• Telehealth services should be integrated as much as possible into the every day way that medicine is practiced at your location. This may involve teams of managers, programmers and other staff at your facility to work together in order to integrate telehealth into the existing scheduling, billing and the medical records delivery system for patient encounters. This may take more than a year to accomplish.

• "Build it (telehealth network) and they will come" does not work. Telehealth requires building external relationships among providers, administrators and other clinical staff at distant sites. Additionally, it also requires support among the same groups of individuals within the network hub. This internal support must go to the very top of the "hub" organization.

• Experience has taught the MTN management staff that a telehealth network requires skilled human resources to run successfully. Therefore, it is our recommendation that "if you can't staff it then don't build it."

• The issue of telehealth reimbursement is not going to be solved quickly. Find areas where telehealth makes financial sense. A few of those areas include surgical follow up where the follow up is part of the global surgical fee, contracts with other hospitals for services, correctional telehealth contracts, and contracts with state mental health facilities. In this vein continue to work with private, State and Federal reimbursement agencies in search of reimbursement for the service.

• Physicians adapt well to telehealth technologies that help them do their job more efficiently. From the clinician's point of view, telehealth must be just as easy as providing in-person care.

• It has been the experience of MTN that the introduction of telehealth technologies alone will not impact established patient referral patterns. The technology appears to be secondary to the service being provided by the specialist to the referring practitioner. To the extent that the specialist is communicating with the referring practitioner about the patient’s treatment, allowing that physician to be part of that process, and keeping the patient in their local area, than more referrals will probably follow. All the technology in the world will not make up for the provision of good services that build good relationships.

• Don't let the issues of liability and confidentiality deter you from developing a telehealth network. These issues are important but they are equally important when dealing with care provided face-to-face. Confidentiality issues can be technically dealt with and liability issues should be discussed with your attorneys.

• If you are thinking about starting a telehealth network do your homework. Review all the literature you can and most importantly conduct several visits to established telehealth sites.

• Itinerant owned and/or managed healthcare facilities may not be as willing to participate in telemedicine projects as locally owned entities. It was the experience of the MTN staff that itinerant owned facilities appear to be concerned with working with another unfamiliar facility. The fact that these companies are at a distance also lends itself to the premise that they may not be as familiar with local concerns, issues and facilities as perhaps they should be. In that regard, anyone attempting to work with such facilities must generally allow ample time to consummate a deal.
  
  

Telecommunication Lessons

• Always purchase your long distance service from "end to end" or "point to point". Purchasing baseline service from individual carriers for a long distance connection is a mistake. It is a mistake because you will not know who to call if you have network problems. Is the problem with telephone Company A? Company B? Company C?...

• Always order your telecommunication services (T1, ISDN) a minimum of 60 days in advance. This will give you and the telecommunications company time to work together to get a particular link operating smoothly. Please note that T1 technology is not all the same. If you have a private T1 network you should make sure the entire network is "framed" the same and running the same line coding format (B8ZS or AMI).

• Just because you have ordered ISDN PRI service doesn’t necessarily mean you have access to anyone else with the same service. There are many different calling plans with this service and depending upon your plan you may have no problems connecting with other locations or you may be somewhat restricted in terms of your connections. Also, many telecommunications do not cross connect well on this service without involving the use of a commercial bridge to make the link. Research all of your options with this service so that the telecommunications companies know exactly what you want the service to do. Also, make the telecommunication companies put their promises in writing so that you have some recourse if problems arise.

• Set up a method for testing and certifying those who will dial into your ISDN PRI network. Do not assume because a site in another state has ISDN that they will be able to call you and have the network connect on the first try. Without prior testing and certification you run a substantial risk of having your meeting, clinic, or educational program fail when you need it the most. The testing and certification will give you a log of all the telecommunication information and settings used so that programs between any two or more sites will connect reliably.

• When ever possible bid your long distance service in an effort to obtain the least expensive rate for that service.
  
  

• Rollable videoconferencing/telehealth systems are not easy to move. The newer models built on stainless steel carts are easier to move than the older "room" systems. However, you must remember that each room where videoconferencing will take place requires the digital connection necessary to make the connection to another site. Thus, if you want to use your rollable system in ten rooms then you will have to wire those rooms accordingly.

• Make sure you stay in contact with the vendor of your equipment in an effort to make sure that as new products are developed that features you need are not removed and that there is downward compatibility between the new and the old.

• Avoid "proprietary" equipment and software as much as humanly possible.

• Ask for test equipment before purchasing so that it can be evaluated. If it is a medical device you must allow the clinicians to test and eventually make the selection of which equipment to purchase.

• When ever possible request equipment bids from multiple vendors in order to select the vendor who provides the biggest bang for the buck. Such bids should also address support after the sale.