with a first service, external advice regarding legal and regulatory issues, reimbursement and billing can be very helpful.

Please contact your TexLa TRC for more information.

The decision concerning what types of specialty consultations to offer should be based on a match between the types of specialty services needed and the availability and willingness of specialists to provide them. Typically the needs for specialty services are broader than the available specialties, but occasionally the reverse is true. An important difference exists between perceived needs, as represented by opinion or intuition, and actual demand, when patients need to see a specialist and will actually use the service.

Demand is determined by a mix of patients who have problems requiring specialist care, the willingness of local physicians to refer those patients to a telemedicine program and whether or not the patients’ insurance policies include payment for a service delivered via telemedicine.

One can begin by focusing on the perceived needs, attempt to sort out which represents actual demands for services and then recruit specialists who will provide those services. Alternatively, one can first create an inventory of available specialties that the organization can offer and then attempt to determine the demand for those services. Either approach will determine the one or more specialty consultation services that are in sufficient demand to justify offering telemedicine.

There are a number of ways to conduct a needs/demand analysis for a given telemedicine consultation service. These include the following:

• Asking involved healthcare professionals including physicians, nurses and other healthcare personnel about their perceptions of the need and demand for the service.
• Using United States Government statistics to determine if the site exists in a federally designated specialty physician shortage area.
• Working with payers to ascertain the numbers of reimbursement claims for patients in the area that have diagnoses related to the target specialty.
• Working with local health care experts to understand the referral patterns of local physicians.
• Examining the claims data or electronic health record from your own organization to determine the numbers of patients with conditions that are addressed by the target specialty.

It is better to make use of at least two of sources of information to properly understand the true potential demand for services, as opposed to the perceived need. Each of the above sources has its own deficiencies for which other sources can compensate.

While there may be a number of patients in need in a remote site’s service area, the demand for a telemedicine consult service is dependent of the willingness of primary care physicians who care for those patients to refer them to a telemedicine service.

Most of these physicians already have well established referral patterns which may or may not include your organization.

If the local physicians already refer patients to your specialists for care, then it is likely that the demand for your telemedicine consults will be higher. If those local physicians refer to other groups of specialists, it is possible that the need is large while the demand for your service is small.