Creating a Telehealth Platform Means Balancing Small, Large Details

As Providence St. Joseph Health rolls out its enterprise telehealth platform, health system executives and ATA thought leaders try to find the balance between a program's individual value and the industry's need for interoperability.


April 29, 2019 – Providence St. Joseph Health is ready to roll out its enterprise-wide telehealth platform.

That’s not to say the seven-state, 50-hospital network hasn’t had telehealth or telemedicine programs in the past – Providence St. Joseph has, in fact, a robust connected care program, comprised of dozens of services. But with April set to turn into May, the health system will soon be able to boast one platform, giving administrators and providers one sandbox in which to play.

“It’s been a long (journey),” Chief Medical Technology Officer Todd Czartoski, MD, said during this year’s American Telemedicine Association conference in New Orleans. “But we’re just about at the point where we can say we have one telehealth program.”

Providence St. Joseph’s effort to create an enterprise-wide platform – which was announced at last year’s ATA conference – is representative of the industry as a whole, and indicative of the bumpy road that the nation’s healthcare ecosystem has faced in moving from fee-for-service to value-based care.

In fact, throughout ATA19, conversation was focused in interoperability and consolidation, pulling everything together under one roof and creating a standards-based model that providers small and large could copy and deploy. But at a time when success is measured in small pilot projects scattered across the country, and when each state has its own rules for telemedicine, and when questions still outnumber answers in sustainability and scalability, the going has been slow.

“We have a wealth of technology today, but a lack of governance and oversight,” Richard Bakalar, vice president and chief strategy officer for VitelNet, said during a panel session on interoperability.

“I think it’s important to realize this is going to be a journey,” he added.

Czartoski knows that all too well.

Providence St. Joseph, whose Washington-based network includes the five largest states in the country, unveiled its new Virtual Health System last year in Chicago with an aim to harness the many and disparate telehealth and telemedicine programs going on in hospitals and medical offices under their purview. But Czartoski said it took some time to corral the programs, many of which were on different levels of maturation.

“We want to get to a point where we can scale up the popular programs and run pilots for new programs,” he said. “But we need to get some discipline around the process.”

That isn’t easy. Each program has its own goals, benchmarks and workflows, and quite often a program that works well in one place won’t duplicate that success in another location.

Consider the challenge faced by the Centers for Medicare & Medicaid Services in creating a reimbursement model for some of these programs. At ATA19, Emily Yoder, an analyst in CMS’ Division of Practitioner Services, laid out the thinking behind new CPT codes included in the 2019 Physician Fee Schedule. Speaking via video feed to a packed conference room, she explained what services will be covered under the new codes and how these codes will enable providers to sustain and expand their virtual care platforms.

But when she opened the floor, Yoder was peppered with some very specific questions that she often couldn’t answer. They came from healthcare providers interested in applying those CPT codes to their workflows, but unsure as to how they fit.

Czartoski says that will be a challenge going forward: identifying the benefits in a specific program, and finding a way to make sure that program can be a part of the whole. Does each new program have attainable clinical goals, provider support and a good value proposition? Does it succeed because of its individuality, or can it be replicated?

Many of the ATA’s thought leaders say the industry is headed in that direction. In the interoperability panel session, Ryan Howells, a principal with Leavitt Partners, said “fundamentally, there has never been better alignment around the topic of interoperability than there is today.”

But talking about interoperability isn’t the same as seeing it. After all, It’s taken Providence St. Joseph more than a year to create an interoperable platform for its telehealth and mHealth programs.

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