Telehealth Architecture and Infrastructure: Connecting with Patients via Technology February 29, 2016

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1 Telehealth Architecture and Infrastructure: Connecting with Patients via Technology February 29, 2016 James Betz Innovative Practice Program Manager GW Medical Faculty Associates

2 Conflict of Interest James Betz Has no real or apparent conflicts of interest to report.

3 Agenda Overview of Virtual Encounters Virtual Encounters Defining Technical Quality Documentation and EHR Integration Information Sharing & Considerations Where We re Headed

4 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

5 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?

6 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

7 The Virtual Visit Increasingly popular for patients & clinicians Multiple types of providers Purpose-built companies Existing providers Payers Requires live audio & video at minimum

8 Evolving Standards and Practices Clinical Quality / Appropriateness Service / Patient Experience Operational Technical Technical Components of Quality Secure Private Simple Clear Reliable Professional Integrated Tailored

9 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

10 Private Settings Physician Distraction, background noise, lighting, camera stability Patient Pre-appointment guidance Participants Patient verification Introduction of assisting staff Closed session/connection

11 Simple Patients Schedule and/or access services Use their device of preference Physicians Incorporate into current practice Use the technology

12 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

13 Clear Patient-specific ADA (including sign language) Language Cultural considerations Age considerations Pediatric Geriatric

14 Reliable Emergency plan Contingency/disconnection plan Stable software Robust connection Survivability Redundancy Technical support Current support? Equipment support

15 Professional Provider Training & Mentoring Attire/appearance Setting/background Physician & patient Ethical conducted Patients are informed Follow normal practice guidelines

16 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

17 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

18 Hardware Patient side Camera Microphone/speakers Proper peripherals/diagnostics Provider side Camera Computer or device Multiple screens Test, train, practice with camera

19 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.)

20 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

21 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

22 Broader Telehealth Data Sharing Rapidly expanding sources of data Tremendous potential, several challenges Capturing Validating Consolidating Processing Presenting

23 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

24 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

25 One Vision: Mobile Integrated Healthcare Use telemedicine as one tool to increase the role of prehospital providers (EMTs & Paramedics)

26 One Vision: Home-based telemedicine kits Worrell Designs, Inc. conceptualized how this might look in the future

27 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

28 Questions Contact Information: James Betz

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