Many European countries are making their first steps on the way to restart economic and social activities, balancing their goals to minimise the impact on citizens' health and to keep capacities of healthcare systems under control. Despite the timing, detailed plans differ between countries depending on the degree of being affected and myriad other factors - though there is a general framework within EU. The 'Joint European roadmap towards lifting COVID-19 containment measures' has a lot in common with other regions’ plans and strategies.

Exit strategy and “reopening economies” phase

The most critical strategic points are the triggers, which allow countries to move from the first phase of slowing the COVID-19 spread to the second phase of reopening economies, and then to the third phase of lifting all restrictions. Safe vaccine or treatments are the main triggers for the third phase, so the time frame between the second and third phases may last months.

Therefore, it is necessary to rethink and rebuild our everyday life, considering the constant presence of COVID-19. Some of the social distancing measures will need to be in place on a long-term basis, especially for senior adults, people with chronic conditions and other populations at heightened risk from COVID-19. And adopting telehealth, as a key technology for safe and efficient communication, should be a part of this new routine.  

During the first phase of slowing COVID-19 spread many healthcare organisations experienced rapid and extremely radical transformation from in-person care to telehealth. They had to embrace and expedite the adoption process, which normally takes months of project planning, pilots, implementing and training. The majority of organisations worked on temporary solutions, while some utlised telephone consultations, Facetime, and Skype etc.

But the experience during these few weeks provided answers on the vast majority of critical questions such as identifying a need for telehealth inside healthcare organisations, defining the value for clinicians and patients, defining the requirements for telehealth platforms, understanding the feedback from users, forming a team of telehealth key supporters, defining algorithms for remote consultation of patients with COVID-19 and many others. The results of these challenging experiences should be utilised and all gathered information should be structured and analysed for future learning and potential implementation.

Telehealth platform implementation

Choosing the technology partner is a key step in telehealth implementation. The list of requirements for vendors evaluating processes can contain the following topics and have to be arranged in order of their importance.

• To establish long-term partnerships, it is important to receive a full overview of a company's business and financial information, experience, references and existing projects.
• The assessment of telehealth solutions can be divided into several sections. The main checklist can include the following functions: audio/ video-conferencing, secure messaging and chat, electronic scheduling with reminder system, dashboards, analytics and reports, billing and online payment, image and file uploads, e-prescribing, geo-location, and digital medicine coding. The data centre (cloud-hosted, private-cloud, on-premise), existing data migration and scalability requirements should be addressed too.
• Key components are interoperability and security requirements. The integration with the EHR, PACS, digital medical devices and other solutions should be focused on. From a security standpoint: GDPR (EU), HIPAA compliance (US), hosting health data regulations, information system security requirements, third-party audits, together with users’ authentication and authorisation process should all be major considerations.
• Branding and customisation will be among the mandatory tasks for many healthcare organisations. Language localisation, branded mobile application (Android, iOS) and personalised intake, along with visit summary forms should all be factored into plans.

The best way to check all the above requirements and to make an informed decision is to pilot potential candidate solutions or at least request a comprehensive demonstration. The main goal of a pilot is to confirm applicability of the exact solution to the current and future needs in telehealth. A patient advocate can participate in the check of the usability: how user friendly interfaces are, if the solution is a non-device specific software and can work on existing users’ devices (computers, smartphones, notebooks and tablets).

Telehealth workflow, document flow and guidelines are important for any healthcare organisation. It’s better to define all steps for patients, clinicians and administrators (before, during and after virtual visits), as well as clear roles and responsibilities with different permission levels. Local policies should be used to identify if a telehealth visit is an appropriate type for the individual patient and document flow should meet the country’s requirements for reimbursement process.

Furthermore, customer service is a key success factor. The level of support during and after implementation, training for users, 24/7 hotline, and technical support are critical.

The budget calculation usually includes hardware, software, services, education, integration, customisation, additional resources. The return of investment calculation will be relevant and useful for the majority of projects.

COVID-19 accelerated a global shift of consumer behavior towards digital solutions for personal, work and healthcare communications. But this alone will not help us to make the right choice in partners when trying to identify the most suitable telehealth platform for implementation and use.

The pandemic may mean that we’ve already answered many questions and recognise our priorities. But we should take this opportunity to rebuild our readiness to this type of crisis and to those that lie in waiting, and effective telehealth is a tool that can help us prepare.