As vice president of infrastructure for Mercy Technology Services, the IT service provider behind Mercy’s 43 hospitals, 300 clinics and now several external hospitals—I’m a busy man. But I’m also a lucky man because I get to be part of healthcare’s digital transformation, including Mercy’s move to virtualized care.
Videoconferencing is an obvious capability for Mercy’s telemedicine services, but the necessary infrastructure to truly support telemedicine goes way beyond videoconferencing.
The network basics
Anytime videoconferencing is being used, provisioning your network for the appropriate bandwidth, network latency and video, and voice prioritization will create a stable, performance-predictable backbone for critical video streams. It’s important to partner with a videoconference technology partner that has good options for all types of bandwidth and latencies—ranging from “fat pipes” and “low latency” to the low-quality Internet connectivity still sometimes found in rural areas. When we implemented videoconferencing for coworker and caregiver collaboration at Mercy, we learned that users won’t tolerate dropped connections or loss of video or audio. Patients trying to communicate with caregivers will have even less tolerance or willingness to monkey around with complicated video. So an important first step for reliable video streaming is to address these network basics.
Once the network is in place, technology leaders still have more to consider to support true integration of telemedicine into a healthcare workflow.
At Mercy, we provide various types of telemedicine services. They include real-time monitoring of hospital patients (TeleICU, TeleSepsis, etc.), remote monitoring and periodic interactive voice/video consults for patients at home (called Engagement@home), and a “specialist on-demand” service we call TeleHospitalist. These Mercy physicians are standing by to teleconsult with remote sites when the need arises—for example, when a stroke assessment is needed for a patient in a rural emergency department.
Here are seven important technology competencies to consider when supporting these types of telemedicine services.
1. Call center and voice systems
While real-time monitoring provides caregivers constant or on-demand video/audio capabilities, other interactions start with a remote site placing a call to Mercy Virtual’s call center to request assistance or a consult. As remote-site subscribers grow, call center technology is necessary to properly queue and route calls to the appropriately skilled and available caregiver standing by to setup the connection. Wireless phones for nurses and real-time directory lookup make it possible for a remote telemedicine provider to connect with the local care team quickly and effectively.
2. Instant messaging and secure texting
At Mercy, telemedicine agents and caregivers are in constant communication. An instant messaging platform with desktop and mobile clients (Cisco Jabber, in our case) has been critical for teams to collaborate in real time. Also, a secure text messaging application loaded onto clinicians’ personal devices allows critical messages to reach dispersed caregivers in a secure, HIPAA-compliant way (as opposed to SMS text messaging).
3. Mobile device management
When providing in-home telemedicine services, it’s important to manage the mobile tablets and other devices used in patients’ homes. Consider methods to easily package in-home kits, provision devices and equipment, and educate patients for quick setup of the kits at home. Also, the technology team will need a way to quickly delete the content if a patient loses a device or no longer subscribes to the service. At Mercy, we found that an effective mobile device management platform is needed to have any hope of managing these devices.
4. Ruggedized video endpoints
Videoconferencing end points mounted in intensive-care rooms and in acute-care units get a lot of use. Telemedicine carts in particular, wheeled in and out of the emergency department for stroke assessments, get wear and tear on the equipment. Mercy spent a good amount of time optimizing equipment protection and designing the most durable, manageable mounting hardware and audio/video equipment on the remote hospital side.
5. Monitoring for performance
For videoconferencing to be reliable for physicians and patients, plan for and implement a comprehensive monitoring platform. Monitoring will ensure videoconferencing endpoints and other components of remote telemedicine are operating properly and ready for the next patient. It’s not good enough to discover a remote device isn’t functioning at the time of use—which could be a time-sensitive, critical situation. Proactive event monitoring and performance analysis results in prevention and keeps the service trustworthy.
6. Integrated scheduling platform
Great equipment and videoconferencing capabilities will go unused unless the process to schedule physicians’ time is fully defined and integrated with their primary schedule. Plan a way for physicians to make time slots available for video visits and determine whether physicians will integrate their video visits with their office visits and whether co-workers who manage physicians’ schedules will manage both in-office and video appointments. The good news is that this task is likely covered within your electronic health record’s (EHR) scheduling and video visits capabilities. However, if physicians are using different EHRs, then this could get complicated.
7. Mobile integration
And finally, when considering video visits as a service for patients, keep mobility in mind and the possibility of enabling video visits on your EHR’s mobile patient app platform (in Mercy’s case, we use Epic’s MyChart). This will require a video technology provider that has demonstrated it can integrate with your EHR’s mobile patient app.