Telemedicine 101. Telemedicine Terminology and OTN s Services Guide

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1 Telemedicine 101 Telemedicine Terminology and OTN s Services Guide

2 OTN Member Facing Roles Service Desk Representatives Provides expert technical support and troubleshooting before, during and after telemedicine events through a dedicated phone line ( ). Collaborate with regional technical services to deploy onsite services as required. Monitor webcasts to ensure technical quality. Regional Managers Lead the process of establishing and managing sites and systems including providing assistance with appropriate equipment selection. Primary liaison for Members with OTN Assist new and existing Members with establishing telemedicine programs. Coordinate Member training requests Contact Centre Agents Provide a centralized point of contact for Members for scheduling and general inquiries, coordinating organizational responses as required. Operate as a high performance team and coordinated system, processes and technologies that connect OTN resources and communication channels Training Team Design and manage interactive e-training courses that teach Members how to use telemedicine equipment. The e-training center can be accessed at training.otn.ca Provide live training sessions to new users that focus on knowledge acquisition and application Work with the Regional Managers to design consistent and effective training plans for telemedicine programs. Regional Technical Services Provide on-site technical support for new sites and new systems. * Please note, that the RTS can be contacted thru your Regional manager or the Service Desk Respond to Member technical issues on site as needed.

3 Types of Videoconferences Educational Videoconferences Videoconferences focused on training, learning and continuing professional development, including lectures, workshops or casebased learning sessions. Educational events can either be: o Closed: where participants are pre-determined and invited o Open: anyone can sign up and participate in the event. Administrative Videoconferences Videoconferences that involve meetings between different sites, like committee meetings, all staff announcements or policy discussions. Clinical Videoconferences Videoconferences focused on patient care. These are the foundation and focus of OTNs services and have 2 subcategories: o Direct Clinical: A consultation with a patient and a healthcare provider. The healthcare provider could be a physician, allied healthcare provider or multi-disciplinary team. o Indirect Clinical: A case conference that does not include a patient. This typically involves physicians or health care providers discussing patient cases and developing a treatment plan.

4 Styles of Videoconferences Point-to-Point Events This is a videoconference between only two sites. In a point-to-point,, you will always see the other site on your monitor, and the other site will see you on their monitor. The microphone usually stays on for these videoconferences, and the participants interact as though they were in the same room. A point-to-point call can be manually connected or begin automatically depending upon how it is scheduled. Multipoint Events This is a videoconference involving more than two sites. It could be as few as three or as many as 85 sites or more. OTN sets up all its multipoint calls using a bridge program. When a call is scheduled to begin, the bridge dials all of the systems at one time and connects them automatically. The call will also end promptly at the scheduled end time. In a multipoint event, the bridge only calls out to the sites once and will not dial back if your system is unavailable. If you are not connected, call the service desk and ask to be placed into the call.

5 Modes of Videoconferences Full Screen mode Full screen mode is the default setting for videoconferences. In this mode, the camera will shift and display the site that is speaking or making the loudest noise. This means that this site will be displayed on the main screen of all the systems involved in the call, making it an excellent mode for presentations and lectures. It is important in a full screen call for all sites except the speaking site to keep their microphones on mute. The mic should only be unmuted when a person at a site wants to speak. Multi-Screen mode Multi-screen mode is a visual set-up where all sites are visible on the screen at the same time. In other words, the effect is much like Hollywood Squares. This set up works only when there are a few sites (let s say five or less) on a call and must be requested when scheduling your event. There are different screen layouts to choose from depending on the number of participants such as side by side, quad, 5 +1 and 7+1 layout. Lecture mode Lecture mode must be requested when scheduling your event. In this mode, the host of the event determines who will be full screen on the participant s monitors at all times. If you are the host of the event and you select Lecture mode, please contact OTN s service desk prior to the event to arrange which site or sites should be full screen through the duration of the event. This is a good layout for ensuring privacy during patient education events or for speakers to monitor the participants at all sites.

6 OTN s Service Offering Videoconferencing OTN supports a variety of videoconferencing systems in order to meet the clinical and educational requirements of both health care professionals and patients. A full list of the supported systems is available in the Technical Service Level Agreement. o Room-based videoconferencing systems make it easy for sharing information due to their larger monitors and data sharing capabilities. o Desktop videoconferencing systems allow administrators and busy clinicians the opportunity to connect from the comfort and privacy of their offices or dedicated telemedicine rooms. o Clinical videoconferencing systems can be portable or utilized in a dedicated clinical space. These systems include peripherals for examinations such as patient cameras for close-up images, ENT scopes and digital stethoscopes. o Personal Computer Videoconferencing (or PCVC) allows health care professionals the convenience and security of utilizing their home or officebased computer to connect with patients or other healthcare providers. Telehomecare Telehomecare provides in-home support to patients with chronic disease. Patients are provided with equipment that allows them to send health information to a trained telehomecare nurse. The nurses provide education/coaching to help the patient manage their own care.. The emphasis is on patient self-management to slow the progression of disease and improve quality of life.

7 OTN s Service Offering Telederm Telederm is a form of asynchronous telemedicine, where the patient is not present. A healthcare professional takes a digital image of a rash or condition, uploads it to a secure server and asks a dermatologist to review it and provide a diagnosis. The patient benefits through improved and timely access to care. thanks to the convenience of making online assessments, diagnoses or treatment recommendations from a dermatologist s office. Emergency Care via Telemedicine Emergency care delivered through telemedicine can support patients who require immediate assessment and treatment (as soon as a remote consultant is available) or patients who have a life threatening condition. OTN supports four emergency services. If you are interested in participating in any of them, please contact your Regional Manager for more information. o Telestroke for tpa is a 24/7 emergency telemedicine application. The focus is on specialist access for stroke patients who are candidates for t-pa. It allows for the assessment & treatment of patients experiencing acute ischemic stroke via a consult with a remote neurologist. o Teletrauma allows for the assessment and treatment of trauma patients using live, two-way videoconferencing with a remote trauma specialist. It supports discussions between physicians and the health care team regarding the stabilization and treatment of trauma patients prior to, or in place of, transport to the trauma centre. o A 24/7 Critical Care (adult & pediatric) telemedicine consult service for ICU patients. Patients are admitted to a virtual ICU, supported by referring physicians who use OTN to consult with an internist, Teleburn o Teleburn allows for the assessment and treatment of burn patients using live, two-way videoconferencing with a remote burn specialist. It supports discussions between physicians and the health care team regarding the treatment of burn patients and provides access to burn specialists for follow-up, if required.

8 OTN s Service Offering Webcasting Webcasting refers to the process where an educational videoconference session is broadcast over the OTN network and the web (Internet) at the same time. There are two kinds of webcasts: o Live Webcasts: Participants can log on to their computer and view the live videoconference session at the same time that it is being broadcast over the OTN network. This session is time dependent, as participants must tune into to the web at the same time as the original videoconference. o Archived Webcasts: This means that the videoconference has been taped and is available for viewing at a later time. It is stored on the servers at OTN, and can be accessed via your computer through the Webcasting link on the OTN website. Webconferencing Webconferencing allows OTN members to hold educational events and meetings using Adobe Connect Pro. This screen sharing software can be used to enhance your OTN videoconference or provide support for a teleconference. Members can share documents, view the presenter s desktop, chat virtually and interact during online meetings, webinars and videoconferences. Host accounts are available on a shared cost basis. Please contact webconferencing@otn.ca for more details.

9 OTN Telemedicine Tools Telemedicine Directory The OTN Telemedicine Directory provides members with an easy way to access Telemedicine consultants and programs. It is also a place to promote, coordinate and manage services offered via Telemedicine. The consultant profile features the types of referrals a consultant accepts, specialized areas of practice and the geographic area served. The site profile features the programs available at a site, the site type and geographical area served. To create your own account and request a profile, telemedicineprofiles@otn.ca. Learning Centre The Centre provides an online and easy-to-use single point of access to all OTN member distance education offerings. The Learning Centre makes it easier to not only to find education events (including searches by area of therapeutic care) more easily, but to actively promote those relevant to your organizations. The Centre can also be used to promote and build education programs. As well as searching for events by subject, date or title, the centre has quicklinks to to other important OTN services such as the e- Training centre, webcasting centre and resource library. Visit for more details.

10 Scheduling Telemedicine Events Scheduling Considerations All videoconference events need to be scheduled. This ensures that: Videoconference equipment is available at the specified date and time (Please note, that when you schedule an event in Ncompass or through the Contact Centre, you are only booking the equipment and not the room); Participants are available at the specified date and time; Privacy and security of patients and participants is maintained; OTN has a record of the videoconferencing activity at your site for its reports to the Ministry and the LHIN offices. Unscheduled events will not be counted toward a site s activity. Self Scheduling using Ncompass Ncompass is an online scheduling tool that allows OTN Members to self-schedule and manage videoconferencing events. These include both clinical and non-clinical events. Using Ncompass, a Member can book video systems, send s to participants and maintain a searchable calendar of events, all in a matter of minutes and from the convenience of your PC. Ncompass also allows members to publish open events so that others can view public events independently from the learning center. (audio) It is a vital part of organizing events on the network, and it is recommended that at least two members of your team be trained in Ncompass. If you are interested in gaining access to Ncompass, please contact your Regional Manager and they will be able to enroll in the online Ncompass course. There may be some circumstances where you need to use OTN-assisted scheduling services. These include: adding off-net sites (those not on the OTN network) to a videoconference adding audio participants to an event If you do require assistance scheduling your event or if you have any questions about OTN full service or premium service scheduling, please contact your Regional Manager or the Contact Centre at or at scheduling@otn.ca.

11 Best Practice Considerations Videoconference Tips Key tips to consider when setting up educational or clinical telemedicine space: Noise: Too much background noise will result in poor quality sound during your videoconference. The microphones on videoconference systems are sensitive to noise, which can be picked up at the far site. Choose a space that is removed from high traffic areas, away from internal and external noise such as air conditioners or plumbing, and consider having the room soundproofed. Size: The size of the space must be large enough to comfortably accommodate the number of users you expect while also housing your telemedicine system, peripheral devices and furniture. Some space will likely be multi-purpose and used for patient consultations, team conferences and larger groups attending educational events or administrative meetings. Windows: If a room has windows, ensure that there are window coverings to ensure privacy and good light control (outdoor light can interfere with your video image.) Depending on the amount of outdoor light a room receives, window coverings may need to be of black-out quality. Room Layout: Typically the telemedicine system is situated in front of the participants. Participants should sit directly in front of the camera so that they don t look like they are looking upwards, downwards or sideways. A horseshoe arrangement of seats for educational sessions permits a clear view of each participant, although some panning by the camera will be necessary to optimize results. This layout can work very well for small groups. For a clinical session, make sure the camera is placed at the bottom of the bed or in front of the stretcher for optimum viewing. Lighting: Proper illumination levels ensures proper skin colour. Regular fluorescent lights can cause a glare or produce a greenish hue, which is misleading during clinical telemedicine sessions. Glare from lights can also make an image look blurry on the videoconference monitor. For clinical telemedicine, many aspects of a physical examination are in fact not color or texture dependent, but require the creative use of shadows to illuminate changes in size, pulsations, or body movement. Consider having a movable light source that offers the flexibility to direct light where fixed lighting is insufficient. Color: Solid shades of blue or gray are ideal for backgrounds when using videoconferencing. These colors bring out healthy skin tones and do not create a visual distraction.