Did you know that the success of your School-Based Telehealth (SBTH) program is more dependent on the people and processes than on technology? Too often, the first question anyone asks when starting a telehealth program is about the type of technology to purchase. However, before you jump into technology selection, make sure you can check all of these boxes:
- I know why I am employing telehealth and can clearly articulate the need(s) I’m trying to solve (if not, see Assessing Needs and Readiness (hyperlink to Assessing Needs and Readiness)).
- I can clearly articulate the program model I will implement and the telehealth services I will launch. I identified and engaged in planning with all members of the SBTH team (e.g., providers, telepresenter, IT, billing, risk management, administrative support, etc.). Each person clearly understands the program model and their specific roles and responsibilities (if not, see Program Models (hyperlink to Program Models) and Implementation (hyperlink to Implementation)).
- I mapped out the ideal workflow and considered the needs of students, the SBTH team, and other key stakeholders (if not, see Partnerships (hyperlink to Partnerships)).
Were you able to check all three boxes? If yes, then you are ready to think about technology selection. If not, come back to this section when you are ready.
Your program model and desired workflow should define the technology you select. The technology and software you choose should enable your providers to deliver the type of care they desire. Do not let the technology or technology vendor dictate your program model and workflow (at least not without your providers agreeing that it is better than what they originally planned. A few key considerations for technology selection are below.
What features and functions does your SBTH team require? What do you want your software or technology to do? What do your students and their families want? The answers to these questions come from a clear understanding of your desired workflow and the role that the technology will play. Bring together your SBTH team and stakeholders to talk through every detail of your workflow and have each person articulate their assumptions about what the technology will or won’t do. Example features and functions include:
- Multi-user video connections (e.g., educational groups, group therapy, family members or caregivers, interdisciplinary team
- Far-end camera control (e.g., providers working with young children who move around a lot)
- File or screen sharing (e.g., interacting with younger children and sharing educational materials or videos)
- Scheduling and appointment alerts (e.g., simplifying the scheduling and appointment reminder process)
- Secure messaging (e.g., protected health information (PHI) sharing and communication)
Does the technology you select need to interface with other existing technologies (e.g., scheduling system, billing system, electronic health record)? Are these interfaces a “nice to have” or a “must-have?” What technical specifications do these interfaces require? If planning to use peripheral devices, you must understand how those devices will interface with your system (wired connection, wireless via Wi-Fi or Bluetooth, wireless USB, etc.).
Does the technology generate or transmit protected health information (PHI)? If so, perform due diligence to ensure that the technology vendor is adhering to HIPAA security standards. While many vendors will claim that their software or technology is HIPAA compliant, technology alone cannot make you HIPAA compliant. Encryption does not make video software HIPAA compliant; neither does having a Business Associate Agreement. Note that HIPAA includes Administrative, Technical, and Physical Controls. Is the technology you need considered a medical device? If so, make sure it has FDA certification. A small subset of mobile apps have medical device designation by the FDA.
What are the connectivity requirements for the technology? Successful video visits/appointments requires both adequate bandwidth and a reliable connection. It also requires a device (phone, tablet, or laptop) with a camera and microphone. If using the technology in various settings, (for example, technology or software used by a family/student at home or by telepresenters and providers at home and in the clinic) then consider available types of connectivity and devices in each settings. When looking at software, ask yourself with what types of devices and operating systems is the software compatible (e.g., smartphones, tablets, laptops, IOS, PC, Android)? For the technology at school, discuss with the school’s IT staff potential issues with firewalls, VPNs, bandwidth, Wi-Fi, and more.
Not all companies are created equal! Do your research. Don’t be afraid to ask questions. Think of a technology vendor as a partner. Find out about the company history: How was it founded? Did it grow out of academic research? How long has it been around? Who are its leaders? Do they have a good track record in the field? Is this purely a technology company, or are providers involved? Is the company a startup? What is their financial profile? Do they have venture capital backing? What is their business model? How invested are they in customer support? Customer reviews and satisfaction with the services provided?
After identifying a technology or several technologies that meet your user needs, technical requirements/specifications, and vendor characteristics, arrange with the vendor(s) to provide product demos. Use this time to ask questions.
Here are a few helpful hints when arranging vendor demos:
- Send them your workflow in advance and ask the vendor to apply their solution to your workflow during the demo. Invite your planning group, SBTH program staff, and key stakeholders to participate in the workflow demo.
- If your telepresenter will need to use peripheral devices such as otoscopes and stethoscopes , have a demonstration of those devices to guarantee the solution provides the audio and image quality required. For medical providers, remember that a cardiologist’s requirements may differ from those of a pediatrician or nurse practitioner.
- Have technical conversations with your IT staff and the vendor following the product demonstration.
A vendor demonstration (demo) is NOT a pilot test. Demos should assist you with narrowing down the field of candidates. Before finalizing your vendor selection, conduct a pilot test in which you bring the technology into your setting and conduct a real-life scenario. The purpose of a pilot is to assess whether the vendor and the software or technology is a good fit within your school or health center environment. Be wary of any vendor that will not allow you to pilot-test their technology in your setting(s). While things may seem to work seamlessly in a demo, the vendor controls the demo.
You may discover during a pilot test:
- The technology requires plugging directly into the wall outlet, but none are available in the telehealth room.
- The technology requires a Wi-Fi connection and the telehealth room is a Wi-Fi dead spot.
- The software will only work using a browser or operating system that your school computers do not support.
- The device requires a USB connection, and your laptop is out of ports.
- Ask for and talk to references. Have conversations with your colleagues from other organizations that may have worked with the vendor before. Ask a lot of questions!
- Make sure you fully understand costs. Ask about one-time and recurring costs (e.g., annual fees, monthly subscription fees, maintenance contracts)
- Make sure you understand their timeline—how long will it take to get the technology? Will it require vendor installation? How long will that take?
- What kind of support and training will the vendor give you? What is the process for onboarding new users? What is the process for troubleshooting or getting assistance? What happens if something breaks or stops working?
Examples from the Field
The use of technology and the right software systems are essential for delivering telehealth services. Health Linc in Indiana and Bogalusa High School-Based Health Center in Louisiana provide primary care and behavioral health via telehealth. They rely on different software systems to communicate and deliver care effectively.
Health Linc in IN serves two school-based sites that are telehealth exclusive. Each provider utilizes Zoom for telehealth visits to protect patient’s rights and confidentiality. They use Advanced Micro Devices (AMD), which provides all the audio channels needed for digital stethoscopes. The telehealth equipment allows the provider to listen to the heartbeat and lungs and examine the patient’s eyes, ears, and throat. It has the capacity for digital cameras for image capture and accessing medical charts. The sites also have rapid testing for flu, strep, and urinalysis.
Bogalusa High School-Based Health Center in LA serves students grades 7-12 and is a part of Access Health Louisiana which operates 19 SBHCs. Bogalusa has offered telehealth services since 2019 and initially provided services through telephone encounters before transitioning to the platform DoxyMe. DoxyMe is a HIPPA compliant and secure platform that provides telehealth services, video conferencing, and virtual waiting room features. The front desk personnel collaborates with the providers to schedule telehealth appointments for students. During a scheduled primary care telehealth visit, the RN calls the telehealth patient and performs a telephone triage. The patient receives a text message or email link that connects them to the DoxyMe platform and the nurse practitioner. For a telebehavioral health visit, the social worker initiates the visit with a phone call and provides the patient with a link to complete the telehealth visit via DoxyMe.
Consumer Technology Association (CTA) and American Telemedicine Association (ATA) Digital Health Directory
- Consumer Technology Association (CTA) and American Telemedicine Association (ATA) Digital Health Directory