Telehealth for SNFs – Part 2: Proven, practical tips for success

By Paul Knight, MBA, Founder, Curatess

In part one of the series, What should “telehealth” be for skilled nursing?, we discussed how leading skilled nursing facilities (SNFs) have found during the COVID-19 pandemic that just adding video chat is not sufficient to avoid pitfalls and realize the full benefits of telehealth to patient care, clinician satisfaction, and ultimately the bottom line. Recapping the top 3 factors, with illustrative examples, to take SNFs beyond ad hoc approaches to telehealth:

  1. Ease of useExample: Reduce the need for facility nurses to have to remember multiple logins for a plurality of video devices and applications. 
  2. Workflows enabling intelligent collaboration across the care teamExample: Do not underestimate what’s involved in scheduling and setting up a telehealth visit. Implement a repeatable process that avoids over-burdening clinicians and accounts for their existing duties. 
  3. Timely and appropriate access to clinical informationExample: Find ways for the remote clinician to have immediate, direct access to the patient’s medical record during the telehealth session. This is particularly important in the absence of an in-person physical exam.

Here we cut across these and other factors by providing some practical tips proven by successful SNF telehealth programs borne from the “new normal” brought by COVID-19. We draw upon both recent experiences and those we’ve gathered over 8 years of designing and operationalizing telehealth workflows leveraging our technology platform

SNF Telehealth Tips:

  1. Mind the network infrastructure 
  2. Train beyond how to use the technology
  3. Communicate, communicate, communicate

1. Mind the network infrastructure 

Reliable and fast internet connections available at the points of care within the facility are critical to building trust and satisfaction across the care team, including families. Here, in a recommended order of action, is a checklist of key considerations often missed

  1. WiFi performance in patients’ rooms

WiFi has become critical for SNF care team members to access clinical systems for patient information and documentation. Yet, we often see WiFi coverage diminish in patient rooms which particularly impacts real-time telehealth sessions. WiFi coverage is often mainly optimized for common areas and the nurse station, not for the bedside.  

Tip: Your IT team can complete a WiFi coverage assessment to identify signal gaps and target remedies.  Or, run an internet speed test from a laptop in each room and compare it with the requirements of your telehealth technology. 

  1. Quality of internet service provider

Your internet service provider (ISP) must provide adequate bandwidth and low latency to the facility to best support telehealth.  Bandwidth describes the two-way data transfer rates determining how much information can be transferred, and latency impacts the amount of communication delay experienced by users in a session. ISPs often provide high inbound but inadequate outbound bandwidth at a SNF’s current tier of service, requiring the facility to upgrade to a higher tier. 

Tip: As different telehealth technologies vary in their requirements, ask your technology provider for their internet requirements and what ISPs and service tiers they may recommend for your area. 

  1. Network Security

Confirm that the network is not blocking required in/outbound requests required by the telehealth solution.  The required network ports and third-party services may vary from one technology to another. 

Tip: Some telehealth solutions offer a network validation tool to identify any potential restrictions.  The key takeaway is to include your technology resources to align access for telehealth.  If your organization doesn’t meet the points highlighted above, a cellular-enabled iPad, tablet, or laptop with unlimited data may be an option for success.

2. Train beyond how to use the technology

While telehealth is a powerful tool to provide care, it should not be used for 911 emergencies.  Your policy and procedure (P & P) should define acceptable treatment for telehealth triage and the expectations for staff.  For example, the clinicians on the bedside and remote ends of a change-in-condition telehealth session should previously have learned and practiced the P & P steps. Here is a sample telehealth P & P. Training should go beyond application training to include how to collaborate with a remote clinician to ensure the patient feels safe and comfortable. A few things to consider:

  • Stable mount or hold the video devices on both ends to avoid jitter
  • Arrange proper lighting 
  • Reduce background sounds such as from media or other conversations 
  • Enable concurrent access to clinical health information during telehealth sessions
  • Recommend headphones be used by the remote clinician to clearly hear the nurse, patient, and, if available, heart and lung sounds from a connected stethoscope.

3. Communicate, communicate, communicate

Communication tailored and consistently delivered to staff and families is crucial to success. Send care team members a frequently-asked-questions (FAQ) to reduce time spent answering common inquiries. 

  • Patients and Family Members
    • COVID-19 has amplified the use and awareness of telehealth among consumers.  However, patients and family members remain largely uneducated about the benefits of telehealth. All facility staff need to convey to patients and their family members the benefits of your telehealth program and what to expect, which will increase their comfort when experiencing the technology.
  • Physicians
    • Your medical director should educate physicians about how the telehealth program will impact patients and workflows in the facility, and gain physicians’ buy-in to help adoption. Make sure their common questions are also addressed in the FAQ.  
  • Hospital & Payor Partners
    • Hospitals and payors rely on SNFs to deliver high-quality care and reduce avoidable readmissions to the hospital. Discuss extending access to your telehealth program to these stakeholders.  For example, establish a change-in-condition protocol to establish telehealth sessions with hospital emergency department clinicians or nurse practitioners to remotely consult SNF bedside nurses, thereby reducing hospital readmissions. Or, collaborate with payors to support their Institutional Special Needs Plans (I-SNPs) patients.

Please contact me if you’d like to share your experiences or need help. Our next article will focus on data flow and interoperability issues that can reveal more benefits you can gain from your telehealth program. 

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