General Tips in Telehealth Implementation

Workflow and Practice Management Strategies

• Identify telehealth practice champions.
  • These are individuals within a practice that can serve as a point of contact for families/caregivers on any questions related to telehealth platforms.
  • These individuals can also train other staff on telehealth software, policy, and payment.
  • In some practices, these champions also take the lead on scheduling all telehealth appointments and updating workflows to support telehealth implementation.
• Implement a flexible scheduling model for telehealth appointments, which allows families/caregivers to schedule appointments in advance as well as to hold “virtual walk-in” appointments.
• Select telehealth platforms that can work with computers as well as smart phones.
• Set up virtual waiting rooms.
• Set up pre-appointment huddles with the practice staff team.
  • These daily huddles can occur before a telehealth visit day in a practice.
  • Clinicians and support staff convene together to discuss upcoming telehealth patient visits and address any foreseeable challenges.
  • This strategy can support care coordination and team-based communication.
• Create a list of high-risk patients and proactively reach out to them to inform them of telehealth options. This proactive outreach can help encourage continuity of care especially during a public health emergency.
• Adjust practice workflows through some of the following strategies:
  • Hold a pre-meeting with families/caregivers to prepare them for the telehealth visit and orient them to the telehealth platform.
  • Add reminders for families/caregivers in advance of telehealth visits so they are aware the visit is occurring virtually.
  • Provide additional training for families/caregivers so they can take vital signs at home and/or assist the clinician in conducting a physical exam via a video visit.
  • Use language interpreters during telehealth appointments to support cultural competency and language access. This may require some additional time for front desk/administrative staff and clinicians to integrate interpreters into the platform and ask families/caregivers in advance of a visit if an interpreter is needed.
• Train staff and clinicians on various aspects of telehealth implementation, including the following:
  • How to operate the telehealth platform
  • How to trouble shoot during a visit
  • How to bill for a telehealth visit

Family Partnership and Engagement Strategies

• Train practice staff to support families in navigating telehealth services.
  • Develop talking points and communication strategies to communicate information to families/caregivers about a practice’s telehealth offerings.
  • Develop step-by-step instructions/directions that families/caregivers can use in order to connect to a telehealth platform.
  • Have a “mock” telehealth session with families/caregivers to practice using the telehealth platform in advance of a visit.
• Provide support to families/caregivers in how to use the patient portal. This can enhance communication between clinicians and families, and be used to support referrals, family/caregiver education, and answer questions from families/caregivers.
• Support flexible telehealth visit options, including audio-only visits, especially for families/caregivers who may not have reliable access to internet.
• Utilize text messages to send reminders and information to families/caregivers about access telehealth visits.
• Provide options/information on where families/caregivers could access internet and/or as private of a space as possible if they do not have these options within their homes.
  • Ask local schools, government offices, shelters, hospitals, and non-profit organizations if they have internet connected computers and private places for patients to sign up to use telehealth appointments.
• Introduce telehealth visits and processes for a telehealth visit to families/caregivers during an in-person visit. This can help build trust and provide opportunities for families/caregivers to ask questions in an in-person setting first.
• Provide virtual tours of a pediatric practice to expecting parents.
• For more information on how to support family-centered telehealth implementation, view the Family Voices Telehealth Curriculum.

Establish a Volunteer Program to Further Support Family Engagement and Practice Workflow

• One practice developed a volunteer program which helped support workflow adaptations, practice management and family engagement. Strategies to support this initiative included the following:
  • Collaborate with local universities to identify students in sociology, psychology or public health to support these efforts.
  • Ask interested students to submit a letter of interest, resume, professional references and complete an interview. Those selected to serve in this role earn class credit.
  • Train volunteers by asking them to complete an online HIPAA training as well as information about common behavioral pediatric diagnoses and effective communication strategies. It is estimated that recruiting and training 2-3 volunteers requires about 12 hours of practice staff management time.
  • Set fixed schedules for each volunteer. Volunteers are required to spend at least 16 hours a week at the practice.

^{The tips and strategies outlined in this promising practice were provided by Behavioral Pediatrics of Rural Georgia.}

Implementation of these strategies resulted in some of the following preliminary outcomes:

• Cost and time savings for families/caregivers through reduced need for travel.
• High family/caregiver satisfaction, based on family satisfaction surveys.
• Ability to continue to provide care while minimizing infection risk.
• Ability to maintain care within the medical home model for patients and families/caregivers.
• Decreased rates of emergency room visits for families/caregivers and patients.
• Improved communication with patients and families/caregivers.
• Increased access to care, especially for families/caregivers in rural areas.
• Increased access to subspecialists.

^{The tips and strategies outlined on this web page were provided by Anonymous Contributors, El Paso Pediatric Associates, Family Voices, National Rural Health Association, University of Florida College of Medicine - Jacksonville/Wolfson Children's Hospital, Valley Health Multispecialty Clinic - Pediatrics | Commerce Avenue, Southern Illinois University School of Medicine Department of Population Science and Policy.}