Telehealth Checklists: Staying on Track Across the Miles

By Dr. Charu Raheja

There is no question that the world has become increasingly complex. There is more to remember, more tasks to complete, and more expected of everyone working in most every profession. We have become smarter, with more skills and technology that help us do amazing things. Unfortunately, even with all the knowledge available, the news is filled with accidents that occur as a result of memory or task failure. Ships run aground, doctors cut off the wrong leg, airplanes crash, and brakes fail to work because someone somewhere forgot to do something important. Whether the memory loss is due to having too many things to remember, or things being so mundane that they are overlooked, checklists offer a simple solution that provides a significant impact.

Checklists Come of Age: “In a nutshell, checklists ensure people are applying all the knowledge and expertise they have consistently well,” says Atul Gawande.

The aviation industry is credited with starting the checklist process in an effort to make sure pilots did everything needed to properly fly the “new and advanced” Boeing 299, which was more advanced than any airplane at the time. However, checklists are now used to carry out complex tasks required by firefighters, insurance companies, police departments, and hospitals.

Whether used in routine and repetitive situations or last-minute emergencies, checklists help people prioritize what is important, balancing judgment and procedures. Checklists can also be used when coordinating activities involving diverse teams that are working together, such as those involved in multi-tiered projects. By using checklists, every stage of the process can be standardized so that each group involved completes the appropriate steps as needed and on schedule.

Checklists in Medicine: In 2001, Johns Hopkins Hospital started using a simple checklist of steps to help decrease the incidence of central line infections in intensive care. The simple steps were:

  • Wash hands with soap before treating the patient.
  • Clean the patient’s skin with chlorohexidine antiseptic.
  • Put sterile drapes over the entire patient.
  • Wear a surgical mask, hat, sterile gown, and gloves while carrying out the line insertion.
  • Put a sterile dressing over the insertion site once the line is in.

After a year of monitoring the results, they found that the ten-day infection rate went from 11% to zero. This prevented forty-three infections, eight deaths, and saved $2 million in costs over a fifteen-month period.

Over the past few years, the benefits of checklists in medicine have reduced numerous medical complications, saved countless lives, and conserved billions of dollars. From local health departments to the World Health Organization, checklists are not only helpful but are critical to successful patient care programs.

Checklists Benefit Telehealth: While known for increasing efficiency, telemedicine can create substantial risk due to its nature of providing real-time patient information across computer networks. It is for that reason that every telehealth program can benefit by implementing a guiding checklist, or series of checklists, which ensures every step is accomplished as required. Here are some of the areas checklists can be useful in telehealth:

  • Relying heavily on technology, telemedicine programs must take extra care to safeguard the transmission of sensitive data. A checklist of each step from planning to implementation ensures each step is properly executed.
  • Run a thorough check on all equipment prior to use so substitutions can be made in a timely manner in the event anything is not working properly. Using a checklist to verify each piece of equipment and the proper procedures will ensure everything is working as required and can minimize technical issues.
  • Make sure all personnel are properly trained on the equipment and on the proper transmission of patient data in conjunction with HIPAA regulations. Training procedures, HIPAA forms, and procedural steps can all be simplified into efficient checklists for everyone to follow.
  • Utilize standardized protocols to improve the consistency of care. From the initial discussion or nurse triage, to the telehealth consultation and reporting, checklists provide an orderly process that covers each step and increases patient safety and satisfaction effectively.
  • Medicare reimbursement filing is organized into a checklist by various agencies so that telehealth providers can make sure they are eligible, and provide the correct information and CPT/HCPCS codes for payment.

Simplicity at Its Best: If organized properly, a checklist often looks like a list of items that are simple and easy, perhaps even absurdly common to people regularly engaged in the process. However, that is exactly why they are so important. A checklist is designed to keep employees from forgetting the simple steps and overlooking the obvious. They keep people and projects on track, and offer protocols that safeguard quality. The best time to incorporate the use of checklists is when you think what you are doing is too simple to forget or too complex to remember every step.

With numerous complexities and simplicities in telehealth, proper checklists and protocols can be the difference between a successful consultation and a waste of resources.

Charu G. Raheja, PhD, is the chair and CEO of TriageLogic Management.

[From the August/September 2013 issue of AnswerStat magazine]