Telehealth Sustainability Toolkit

The sustainability toolkit will help your family planning organization do a self-evaluation of your telehealth services. The tools will be most effective when you go through all the steps in this toolkit. The components build on each other to help your agency consider its telehealth infrastructure and determine the best path forward in order to develop a well functioning, sustainable telehealth program within your overall clinical services. Sustainability is not an on/off switch, and big, sweeping changes are not needed to attain it. This toolkit will help you and your organization identify small adjustments that you can make within different elements of your agency to move it in the direction of increased telehealth sustainability.

There are four steps to follow in this toolkit:

  1. Assess your telehealth program maturity using a sustainability plan
  2. Administer a clinician (or clinical services provider) survey
  3. Optimize your telehealth workflows
  4. Toolkit Synthesis Brainstorm

Each step will prompt you to reflect on a different part of your organization and collect data on key telehealth workflows and processes. Then, you will combine these takeaways in the Toolkit Synthesis Worksheet to find areas of improvement and action steps you can take to improve their respective sustainability. This toolkit will help you think iteratively about this process: you can re-do it as needed to identify the next aspect of your telehealth practice to work on. The tabs below will guide you through the toolkit. There is a brief introduction to each step, with each resource available as a PDF document to print and/or take notes in electronically.

The Training Center developed this toolkit in partnership with Sam Lippolis of Telehealth Easy, a telemedicine expert with over 12 years of experience helping clinicians and organizations set up and scale successful telehealth programs. Start with this short video, where Sam introduces the toolkit and walks you through each step:

Step 1: Assess Your Telehealth Program Maturity

The first step in developing a sustainable telehealth program as part of your family planning program is to assess your telehealth program maturity. Though many family planning providers began offering telehealth services as a result of the COVID-19 pandemic, utilization of services may have changed over time. Therefore, it is important to assess your long-term telehealth strategy and goals, as this can inform staffing, investments, communications with clients, technology needs, and support requirements. This maturity assessment is best done as a team session discussing your answers to reach a shared decision about where the organization is on the maturity continuum. Print out the Telehealth Maturity Assessment below and follow the instructions within to complete this first step.

Telehealth Maturity Assessment Instructions and Template

The four levels of this telehealth maturity are outlined below.

Level 1 – Sporadic (Beginner)

A family planning organization at level 1 may include: 

  • 1-2 pilots or services being done by 1-2 clinicians
  • No centralized or standardized telehealth services across organization, clinicians or services
  • No standard process for technical support
  • No formal leadership, advocacy or governance for telehealth
  • Growth is stagnant or declining; telehealth is withering on the vine

Level 2 – Coordinated (Intermediate)

A family planning organization at level 2 may include: 

  • Several (this number depends on your organization size) “super user” clinicians or specific services that consistently provide telehealth
  • A few front desk, scheduler, MA or nurse champions that know the telehealth process to schedule patients and make sure they connect to appointments. A workflow may or may not be written down
  • A person from IT available to help, but there’s no standard process for technical support
  • Leadership is supportive of telehealth but doesn’t advocate or have governance for telehealth
  • Growth is increasing slowly month over month

Level 3 – Integrated (Advanced)

A family planning organization at level 3 may include: 

  • Several (this number depends on your organization size) “super user” clinicians or specific services that consistently provide telehealth
  • Patients are offered telehealth services for appropriate appointments, they do not need to request telehealth services
  • Front desk and schedulers know which services are offered virtually. There is a written document or informational reference in the EMR for which appointments can be virtual
  • Workflows for tech check with patients, scheduling appointments, rooming patients, and post visit are all documented
  • All staff have been trained on workflows
  • Telehealth visit types are in EMR to distinguish between in person, phone, video, email, etc.
  • A point person acts as a telehealth coordinator within organization as a portion of full time equivalent (FTE)
  • IT has formal process for support and technical operations
  • Leadership is supportive of telehealth, encourages utilization and reviews key performance indicators (KPIs) during leadership meetings
  • Governance of telehealth is included in leadership structure 
  • Growth is increasing month over month with # of clinicians and # of services offered

Level 4 – Strategic (Expert) 

A family planning organization at level 4 may include: 

  • All level 3 AND
  • All clinicians or specific services consistently provide telehealth where clinically appropriate 
  • Organization has a dedicated telehealth coordinator/manager to handle training, operational support, new services launches, coordination between IT and clinicians, and strategic planning
  • IT department has dedicated FTE (if volume is appropriate) to support technical needs and roll out new and updated technology as required
  • Leadership has telehealth as part of strategic planning, annual budgeting for FTE, technology allocation and growth targets
  • Telehealth dashboard is part of KPI review
  • Growth is directly impacting organization strategic goals

Step 2: Administer a Clinician (or Clinical Services Provider) Survey

The second step in a family planning agency’s sustainability assessment process is administering a telehealth clinician survey. This step should be completed after completing the Telehealth Maturity Assessment (Step 1). The purpose of a telehealth clinician survey is to learn the clinicians’ perspective, their comfort level with telehealth and their specific recommendations for improvement. Having clinician buy-in and clinician champions is key to organizational telehealth change and sustainability. Use the resource below as a guide for developing your own clinician survey, adjusting as necessary to fit the specifics of your organization.

Telehealth Clinician Survey Instructions and Guide

Step 3: Optimize Your Telehealth Workflows

The third step in a telehealth sustainability assessment process is to optimize your telehealth workflows. Ideally this step of the sustainability assessment process is completed after administering and analyzing a telehealth clinician survey (Step 2) to incorporate clinician feedback into the improvement process. The worksheet below will guide you through an assessment of your organization’s telehealth workflows. 

Optimizing Telehealth Workflows Instructions and Worksheet

Here is an example of what a completed worksheet might look like, along with associated improvement ideas.

Sample Telehealth Workflows Worksheet

Step 4: Toolkit Synthesis Brainstorm

Use this worksheet to consolidate your notes from Steps 1, 2, and 3 of this toolkit. Each question will ask you to synthesize the results from each step into a few concrete takeaways. This worksheet is a space to look at the results from each step all together, and then think through a structured brainstorm of turning those common themes into actionable steps. You will select a few elements of your telehealth program to focus on during sustainability planning and identify small adjustments that you can make within those elements to move your agency in the direction of increased telehealth sustainability. Print out the worksheet below or fill it out electronically to complete this iteration of the Telehealth Sustainability Toolkit.

Toolkit Synthesis Brainstorm Worksheet