Telepresence technology -- Web-enabled, two-way video that puts a remotely located person in a conference room with a larger group -- can be used for a number of telemedicine initiatives, from virtual patient exams to specialist consultations. It's typically more sophisticated than traditional videoconferencing in that it can employ tablets and smartphones and enable more collaboration.
The key to smooth telepresence implementations in health care -- complex as they can be -- is answering two questions up front. University of North Carolina Lineberger Comprehensive Cancer Center's telemedicine director Michael Young provided these questions in a webinar sponsored by the Health Information and Management Systems Society (HIMSS) and Cisco Systems Inc.
- Why are we applying telemedicine to solve this problem?
- How are we going to do it?
In UNC's case, the "why" was to share multidisciplinary knowledge across the state to benefit more cancer patients than it had served before. The "how" was a virtual tumor board.
At his facility, a multidisciplinary group of cancer specialists from the center convene the tumor board in a conference room with cameras and microphones set up to capture everyone's face and voice. Oncologists or other physicians from across the state can call in and discuss a patient's history; they can supplement it with radiology and pathology images projected on the conference room wall.
Together, the group of specialists gathered in the conference room can map out care paths with the remote physician. The cancer doctors can also conduct genetic counseling and pain management one-on-one with patients through the service, too. In 2010, the second year of its existence, the service logged about 400 hours of tumor boards spread over five sites.
Whether your facility's telemedicine initiative is an ambitious project like UNC's or something on a smaller scale, Young offered some tips for design and implementation of health care services utilizing telepresence technology.
Go as high definition as you can afford. "The better the picture, the better the experience is for that particular physician," Young said. "It's obvious, but it's important."
It's easy to concentrate on the telepresence technology itself and forget about other ambient environmental factors.
Make information gathering for consultations simple and straightforward. If it takes weeks for a participant to pull together patient data and imaging studies, that's a bottleneck no high definition picture can solve.
Ditto on scheduling. It's probably not top of mind for CIOs dazzled by hardware vendors' state-of-the-art telepresence technology, but ironing out practitioner scheduling over a wide area is a complicated logistical hurdle. Young said that Web-based meeting schedulers that interact with everyone's Outlook server can be an effective solution. (UNC uses MyVRM.com.) The other way, as he sees it, is having a telemedicine coordinator manually schedule meetings one phone call at a time.
Engage the whole room. Make sure no one in the room can hide from cameras, grab a phone, check email or otherwise become distracted and disengaged. When that happens, the quality of the telepresence experience diminishes.
Get the legal department involved. From early stages, legal staff need to understand the HIPAA implications of the patient data that will be shared -- and how it will be monitored and protected -- in your telepresence workflow. Legal should also know who owns the equipment and the activity level it will support. Once these are established, legal staff can draft a formal, straightforward memorandum of agreement for all participants in the project.
Speaking of HIPAA… Streaming video is covered under the HIPAA Privacy Rule but not necessarily the HIPAA Security Rule, since there are no files on servers to hack, per se. If you can encrypt video calls, do it. Make sure telepresence room design prevents uninvolved passersby from hearing or seeing the proceedings, too. Another HIPAA concern is how and where the meeting proceedings are documented -- in an electronic health record (EHR) system, for example -- so they can be made available to patients and practitioners.
Test hardware, side-by-side, in your workflow. Maybe you'll find that one system works faster, but another has cleaner server integration. UNC tried several different setups at various sites in its network before standardizing on one vendor, Cisco.
Rigorously test audio and lighting. Again, it's easy to concentrate on the telepresence technology itself and forget about other ambient environmental factors. Ensuring sufficient lighting -- but not too much -- to create quality video can make the telemedicine service more effective and efficient. "Buy the brightest projectors you can afford and build the room around it," Young said.
Hit up the U.S. Department of Agriculture. Believe it or not, the USDA funds the purchase of telepresence technology for certain rural facilities in its Distance Learning and Telemedicine Program. Haven't sharpened your grant-writing skills lately? Vendors can not only identify additional sources for grants but may also offer assistance in writing proposals.