09-0824-2 ctec program guide-staffing w cm edits.indd

Staffi ng a Telehealth ProgramPROGRAM GUIDE

CTEConline.org

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Staffi ng a Telehealth Program

Program Guide

This Document was developed through a joint collaborative between the California Telemedicine and eHealth Center (CTEC) and the University of Minnesota Great Plains

Telehealth Resource and Assistance Center (GPTRAC/UoMN).

developed by:

Mary DeVany, GPRAC/UoMN &

Christine Martin, CTEC

A Publication of:

California Telemedicine and eHealth CenterChristine Martin, Executive Director

This publication was made possible by grant number G22TH07770 from the Offi ce for the Advancement of Telehealth,

Health Resources and Services Administration, DHHS.

© 2011 California Telemedicine and eHealth Center.

Staffi ng a Telehealth Program | 1

Introduction

Staffi ng is oft en viewed as one of the most costly and criti cal components in developing and operati ng a successful telehealth program, but it is the staff that will ulti mately determine the success of the program. It is important to take a good look at how best to develop this important program component.

Staffi ng consists of a variety of functi ons, roles and responsibiliti es, each role necessary for smooth and effi cient delivery of services and operati on of the telehealth program. As part of the program development process, each telehealth program will need to determine how each functi on will be addressed – With existi ng staff ? With new staff ? Within which department? Developing telehealth program staffi ng will be infl uenced by factors including the type of service site, anti cipated services and service levels, size of the site, and available funding.

While the roles and functi ons necessary for telehealth operati ons has been well defi ned and described, each program will need to adapt the general knowledge for their unique needs and resources. Additi onally, organizati ons have staff with diff erent skills, strengths and interests. Making the most of existi ng staff strengths and structure will be an important considerati on when developing your staffi ng plan.

In the CTEC Program Development process, staffi ng considerati ons, analysis and decisions occur during Step Two, Defi ne A Program Model and Step Four, Develop The Detailed Program Descripti on and Plan. The staffi ng plan that is needed for any given program should be developed as the programs design is established. The size, scope and type of program will impact staffi ng requirements and should be taken into account before staffi ng decisions are fi nalized.

This guide provides informati on and suggesti ons for staffi ng a successful telehealth program. It describes the functi ons, roles and responsibiliti es most oft en associated with telehealth programs. This guide contains a template to assist programs in identi fying and assigning criti cal functi ons, roles and responsibiliti es and contains sample duty statements for some commonly used positi ons. This guide can be used to identi fy any gaps in the staffi ng plan for your new program, as well as to provide a few ideas to help strengthen an existi ng, growing telehealth program.

The informati on presented is generally adaptable to all types of telehealth programs.

CTEC has three on line training videos that support this guide: Pati ent Site Roles and Responsibiliti es, Provider Site Roles and Responsibiliti es and What Every Telemedicine Presenter Needs To Know. Other program assistance materials can be found at CTEC Center for Applied Telehealth - www.cteconline.org.

2 | Staffi ng a Telehealth Program

Eight Key Functions and Corresponding Staff Roles

Eight functi ons have been identi fi ed as essenti al when establishing and then sustaining a telehealth program. Covering all these functi ons and roles is vital to success. It is important to understand these functi ons, how they diff er and how they work together. It is valuable to consider each of the functi ons before deciding on staff roles, responsibiliti es and assignments. The eight functi ons are:

1. Project Management2. Program Management 3. Program Operati on and Site Coordinati on4. Clinical Directi on and Oversight5. Clinical Referrals6. Clinical Service Provision7. Pati ent Presentati on8. Technical Support

Aft er considering the necessary functi ons for a telehealth program, each functi on needs to have a more defi ned set of roles and responsibiliti es. These can then be assigned to specifi c staff , either new or existi ng. In many programs one person may be responsible for or perform more than one functi on or role. The actual number of staff will need to be identi fi ed as your program scope, service type and service levels are identi fi ed.

1. Project ManagementFunctionProgram Development / Project Management – The Project Management functi on is part of the initi al development or subsequent expansion of a telehealth program. The Project Management functi on coordinates all the eff orts necessary to research, plan, build, implement and manage the program. Project management involves using specifi c tools to defi ne the project, identi fy and involve stakeholders, track and manage the specifi c steps (including ti melines), resources, and goals necessary for the project to be successful. Proper project planning and management (including the use of appropriate tools and processes) helps to assure that clinical, operati onal and technical expectati ons and requirements are identi fi ed, met, or exceeded, therefore encouraging the successful outcome of the project.

Projects by their nature are limited in scope and ti me and the Project Management functi on concludes at the end of the development process. The project management functi on is diff erent than the on-going program management functi on discussed below. Best Practi ce: Successful program development has an assigned project manager.

Make sure to identi fy the diff erences between the “project” of the initi al implementati on or expansion of a telehealth project, and the on-going operati ons of the insti tuti onalized and sustained telehealth program. It is common in smaller programs to have the project management functi on combined with the program management functi on. The same individual developing the program is then responsible for managing ongoing operati on.

The Program Development Functi on should be assigned before any of the work begins on the development of the telehealth program.


RoleProgram Developer / Project Manager – The Project Manager role assumes responsibility for overall development of the telehealth program, including research, creati on of development products such as needs assessments and program descripti ons, create and execute project work plans and revise as appropriate to meet changing needs and requirements, identi fy resources needed and assign individual responsibiliti es, manage day-to-day operati onal aspects of specifi c projects and the corresponding scope. This positi on is responsible for all project accounti ng aspects including the tracking and reporti ng of team hours and expenses and managing of the project budget.

This positi on is responsible for identi fying the key stakeholders and incorporati ng them in the planning and implementati on processes. At this point, many of the positi ons that are indicated below may not have been identi fi ed, but there should be representati on from the various stakeholders they represent (administrati on, nursing, IT, rural/specialty medical staff , clinic staff , etc.)

If your organizati on is fortunate to have a full ti me project manager on staff , this person will transiti on the project, at its completi on, to the program manager. However, in small clinics it is oft en the case that the program manager also functi ons as the project manager. The descripti on of the role simply shift s from that of getti ng the project up and running to that of the long-term operati onal aspects.

It can be very helpful to obtain technical assistance from experienced telehealth program developers during the initi al development of a telehealth program. They bring experti se, experience and oft en tools to support the development process.

2. Program ManagementFunctionProgram Management – The on-going operati onal aspects of the telehealth program fall under this functi on. This includes general management acti viti es such as increasing organizati onal awareness, on-going staffi ng, human resources management, policies and procedures, coordinati ng with other pati ent care departments, educati ng pati ent-care departments, providing the guidance and training necessary to meet the needs of pati ents being served, coordinati ng the licensing/credenti aling needs of practi ti oners, encouraging and coordinati ng service development and expansion, tracking customer sati sfacti on (remote sites, pati ents, providers, etc), data collecti on (service uti lizati on, service access, etc.) and performance monitoring and reporti ng.

RoleProgram Manager – The Program Manager role is responsible for managing all the operati onal aspects of the telehealth program including but not limited to needs assessment, policy and procedures, workfl ow and staffi ng. This positi on is usually responsible for planning, designing, controlling, directi ng, coordinati ng, and evaluati ng the performance and status of all resources (personnel, hardware, soft ware, bandwidth, etc.) of the telehealth department.

This positi on works in cooperati on with all of the positi ons indicated below to provide guidance and assistance. Additi onally, this is the positi on that interacts regularly with the organizati onal leadership to keep them educated and updated on telehealth acti viti es.


3. Program Operation and Site CoordinationFunctionProgram Operati on / Site Coordinati on – This functi on includes acti viti es related to operati ons and providing assistance as needed to the practi ti oners at both the pati ent and practi ti oners locati ons. The success of the remote pati ent site is criti cal to the overall success of the enti re telehealth program. A signifi cant amount of coordinati on and commitment is required at the pati ent site. It is important to have a specifi c point of contact to provide assistance to other local staff and to serve as a champion for the telehealth program within the facility.

RolesTelehealth Operati ons Manager or Telehealth Coordinator – The Telehealth Coordinator is perhaps the most used role for telehealth programs. In smaller organizati ons the Telehealth Coordinator oft en functi ons as the Program Manager, the Service Coordinator and the Clinical Presenter. This positi on is usually responsible for developing and enhancing clinical telehealth services and applicati ons. This includes, but is not limited to, consulti ng with partner sites to determine and assess clinical needs and requirements; establishing and documenti ng proper procedures and policies regarding telehealth consultati ons, training personnel involved, assuring scheduling and other processes operate eff ecti vely and integrate with overall organizati onal processes; and communicati ng regularly with the medical director and program manager. These positi ons are used at both pati ent and provider sites.

As clinical services are identi fi ed and developed, this positi on will likely have some interacti on with the organizati on’s clinic management and/or business development leader(s), and with the billing, quality, and credenti aling departments as well.

While the ulti mate goal is to incorporate telehealth services as a component and tool of a clinical practi ce, thereby allowing clinic staff to be responsible for conducti ng their own telehealth events, as a program is initi ated it is likely that this positi on will be acti vely involved in the delivery of pati ent services. Assistance may be needed with scheduling medical specialists for telehealth consultati ons, coordinati ng with remote sites and verifying the presence of the pati ents to be seen, ensuring that the necessary clinical records and informati on is available for the pati ent and the clinician, confi rming licensing and credenti aling, and verifying that the equipment is functi onal prior to the beginning of consultati ons. The telehealth coordinator may functi on as a clinical presenter during pati ent care visits and may also complete any necessary paperwork including billing forms and communicati ons with referring practi ti oners.

Because of the functi ons of this positi on and the knowledge and skills required in the area of pati ent care and issues surrounding providing that care, many programs fi ll this role with a Registered Nurse (RN).

Pati ent Site Coordinator – Some programs diff erenti ate between the Provider Site Coordinator (someti mes called a Hub site) and a Pati ent Site Coordinator role. Pati ent site coordinator serves as the prime contact person at the remote (pati ent) service locati on. This positi on is oft en required to handle multi ple functi ons serving as an advocate for telehealth within the facility, coordinati ng the actual use of the equipment by various interested parti es (educati on, pati ent services, administrati on), assuring proper policies and procedures are in place, assisti ng with data collecti on and evaluati on acti viti es, and coordinati ng with other staff to assure Medical Staff requirements are met.

Many rural sites do not have the luxury of multi ple individuals to serve in the many roles indicated in this listi ng, so oft en one person has to be versed in a variety of responsibiliti es.


4. Clinical Direction and OversightFunctionClinical Directi on and Oversight – This functi on assures that there is adequate and appropriate clinical oversight to the services being provided by telehealth. Making sure that telehealth services are provided appropriately, are meeti ng the identi fi ed needs and are accessible, all without undue burden to the pati ents and staff being served is important. This functi on occurs at both the pati ent site and the provider site.

RoleClinical Director – The Clinical Director serves as the liaison between the telehealth program and the rest of the organizati on’s clinical staff for the purposes of program awareness, provider recruitment, service development, provider training, and general communicati on. This positi on oft en serves as the program champion by providing encouragement, directi on, and medical/clinical oversight of the telehealth program. The Clinical Director works closely with the Program Manager, Operati ons Manager and Telehealth Coordinator. A Clinical Director should be assigned at both the pati ent and provider sites.

5. Clinical ReferralsFunctionClinical Referrals – The practi ti oner at the pati ent site is oft en the gate-keeper for pati ents as they access telehealth services. Oft en, it is the practi ti oner who will identi fy a pati ent with a need to receive specialty care uti lizing telehealth services. Already-established relati onships with specialty providers is oft en what determines the referral.

RolePati ent Site Referring Clinician – In medical setti ngs, this is usually performed by the pati ent site primary care provider. The referring clinician at the pati ent site determines when a pati ent needs a service not available on site and will make the referral to a telehealth practi ti oner. The referring clinician identi fi es pati ents that may be suitable for telehealth services and oft en is the initi ator of the consult for specialty services.

This positi on relies on the combined skills of the remote site coordinator and the pati ent presenter to facilitate the telehealth interacti on between pati ent and telehealth specialty practi ti oner. Additi onally, there may also be interacti on with the Telehealth Coordinator and the Medical Director to ensure that services are available to meet the community’s needs and to address any quality improvement issues..


6. Clinical Service ProvisionFunctionClinical Service Provision – The practi ti oner at the specialty or other service site provides the service being requested by the referring practi ti oner. The clinician may also directly request telehealth services for a pati ent as part of their follow-up care.

RoleTelehealth Provider / Clinician / Practi ti oner –The practi ti oner is located remotely from the pati ent and is oft en a clinical specialist of some kind. This positi on is responsible for leading and conducti ng the actual pati ent interacti on as well as directi ng the acti ons of those assisti ng the pati ent. In some cases, the practi ti oner is actually directi ng the care of the pati ent remotely. In other cases, the practi ti oner is serving only in a consultati ve role to the pati ent’s primary provider.

This positi on usually relies heavily on the services of the pati ent presenter when seeing a pati ent. In many pati ent events, informati on from an electronic stethoscope, various video scopes, or other peripheral devices may be needed, as well as informati on from the pati ent’s electronic medical record.

7. Patient PresentationFunctionPati ent Presentati on – Since the idea of telehealth is to access services not available within the facility, it is expected that the practi ti oner providing the service is not physically located with the pati ent. In most cases, the remote clinician will require some level of clinical or techological assistance with the pati ent interacti on or examinati on. This includes serving as an extension of the clinician by assisti ng the pati ent, operati ng the telehealth equipment, uti lizing peripherals, as needed, and ensuring that a pati ent’s needs and the standards of care are being met.

RolePati ent Presenter – The pati ent presenter works with the remote telehealth clinician to present the pati ent. This presenter explains the visit to the pati ent and introduces the pati ent to the practi ti oner. The presenter is tasked with obtaining informed consent based upon the facility’s policy, ensuring that the pati ent’s charts are available and accessible, and anti cipati ng and preparing the pati ent for the event. This person serves as the extended hands, eyes and ears of the practi ti oner at the pati ent-end of the connecti on during live interacti ve consults. This requires the ability to operate the telehealth equipment and usually requires the understanding and use of various scopes and other peripheral devices. This also involves pati ent discharge, pati ent educati on and coordinati ng of additi onal care. When store and forward equipment is used, the presenter captures the digital images as well as the necessary clinical informati on to forward to the remote practi ti oner.

The role of Pati ent Presenter can be fi lled by many individuals. Many organizati ons have determined that having only one or two individuals trained to serve as the pati ent presenter is not very effi cient. In order to incorporate telehealth as a core service, some organizati ons have determined that all nursing


staff should be able to serve in this capacity, to be able to present their own pati ents to the telehealth practi ti oner as the need arises.

8. Technical SupportFunctionTechnical Support – Making sure that the equipment and network is set-up to encourage the smallest amount of “down ti me” and the highest level of “usability” is a signifi cant part of the technical support functi on. While the technology has certainly become much easier to use over the past many years, there is sti ll a need to be able to provide on-going technical support to the users of the telehealth services. Nothing is infallible, and while the frequency of equipment failure or glitches are small, there is a likelihood that equipment challenges will occur when you least want them.

Role Technical Specialist/Network Analyst – The technician is responsible for the day-to-day functi oning of the telehealth equipment and related network issues and peripherals (i.e. bridge, stethoscopes, modems, etc.). This includes the appropriate testi ng, operati ons and maintenance of the equipment, supporti ng proper and appropriate usage by the users, establishing/maintaining appropriate network infrastructure, and adhering to appropriate equipment-related organizati onal policies and procedures. This person should be available when there are technical diffi culti es with live telehealth sessions.

This positi on works in regular cooperati on with Telehealth Coordinator in order to maintain a usable network to best meet the needs of the pati ents served. In larger organizati ons, the technical and network roles are oft en served by diff erent people.

Some Additional FunctionsThere may be, depending on the services provided, additi onal functi ons that should be addressed. Some of these include:

FunctionDistance Educati on Coordinati on – Some organizati ons have established a very specifi c focus on educati onal off erings. As a result, the coordinati on of these events is important for proper delivery and improved educati onal value. Making sure that both presenters and parti cipants have a rewarding experience is the primary goal.

FunctionEvent Scheduling – If the volume of your services climbs to a level of use that can justi fy it, having someone task specifi cally with scheduling may be helpful. Some programs establish diff erent scheduling processes between administrati ve and educati on events and clinical events and have chosen to keep these two focuses separate in the scheduling process. Some programs have not necessitated the need for the separati on and both focus areas are scheduled through the same process.

FunctionAdministrati ve Assistance/Accounti ng – In some larger health system-based programs and some university-based programs, the involvement of and someti mes volume of grants dictates the need for additi onal administrati ve and accounti ng assistance.


FunctionQuality and Research – In some organizati ons, the importance of evaluati on and data comparison is at such a level that it is established as a separate functi on.

FunctionPati ent Monitoring – In the case of home health programs, establishing and maintaining a relati onship with the pati ent being monitored is a key functi on. Observing and communicati ng with the pati ents involved in the program is the core to home-based telehealth services.

Identify Other Key Stakeholders Additi onal organizati onal members on both ends of the service need to be involved in and aware of the telehealth implementati on as well as be kept apprised of the conti nuing acti viti es and services of the telehealth program. This on-going communicati on will encourage long-term support of your telehealth program and lead to its ulti mate sustainability. The fi rst step to fi guring out how to incorporate telehealth into the organizati onal infrastructure is through regular communicati ons and awareness building.

Chief Executi ve Offi cer/CFO/CIO/Lead Administrati ve Team – Organizati onal leaders need to be infomed and educated about the benefi ts and operati on of telehealth. As organizati onal prioriti es are identi fi ed, it is important for them to understand exactly how telehealth services can make an impact and assist the organizati on in accomplishing annual and long-term goals. If they understand the value that telehealth can bring to the organizati on, they are much more likely to support it, philosophically and budgetarily, in the future.

Chief of Medical Staff – In many organizati ons this is a rotati ng positi on, but it is important to establish communicati on early and oft en with whomever is serving in this role (and then again when the next person takes over). Gaining this persons support, or at least building their awareness, is an important block in the foundati on of the program. If the organizati on has a full-ti me positi on for this role, it would be highly benefi cial to engage this person as a telehealth champion. As new providers/physicians are recruited to serve within the organizati on, that person has the opportunity to encourage or require the use of telehealth services.

Director of Nursing/Chief Nursing Offi cer – This person directs the overall acti viti es of the organizati on’s nursing staff . This person is pivotal to telehealth program success. Gaining their support and buy-in from the beginning of the project planning phase is important.

Business Offi ce/Billing Staff – Communicati ng with someone who understands your organizati on’s billing process and working with them to make a plan for incorporati ng telehealth services into the established structure will be important.

Outreach/Service Development Staff – As you consider and evaluate services to provide and/or receive, make sure to stay in regular contact with other staff also involved in outreach acti viti es. It is important to collaborate with others striving to develop and grow services so as to not present confl icti ng messages and to create partnerships that support the eff orts of the outreach staff .

Training/Educati on Staff – Oft en one of the services off ered by a telehealth program is educati on. It is important to involve the educati on staff in the initi al planning and stay in regular communicati ons with them along the way. Staying informed about current and future educati onal needs as well as current in-house off erings will help to develop a plan for future development eff orts. Additi onally, they can help identi fy appropriate training methods for training staff of the telehealth program. They may


also have regularly scheduled educati on sessions where awareness-building for telehealth could be incorporated. It is also necessary to appropriately train individuals to be successful clinical presenters.

IT Staff – Keeping in close communicati on and establishing a partnership with this group will be a criti cal key to the overall, and long-term success of the telehealth program. Providing telehealth services will have an impact on the facility’s current network infrastructure. Establishing regular communicati ons with this group, including making plans to manage the initi al impact, as well as the on-going anti cipated usage and potenti al service growth, will strengthen their understanding of, commitment to and ulti mately their support of telehealth services within the organizati on. This group oft en does not get to see the impact they have on direct pati ent care, so make sure to share your success stories with them.

It is important to keep in mind that these positi ons need to be addressed at both the pati ent site and the provider site. It is important that communicati ons be acti ve to and from the leadership at both the remote facility and the provider locati on. Garnering support for the telehealth eff orts is important at both ends of the telehealth services link. A weakness on either end can lead to failure.

Organizational Placement of Telehealth Many developing programs ask about the ideal placement within the structure of your organizati on. In May of 2007, the University of Kentucky, Kentucky Telecare telehealth program conducted a survey of telemedicine programs across the country to obtain informati on on this subject. The results indicate that there is not one best answer, but each organizati on had to try to identi fy the best fi t for their program. The survey results indicate:

• 44% telehealth program located within an administrati on-level department

• 15% Informati on Technology

• 11% Clinical Enterprise

• 9% Educati on

• 21% other

It is likely that as the telehealth program is initi ated within a facility or organizati on the staffi ng will be organizati onally located across several already established departments, with one or two individuals serving as the leader(s) responsible for the success of the overall program.

There may be logic for dividing out components of your program which will always remain under another department’s control. Some examples of this might be: credenti aling and privileging – it might be best to simply coordinate with the current credenti aling department instead of taking on those complicated processes specifi cally for the telehealth-related services; or technology – there may be some value in having the informati on technology department be in charge of the actual telehealth hardware as they may already have processes and understanding for hardware installati on requirements, upgrades, network issues, tracking and more.

In situati ons where responsibiliti es are delineated out to other departments, it is highly recommended that a specifi c individual (or individuals) be identi fi ed as the department lead for telehealth. This helps to develop a level of experti se in telehealth-specifi c issues and needs and identi fi es a “go to” person for questi ons and diffi culti es that might arise.


Developing A Staffi ng PlanNow that you have an understanding of the functi ons and commonly used roles, it is ti me to develop a staffi ng plan for your organizati on.

The number of staff recommended for your program will depend on the size of your organizati on as well as the anti cipated size and volume of your initi al program implementati on. While oft en one person can be involved in multi ple program roles, especially at the beginning, organizati ons are strongly encouraged to be careful not to overload one person with too many various components. This not only can weigh very heavily on one person, it can also have a detrimental impact on your program. By spreading the responsibiliti es across multi ple individuals, a program builds multi ple levels of buy-in and commitment to the success of the program. As the number of clients being served through the program grows, the staffi ng will also need to grow to meet the pati ent need. At some point in the program development, it may be necessary to have a stand-alone telehealth department and staff . However, as the program begins, the responsibiliti es of telehealth may be best served by existi ng staff

While program structure may vary signifi cantly, the core functi ons and responsibiliti es of those same programs are oft en very similar.

A matrix similar to the one below can be used to identi fy who is doing what at both ends of the service and to also identi fy responsibiliti es that may not be currently covered. A more detailed Sample Staffi ng Matrix and a corresponding template is found in the Appendix of this Guide. This matrix can be used to identi fy large functi onal group responsibility but can also be used to add specifi c acti viti es and tasks as they are identi fi ed and assigned.

Sample Staffi ng Matrix

Functi onal Area

Identi fi ed Staff Role / Positi on

Proj

ect

Man

ager

Prog

ram

M

anag

er

Prog

ram

Co

ordi

nato

r Pr

ogra

m

Ope

rati o

ns

Pati e

nt

Pres

ente

r

Refe

rrin

g Cl

iniia

n

Rem

ote

Practi ti

one

r

IT S

taff

Clin

ical

D

irect

or

Program Development /Project Management

X

Program Management X

Program Operati ons / Site Coordinati on

X

Clinical Directi on and Oversight

X

Clinical Referrals XClincial Service Provision

X X

Pati ent Presentati onTechnical Support X X


Identifying Necessary Skills and Knowledge Telehealth will require that staff learn some new skills and expand their knowledge base to incorporate the technical and clinical aspects of telehealth. For some staff , operati on of the equipment and medical peripherals will be a necessary competency. Learning to work with clinicians and pati ents using videoconference technology will be criti cal.

The Skills and Knowledge Area Matrix found in the Template Secti on of this Guide provides a listi ng of skills that each positi on should have and its related importance for the indicated positi on. This informati on will help you identi fy what training will be required and may assist in determining which staff may be right for certain functi ons and roles.

Assigning Responsible Staff The following is a list of high level functi ons that should be addressed, in some manner, as you begin to establish, or expand, your telehealth program. These functi ons may be fi lled by individuals identi fi ed as telehealth staff or by those in other departments providing directed assistance.

Functi on Positi on Responsible for Functi on

Staff Member Assigned

Project Management

Program Management

Operati ons/Coordinati on

Clinical Directi on

Clinical Referrals

Clinical Service Provision

Pati ent Presentati on

Program Challenges Related To Staffi ngStaffi ng challenges can impact developing and maintaining a successful, progressive telehealth program. Program Development eff orts and ongoing management will need to consider strategies to address these areas. Some of those challenges center on staffi ng issues.

1. Finding The Right PeopleImplementi ng telehealth takes fl exibility and a commitment to change. Oft en the fi rst challenge is fi nding interested and enthusiasti c individuals who will be committ ed to the program and making things work. It is important to have key staff that have a fl exible work style, a customer-service/pati ent-centered focus, and an interest in fi guring out how to make things work. Knowing that bringing something new or diff erent into an organizati on can be complicated, the people working on the project, and hopefully ulti mately the long-standing insti tuti onalized program, must understand the diffi culti es before them and sti ll be excited about the opportuniti es telehealth can bring to the organizati on in spite of the challenges. Good communicati on skills are a must and a willingness to learn about new technologies.


2. Staff RetentionMany programs report that staff turn over is on-going challenge, parti cularly in rural health clinics. As the program is initi ated, having an understanding that this will happen, and being prepared for it when it does happen, will help sustain the program in the long run. One of the important things to consider when developing the telehealth program is how much of the success of the program is ti ed to one person…and what would happen if that one person was no longer there. Making sure that appropriate policies and procedures are identi fi ed and in place, as well as having detailed job descripti ons, will be helpful as transiti ons occur. Additi onally, it is important to make sure that departmental staff are cross-trained in all roles to reduce the challenge of staff transiti ons. Some of the key staff that could see regular change include: administrators, program managers, clinical presenters, practi ti oners/physicians at both the pati ent and specialist locati ons, remote site telehealth coordinators and technical staff . Assuring that the organizati on supports and understands the program will signifi cantly lessen the impact of staff turn-over issues when they occur.

3. Obtaining Adequate and Appropriate Training At The Right TimeTraining of staff is an ongoing need As vacancies occur and telehealth program staff are hired, training will be necessary in both clinical and technical aspects of the program. In additi on, keeping up skills is necessary when use of the telehealth equipment is infrequent. Both of these situati ons require the availability of training. Newly developing programs will need to identi fy strategies for training. This guide contains a detailed matrix on skill sets required by diff erent staff involved with telehealth. CTEC has a series of training videos that can be used for training. The Nati onal School for Applied Telehealth, the Univerity of Minnesota, the University of California and others have on-line and in person training programs available.

4. Budgeting for Required Staff Identi fying on-going budget dollars to support the program in the long run can be a signifi cant challenge. Oft en initi al start-up funding can be obtained from local, state, federal, or foundati on grant dollars to support the initi al pilot project. The on-going dollars needed to support the staff necessary for maintaining strong, sustainable programs is oft en more diffi cult to identi fy. This is where your on-going evaluati on and data tracking acti viti es will show their value. The ability to demonstrate dollars-saved, revenue gained, increased pati ent volume, a reducti on in provider turn-over, increased pati ent sati sfacti on and more, will go a long way to help in securing those annual operati ng dollars that are needed to sustain the program, including the positi ons identi fi ed above.

Conclusions and Best PracticesAs determinati ons are being made regarding the appropriate staffi ng structure and model for your organizati on, it is important to remember that there are no carbon copies. Each organizati on has a unique history, culture, need, and structure. Additi onally, each team member brings unique skills and interests to the program. Understanding your organizati on, your team members, and then making sure that all of the necessary program needs and functi ons are being met, will certainly help you develop a staffi ng structure that will best meet the needs of your telehealth program.

Ulti mately, it is important to keep the main goal of telehealth in mind during all planning and discussion sessions: how the program can best meet the needs of the pati ents served as well as the clinicians


serving them. Keeping the pati ent in mind, among all of the other factors being considered as the program is being developed (strategy, budget, equipment, etc.), will help to guide your decisions.

Best Practi ces related to staffi ng include:

• Assure that the functi on of project management has been assigned to a staff member or a contractor

• Contractors with telemedicine development experience can be used to assist a newly development program with project management and with program development experti se.

• Find training programs that support diff erent staff functi ons.

• Find ways to regularly assess staff skill levels and to provide immediate training to newly assigned staff .

• Have more than one staff member skilled and assigned to pati ent presentati on


Tools & TemplatesTemplate: Staff Positi ons Responsible for Functi onal Areas

Template: Staff Assignments by Functi onal Area

Skill and Knowledge Area Matrix (CTEC Document)

Sample Duty Statements:

Program Manage, Telehealth Program Coordinator, and Clinical Presenter


TemplateStaff Positions Responsible for Functional Areas

Functi onal Area

Identi fi ed Staff Role / Positi on

Proj

ect

Man

ager

Prog

ram

M

anag

er

Prog

ram

Co

ordi

nato

r/

Prog

ram

O

perati o

ns

Pati e

nt

Pres

ente

r

Refe

rrin

g Cl

iniia

n

Rem

ote

Practi ti

one

r

IT S

taff

Clin

ical

D

irect

or

Program Development /Project ManagementProgram Management

Program Operati ons / Site Coordinati onClinical Directi on and OversightClinical ReferralsClincial Service PRovisionPati ent Presentati onTechnical Support

TemplateStaff Assignments by Functional Area

Functi on Positi on Responsible for Functi on

Staff Member Assigned

Project Management

Program Management

Operati ons/Coordinati on

Clinical Directi on

Clinical Referrals

Clinical Service Provision

Pati ent Presentati on


Skill

s an

d Kn

owle

dge

Area

Mat

rix

List

ed b

elow

are

som

e im

port

ant s

kills

and

kno

wle

dge

area

s fo

r te

lehe

alth

pro

gram

staff .

Six

com

mon

ly u

sed

role

s ar

e id

enti fi

ed

and

the

leve

l to

whi

ch th

at p

ositi

on re

quire

s th

at s

kill

have

bee

n w

eigh

ted

betw

een

+ an

d ++

++ (l

ow to

hig

h).

In m

any

orga

nizati o

ns, m

ulti p

le

role

s m

ay b

e as

sign

ed to

one

staff

per

son.

For

a b

rief

defi

niti

on o

f eac

h ro

le, p

leas

e re

fer

to th

e en

d of

this

doc

umen

t.

TH

IS M

ATRI

X IS

PRO

VID

ED A

S A

GU

IDE.

EVE

RY P

ROG

RAM

WIL

L N

EED

TO

DET

ERM

INE

THE

SPEC

IFIC

ATIO

NS

FOR

ROLE

S W

ITH

IN T

HEI

R O

WN

PRO

GRA

M.

Skill

or

Know

ledg

e A

rea

Nee

d fo

r Sk

ill o

r Kn

owle

dge

Are

aPr

ogra

m

Man

ager

Tele

med

icin

e Si

te

Coor

dina

tor

Pati e

nt

Pres

ente

rRe

ferr

ing

Clin

icia

nRe

mot

e Pr

acti ti

one

rTe

chni

cal

Spec

ialis

tU

nder

stan

d th

e be

nefi t

s of

te

lehe

alth

pro

gram

s++

++++

+++

++++

++++

++++

++

Prep

arin

g a

need

s/m

arke

t A

naly

sis

++++

+++

++

+

Busi

ness

mod

el

deve

lopm

ent a

nd

sust

aina

bilit

y

++++

+++

++

+

Org

aniz

ati o

nal R

eadi

ness

++++

+++

++

+

Stra

tegi

c pl

anni

ng a

nd

tele

heal

th a

pplic

ati o

ns++

++++

+++

+++

Proj

ect m

anag

emen

t for

tel

++++

++

Man

agin

g or

gani

zati o

nal

chan

ge++

++++

+++

++++

++


Skill

or

Know

ledg

e A

rea

Nee

d fo

r Sk

ill o

r Kn

owle

dge

Are

a

Prog

ram

M

anag

erTe

lem

edic

ine

Site

Co

ordi

nato

rPa

ti ent

Pr

esen

ter

Refe

rrin

g Cl

inic

ian

Rem

ote

Practi ti

one

rTe

chni

cal

Spec

ialis

t

Impa

ct o

f tel

ehea

lth o

n or

gani

zati o

nal o

perati o

ns++

++++

++++

+++

++++

++++

Lega

l Con

side

rati o

ns++

++++

++++

++++

++++

+

Priv

acy

and

Secu

rity

++++

++++

++++

++++

++++

++++

Reim

burs

emen

t++

++++

++++

+++

+++

Practi c

es o

f suc

cess

ful p

rogr

ams

++++

++++

++++

++++

++++

++++

Eval

uati o

n of

pro

gram

ope

rati o

n an

d eff

ecti

ven

ess

++++

++++

++++

+++

Man

agem

ent r

eporti n

g++

++++

++

++

+

Tele

med

icin

e A

pplic

ati o

ns++

++++

++++

++++

++++

++++

Tele

heal

th T

echn

olog

ies

++++

++++

++++

++

Equi

pmen

t typ

es

++++

+++

+++

+++

++++

Equi

pmen

t spe

cifi c

ati o

ns a

nd

stan

dard

s++

+++

++

++++

Equi

pmen

t sel

ecti o

n++

++++

+++

+++

++++

Ope

rati o

n of

Tel

emed

icin

e Eq

uipm

ent

+++

+++

+++

++++

Equi

pmen

t mai

nten

ance

++

++

+++

++

Equi

pmen

t tro

uble

shoo

ti ng

++

+++

+++

++

Tele

com

mun

icati

ons

fund

amen

tals

+++

+++

+++

++


Skill

or

Know

ledg

e A

rea

Nee

d fo

r Sk

ill o

r Kn

owle

dge

Are

aPr

ogra

m M

an-

ager

Tele

med

icin

eSi

te C

oord

inat

orPa

ti ent

Pres

ente

rRe

ferr

ing

Clin

i-ci

anRe

mot

ePr

acti ti

one

rTe

chni

cal S

pe-

cial

ist

Vid

eo s

tand

ards

and

spe

cifi c

ati o

ns+

++

++

++++

Tele

com

mun

icati

ons

inst

allati o

n+

++

++++

Tele

com

mun

icati

ons

ope

rati o

n +

++++

++++

tele

com

mun

icati

on

mai

nten

ance

+++

++++

Trou

bles

hoot

tele

com

mun

icati

ons

co

nnecti o

ns++

+++

++++

Serv

ice

leve

l agr

eem

ents

+++

+++

++

Tele

med

icin

e sp

ecifi

c cl

inic

ope

ra-

ti ons

pro

cedu

res

+++

++++

++++

+++

+++

+

Sche

dulin

g an

d fo

llow

-up

++++

++++

++++

+

Tele

med

icin

e sp

ecifi

c re

ferr

al p

ro-

cedu

res

++++

++++

++++

++++

+++

Man

agin

g m

edic

al R

ecor

d++

+++

+++

+++

Reim

burs

emen

t++

++++

++

+

Clin

ical

pro

toco

ls++

+++

++++

++++

++++

Role

of t

he p

ati e

nt p

rese

nter

and

ho

w to

wor

k w

ith p

rese

nter

s+

+++

++++

++++

++

Perf

orm

ing

tele

med

icin

e co

nsul

ta-

ti ons

++

++++

++++

++++

++++

Info

rm p

ati e

nts

abou

t tel

emed

icin

e pr

oces

s++

++++

++++

++++

+

Usi

ng th

e te

lem

edic

ine

equi

pmen

t+

+++

++++

+++

++++

++

Dat

a co

llecti

on

++++

++++

+++


Defi nitions for Commonly Identifi ed Telemedicine Staff Members

Program Manager: The program manager provides overall management and oversight of program acti viti es. The program manager is the leader of the telemedicine team. He or she represents the group, advocates on its behalf to the organizati on and manages the staff . The manager reports on the functi on and progress of the service, directs any process and improvement acti viti es, negoti ates budgetary issues, recruits and hires staff , sets prioriti es in consultati on with the team, and supervises its functi oning.

Telemedicine Site Coordinator: The telemedicine coordinator manages the day-to-day clinic operati ons. He or she develops operati onal protocols, schedules medical specialists for telemedicine consultati ons, schedules and verifi es the presence of the pati ents to be seen, ensures that the necessary clinical records informati on is available for the pati ent, and verifi es that the equipment is functi onal prior to the beginning of consultati ons.

Pati ent Presenter: The pati ent presenter works with the remote practi ti oner to present the pati ent. This person introduces the pati ent to the practi ti oner and explains the visit to the pati ent. The presenter is usually tasked with providing and documenti ng the writt en and verbal pati ent consents (required in California) and ensuring that the pati ent’s charts are available. This person is the extended “eyes and ears” of the practi ti oner at the other end of the connecti on during live interacti ve consults. When store and forward equipment is used, the presenter captures the digital images as well as the necessary clinical informati on to forward to the remote practi ti oner

Referring Clinician: The referring clinician determines when a pati ent needs to be seen by a remote practi ti oner. The clinician screens pati ents that may be suitable for telemedicine services and initi ates the consult for specialty service.

Remote Practi ti oner: The remote or consulti ng practi ti oner is responsible for conducti ng the actual telemedicine visit.

Technical Specialist: The technical specialist possesses the technical skills to set up and maintain all telemedicine equipment. This person is tasked with ensuring that telecommunicati ons and networking issues are addressed and resolved and should be available when there are technical diffi culti es with live examinati on sessions.


Sample Duties Statement

Program ManagerManage all aspects of the telehealth department including but not limited to staff , programming and system implementati on, hardware/soft ware requirements, system/user prioriti es, and workfl ow. Responsible for planning, designing, controlling, directi ng, coordinati ng, and evaluati ng the performance and status of all resources (personnel, hardware, soft ware, bandwidth, etc.) of the telehealth department.

Duti es and Responsibiliti es

• Reviews and establishes departmental policies, procedures and plans.

• Develops and directs telehealth prioriti es for the organizati on in concert with and at the directi on of leadership.

• Responsible for the collecti on, analysis, maintenance and reporti ng of stati sti cal data to identi fy, diagnose, and correct problems/factors aff ecti ng performance, to track uti lizati on, and other needs.

• Designs methods and procedures for effi ciency, producti vity, and control of operati ons and coordinates day-to-day operati ons.

• Provides planning, consultati on and advisory services on telehealth development and issues to determine feasibility and applicability to organizati onal needs.

• Maintains eff ecti ve communicati on and awareness by consulti ng with physicians, physician offi ces, affi liates, and department directors and/or representati ves to discuss telehealth needs and directi ons.

• Prepare the departmental annual budget and with on-going review and acti on assure that budgeted objecti ves are achieved and that cost and expense objecti ves are met.

• Represent the organizati on on appropriate telehealth-related acti vity and/or planning groups on an organizati onal, regional and nati onal level.

• Supervise the administrati on of telehealth-related grant funds.

• Serve on any and all grant fund related committ ees (federal, regional, state, and local).

• Be knowledgeable on public policy issues and the possible impact to telehealth services

• Acti vely advocate and build the awareness for telehealth at all governmental levels.

• Balances limited resources with confl icti ng prioriti es.

• Oversees the coordinati on of scheduling for all related faciliti es (bridge acti viti es) for all intra-network, and inter-network conferences.

• Oversees the coordinati on eff orts with the Educati on Departments on the availability of programs to be broadcast via telehealth.

• Approves the purchase, license, or other acquisiti on of telehealth-related systems for the organizati on in

order to encourage cohesion and compati bility.



Telemedicine CoordinatorResponsible for developing and enhancing clinical telehealth applicati ons. This includes, but is not limited to, consulti ng with rural partner sites to determine and to assess their clinical needs and requirements; establishing and documenti ng proper procedures and policies regarding telehealth consultati ons; and training personnel involved.


• Serve as primary liaison with primary care physicians and their clinical staff .

• Assist clinicians develop telehealth applicati ons.

• Promote the awareness of telehealth usage/applicati ons among medical staff , the nursing community and allied health professionals within the organizati on and the region.

• Develop/Manage/Coordinate clinical eff orts within the organizati on and at partner sites.

• Work with the program manager and other clinicians to conceptualize and develop clinical applicati ons.

• Assist the clinicians during consultati ons when necessary.

• Train rural partner site nurses, physicians, and care extenders to perform clinics.

• Become familiar with issues and concerns that may arise regarding pati ent billing.

• Be involved with educati onal program development and assist presenters as necessary.

• Parti cipate in and develop appropriate documentati on of usage, sati sfacti on, and other relevant stati sti cal and quality data and informati on.

• Travel to partner sites to promote clinical involvement of rural clinicians.

• Work in cooperati on with all telehealth staff to develop appropriate guidelines and policies/procedures.

• Be knowledgeable on public policy issues and the possible impact to telehealth services.



Clinical PresenterResponsible for scheduling pati ents, preparing charts, presenti ng pati ents to the remote physician, completi ng required pati ent charti ng and collecti ng encounter data.


• The clinical presenter is present during every telemedicine visit to properly inform and introduce all parti es involed prior to the start of each visit.

• Excellent verbal and writt en communicati on skills to convey informati on clearly to the remote physician.

• Maintains pati ent confi denti ality

• Presents each pati ent visit and locates and presents medical informati on from the medical record as directed by the att ending physician.

• Assures that the required clinical follow up, diagnosti c testi ng and medicati on processing are completed.

• Responsible for operati ng and basic trouble shooti ng of telemedicine equipment.

• Regularly communicates with the Telemedicine Coordinator and provides feedback on insti tutaional procedures that may exsit that impact the operati on of telemedicine.

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