By Dr. Alan Roga, President, Provider Division, Teladoc

Today, 76 percent of hospitals and health systems either offer some telehealth services or plan to in the coming year. For many of these organizations, the common thought process is that with the deep involvement of their clinical providers, the organization can connect with patients, and the program will be successful by simply adding a video system or basic platform. However, with the rapid pace of telehealth program adoption, organizations are now learning that success depends heavily on the breadth of operational planning and support resources.

Telehealth does more than change how providers interact with patients. It requires changes that span operations, including clinical, IT, marketing and more. Many hospitals learned the full scope and importance of operational support required only after their program was implemented. As a result, they were forced to address issues reactively.

Those with telehealth experience highly value operational planning: Executives and managers at organizations that have telehealth programs in place are three times more likely to rate operational support as a critical factor to program success than those that are only in the planning stages of their telehealth program (see Figure 1). Organizations that are planning or considering telehealth programs can learn from those experiences.

Figure 1 — Operational Support & Telehealth Success


Source: Teladoc-Becker’s Healthcare Hospital & Health Systems 2016 Benchmark Survey: Consumer Telehealth.

It is easy to underestimate the scope of what planning must address. Organizations rightfully focus heavily on their overall telehealth strategies, including which services to offer. Once that strategic guidance has been set, the focus tends to shift to selecting the telehealth software solution. Getting the strategy and choosing the right solution are essential for telehealth program success, but the missing key component to a program’s sustainability is the consideration around operational support.

There are three core components to a consumer telehealth offering:

  • A customer engagement and marketing strategy to drive awareness and garner adoption;
  • A platform to provide a great user experience, provide security and communicate with the native electronic health record (EHR); and
  • A provider strategy with effective recruitment and training for providers to ultimately execute on care delivery.

All of these components require operational support. However, hospitals do not need to develop and manage all three components internally. Third-party organizations can provide any or all of the services, including complete solutions with their own provider networks.

After failing to align the program to organizational goals, planning for operational support is the second most common mistake made by health systems. In our experience, organizations underestimate operational support by a factor of 10. That is not an exaggeration, nor is it an intractable obstacle. The operational questions that come up during telehealth program planning and implementation are eminently solvable. The sooner relevant operational considerations are identified, the faster your telehealth program will return value to your patients and your organization.

Here are some of the operational questions that must be answered before a telehealth program goes live. This is just a sampling; there are many more operational questions to be addressed.


  • If patients or physicians could not log in in the middle of the night, how would you assist them?
  • How will you provide 24/7 technical support capabilities for consumers and providers?
  • How will you perform member attribution and ensure services are covered?
  • Where will providers document? What type of information flow and integration will occur with your native EHR?
  • Does your team have experience with third-party administrators and different eligibility file formats (such as CSV, 837 and others)?
  • How will patients receive answers for general inquiries?
    • Do you have a call center?
    • If not, should you create a call center, or would it be better to work with a third-party provider?


  • How are you going to oversee clinical quality?
  • Are you going to build protocols, reports and monitoring internally?
  • If the patient's pharmacy of record is closed when a telehealth consultation is completed, how are you going to re-route that patient’s prescription 24/7? Are you going to make patients wait until business hours?
  • Which providers are going to be on the platform?
  • Do you have enough resources to provide 24/7 coverage?


  • How will you generate consumer awareness and adoption for your program?
  • Does your marketing department have experience with consumer programs?
    • Does it have experience with sales acquisition?
    • Does it have experience with digital marketing, including social media?
  • Where will the print, digital and social assets to drive adoption come from?
    • Does your internal team have creative capabilities to create assets for consumer collateral and engagement tools?
    • If you needed to mail and email welcome packets and digital flyers, how would you accomplish it?
    • Do you have a relationship with commercial printing firms for large-volume discounts?

Health systems will typically thoroughly vet technology platforms, including bringing in their internal technology teams to perform software and security reviews through multiple meetings. This is understandable because the user experience component of telehealth software is very important. However, I am surprised at how often operational support is not identified and prioritized in the planning or evaluation process. The provider-patient telehealth interaction cannot occur without the requisite operational support in place.

In our opinion, operational support should be treated as important as technology vetting. The full evaluation process needs to cover operational support and should include on-site visits to potential service providers to get a better understanding of their scale, scope and how well they can support your operations. Conducting site visits and client reference checks is very valuable for assessing capabilities, and for identifying additional operational considerations to address.

Telehealth has many specific operational considerations, but in one respect it is like every other type of care delivery: details matter. To get the details right for your organization, take a broad approach to operational planning, create multidisciplinary teams, involve members early in the planning process and conduct site visits of telehealth service providers and health care facilities that are providing telehealth services. Taking those steps will go a long way to creating a smooth rollout and reduce the time to value for providers and patients.