Change management culture to support telehealth technologies

Identify a clinical problem

One important step toward gaining physician and staff buy-in and creating a change management culture that supports implementing telehealth technologies -- or any new technology -- is to identify a clinical problem that telehealth can help solve.

Start with a problem that people actually recognize is a problem. Don't build technology solutions first.

"Start with a problem that people actually recognize is a problem," said Neil Evans, M.D., chief officer of the Office of Connected Care at the U.S. Department of Veterans Affairs (VA) and associate chief of staff for informatics at the VA Medical Center. "Don't build technology solutions first."

Evans said that at the VA, "We think about problems in three categories." Those categories are:

• access to health information and health relationships;
• access to useful health information; and
• increasing the convenience of healthcare and the value of the experience.

"Is this a solution that's going to help my customers, veterans, get access to the trusted healthcare relationship they're coming to the healthcare system for?" Evans said. "Is this something that is going to give them access to tailorable, useful, valuable health information, their own health information? ... Is this something that's increasing the convenience of healthcare or increasing the value of the experience?"

Evans suggested trying to use this framework when thinking about whatever problem a healthcare organization wants to solve with telehealth technologies -- or any other digital technology.

Discuss the possibility of telehealth with physicians

Getting hospital staff on board with a new technology can be a challenge. John Jenkins, M.D., chief clinical officer of connected care at Cone Health, a nonprofit network of healthcare providers in North Carolina, suggested having a conversation with physicians about the possibilities of telehealth.

Jenkins shared how his team did this with the oncology department.

"What came out of that meeting was a dedicated symptom relief telehealth clinic that was devised for our patients who are undergoing chemotherapy and radiation therapy so you don't have to go all the way to the hospital to have your symptoms assessed and then a treatment plan started," Jenkins said. "It's been an incredible patient satisfier."

This, in turn, helped the physicians see that "this is something we need to be doing," Jenkins said.

"We demonstrated the success of the platform and then we curated the information to the primary care providers and now it's the best thing since sliced bread," he said.

The goal should be ease of use

Bokser said that from the very beginning the goal should be to make technologies "delightful and easy to use."

Jenkins likened this goal to "how Amazon changed retail."

"Several years ago you'd go to the mall and buy something. I can't think of the last time I went to a mall, but I do know that I have an amazon package waiting for me at home," Jenkins said. "So they were able to figure out how to revolutionize access to merchandise so that people could have access when they want, where they want, and how they want. I think healthcare is challenged to be able to provide that kind of access to care."

Bokser provided an example of a technology that linked UCSF's EHR care team to the paging system. The technology made peoples' lives easier and "it spread virally," he said.

"Very little training, very little executive buy-in," Bokser said. "It was truly one of those well designed technologies. Unfortunately those are not the norm; they tend to be the exception, but they need to become more of the norm."