Telehealth projects look different depending on the healthcare organizations putting the technology to work and the goals they're hoping to achieve, said Sue Schade, former CHIME-HIMSS CIO of the Year and current principal at StarBridge Advisors on Tuesday.
She should know. Recent years have seen her working at four major health systems with four different strategies and priorities for rolling out virtual care capabilities: Partners HealthCare, University of Michigan Health System, University Hospitals and Stony Brook Medicine.
Along the way, Schade has learned some lessons about what it takes to get a program launched.
Most people think of telehealth as a useful innovation for remote or rural areas, but as was emphasized over and over at the HIMSS Pop Health Forum, where Schade spoke this week, one of the biggest challenges to population health is often a lack of reliable transportation options, even in busy metropolitan areas.
Schade's previous employers – in Boston, in Ann Arbor, in Cleveland, on Long Island – showed that telehealth could be a valuable tool for patient engagement in urban or rural settings alike.
But each health system had its own unique set of challenges and opportunities as it worked to get remote care initiatives up and running.
At Boston-based Partners HealthCare, where Schade was CIO of Brigham and Women's Hospital for more than 12 years, the program was pioneered by innovators such as the renowned Joseph Kvedar, MD, founder of Partners' Center for Connected Health.
There, program leads did "a really good job connecting innovators with the operational leaders – to try to find out what kind of problems they could solve with the various solutions they were able to test and deploy," said Schade. "You really had a model there of an innovation center connecting up to operational issues."
At Michigan Medicine, formerly known as University of Michigan Health System, Schade worked for three years at a world-class academic medical center that employs "some of the best physicians, specialists and subspecialists" and served patients from every county in the state.
But one challenge there, she said, was that a more "academic approach to telehealth" was often built on existing departmental services that were each "doing something on their own, supporting it themselves with their own tools but not looking to coordinate or leverage any central program," said Schade. "They struggled with the strategy, how to organize, who should lead it."
Another lesson there had to do with electronic health records, she said. The health system is on Epic, but had to interact with "so many more institutions (that) didn't have Epic," she said.
The lesson: "If you're going to leverage your core EHR for your telehealth work – which I encourage you to look closely at doing – take it as far as you can, but it will only go so far and you will be working with other institutions in the geographic area that don't have that same EHR, just as you do with HIEs."
At Cleveland-based University Hospitals, where Schade spent eight months in 2016 as interim CIO, said one of the motivators for telehealth success was to keep pace with the ever-innovative hometown competition, Cleveland Clinic.
UH had an emerging program, had instituted governance and had several pilots, she said, but "the challenge was having a clear strategy and program that was right for them – and not just thinking about the competition and that they were trying to keep up with the Cleveland Clinic."
At Stony Brook Medicine, in the middle of Long Island, the key was also to ensure the program was the right fit for its own goals. The health system tended to focus on populations on the eastern, more rural half of the island (compared with competitor Northwell Health, which primarily serves patients in denser Nassau County and into Queens).
Schade spent five months as interim CIO at Stony Brook earlier this year, and said a key driver was "having a strategic view in their east-looking strategy" and tailoring their program accordingly, she said. "Where does telehealth fit into their population health goals for that community?"
Know your goals, get docs on board early, use a common platform
That, said Schade, was one of the key takeaways for anyone considering launching a telehealth program. Don't do it just for the sake of it – know what you want to achieve, and how you want it to fit into your hospital's larger mission.
"You really need to focus on strategy," said Schade. "Understand what your business drivers are. And from that specific programs will become clear."
Another must-do? "I can't emphasize enough the importance of physician leadership," she said. "They are the ones delivering care, they will be the ones delivering any forms of telehealth, so they really need to be in the middle of it. IT cannot lead, it has to be a partnership."
Foresight and strategic planning across the enterprise are critical, said Schade.
"A lot of planning goes on. You need to form your oversight group, you need to identify what your priorities are. It's important that you bring in the right operational people from a billing and reimbursement (and) legal perspective. People who manage access. All of those folks need to be at the table and part of this."
As for technology, "it's very important that you look at a common platform and tools." At Michigan Medicine, "a lot of activity was already going on," she said. "You to inventory in a situation like that: Who's already doing what? What tools are they using? What services are they providing? Can we bring that together, can we consolidate?
"And then how are we going to leverage the core EMR vendor?" she added. "All EMR vendors, they may be in different places, but they're all trying to something in this space. So you need to figure out where they are, what their roadmap looks like and how far you can take them before you start bringing in a lot of bolt-on products."
Ultimately, said Schade, "you need to commit and invest. This cannot be a one-off or a hobby. It takes time. It takes money. Pilot, then scale up. There's a lot behind the scenes that needs to get done and invested in. In terms of an overall budget, the whole area is kind of fluid. So you need to have some kind of placeholder, baseline budget to start with and then let it evolve over time."