Children's Hospital Colorado
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Tackling Barriers and Improving the Benefits of Telehealth


Doctor on telehealth conference

Can we fine-tune telehealth to create a seamless experience for our patients and providers?

The COVID-19 pandemic led to a rapid paradigm shift in clinical care. Children’s Hospital Colorado was largely prepared for that shift thanks to its established telehealth team — who foresaw the benefits of such a program and had been laying the groundwork for nearly a decade. Now almost a year into an unprecedented global health crisis, those benefits are more obvious than ever. In the Department of Pediatrics at Children’s Colorado, focus has shifted from a simple service offering to a long-term, integrated, sustainable model.

“We’re focused on two aspects when it comes to our ambulatory practices,” says Elizabeth Jackson, MHSA, Clinical and Business Administrator in the Department of Pediatrics. “How we can optimize telehealth to make sure we have the best possible patient-provider experience and working with each clinical program to identify its so-called sweet spot.”

Identifying the sweet spot

A “sweet spot” is the ideal mix of in-person versus virtual appointments, a target percentage based on a program’s goals, service model and what it feels is most realistic for its providers and patients. Part of identifying a sweet spot is recognizing opportunities for better, more convenient and lower-cost care with telehealth.

“We do a lot of chronic disease management,” Jackson says. “Telehealth gives us the opportunity to reduce the number of times patients and families have to physically come in but increase the number of times we see them.”

For example, a patient with a chronic condition may traditionally have been seen every six months. Now, they might be seen every three months, swapping between in-person and telehealth. “It really improves quality of care,” says Jackson.

Optimizing the experience

Reaching that sweet spot requires buy-in from patients and providers, which you won’t get unless you focus on their experience. So the Department of Pediatrics, in partnership with Children’s Colorado, launched an assessment to identify key barriers to telehealth.

Technology and visit support, of course, topped the list. Along with the more obvious device or bandwidth issues, there is opportunity to optimize the care team around the telehealth visit. Nurses and medical assistants are a crucial part of the in-person care visit process — and are vital for the success of telehealth visits, too.

Patient and provider preference was also notable, with some on both sides favoring face-to-face interactions, perceiving quality of care is better that way. Other barriers include language and interpretation services, out-of-state limitations with licensure and billing, and increasing the nimbleness of the scheduling system to swap between in-person and telehealth. Jackson and her team presented their findings to the hospital’s leadership team, making process recommendations and highlighting opportunities for investment in additional infrastructure.

“Telehealth is here to stay,” she says. “This assessment serves as a baseline for the next phase of how we can improve it within the Department of Pediatrics, particularly when it comes to helping providers and patients experience telehealth benefits.”

Expanding the initiative

Over in the Department of Pediatric Urology at Children’s Colorado, physician assistant John Colby, PA-C, and his team are in the midst of telehealth research related to collecting patient satisfaction data. “We’re trying to understand whether the process is easy for our patients, their families and our providers and if there are aspects they don’t like so we know where to make adjustments,” he says.

And within the Department of Pediatric Surgery, pediatric surgeon Jose Diaz-Miron, MD, is assessing surgeon and patient satisfaction in hopes of identifying telehealth barriers that affect low utilization.

If those efforts sound similar to Jackson’s Department of Pediatrics initiative, it’s because they are. Nearly every clinical program at Children’s Colorado wants to know how to make the telehealth experience better for patients and providers.

“We’re hoping the Department of Pediatrics assessment can serve as a model for these other departments so we’re not all working in a vacuum,” Jackson says. “Addressing known barriers collectively at an organizational level will help us continue to effectively integrate telehealth and make it sustainable for everyone."