Telemedicine Tools of the Trade

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1 Telemedicine Tools of the Trade David Smith, Senior Project Manager UMass Memorial Health Care, Worcester MA DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure David Smith Has no real or apparent conflicts of interest to report HIMSS

3 Learning Objectives Define the basic components of an effective telemedicine program Compare and contrast alternative technologies for deploying telemedicine solutions Use home-based systems or mobile applications to extend telemedicine access Construct the right infrastructure for a telemedicine implementation

4 UMass Memorial Health Care 7-hospital healthcare network serving Central MA Clinical partner of UMass Medical School 13,750 employees 3,100 RNs / 1,700 MDs 1,125 beds $1.4B annual revenue 60,000 annual inpatient visits Over 1,200,000 annual outpatient visits

5 UMMHC Telemedicine Programs Tele-ICU Real-time video and biosignal monitoring of adult ICU patients Tele-Stroke Interactive neurology exams for rapid stroke treatment decisions Tele-GI Remote GI consultations serving local prison populations Capsule Endoscopy Pillcam capture of digestive tract images for specialist review Cancer Telemed (Pilot) Web-based video consult between patient, provider and specialist(s)

6 Telemedicine Defined The use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Source: American Telemedicine Association

7 Telemedicine Technologies Store and Forward Asynchronous Transmission of medical images or biosignals for offline evaluation Examples: Tele-Radiology, Tele-Dermatology, Capsule Endoscopy

8 Telemedicine Technologies Store and Forward Asynchronous Transmission of medical images or biosignals for offline evaluation Examples: Tele-Radiology, Tele-Dermatology, Capsule Endoscopy Remote Monitoring Asynchronous or real-time Transmission of patient vitals or self-monitored data Examples: Tele-ICU, at-home diabetes management

9 Telemedicine Technologies Store and Forward Asynchronous Transmission of medical images or biosignals for offline evaluation Examples: Tele-Radiology, Tele-Dermatology, Capsule Endoscopy Remote Monitoring Asynchronous or real-time Transmission of patient vitals or self-monitored data Examples: Tele-ICU, at-home diabetes management Interactive / Telepresence Real-time Transmission of audio/video with physical examination Examples: Tele-Stroke, Tele-Psychiatry, Tele-GI

10 Telemedicine Components Data Transmission DICOM HL7 interfaces Fax, secure , web portals

11 Telemedicine Components Data Transmission DICOM HL7 interfaces Fax, secure , web portals Audio/Video Transmission IP video surveillance Videoconferencing networks Robots, personal video, telephone

12 Telemedicine Components Data Transmission DICOM HL7 interfaces Fax, secure , web portals Audio/Video Transmission IP video surveillance Videoconferencing networks Robots, personal video, telephone Delivery and Access PC or laptop, attached medical devices, mobile medical carts EMR/EHR/PACS/RIS/HIE systems Call management systems, media servers

13 Functional Components: Patient-Side Video Endpoint Robot IP Camera Mobile Video Cart Bedside Monitor

14 Functional Components: Remote-Side Video Tablet Biosignal Monitoring USB Camera Home Monitoring Integrated Base Station

15 Functional Components: Management Device Management Call Management Multipoint Bridge Content Management Border Security

16 Choosing the Right Platform Define the basic requirements for your telemedicine program...

17 Choosing the Right Platform Define the basic requirements for your telemedicine program... What are the delivery mechanisms?

18 Choosing the Right Platform Define the basic requirements for your telemedicine program... What are the delivery mechanisms? Is two-way and/or high-definition (HD) video required?

19 Choosing the Right Platform Define the basic requirements for your telemedicine program... What are the delivery mechanisms? Is two-way and/or high-definition (HD) video required? Is digital recording or store and forward technology needed?

20 Choosing the Right Platform Define the basic requirements for your telemedicine program... What are the delivery mechanisms? Is two-way and/or high-definition (HD) video required? Is digital recording or store and forward technology needed? Are advanced video features required? (e.g., PTZ, FECC)

21 Choosing the Right Platform Define the basic requirements for your telemedicine program... What are the delivery mechanisms? Is two-way and/or high-definition (HD) video required? Is digital recording or store and forward technology needed? Are advanced video features required? (e.g., PTZ, FECC) Can in-place systems and technologies be used?

22 Choosing the Right Platform Define the basic requirements for your telemedicine program... What are the delivery mechanisms? Is two-way and/or high-definition (HD) video required? Is digital recording or store and forward technology needed? Are advanced video features required? (e.g., PTZ, FECC) Can in-place systems and technologies be used? What are the integration points with downstream systems?

23 Choosing the Right Platform Define the basic requirements for your telemedicine program... What are the delivery mechanisms? Is two-way and/or high-definition (HD) video required? Is digital recording or store and forward technology needed? Are advanced video features required? (e.g., PTZ, FECC) Can in-place systems and technologies be used? What are the integration points with downstream systems? What is the point of entry for end users?

24 Choosing the Right Platform Define the basic requirements for your telemedicine program... What are the delivery mechanisms? Is two-way and/or high-definition (HD) video required? Is digital recording or store and forward technology needed? Are advanced video features required? (e.g., PTZ, FECC) Can in-place systems and technologies be used? What are the integration points with downstream systems? What is the point of entry for end users? Is the solution scalable, reliable and secure?

25 Designing Your Solution Common considerations for deploying a telemedicine program...

26 Designing Your Solution Common considerations for deploying a telemedicine program... Centralized versus de-centralized access to systems and tools

27 Designing Your Solution Common considerations for deploying a telemedicine program... Centralized versus de-centralized access to systems and tools Network design including firewall traversal and VPN tunneling

28 Designing Your Solution Common considerations for deploying a telemedicine program... Centralized versus de-centralized access to systems and tools Network design including firewall traversal and VPN tunneling Using registrar services, bridges, and edge appliances

29 Designing Your Solution Common considerations for deploying a telemedicine program... Centralized versus de-centralized access to systems and tools Network design including firewall traversal and VPN tunneling Using registrar services, bridges, and edge appliances Integration with other communication tools ( , fax)

30 Designing Your Solution Common considerations for deploying a telemedicine program... Centralized versus de-centralized access to systems and tools Network design including firewall traversal and VPN tunneling Using registrar services, bridges, and edge appliances Integration with other communication tools ( , fax) Redundancy and downtime planning, system administration

31 Designing Your Solution Common considerations for deploying a telemedicine program... Centralized versus de-centralized access to systems and tools Network design including firewall traversal and VPN tunneling Using registrar services, bridges, and edge appliances Integration with other communication tools ( , fax) Redundancy and downtime planning, system administration Interworking support for multiple protocols (H.320, H.323, SIP)

32 Designing Your Solution Common considerations for deploying a telemedicine program... Centralized versus de-centralized access to systems and tools Network design including firewall traversal and VPN tunneling Using registrar services, bridges, and edge appliances Integration with other communication tools ( , fax) Redundancy and downtime planning, system administration Interworking support for multiple protocols (H.320, H.323, SIP) Compatibility with multiple manufacturers and entry points

33 Designing Your Solution Common considerations for deploying a telemedicine program... Centralized versus de-centralized access to systems and tools Network design including firewall traversal and VPN tunneling Using registrar services, bridges, and edge appliances Integration with other communication tools ( , fax) Redundancy and downtime planning, system administration Interworking support for multiple protocols (H.320, H.323, SIP) Compatibility with multiple manufacturers and entry points Scalability for future growth

34 Video Platform Comparison Technology Pros Cons IP Video Surveillance Higher image quality Cost effective in large scale Wireless, easily scalable Not suited for 2-way video Higher bandwidth usage Videoconferencing Feature rich Best suited for 2-way video Standards-based Expensive Not firewall-friendly Personal Video Inexpensive Suited for 2-way video Easily accessible Lower image quality Less secure

35 Case Study: Tele-Stroke The Problem: Stroke is the 3 rd leading cause of death in the US* Many rural areas lack access to 24x7 neurology expertise Brain-saving treatment (tpa) is extremely time sensitive The Solution: Deliver rapid access to a specialist through videoconferencing Provide remote interpretation of brain image (CT scan) Use mobile video cart for physical exam and treatment plan *Source: Centers for Disease Control and Prevention (CDC)

36 Case Study: Tele-Stroke Program Requirements: Two-way audio/video capability Mobile video cart in Emergency Room HD video with pan-tilt-zoom and far end camera control Access to patient CT scan Multiple points of entry (both on and off network) Support for both ISDN and IP calls Redundant call management and registrar services Ability to perform remote consultation from home

37 Case Study: Tele-Stroke Program Components: Commercially available HD videoconferencing endpoints Custom mobile video cart with backup HD webcam Clustered video communication servers Secure VPN tunnel between sites Virtual Desktop solution for remote access to systems

38

39 Tele-Stroke in Action NECN News Story Source: New England Cable News broadcast, 19 Jul 2011

40 Tele-ICU Program Results Measure Pre Tele-ICU Post Tele-ICU ICU Mortality Rate 10.7% 8.6% ICU Length of Stay (Days) Stress Ulcer Prevention 83% 96% DVT Prophylaxis Prevention 85% 99.5% VAP Cases 13% 1.6% Cardiovascular Protection 80% 99% Source: JAMA, Published online 16 May 2011

41 Summary Understand your service lines and the basic requirements for delivering an effective telemedicine program Choose the delivery method(s) most suited for your program; consider cost, ease of deployment, and compatibility Leverage emerging technologies, where practical, to extend the accessibility of your program Build a secure and reliable foundation to support current needs and future growth; share investments across service lines

42 Questions? For further information please contact: David Smith

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