ORGANIZATIONAL ASPECTS OF TELEMEDICINE IN SMART HEALTH

April 05, 2020

What is the TELEMEDICINE ORGANIZATIONAL ASPECTS in smart health?The target of telemedicine is to Healthcare professional (s) requesting and required, around a referrer.

Steps to follow

Identify the needs (analysis of health / business needs, contribution of telemedicine, types of actions implemented, profiles of the patients concerned and estimation of the volume).

Specify the methodology (stakeholders involved, changes induced for the patient and for professionals, medico-economic model), the portage of the project and detail the telemedicine protocol and the material conditions.

Define governance (Steering, operational, ethics, evaluation committee, etc.). Implement governance and organization. Adapt them to needs.

Points of attention

Design the telemedicine project in response to an identified need and as belonging to a medical project.

Identify a strong medical carrier, supported by a referent.Evaluate the necessary skills upstream, inform / raise awareness / support change and train all the players concerned.

Protocol the various stages of telemedicine care, and test / experiment.

Deadlines • 3 to 6 months (medical project and protocols).

THE PROCEDURES TO FOLLOW

NEEDS :Those in private hospitalization are reporting an increase in the need for care. Telemedicine is presented as a complementary tool to assist in the care and monitoring of patients within the establishment.

Whether it is home care (hospitalization at home, complex and chronic wounds, etc.) or care in centers geographically distant from reference establishments (medical dialysis unit for example), telemedicine helps maintain quality of care and taking care of patients beyond the geographical limits of the establishments.

It also constitutes a tool for coordinating treatment upstream and downstream of hospitalization and provides solutions to speed up in this context the implementation of the shift in ambulatory care desired by the public authorities.

Finally, it meets the needs for access to care in isolated areas or areas in tension in terms of medical demography as well as the requests of patients who wish to maintain follow-up of their care, including mobility.

GOVERNANCE :

The governance put in place in a telemedicine project integrates each stakeholder and contributes to decision-making. Within the establishment, the representatives of the management, the information systems management, the medical and paramedical professionals concerned must be informed and strongly associated.

It is generally structured in several instances which are mobilized differently depending on the subject and the scope of the points to be dealt with:Strategic Committee (or Management Committee): Participants: Management of the establishment Role:– Discuss, validate and carry the project within the establishment– Integrate it into the overall strategy of the establishment (within a portfolio of projects)– Have a global vision, consider mutualizations

Frequency: Quarterly

Steering committee:Participants:– Telemedicine activity coordinator and its potential partners(the director of the establishment, the referent and the project manager, representing the doctors)

possible Role:– Develop and implement the project strategy– Organize and coordinate the deployment– Develop and validate the communication policy of the project Frequency: Monthly to half-yearlyEvaluation Committee (sometimes merged with the Steering Committee) Participants:– Members of the Steering Committee– Role Evaluators:– Analyze the evaluation produced– Develop the indicators– Make decisions to carry out the evaluation Frequency: Quarterly to half-yearlyOperational Committee (or Monitoring Committee or Project Team): Participants:– Telemedicine activity coordinator and its potential partners(the project manager and / or representative of health professionals)Role:– Lead the operational implementation of the project in the territory considered.– Monitor the progress of the results and deliverables of the different phases. Frequency: Bi-monthly to monthly.

ORGANIZATION AND IMPLEMENTATION OF TELEMEDICINE PROJECTS:

Developing a telemedicine project requires implementing an organization that facilitates the use of this method of care.

One of the keys to success lies in supporting change management, which involves putting in placeplaces training sessions for all stakeholders: doctors, paramedics, patients, etc.

This short training (1h to 2h) begins with sufficient information on the device and its contributions in order to gain the support of caregivers and patients to facilitate its deployment.

The definition of the organizational protocol and its dissemination to the parties concerned are essential for the goodoperation and ownership of the device.

As an example, the process for the minimum implementation of a telemedicine project is detailed below:

1.Request for a telemedicine certificateNeed a specialist opinion (on a course of action, a therapy to be adapted): +/- diagnosis to be made, +/- follow-up of a chronic pathology, +/- trips outside difficult or impossible

Preparation of the “core curriculum” telemedicine dossier (form)

Request for a telemedicine certificate from the professional expert (remote medical expert) Validation of the request (reservation of a consultation period)Information from the attending physician

2.Preparation telemedicine session

Patient information

Obtaining the patient’s consent (or his legal representative when this is impossible, cf. cognitive disorders, impossible communication, patient under protection …)

Preparation of medical records Family information Staff information

3. Telemedicine session (here for teleconsultation)Preparation of the room of the requesting site

Availability of the patient’s medical file

Checking Internet connections

Commissioning of telemedicine software

Meeting in teleconsultation room

Arrival of the patient

Installation of people

Computer on, checking the correct framing

Start of teleconsultation session

4. after the telemedicine session

Possible debriefing

Consultation report

Report of the telemedicine session Quality assessment

RECOMMENDATIONS

A telemedicine project is above all a new organization of care which is part of a shared medical project, responding to an identified need. The medical service rendered to patients must not be less than the medical service rendered by the usual organization without telemedicine.

A telemedicine project is based on a new organization of care and professional practices which must be formalized according to the minimal process detailed above. The implementation of a telemedicine project must be done “step by step”, in coherence with the overall strategy of the establishment.

It is necessary to specify who intervenes, when and in what form, during the 3 main stages of implementing a telemedicine device:Step 1: Strategic framework (definition of the telemedicine development program).Step 2: Operational framework (development / design of the device).Step 3: Experimentation then generalization.

ACCORDING TO WHAT STEPS?

.Identify the needs (health / business needs analysis, contribution of telemedicine, types of act implemented, profiles of the patients concerned and estimation of the volume)

.Define governance (Steering, operational, ethics, evaluation committee, …)

.Specify the methodology (stakeholders involved, induced changes for the patient and for professionals, medico-economic model)

.Specify the porting of the project

.Detail the telemedicine protocol and the material conditions

.Implement governance and organization

.Adapt governance and organization as needed

Books to know more about Telemedicine

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