Virtual Health Failure Factors—Why Some Programs Fail

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By Paul Murphy

Virtual care failures? 

Virtual healthcare, including telehealth and telemedicine, are becoming more common place, benefitting hundreds of patients, continually demonstrating their success. So why do some virtual health programs fail? What are some of the failure factors?

Clinical Champion Lacking

An engaged and committed clinician is essential. The ideal situation is to have a clinical champion who also has business and/or program management. It is not necessary for the clinical champion to have expertise in all clinical disciplines. Rather, it is the ability of the clinician to mentor / coach colleagues that is key. Business and / or program management experience is valuable in the provider’s ability to assist the remainder of the team with planning and operational details. 

Administrative Champion Missing

An administrative champion is also important. Their input and / or support can directly influence the program’s success. Potential factors influenced by administrative champions including funding (yes, we will invest), implementation timelines (sorry, project X takes priority), and why should we do this (lacking a vision)? Without an administrative champion a virtual health program may be headed for failure. 

Inadequate Staff

Prior to embarking on any virtual health program, having adequate staff to respond to and manage virtual consults is critical. Regardless if the program involves 24/7 emergent consults or scheduled patient follow-ups, the inability to respond to and conduct virtual consults will negatively impact the program. A variety of factors can quickly arise including the inability to provide the care that the program is intended to support, failing to meet service level expectations, and dissatisfaction from patients and other stakeholders. 

Going-Live without “Due Diligence”

An important step in implementing a virtual health program is to test the program or conduct “mock” scenarios prior to going live with real patients. Mock scenarios have numerous benefits including catching nuances, identifying process flow issues, and ensuring that the clinicians have the necessary and needed access required to successfully complete the virtual consult. Going-live without such due diligence only to discover issues (that could have been addressed during due-diligence) can result in significant disruptions in patient care, patient dissatisfaction, clinician frustration, and numerous “fire drills”. 

Scope of Service Details Not Sufficient

In the rush to implement a virtual healthcare program, the scope of service (or service level expectations) may be overlooked and/or brushed aside. An example of this when technology is selected, an originating site (clinic, hospital, or patient) is identified, and the program goes live. Within hours operational issues develop and it is quick discovered that various details have been overlooked. Even in pilot or beta scenarios, defining service level details is important to avoid such issues.   

Skipping Legal Input 

Successful virtual health programs include legal and compliance review early in the planning. Waiting to seek legal or compliance guidance can be detrimental. Depending on the nature and/or severity of the issue, it may be necessary to put the program on “hold” or terminate the program. 

Infrastructure Lacking

Sufficient infrastructure, especially technology and the staff to support the technology, is essential to supporting a successful program. Technology that is cumbersome to implement, deploy, and / or maintain will hinder a virtual healthcare program’s success. Provider frustration (e.g. remote access isn’t working), patient dissatisfaction (e.g.my connection keeps dropping), and extensive technology “fire drills” (e.g. peripherals not working with the device) are not ideal.

Rules Broken

The virtual health program is live. Positive patient feedback is received. Positive patient outcomes are reported. Meanwhile, individuals are manipulating the billing process. Hundreds of false claims and transactions occur while millions of dollars are misallocated. Eighteen months after launching regulatory entities close the program and multiple individuals are convicted of a variety of crimes.2 


Reference:

1.Loizos, C. (2019). Venture-backed telemedicine startup Call9 is shutting down. Source: https://techcrunch-com.cdn.ampproject.org/c/s/techcrunch.com/2019/07/01/venture-backed-telemedicine-startup-call9-is-shutting-down/amp/   

2. LaPointe, J. (2019) Telemedicine at Center of Billion-Dollar Healthcare Fraud Scheme. Source: https://revcycleintelligence.com/news/telemedicine-at-center-of-billion-dollar-healthcare-fraud-scheme 

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