Use Quality Touches To Create A Telehealth Envelope of Care

How a New York Health Center is Building a Telehealth Envelope of Care Around Patients

It’s Not The Tech, It’s The Touch

At Long Island Select Healthcare, we use telehealth workflows to increase access to care, make the traditional evaluation process more efficient and apply our resources to their highest tasks.  Beyond that, though, I’m seeing opportunities to use telehealth to deliver more personalized care and create more deeply satisfying outcomes for every patient.

I believe the key to taking better care of people is to increase the number and value of “care touches” to the individual.  These care touches are part of a framework that creates an “envelope of care” that surrounds and protects the patient. A touch can be delivered in a wide variety of ways, in real time or not, by a human or a bot (artificial intelligence).

Read on to see guiding principles LISH is following to create a comprehensive virtual care program that delivers quality touches that weave an envelope of care that surrounds, protects and enhances the health of our individuals.


James Powell, MD, Chief Executive Officer, Long Island Select Healthcare (LISH), a Federally Qualified Health Center

With telehealth, technology can help deliver more touches, more efficiently, less expensively, and still feel very personal.”
An older couple is protected by supporting hands

What is A Telehealth Envelope Of Care?

The envelope of care describes a model built to nurture, protect, heal, manage and educate a patient and engage them in their own care. It is designed and delivered by professionals who are looking at patient needs in a comprehensive and coordinated way. The envelope is “constructed” of the touches the patient regularly receives from care team members. A touch can be an office visit, an email or a voice-activated survey asking about symptoms.

The envelope of care is powered by the Electronic Medical Record, but fully realized by the technology of telehealth. Telehealth enables health centers and practices to expand care options, add new care modes and connect with other specialists and care teams who serve the same patient.

Why Are Quality Touches Important?

A quality touch is important because it delivers something the patient values. It could be a text message that reminds a patient to come to an appointment. A discussion with a dietician on eating a healthy diet is a quality touch. So is providing a prescription for a medication to alleviate heartburn.

Care teams string multiple quality touches together to create a need-based flow of actions and information that are valuable to the patient.

Some observations:

  • Patient value is created with relationships.
  • There is more value, but also more cost, when the provider is involved in the touch. Since patients retain less than 30% of the message, care teams should reinforce these messages with their own quality touches.
  • Intimacy can be built through the use of telehealth, where patient and provider can see faces up close and unmasked.
Black woman sitting with baby on her lap, holding a phone on which she is doing a video visit with the baby's pediatrician
Man on weight scale, happy that his doctor is monitoring him

Start With The Four Cornerstones Of Care

Comprehensively managing health requires that care teams help patients work toward goals in four important aspects of life:

  • Physical health – maintaining physical capabilities such as the ability to breathe easily, walk, move, see, hear, touch.
  • Mental health – practicing good mental hygiene, reducing and managing anxiety and stress, managing destructive behaviors and habits.
  • Socialization – having friends and companionship, loving and being loved, the ability to communicate and express, listen, and be heard.
  • Financial stability —  the ability to work, pay bills, live within a budget, save, obtain or pay off a credit card.

To build an envelope, address all four cornerstones of care. It helps patients be more activated and more likely to comply with care plans, engage with the practice, and feel satisfied with their care.

Add Care Modes To Keep Patients In Your Eco-System

Telehealth makes it easier to add Care Modes to your primary care practice, such as acute or urgent care, preventive care, episodic care and chronic care monitoring. You may even want to offer transitional care from hospital to a step-down facility or home. Keep them in your eco-system with care they may otherwise have sought elsewhere. Use telehealth to:

This helps preserve continuity of care even during a pandemic, and generates billable services.

oman shaking hands with doctor coming out of her computer screen

Create A Dialogue With Patients

Create dialogue with patients, mixing and matching the elements of human and bot, real time and “at your convenience:”

  • Synchronous (real time) and live between humans: such as a video visit or phone call with a medical professional
  • Synchronous and virtual: such as a survey pushed to the patient by the virtual assistant
  • Asynchronous (not in real time) and human: such as a photo of a rash taken by the patient for review by the care team
  • Asynchronous and virtual: such as an automated appointment reminder text to the patient
Don’t assume patients or even healthcare professionals are comfortable, confident and competent with technology. When people struggle with a software app or taking a vital sign reading with a device, they get frustrated and many give up. Telehealth Associates helped LISH develop assessments to screen patients to determine who would be most successful with monitoring devices and video visits. The results showed the need for multiple approaches to address digital competency.

Care Teams are Hybrids, Too

The composition of the care team is important. Telehealth programs should be designed to have members working at the top of their license. That’s why telehealth care teams are hybrids also, and can include artificial intelligence — automated care coordinators or “bots” that perform repetitive task such as scheduling appointments, sending appointment reminders, helping patients log into video sessions, collecting data from remote devices, and so on.

LISH is currently exploring using “bots” for scheduling and interactive surveys.

Explains Dr Powell, “To deliver a quality touch, the ‘bot’ has to be perceived as part of the team. We instructed our vendor to create scripts for the bots that use ‘we’ and ‘us’ so patients view the text or phone call as being from LISH, not a machine.

“We have spent months on scripting language — identifying ways the bot can ask questions and understand and interpret or clarify what the patient responds.

“We’re starting very conservatively, with simple tasks and escalating the patient to a live care coordinator when there is any question of understanding. But over time, the system will learn from the feedback and we will become more sophisticated.”

Human texting with a chat bot
If the patient says, “I feel lousy,” the bot can ask questions to clarify and quantify, such as:

-Do you feel depressed or lonely?

-Are you in pain?

Why Work with Telehealth Associates?

Telehealth Associates encourages your pursuit of telehealth and is here to support you on your path. Our deep experience with telehealth grant projects makes us an invaluable partner, able to shorten your learning curve and get you up and running with telehealth swiftly. In addition to our expertise and resourcefulness, we are responsive, diligent and we deliver what we promise.

We believe access to quality health care is a right, and we want to build telehealth programs that bring the right care to the right people at the right time, using the right resources to achieve the right outcome. We do this by developing strong enduring relationships based on trust and being proactive. We care deeply that our clients succeed, and we are always planning for their next success.

Contact us with questions, to explore options or for a complimentary session to talk about your next steps in implementing your telehealth program.