Establish a formal telehealth specific governance structure and appoint telehealth leaders.
‘Governance’ is the systems, processes and relationships through which an entity is directed or controlled.
‘Clinical governance’ is an organisation-wide approach to the continuous quality improvement of clinical services. It involves the systematic joining-up of all patient safety and quality improvement initiatives within a health organisation. (HQSC Clinical Governance: Guidance for health and disability providers)
Telehealth can be considered as a strategic opportunity to change the way patients receive, or be empowered to take responsibility for their own, care. It is much more than a way of making an existing service model more efficient.
Good governance is essential to making telehealth mainstream in the delivery of health care. It is needed to realise the full potential for telehealth technologies in improving access to health care for patients, reducing clinical risk, and to using clinical administrative resources more efficiently.
Establishing a formal specific telehealth governance structure and appointing telehealth leaders or clinical champions are vital. One option is to set up a telehealth governance group as a subcommittee of or incorporated within the primary health organisation (PHO) clinical governance group. Strong leadership is needed to improve understanding and gain buy-in at the managerial and clinical policy levels of health service organisations.
Governance is also paramount to ensure clinical collaboration and seamless technical interconnectivity between health providers. This includes sharing learnings on equipment configurations, protocols and procedures, and technical and IT systems support.
Strategic direction on the implementation and use of telehealth, including the alignment of telehealth with appropriate remuneration frameworks, will help to overcome resistance to adopting new technologies. Governance should be tailored to patient engagement and community care. Furthermore, it is important to invest in robust evaluation of the clinical and fiscal benefits from telehealth use. Investment should be based on ‘hard data’ rather than on aspirational individual thinking and leadership.
The College recommends addressing the following matters to increase the sustainability of telehealth:
1. Establish a telehealth governance group
Functions of the governance group should include:
- Sponsoring and supporting planning, implementation and ongoing activities to start and sustain the telehealth programme.
- Developing an investment plan and providing oversight of telehealth investment, eg approving investment in equipment, facilities, support staff and evaluation. This helps to ensure technical infrastructure meets any current unmet demand from the practice and for future growth.
- Advising senior management on strategy on telehealth.
- Ensuring the adoption of standards and guidelines for the effective use of telehealth (eg HISO standards for interoperability and interconnectivity)
- Ensuring robust information governance mechanisms so the organisation holds and shares data safely, and gives people the confidence to share their data across care settings. This includes transparency about how patient data will be used, informed consent processes for data analysis, and protecting data systems against cyber-attacks and reporting breaches.
- Communicating and promoting the use of telehealth with users including staff and patients. Planning and implementation must be responsive to the needs of patients and staff.
- Promoting collaboration with parties from other organisations.
2. Appointing a clinical telehealth leader or clinical champion.
3. Appointing telehealth programme manager or facilitator.
4. Agree on telehealth strategies and policies
- Formally document telehealth policies to govern the introduction and use of telehealth services in the organisation.
- Protocols and guidelines for using telehealth tools
5. Dedicate resources for programme management, facilitation and technical support.
In order for telehealth consultations to become mainstream, it is important for practices to employ a mechanism to evaluate the outcomes of telehealth use, to assess patient experience and clinical safety, and any efficiency gains. Credible data is necessary for evaluation, to relate telehealth use to health outcomes, and for telehealth to be appropriately recognised in contracts and reimbursement policies.