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

jbetz@mfa.gwu.edu

www.linkedin.com/in/jamesmbetz