The Maturity Model provides high level guidance for advancing telehealth capabilities. It’s the “what” we hope to achieve. This is the model for People; view the full Maturity Model.
|Sustainability Curve 1:|
|Sustainability Curve 2:|
|Sustainability Curve 3:|
EXPANSION & SUSTAINABILITY
|Rapid adoption of phone/video visits by health centers; variability in digital access for patients||Care teams competent in using telehealth for patient care and engaged in ongoing innovation; all patients able to access telehealth modalities||Providers routinely utilize access to specialty consults; patients engage in tech-enabled community-based care|
Drivers of Success
The Drivers of Success represent “how” to improve performance. These are the drivers for People; view the full Driver Diagram.
- Provider & staff training
- Patient education
- Digital equity
- Satisfaction/Engagement surveys: patients, staff, providers
Provider and Staff Training
A comprehensive provider and staff training approach includes the following steps:
The provider champion and telehealth team, with the support of the health center leadership, need to develop or adapt existing training tools for use at the health center. Trainings and updated workflows should be shared broadly through several avenues: email, intranet, handouts, and live or recorded meetings. Remember to encourage discussion and feedback on new processes and workflows, and emphasize the importance of iterative improvement. Be sure to document changes over time.
|training tools checklist|
|Use of the telehealth technology platform(s)|
|Updated workflows for nurse triage, scheduling, patient outreach, care team huddles, and “virtual rooming” of patients|
|Training on “webside manner”|
|Decision tree and workflow for scheduling telehealth and in-person visits|
|Documentation and billing for telehealth services|
Telehealth Classroom, NETRC
This Telehealth Classroom training portal has been developed by the federally funded Northeast Telehealth Resource Center (NETRC), to assist regional stakeholders, including health systems, health centers, and providers to successfully implement telehealthVisit website
Provider Communication Strategies for Telehealth, PCDC
A one page guide for providers that highlights communication strategies that can be utilized during virtual visitsPDF ↓
Provider guide: Telehealth visit best practices, Stanford Department of Medicine
Short checklist of best practices for set-up, webside manner, virtual physical examVisit website
Provider guide: Telehealth etiquette, Southeast Telehealth Resource Center
Short videos for providers on the good, the bad, and the ugly of telehealth etiquette.Visit website
Provider guide: Telehealth visit etiquette, AMA
Short checklist for telehealth visit etiquette from the AMAVisit website
The primary goals of patient education are to help patients understand how telehealth can be used as another method of receiving health care, to prepare patients for a telehealth encounter by teaching them how to use the necessary technology, and to empower patients to access the modality of care that best meets their needs.
In order to ensure the diverse patient populations of community health centers are able to take full advantage of the opportunities offered by telehealth, it is important for the telehealth team, with support from health center leadership, to develop a strategy for helping patients understand the benefits of telehealth and how to “navigate” the technology:
- Empower Community Health Workers (CHWs), Patient Navigators, or Telehealth Navigators to work with patients and community members to help them navigate the technology and understand the role telehealth can play in their care
- Spread awareness about the role of telehealth during all encounters with patients (virtual and in-person) via patient portal messages, signs in waiting rooms and exam rooms, at the point of scheduling, via social media, and on the health center website
- Ensure health center staff have a consistent message to share with patients about the role of telehealth in their health center
- Utilize in-person encounters to train patients on the use of technology that may be needed for telehealth
- Review all training materials and documents to ensure that they have been vetted and tested for accuracy before distribution to patients
Patient Guide: Making the Most of Your Virtual Health Care Visit, Comagine Health
Detailed checklist for patientsVisit website
Patient Guide to Telehealth & Zoom
Fenway Health’s information on their website for their patients about telehealth, including how to prepare for a visit (English and Spanish)Visit website
Patient Guide to Virtual Visits, CHC Inc.
Step by step guide from a community health center; includes detailed zoom instructionsVisit website
Patient Guide: What to Expect From a Telehealth Visit (video)
Video provides information for patients on what to expect from a telehealth visit from home.Visit website
Patient Information Sheet (English)
One-page patient handout about how to prepare and what happens during a telehealth visit, from the Telehealth Consortium (English version).PDF ↓
Patient Information Sheet (Spanish)
One-page patient handout about how to prepare and what happens during a telehealth visit, from the Telehealth Consortium (Spanish version).PDF ↓
While telehealth has been embraced throughout the COVID-19 pandemic for its convenience and ease of access, many people served by health centers face barriers to effectively accessing telehealth and, in particular, televideo visits and remote patient monitoring (RPM). The barriers include:
- Reliable access to broadband internet
- Reliable access to smartphones and/or computers
- Reliable access to private spaces to carry out telehealth visits
- The need, in many instances, to add interpreters to appointments
- Understanding of and engagement with telehealth as a safe and effective modality of care
- Digital literacy in general and knowledge of the telehealth interface, specifically
Collectively, the lack of access to telehealth and other online services is known as the digital divide. Addressing digital equity means eliminating this divide and ensuring that individuals and communities have the tools and information needed for full participation in not only telehealth, but also educational supports, social services, and the economy.
On the health center side of the health equity equation, health center providers have reported that they spend a great deal of time educating patients on the usefulness and pragmatism of telehealth. Such education could easily and perhaps even more effectively be carried out by others on the care team. Providers also report that they typically conduct these telehealth appointments on their own, rather than with the care team supports they have in place for in-person visits.
To enable a diverse population to take full advantage of telehealth, health centers may add a new role, called Telehealth Navigator, or expand the role of existing Community Health Workers to help patients understand the benefits of virtual care services and how to “navigate” the technology. Responsibilities of the navigation role include:
- Calling patients in advance of scheduled telehealth visits to ensure they are trained and confident in their ability to participate, and to confirm availability for the visit
- Ensuring that their equipment is working and that they can access the technology
- Arranging to add interpreters to telehealth visits, if needed
- Reaching out to patients who are overdue for a visit
- Scheduling telehealth visits and providing associated training
- Providing training on remote patient monitoring equipment
- Providing education for patients on-request by providers
- Providing community-based education through outreach and engagement with local community-based organizations.
Telehealth Navigator Job Description
A sample job description for a Telehealth Navigator that was developed by the ConsortiumPDF ↓
Within Massachusetts, access to broadband services is correlated with race and socioeconomic status, namely: people who are non-white and of lower socioeconomic status have poorer access to broadband. In 2020, 101,000 health center patients did not have access to broadband. In predominantly minority census tracts, 1 in 4 households are without broadband, compared to tracts that are 95% white, which have only 1 in 8 households without broadband. Moreover, many health centers lack the necessary network equipment and broadband capabilities to carry out secure telehealth sessions with patients. With more health care taking place over the internet, under-resourced communities with limited broadband services can find themselves cut off from telehealth.
To achieve advanced telehealth capabilities and serve patients equitably, health centers will need to implement new strategies:
- Screening patients for technology access (device, internet, digital literacy) perhaps as a part of the routine health related social needs screening process
- Referring patients to state and local resources that provide reduced cost internet services or equipment
Digital Needs Screening Questions, UCSF
Screening questions for digital needsPDF ↓
FCC Emergency Broadband Benefit Program
The Emergency Broadband Benefit is an FCC program to help families and households struggling to afford internet service during the COVID-19 pandemicVisit website
Satisfaction & Engagement Surveys
Patient, provider, and staff satisfaction are important measures of success for your telehealth program. Satisfaction survey data should be used by health centers to evaluate and improve processes and workflows.
Patient satisfaction surveys
Patient satisfaction is a common indicator of quality of care. To identify potential disparities in care, patient satisfaction survey results should be analyzed by race, ethnicity, and language when possible.
Patient Satisfaction Survey, Lowell CHC
A patient satisfaction survey from Lowell Community Health Center that is sent to patients after their visitPDF ↓
Telehealth Patient Experience Survey
Patient experience survey for telehealth visits from the Telehealth ConsortiumPDF ↓
Provider satisfaction surveys
Provider engagement plays an important role in the success of care delivery transformation efforts. As health centers update and adjust workflows, processes, and team roles with the growth of telehealth, its important to measure and understand the provider and staff experience.
Massachusetts Health Quality Partners (MHQP) developed the “Together for Better Telehealth” program to understand providers’ experience with telehealth during the COVID-19 pandemic. Results from this series of surveys are available in the resource below.
Telehealth Provider Survey Results, Massachusetts Health Quality Partners, 2020
“Together for Better Health” survey of Massachusetts clinicians includes practical solutions, useful ideas, tips and tricks for how to improve telehealthVisit website