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Telehealth Architecture and Infrastructure: Connecting
with Patients via Technology February 29, 2016
James Betz
Innovative Practice Program Manager
GW Medical Faculty Associates
Conflict of Interest
James Betz
Has no real or apparent conflicts of interest to report.
Agenda
• Overview of Virtual Encounters
• Virtual Encounters – Defining Technical Quality
• Documentation and EHR Integration
• Information Sharing & Considerations
• Where We’re Headed
Learning Objectives
• Discuss technical components of quality of services during virtual
encounters
• Evaluate needs and concerns for visit documentation and EHR integration
• Examine the technological aspects of sharing telehealth information and
encounters
Telehealth – World of Possibilities
• Technology empowers us to develop new ways to provide care
– Store & forward
– Remote monitoring
– Asynchronous consultation
– Physician-to-physician consultation
– Patient consultations (virtual visits)
• Patients & providers interested – but how to do it right?
Connected to the Value of Health IT Satisfaction: Patients can connect
conveniently and safely
Treatment: New ways to deliver care
Savings: Potential for tremendous savings
http://www.himss.org/ValueSuite
The Virtual Visit
• Increasingly popular for patients & clinicians
• Multiple types of providers
– Purpose-built companies
– Existing providers
– Payers
• Requires live audio & video at minimum
Evolving Standards and Practices
• Clinical Quality / Appropriateness
• Service / Patient Experience
• Operational
• Technical
• Technical Components of Quality
– Secure
– Private
– Simple
– Clear
– Reliable
– Professional
– Integrated
– Tailored
Secure
• Connection to network
– WiFi or ethernet
• Connection between users
– Peer-to-peer or hosted?
– 256-bit AED encryption
• Remotely stored information
– Vendor servers
• Locally stored information
– Screenshots
– Recordings
– Imported information
• Devices
– Anti-virus
– Firewall
– Storage
Private
• Settings
– Physician
• Distraction, background noise, lighting, camera stability
– Patient
• Pre-appointment guidance
• Participants
– Patient verification
– Introduction of assisting staff
– Closed session/connection
Simple
• Patients
– Schedule and/or access services
– Use their device of preference
• Physicians
– Incorporate into current practice
– Use the technology
Clear
• Connection
– Minimum bandwidth of 384 Kbps up/down
– May increase depending upon software
• Video quality
– Resolution at least 640x360
– Speed of at least 30 frames per second
• Audio quality
– Feedback
– Headsets
– Microphone
Clear – Patient-specific
• ADA (including sign language)
• Language
• Cultural considerations
• Age considerations
– Pediatric
– Geriatric
Reliable
• Emergency plan
• Contingency/disconnection plan
• Stable software
• Robust connection
– Survivability
– Redundancy
• Technical support
– Current support?
– Equipment support
Professional
• Provider Training & Mentoring
• Attire/appearance
• Setting/background
– Physician & patient
• Ethical conducted
• Patients are informed
• Follow normal practice guidelines
Integrated
• Practice schedule
– Consider new appt type
– How will patient wait?
• With current EHR
– Template design
• With billing systems
– GT modified
– Accurate classification of appointment
• With peripherals & diagnostics
– According to appointment type and setting
Tailored
• Consider the patient, physician, type of visit, information needed, etc.
• Diagnostic instruments
– Vital signs
– Point of care testing
• Special cameras
– Exam cameras
– Pan tilt zoom cameras
• Interventions
– Injections
– Other appropriate treatments
– Access to pharmacy & labs
Hardware
• Patient side
– Camera
– Microphone/speakers
– Proper peripherals/diagnostics
• Provider side
– Camera
– Computer or device
– Multiple screens
– Test, train, practice with camera
Software
• Options for Audio/Video
– Repurpose commercial
– Obtain specialized stand-alone
– Utilize EHR-integrated
• Considerations
– Security
– Cost
– Ease of use
– Integration with practice & tech
– Scalability
– Future needs
– Quality (feedback, etc.)
Documentation
• Don’t overcomplicate – this is just a different kind of visit
• Acknowledge and document the setting
• Use caution when documenting patient-reported data
• Pay attention to security if sending instructions
Virtual Encounter Data Considerations
• Particular considerations for transmitting labs and prescriptions
• Responsibility to coordinate future care
– Communicate with PCP
• Patient portal / access to data
– Own portal
• Challenge to keep patient-reported data properly classified
Broader Telehealth Data Sharing
• Rapidly expanding sources of data
• Tremendous potential, several challenges
– Capturing
– Validating
– Consolidating
– Processing
– Presenting
Opportunities
• Increase the ease and flexibility of care
• Reduce the costs of care
– Reduce infrastructure
– Increase efficiency
– Save patients time & cost
• Engage patients; reduce no-shows
• Use non-physician providers more appropriately/broadly
Where Are We Headed?
• Number and size of providers expanding
• Fewer barriers to rapid expansion
– Licensure issues being challenged
– Network infrastructures expanding
– New software features
• New limits to find and test
– What can be addressed via telemed
• Continued challenges in coordinating care
– Folding telehealth into current practice patterns
– Coordination amongst providers
One Vision: Mobile Integrated Healthcare
• Use telemedicine as one tool to increase the role of pre-hospital providers (EMTs & Paramedics)
One Vision: Home-based telemedicine kits
• Worrell Designs, Inc. conceptualized how this might look in the future
Value of Health IT Satisfaction: Services reporting high
rates of satisfaction. Increases choice
Treatment/Clinical: New options to
improve care
Savings: Reduce brick & mortar,
increase provider utilization, deliver
more efficient care
http://www.himss.org/ValueSuite
Questions
Contact Information:
James Betz
www.linkedin.com/in/jamesmbetz