Deployment and support of a home telehealth program has many considerations to make in advance of purchasing equipment. If the work is done ahead of time to prepare your program your chances of success will be much greater once your equipment has been deployed. According to the experts, home telehealth is much more than the hardware and software that you are going to deploy. When it is a programmatic effort that fills or enhances an existing clinical need, your chances of success are much greater. Traditionally home telehealth has been deployed by home care agencies for vital signs and disease state symptomology monitoring. The possibilities for home telehealth monitoring use are expanding rapidly and may look radically different than vital signs monitoring for a home care agency.
Planning
When planning to deploy home telehealth equipment a great deal of work is required before you will be ready to actually deploy the equipment. You need to consider the budget that you have for your program, determine your clinical need, select the appropriate equipment and vendor to meet your programs need, and then finally have a plan to actually deploy and later support the equipment for your program.
Budget
Budget considerations for a home telehealth program go way beyond dollars and cents. Some people find that identifying budget considerations will help you define the program that you are capable of running. Ideally you will already have a clinical need identified and preparing a budget will only help you solidify the program you will be able to develop.
Identifying a clinical need is an important first step; your clinical need will determine the scope of your program. You must determine what clinical problems you are going to address by introducing home telehealth into your program. Once you have identified the clinical needs you are going to address you will be able to decide which patients home telehealth monitoring will be used for. You can then extrapolate from the clinical problems and potential patients served what your programmatic investment in home telehealth will truly be. You can determine cost avoidance and cost saved to get an overall ROI for the program.
After a clinical need has been defined, it allows you to then go on to make sure you represent every element of the program in your budgetary analysis. For some organizations, these initial steps of clinical need analysis and budgetary estimation and analysis must be completed before funding can be secured. This will depend on the funding sources for your program.
Once the clinical problems you are going to address have been identified, you will be able to identify what your program hardware and software needs will be. When considering equipment you will need to decide if you can find one vendor to meet your needs or if you will work with multiple vendors. There may be cost benefits to working with a single vendor when it comes to ordering equipment in volume. To prepare your budget you will have to get pricing estimates from the vendor(s) on all of the costs associated with running a home telehealth program. Some associated costs you will need to consider: hardware, software, data hosting, interfacing costs, staffing, call centers, telecommunications options, and any additional custom programming necessary.
- When purchasing hardware you can buy the hardware outright or rent/lease the equipment for a monthly fee. Another budget consideration related to hardware is the physical space of where you will store the equipment while it is waiting to be deployed to patient’s homes. You may need additional space to do minor maintenance on units and clean units before they are redeployed. You will need to project into your budget for hardware loss, theft, depreciation and malfunction. You will need to project into your budget for technology refreshment based on the lifecycle of the hardware involved in your program. You may also need to project scalability into your budget to grow your program as new hardware becomes available in the future. You may also want to project scalability into your budget anticipating positive program deployment, patient acceptance, clinical effectiveness, and positive provider adoption of home telehealth.
- Some vendors offer their software for free with the purchase or renting of their equipment, some vendors offer their software for free but have upgrades to the software also available for purchase, and some vendors require you to purchase their software along with their hardware.
- Some vendors will charge for data hosting as an outright monthly cost while others have it considered into the cost of the monthly rental or leasing fees. If your organization prefers to host your own data, then you will need to budget for the purchase of your own home telehealth server and the associated costs.
- Most vendors will offer interfacing with some of the larger and more well know electronic health records. Generally this interfacing is at no additional cost, however if you have an electronic health record that the vendor has not already interfaced with you may have an associated interfacing cost.
- You will need staffing to deploy the equipment into patients’ homes, to work with patients on using the equipment for their clinical care, and staff to address the data generated by the home telehealth equipment. If you buy units that can be upgraded, you may need to budget for staff time to upgrade the units unless they offer the ability to do remote upgrades. If you are adding home telehealth on top of your staffs previously assigned duties you may not have to budget as much additional staffing costs. Realize that initially you will potentially have to budget staff time for training, deployment, and patient education. You may wish to add additional FTEs based on a projected workload shift, realizing that over time you may be able to subtract FTEs based on savings. Some of the home telehealth vendors will offer a service to deploy your equipment to your patients and teach them how to use it for a cost. There are also third party vendors that can handle the equipment deployment into patient’s homes for additional costs. There are even third party vendors on the market that will develop your whole home telehealth program for you, choosing equipment, vendors, deploying the equipment, etc… all available at a cost.
- If you plan to use a call center to deal with your incoming data you may have an additional associated cost for the call center service. You may also want to evaluate the number of patients that you will have in your program using home telehealth to see the cost effectiveness of hiring a few additional FTEs to function as your own internal call center to address your home telehealth data. There are staffing models available that may help guide you on the number of FTEs necessary related to the number of patients being monitored.
- You may need to consider purchasing additional telecommunications service options for your business to support the home telehealth operations. You may also need to consider your patient population and the type of home telehealth hardware you will expect them to support. Depending on the amount of bandwidth they are going to need to support the equipment, you may want to consider budgeting to assist them in the associated monthly costs.
- Aside from miscellaneous additional costs of the program, you may also have costs associated with any additional custom programming that is necessary for your program. For example, some programs want their home telehealth software and hardware to also interface with their billing software.
Support Plan
Once you have defined your budget you can use the elements that you have already budgeted for to help you further define your support plan. You should have already budgeted for the main components of your support plan, but if new elements are discovered, make sure to add them to your budget. A support plan is very cyclical, and depends widely on the lifecycle of the type of technology that you are deploying. It starts with purchasing equipment, installing equipment, providing initial and ongoing training for users, supporting the equipment, updating and repairing the equipment, and then preparing for the next equipment deployment cycle. In the case of home telehealth, some of the elements of the support plan may very likely be taken care of by the home telehealth vendor.
Initial
You will have an initial investment in the purchase and installation of the new equipment, as well as training the users on the new technology. You may want to consider a pilot to see how the deployment goes and give your program a cushion to work out the kinks associated with any new program deployment. A pilot can aide you in identifying elements that you may not have known to consider and make concessions for them, and sometimes determining the future success or failure of your clinical program.
Warranty
Each manufacturer offers different warranties and warranty terms. It is essential to understand the terms for the equipment that you have purchased. Many organizations have biomedical technicians that service medical equipment used within their organization, but many of the home telehealth equipment warranties will be voided if you attempt to repair the units yourself. You need to consider the price of the units that you are purchasing related to the estimated product lifetime when considering additional warranties for equipment that you purchase. If home telehealth units are required to be sent back to the manufacturer for repair they are effectively being taken out of use for that time period. This option is often inconvenient in a large organization or for a clinical program that depends on the equipment for regular operation. You might want to consider having additional back up units for use while damaged units are being repaired.
Training
Staff will have to be trained on how to use the home telehealth hardware and software. Decisions need to be made if training be provided by the vendor to all staff, or to a group of train the trainers from within your organization. Proper training in the use of the equipment may prolong the lifespan of the equipment, because theoretically users who know what they are doing will avoid misusing the equipment and leading to support issues. Also, having users who are trained in the use of the technology initially will reduce the amount of ongoing support that is required. Proper training facilitates adoption of the technology and the best utilization of the home telehealth equipment. Hopefully with proper training, clinicians will be referring the right patients and you will begin to see an impact on the clinical problems that you put your program in place to address.
Ongoing
Deploying a technology into the field is like gardening. You work hard initially planning and preparing, then you plant it and hope for the best. Any good gardener knows without weeding and watering your harvest will be marginal at best. You need to plan for ongoing support for the technology in just the same way.
Upkeep/Upgrades
The technology that you deploy will eventually break and/or malfunction with repeated use. You can plan for this with an ongoing support plan. When considering ongoing support, you have to take all of the home telehealth hardware and software into consideration. You may have repairs, warranty related replacements, replacements that are not covered by warranty such as loss and theft, and equipment updates to contend with. The home telehealth units will also age and eventually need to be refreshed as part of the product lifecycle.
Technology Refresh
Depending on your initial investment and the involved technology’s lifecycle, you will have to make some decisions surrounding a technology refresh at some point. Some home telehealth technology is ever-evolving, with new units coming out every year, while others are more durable and may last longer. At times it will not be the actual home telehealth hardware or software that needs upgrade, rather the role of the technology in the clinical program may change and require new technology to be considered and purchased. When considering a refresh you will have to decide on a timeline for the refresh; will it be done all at once or incrementally. If you plan on blending old technologies with new, is there backwards compatibility between the hardware and/or the software? Does the vendor offer the ability to do upgrades remotely, or do they have to be done by staff in person.
Vendor Selection
With a budget and support plan in place, now you are able to select a home telehealth vendor to establish a relationship with. With your clinical need and patient population in mind, decide what home telehealth hardware you will be using in your program before selecting a vendor. Establish what your data needs and reporting requirements will be, so you know what you will need from the home telehealth software. Know what systems you will want the home telehealth software to interface with and be prepared to ask the vendor questions related to interfacing their product. When you know your hardware and software needs, then it is time to research the vendors on the market.
The home telehealth market is a very competitive market, and doing thorough market research may be difficult. Utilize internet resources and request product information to the best of your ability. You may have difficulties getting concrete information without contacting vendors. A word of caution as you approach vendors requesting information. Once vendors are contacted, you may still have difficulty getting information from vendors beyond basic information. Some vendors may even be reluctant to give pricing until they can understand the program that you are interested in starting. In order for you to get more information about products and get more specific questions answered some vendors may require you to sign a nondisclosure legal agreement. All of this caution on the vendors part is most likely related to an intensely competitive market, and is reasonable to a certain extent. Just be aware that the more information that you are willing to share about your program may facilitate more information sharing on the vendor’s part.
Once vendors have been contacted it is important to get product demonstrations from the companies that you are seriously considering. Ask to see their hardware and software so you know exactly what you are getting into before you make any commitments to purchase. Some vendors may not come to you for a demonstration but will be able to offer a webinar demonstration and marketing pitch and allow you to ask your questions. Some vendors will even invite you to come to their facilities to see their home telehealth systems. It is always good to ask the vendor what hardware and software they feel will meet your programmatic need as well. Utilize their experience in deploying hardware and software to your advantage. Review the vendors policies and procedures, certifications, waivers, FDA clearance, quality assurance principles, problems mitigation philosophy, equipment replacement policies, and technical support options.
Once you feel you have enough information about the product and the particulars about the vendor, ask to have customer references to speak to that have worked with the company in the past. It is also helpful to have a good network of colleagues that can also give you unbiased experiential opinions about certain vendors as well.
Purchasing
Once you have completed the extensive planning and vendor selection process, purchasing the equipment will not be difficult, assuming that you have been able to secure the budget you planned for. Each organization has different methods and processes that they use when purchasing equipment, but the good news is you will know exactly what you need to purchase in order to get your program operational. In this instance, included in the purchase process may be the hiring of new or additional staff or repurposing existing staff members. You need to allow adequate time if you need to hire new staff before a project can be operationalized, and you may need a contingency plan in the case you are not able to find adequate staff. Also, as part of your planning process you need to consider your timeline for purchasing the necessary equipment so you receive equipment in a timely fashion and do not inadvertently stall the start of your program.
Deployment
With all of the work that has been done in the planning phases of your project, deployment of the equipment should fall right into place. Deployment of a home telehealth program starts with the deployment of the training and support plans. It does not matter if you are handling the deployment of these plans internally or through a vendor, they must be put in place before equipment can be received and/or distributed to patients.
There are a few remaining considerations as you move forward with deployment. These considerations should have been addressed as part of your planning process but must be in the forefront of the deployment efforts. Remember you will need to determine where you will have the equipment shipped. Are you working with a vendor or third party that will allow your equipment to arrive directly at the patient’s home? Did you budget out room for a staging area if you are going to receive the equipment in your office first for storage and staging? If you are going to receive the equipment internally first, do you have a plan to inventory the equipment? Do you have a plan to deploy the equipment in a systematic fashion, ensuring that the proper equipment makes it to the proper patients in a timely fashion? Did you budget for staff to be in charge of the equipment management process?