Toolbox Module

Introducing Telemedicine Services to the Community

Once all the necessary arrangements are made, what is the recommended process for introducing telemedicine at a remote site?

This answer assumes that the provider site has already been set up, the telemedicine consultation services that will be offered have been determined, the operating protocols are in place, the necessary business agreements have been signed, the necessary technology has been installed connected and tested at both sites, the remote site staff has been recruited and trained, and a local telemedicine champion has been recruited. What remains is the process of introducing the telemedicine consultation service to the local providers, staff and the community. This is a process of awareness marketing with the following objectives:

  • All physicians in the community should be aware that the telemedicine consultation service is available, how it operates, what it will be able to do for their patients if they are referred to the service and what it does for them and their community.
  • Every referring physician should be aware of who is providing the specialty consultations and what their qualifications are.
  • The local staff members, both in the physician’s offices and in the facility where the service is provided need to be aware that telemedicine is available and have a general idea of what it does.
  • The community should be aware that the telemedicine consultation service is being offered, how it works and what its benefits are for the community.

How should telemedicine be introduced to local physicians?

When a local physician is asked to make use of a telemedicine consultation service, he or she is essentially being asked to refer patients who need the service to a physician at another facility or organization that he or she is likely to neither know nor have any idea regarding his/her level of skill and competence. Furthermore, a referring physician may be skeptical of the value of telemedicine due to the concern about the potential loss of the doctor-patient relationship that is fostered in face-to-face care. He or she needs reassurance that the specialists are not simply appropriating patients, but are available in a supportive role. For these reasons, local physicians should have an opportunity to see the service in action at their convenience and to meet and talk with the specialty providers. Face-to-face meetings are best for establishing this relationship, but videoconferencing does work as an alternative. In addition, sharing documents describing the background, training and experience of the specialists can be helpful. While this information is typically part of the credentialing process, it should be widely shared with all physicians who might refer their patients. Finally, it is quite important that the local telemedicine champion plays a leadership role in introducing the consultation service. His or her confidence and support will lend a great deal of credibility to the service.

Why are local referral patterns so important?

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.

How can the local providers be informed of the availability of telemedicine services?

Physicians are almost always very busy and are targeted by so many sales people that they are usually reluctant to meet with an individual who is not their patient or who they otherwise do not know. Thus, gaining the attention of that provider to explain the service that is being made available is not easy. The two best approaches are to set up one-on-one meetings between local physicians and the telemedicine champion. However, since the champion is typically a busy physician, this may be difficult to accomplish. The next best method is to get on the agenda of an existing forum where most of the local physicians are likely to be present.

What are good forums for meeting local physicians?

If the remote setting is a rural hospital in a small town, one is likely to find that most, if not all, of the physicians attend periodic medical/clinical staff meetings. This is an excellent opportunity to introduce not only telemedicine, but also the specialty providers via telemedicine. Another method is to offer a Continuing Medical Education (CME) session that focuses on telemedicine. Providers can attend the session, learn about telemedicine and earn required credits to maintain their license at the same time. A third approach is to set up an introductory session for your consultation service in conjunction with a local professional meeting that many providers normally attend.

What are the better strategies for introducing providers to telemedicine?

There are two basic strategies to introduce providers to telemedicine that should be used together. The first is the personal testimonial by a respected peer as to the costs and benefits of a telemedicine consultation service. That respected peer should be, if at all possible, either the local telemedicine champion or a locally well-known medical professional. The second is the hands-on demonstration where the provider can see and hear how a consultation works. This should be done using a scenario that allows the provider to develop an accurate sense of what happens (and does not happen) during the consultation.

What other local staff need to be informed and acquainted with the service?

Every member of the health care team at the remote facility should be aware that a telemedicine consultation service is being offered and have some idea of how it works. The goal is to create widespread support for the program so that people think of it when the need is seen. Beyond that, different members of the team need to know specific items of information.

What does the CEO need to know?

The Chief Executive Officer and his or her immediate administrative team need to be aware that the service is being offered, how it works and what its benefits are for the patient. In addition, they need to understand what the impact of the service will be on the local provider community and on their own facility. They should learn how much the service costs, what is the nature of those costs and how much additional revenue is generated and from what source. Finally, they need to know the regulatory and legal ramifications associated with the service.

What does the Director of Nursing need to know?

The Director of Nursing, if that person is not a member of the administrative team, needs to know the same information as that team. In addition, the Director of Nursing needs to understand the impact of telemedicine on the nursing staff of the organization. This includes estimates of nursing hours required, types of expertise needed, staff training requirements and whether or not personnel can be shifted from other services or if new hires will be necessary.

What do staff nurses need to know?

In addition to a general awareness of the available of telemedicine consultations, staff nurses need to have a sufficient understanding of the service to be able to explain what happens and the benefits it provides when a patient asks them about it. Staff nurses who take on the role of becoming telemedicine presenters also need to be fully trained in the service including set up and operation of the technology, contents and application of the protocols, interacting with the provider and the patient and documentation requirements.

What does the business office need to know?

The business office needs to understand the billing processes for telemedicine and how it differs from normal billing practices. For remote sites, the billing is generally limited to a facility fee for the use of the facility to expedite a consult (e.g., Medicare payment policies), but may be more extensive under contractual arrangements for services where the local facility assumes the billing for services role. The other important topic is the reimbursement that is available for telecommunications services in rural health facilities to bring their telecommunications costs in line with what is available in urban areas. An application process to the Universal Service Fund must be completed annually through the Universal Services Administration Corporation. See the FCC link below for further details. For more information on reimbursement, see the Reimbursement Module (Coming Soon).

FCC Rural Heath Care Program

How should the local community be informed of available telemedicine services?

In terms of generating referrals for the telemedicine consultation service, the local community should be aware of its existence, how it works and what its benefits are for the average person. This can be accomplished through a variety of means. These include:

  • Features in the organizations publications that are distributed to the community. Such features should focus on telemedicine stories and how patients benefited from the service.
  • Articles in local newspapers that describe the consultation service. Inviting local reporters to tour the telemedicine facility, view a demonstration, talk with the staff and learn about the benefits of the service can generate publicity.
  • Feature segments on the local television station. Just as print reporters are invited, you should also invite the broadcast media in to learn about the service.
  • Presentations at local social, fraternal and religious organizations. These groups are often looking for outside speakers who will provide an interesting presentation as part of their periodic meetings. A short presentation should be created for these groups that promotes the telemedicine service and that can be easily slotted into their meetings.
  • Exhibit booths at local events such as county or state fairs and health-related events.

Telemedicine at the Minnesota State Fair