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This is another in a series of blogs chronicling the development of AcuteCare Telemedicine (ACT). Much of this reflection involves lessons learned at 2011’s Annual Meeting of the American Telemedicine Association (ATA). What follows is an amalgam of facts, experience and opinions culled from that fantastic symposium and honed by hindsight. Today’s blog will focus on ACT’s approach to accountability and relationships.
Accountability refers to the promise of optimal healthcare outcomes while maintaining an expected return on investment. Patient and physician satisfaction are cornerstones of accountability, but to depend solely on these measures has become passé. Administrators want measurable financial and clinical outcomes, and to obtain and retain clients, will expect supporting data for all assertions.
One must constantly seek meaningful measures of the services promised; encounter surveys gather data on every patient interaction, regardless of outcome. This data measures service utilization (e.g. stroke vs non-stroke, tPA vs. non-tPA, etc.) and efficiency (e.g. response time, “door to needle” time, etc). Constant focus on patient outcome requires frequent Mordibity & Mortality conferences. This leads to continuing education, reduced miscommunication and shared responsibility. Finally, financial impact (more specifically than simply “satisfaction”) can be obtained with quarterly or annual reviews of year-to-date ICD-10 referenced charges or admissions. However, emotionally powerful patient anecdotes must complement the sterile numbers. It is this human component that provides the raison d’etre, separating telemedicine from any number of telecommunication ventures.
Accountability also extends to the development and maintainance of relationships with ACT’s clients. A client considering telestroke invests significant time and capital and must undergo a fundamental paradigm shift regarding what constitutes optimal patient care. To facilitate this endeavor, a telemedicine service needs to become as integrated as possible into the culture of its remote partners. One cannot afford to simply be the latest technological gimmick, but rather must provide an approachable solution.
Frequent contact is paramount and must not be limited to patient encounters. Not all interaction can take place in the cloud; physical meetings allow remote presence technology to become an alternate mode of communication between colleagues, rather than a proxy for an actual relationship. Communication is the foundation of every meaningful relationship. Listening to the client will uncover their goals and challenges. The telemedicine service will integrate more fully with a remote partner, helping the client on their terms. This may result in vertical integration with mutually beneficial services including electrophysiology studies, clinical trials, medical directorships, etc.
Horizontal integration may include multiple disciplines such as telestroke, teleICU or telepsychiatry. Ultimately, integration into a client’s business model and culture is crucial for long-term sustainability. ACT assures clients are not simply invested in telemedicine services, but in their relationship with ACT.