Advancing Organizational Objectives with Telehealth

The telehealth boom is upon us. And because sleep medicine professionals generally employ non-invasive assessment, diagnosic, and treatment modalities, the field is particularly well positioned to leverage the benefits of telehealth. Indeed, proper application of telehealth strategies has the potential both to improve healthcare outcomes and also reduce costs.

Yet the first step to incorporating telehealth into your organization has nothing to do with technology. It has everything to do with clarifying your strategic vision, and then identifying areas where technology might support this vision. Strategy drives tactics which drive technology. Not the other way around.

In this article, we’ll consider three essential strategic objectives for sleep health organizations and how telehealth approaches can support them. This list is not exhaustive, but a sampling of three of the most common issues I see in my work as a trusted advisor.

Strategic objective #1: Improve efficiency

The two driving forces of 21^st century medicine will be improving patient-centered care and reducing costs. In light of the well-documented shortage of trained sleep specialists, it is incumbent on sleep medicine providers and the field at large to maximize accessibility to sleep specialists. One important way to do this is to increase provider efficiency.

Opportunities for telehealth:

1. Improved office flow. When patients complete registration and intake questionnaires before arriving at the office, paperwork burden is reduced, office efficiency is increased, and patients leave more satisfied with their healthcare experience.
2. Standardized patient education. Any busy sleep medicine physician will tell you that the biggest “time wasters” are explaining sleep apnea twenty times per day, and dictation. By utilizing multimedia technologies, providers can ensure patients receive the right education at the right time, based on their specific complaints.
3. Automated report generation. Much patient history can be obtained through electronic means, which can then be automatically formatted into a preliminary dictation/report. This report can be seamlessly integrated into the EHR, or uploaded manually.

What to look for:

1. Fully customizable intake questionnaires and point and click report formatting.
2. High quality, evidence-based multimedia and interactive patient education.
3. Adherence tracking.
4. Integration with EHR.
5. Back end data aggregation and query-able database.

Strategic objective # 2: Facilitate team-based care

In addition to increasing efficiency within the sleep medicine office, telehealth can improve quality of sleep medicine care and maximize resource utilization within the larger health care system. For example, imagine a hospital system with only one bona fide sleep disorders center, but multiple satellite primary care clinics. By utilizing a shared platform for screening, assessment, education, and triage, best practices can be effectively disseminated system-wide. Primary care providers inclined to treat sleep complaints can access specialist guidance when needed, and those patients who do require specialist care will arrive more carefully selected and prepared for the process. (Telehealth approaches can also improve team-based care within the sleep center itself, for example by proactively managing PAP adherence or guiding mid-level provider activity.)

Opportunities for telehealth:

1. Customization. Specific screening, assessment, and triage functions at both satellite and sleep center levels.
2. Improved information dissemination. Secure communication and document sharing between satellite and sleep center.

What to look for:

1. Secure messaging between providers.
2. Easy and intuitive color coding, for example for “red alert” patients.

Strategic objective #3: Provide gold standard treatments for the full range of sleep disorders, including CBT for insomnia

One of the biggest challenges facing the field of sleep medicine is how to effectively disseminate evidence-based best practices. No disorder better exemplifies this challenge than chronic insomnia. Cognitive-behavioral treatments for insomnia are recommended by the NIH, the AASM, and every other leading organization as first-line treatment for chronic insomnia. Yet, in part due to a gross shortage of certified behavioral sleep providers, this powerful, cost-effective therapy for the most common sleep disorder in the US populace remains woefully underused.

Opportunities for telehealth:

1. Recommend “self-help” internet based CBT for insomnia
2. Oversee provider-directed, interactive internet based CBT for insomnia
3. Implement telemedicine with live provision of CBT services

What to look for:

1. Ongoing monitoring of patient/access to provider
2. Integration with your organizational clinical flow, including existing technologies and EHR if desired

The future is now: What to do next

Several years ago, a good friend in the western United States told me he wasn’t concerned about the impact of home sleep testing, because Massachusetts was an anomaly and there was no reason to believe its use would spread. When we spoke several weeks ago, and he confided that he virtually cannot obtain authorization for an in-lab sleep study, and that the primary care providers in his area have aggressively pursued HST. I didn’t have the heart to say, I told you so.

Telehealth is on the rise, and sleep medicine will prove to be fertile soil for the coming tehealth boom. In the final part of this series, we’ll take a closer look at real time telemedicine, what it might mean for our field, and how you can leverage it to your advantage.