Moving Telehealth Forward Through Benchmarking

By Julie P. Cartwright, RN MBA

What tells us whether we made a good decision or if we are headed in the right direction along a defined path? Some would say we do so by measuring results. We look at maps drawn from the explorations of others. We compare the outcomes of our own experiences with the experiences of others. We set goals, and when we achieve them we know we made the right choices. Knowing where we are going in the practice of telehealth nursing is no different.

What is telehealth? The American Academy of Ambulatory Care Nurses (AAACN) Telehealth Nursing Practice Special Interest Group defined telehealth practice as a wide range of services delivered, managed, and coordinated by all health-related disciplines via electronic information and telecommunications technologies. The term telehealth represents the provision of health care beyond diagnosis and treatment to include services that focus on health maintenance, disease prevention, and education.

Within that framework, the subset of telehealth nursing has emerged. Telehealth Nursing, also known as telenursing, focuses on the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing. Telehealth nursing is a broad term encompassing practices that incorporate a vast array of telecommunications technologies such as telephone, fax, electronic mail, Internet, video monitoring, interactive video. Telehealth nursing is continually evolving. Telehealth nursing interventions encompass various types of nursing other than direct, hands-on patient care. Components of this practice, guided by nursing standards, include assessment, triage, consultation (such as information, advice, and symptom management), disposition, surveillance, and follow-up. Some established components of telehealth nursing are currently telephone nursing and tele-homecare.

Telehealth nursing has come into it’s own as a practice specialty and is recognized with its own certification exam offered by the National Credentialing Council (NCC). Have we been effective in moving a nursing practice modality, traditionally practiced hands-on and during face-to-face encounters, to the less traditional mode of Telenursing? In order to know that, we need to explore where Telenursing has been and where it is going.

One approach was to develop a web-based data collection tool that could address this gap in knowledge. As the practice strives to achieve quality programs, it continues to search for data on successful performance. In 1999, an AAACN colleague and I joined forces and developed a benchmarking survey tool (TBS-TelehealthSurvey) that was designed to do that.

TBS established an ongoing database that has attempted to capture the breadth and depth of telehealth practice. What the survey reveals is that there were so many more variations on the telehealth theme than it could possibly differentiate between in order to keep its promise. The promise was to make apples to apples comparisons. What was discovered in this process is that there are many different varieties of apples: Macintosh, Golden Delicious, and Granny Smiths, to name a few. Some apples are good for cooking and some are good for eating. So it goes with telehealth programs. Some telehealth programs are disease management focused, others community services focused (traditional telephone triage models), and some are marketing focused. The definitions, terms, and base of valuation changes over time and what was a “Macintosh” in 2001 may have become a “Granny Smith” by 2003. The biggest finding, however, was the challenge of relevance of aggregate data to individual varieties of telehealth programs. The more blended the data, the less relevant it becomes to individual program decision-making. That is why we at HMS Northwest (HMS) feel it is a time for change.

We have evidence of changes in gathering data, reporting of data, and managing data with other benchmarking providers for the call center industry. One example is that of Jon Anton’s work with BenchmarkPortal. BenchmarkPortal limits its core survey to that of 37 key questions. This process mainly identifies the source of the information (demographics) and key operational indicators. BenchmarkPortal then uses “one minute surveys” and audit processes to capture in-depth information for a specific target, client, or objective. HMS has also moved to conducting client specific audits that have met with great success. Audits are done on an individual basis identifying a specific type of “Macintosh” from among its clients and resources outside of telehealth that best matches the situation.

HMS dedicated TBS to serve the practice and in conjunction with AAACN, continues to support its original goals. Those goals are:

  • To document what is happening in the industry
  • To add to the body of research building within the industry
  • To contrast and compare reality in the field to the professional understanding of the work
  • To provide a venue for you to obtain peer group comparisons

The process establishes a record of the telehealth benchmarks (measurements) reported by various organizations/programs, from a single provider triage program to a large multi-state call center. The data collected permits differentiation among the types of services, populations, and resources to allow evaluation, exploration, and comparison of similar organizations or activities. In addition, by combining, the top reported performance benchmarks, best practices (that is, the top achievable levels of performance), are identified. This process is defined as the sharing of performance information to identify operational and clinical practices that lead to the best outcomes.

As HMS continues to move this initiative forward, it plans to look at new approaches in data collection and reporting. We have been asked to contribute relative findings and correlations found among the data collected as a regular feature in AnswerStat. Look for “A Piece of the Puzzle” in the next edition of AnswerStat. Please let us know if you have a specific request, we will try to address it in future publications.

Julie P. Cartwright is a Certified Call Center Auditor (CCCA), an RN, and holds an MBA. She is president and CEO of HMS Northwest Inc. in Port Angeles, WA.

[From the Fall 2004 issue of AnswerStat magazine]