How to get Started in Telemedicine

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1 equipment telemedicine software lth equipment exam camera telemedicine software telemedicine technology global nology medical image automation software global uipment innovative telemedicine DICOM PACS HL7 consultation tele-psychology emergency tele-pharmacy are video conference equipment work together connected ogy emergency tele-pharmacy innovative global video media time n tele-psychology emergency tele-pharmacy innovative global video nected consultation tele-psychology emergency tele-pharmacy e equipment work together connected consultation technology gy medical image automation software global telehealth video software video conference equipment work together chology emergency tele-pharmacy innovative global re video conference equipment work ected consultation tele-psychology ation tele-psychology emergency tele-pharmacy innovative global video media time ealth telehealth equipment exam camera telemedicine equipment telemedicine software gy medical image automation software global telehealth video conference equipment er connected consultation tele-psychology emergency tele-pharmacy innovative ergonomic design attractive images equipment work together connected y innovative global video media time money ive images DICOM PACS HL7 Research tele- er connected consultation tele-psychology emergency tele-pharmacy innovative ergonomic design attractive images equipment work together connected m camera telemedicine equipment telemedicine software images DICOM PACS HL7 -forward software video conference equipment work telehealth equipment exam telemedicine telehealth equipment exam camera telemedicine equipment edicine telehealth technology medical image automation telehealth equipment video conference equipment work cy tele-pharmacy innovative global video media nce equipment work together connected consultation tele-psychology store-n-forward software video nsultation technology global telemedicine telehealth technology medical image ce equipment innovative telemedicine DICOM PACS HL7 Research tele-health onference equipment work together connected consultation tele-psychology store-n-forward software video tele-psychology emergency tele-pharmacy innovative global video media time images DICOM PACS HL7 Research video conference equipment work together connected consultation tele- cameras scope monitor technical PACS conference clinic store-n-forward together connected consultation DICOM PACS HL7 Research tele-health nference equipment work together connected consultation teleal video solution cameras scope monitor attractive images DICOM PACS HL7 nference equipment work together connected consultation teleharmacy innovative global video media time monitor attractive images DICOM PACS HL7 conference clinic store-n-forward nference equipment work together sultation technology global telemedicine medical image automation software global nference equipment innovative telemedicine esearch video conference equipment work sultation tele-psychology emergency teleal video monitor attractive images DICOM PACS HL7 conference clinic store-n-forward nference equipment work together tele- psychology emergency teleal video monitor attractive images DICOM PACS HL7 conference clinic store-n-forward nference equipment work together tele- psychology emergency teleal video monitor harmacy innovative global video media time cameras scope monitor technical design attractive images DICOM le-health video conference equipment work How to get Started in Telemedicine by:

2 Research In order to begin doing telemedicine, there are some preliminary steps to take. As with anything worth and money by adding telemedicine to your practice;; the advance preparation can help you have a better return on your investment and possibly increase patient satisfaction It s important to: Research: to telemedicine. Locate: Where will the equipment be placed? How do you expect to get a return on your investment? Investigate: reimbursed)? Gauge Interest: Have you considered an informal assessment of patients feelings about telemedicine? Many patients appreciate the convenience of telemedicine. Others may prefer in-person visits. Is this due to unfamiliarity with telemedicine? Patient acceptance of telemedicine practices is often improved by good communication in advance. Make sure everyone understands how his/her job may be affected. Are they willing to adjust and support the technology?

3 Starting Point Not knowing your level of expertise, we ll begin with some basic suggestions and pose a number of questions for you to answer. Draw up a plan: How do you expect the telemedicine program to tie into your regular in- person practice? $UH \RX SODQQLQJ WR H[WHQG \RXU SUDFWLFH DQG RSHQ VDWHOOLWH RI FHV VWDIIHG E\ PLG OHYHO SURYLGHUV" What type of clinic hours will you devote to telemedicine? What time could you save by implementing telemedicine? How will your telemedicine program be used? a. Primary care consults? b. Specialist consults? c. Mental Health? d. Tele- ICU? H (PHUJHQF\ 'HSDUWPHQW XVH" VXFK DV 7HOH VWURNH f. Pediatrics? g. Pathology? h. Tele- pharmacy? L :KDW VSHFL F WHVWV RU DVVD\V DUH QHHGHG IRU WKH FRQVXOWV" All of these utilize telemedicine equipment. Systems can be designed to work with a variety of specialties, but the solution is typically designed to focus on one essential area of interest.

4 Will your equipment work with: - The existing legacy equipment? - New equipment or networks that are installed/upgraded? communication system)? Will the equipment you use be: - The hub of the telemedicine practice? In other words, the central contact point for videoconferences. - Used to videoconference with some other central location? The hub will usually determine whether the video connection is hardware- or software-based. videoconference from there? These are all important considerations to understand at the beginning.

5 Equipment 6RPH SK\VLFLDQV DUH WKH WHFKQRORJ\ ³FKDPSLRQV RI WKHLU SUDFWLFH 7KH\ ZHUH WKH UVW WR LQWHJUDWH WDEOHW FRPSXWHUV ZLWK (05V WKH UVW WR JHW D ³VPDUW SKRQH DQG QRZ WKH\ PD\ KDYH DQ L3DG :RUNLQJ ZLWK new technical devices comes easy to them. But even if you just recently got around to setting up your UVW HPDLO DFFRXQW \RX FDQ OHDUQ ZKDW \RX QHHG WR NQRZ DERXW WHOHPHGLFLQH HTXLSPHQW IDLUO\ TXLFNO\ Here are some initial suggestions: - Look for systems that are intuitive. Are there controls for hardware and/or software? Does the location of the controls make sense and are they easy to use from the get- go? - Check which systems are ergonomic in design because if you and your associates are comfortable using them, your patients will be comfortable. - Ideally, you want equipment that is ready to go out of the box. How clear is the user manual? If the getting started manual is more than a few pages long, you may not be able to begin using it immediately. +RZ ZLOO \RXU HTXLSPHQW DUULYH DW \RXU RI FH",Q SLHFHV ZLWK assembly required? A few companies offer white glove service, delivering the product to your door, fully- assembled, functional and ready to plug in for use. Your Telemedicine Solution 0RVW SHRSOH EHJLQ ZLWK D EDVLF V\VWHP DQG RU ZRUN ZLWK D WHOHPHGLFLQH GHVLJQ UP WR KHOS WKHP determine what they need for their practices. Systems vary because uses vary. A tele- stroke practice, IRU H[DPSOH FDQ EH D VLPSOHU WHOHPHGLFLQH GHVLJQ WKDQ RQH IRU DQ (DU 1RVH DQG 7KURDW SUDFWLFH WKDW may require scopes, cameras, and an illumination device.

6 Your Telemedicine Solution Identify the kind of equipment you will need for your telemedicine practice: Do- it- yourselfers can purchase and assemble individual items. Here s a situation where a checklist would be helpful. - Monitors: What do you want to see? What size would work best? How many do you need? - Computers: What connections do they have? What is the operating system? 0LFURSKRQHV (FKR FDQFHOOLQJ RPQL GLUHFWLRQDO RU XQL GLUHFWLRQDO" - Image Automation Software that captures and stores images, sometimes referred WR DV ³6WRUH DQG )RUZDUG 7KHVH DUH ³YLVLEOH OLJKW LPDJHV DV RSSRVHG WR QRQ visible light images, such as x- rays, etc.). 'RHV WKH ZRUN VXUIDFH QHHG WR EH UHVLVWDQW WR JHUPV DQG RU FRQWDPLQDWLRQ" 7KLV LV a consideration for patient safety.) 9LGHR FDPHUD V +,3$$ FRPSOLDQW YLGHRFRQIHUHQFLQJ VRIWZDUH RU QHWZRUN KDUGZDUH FDOOHG D &2'(& H[DPLQDWLRQ FDPHUD V FDEOHV RWKHU SHULSKHUDOV HYHQ GHVN RU RI FH IXUQLWXUH Continuity: Integrated, standardized equipment will lead to easier rollouts, training and support. Only WKRVH ZKR UHDOO\ NQRZ ZKDW WKH\ DUH GRLQJ VKRXOG EX\ XVHG HTXLSPHQW <RX PD\ SD\ OHVV RQ WKH IURQW HQG EXW LQWHJUDWHG HTXLSPHQW ZLOO VDYH \RX PRQH\ LQ WKH ORQJ UXQ $QG \RX ZRQ W KDYH FDEOHV UXQQLQJ here and there which makes it look like you did put it together yourself.) <RX PD\ FKRRVH WR EX\ D V\VWHP RII WKH VKHOI IURP D TXDOL HG DQG H[SHULHQFHG vendor. Buying off the shelf may seem more attractive, especially if a custom order might take weeks or months for delivery. But will the off- the- shelf system be exactly what you need now? And ask the vendor if such a system is expandable for future growth. <RX FDQ SXUFKDVH D VFDODEOH V\VWHP GHVLJQHG VSHFL FDOO\ IRU \RXU SUDFWLFH 7KH advantage of this option is the equipment suits your practice, and may have the JUHDWHVW ÀH[LELOLW\ IRU IXWXUH JURZWK 0DNH VXUH WKDW LI \RX EX\ 9HUVLRQ WRGD\ KRZHYHU WKH FRPSDQ\ VWLOO LQWHQGV WR VXSSRUW LW ZKHQ LW UROOV RXW 9HUVLRQ $OVR make sure that the equipment, both hardware and software, works with your current FRPSXWHU V\VWHP )RU H[DPSOH VRPH HTXLSPHQW QRZ ZRUNV ZLWK :LQGRZV EXW PDQ\ VWLOO UHTXLUH :LQGRZV ;3 RU :LQGRZV

7 Your Telemedicine Solution Whichever route you choose, there are factors to consider, both during and after the purchase. especially important when working internationally and making sure the equipment is cleared for sale - What is the quality policy of the manufacturer? Interoperablity Standards: - Manufacturer interoperability? - Will the equipment or software work with outside devices that may be different from your setup?

8 Support: - Are there service contracts? - What types of service are available? - What does the service contract cost? - When is the customer service available? - Business hours? - What is the cost difference on these? - Will the company repair or replace a defective piece of equipment, or will it wash its hands of the - If two pieces of equipment are not compatible, what happens? - Would you like a single point of contact for technical support? - Will you have to contact one, two, or maybe three companies for help? - Who owns the technical support process and will ultimately be responsible?

9 Video and Images: Most companies offer Web cameras that can be controlled remotely by the physician. Because they can pan, tilt and zoom, they provide a good overall image for communication purposes, but their closeup capabilities are somewhat limited. To get good close-up images of skin, wounds or eyes, however, the remote practitioner will need an examination camera. Some examination cameras have automatic focus;; others are manual focus. Automatic focus cameras may seem to be the easiest to use, but the healthcare provider gives up control of the image to the camera. Occasionally, the camera will have trouble focusing on what the provider wants it to. Getting the camera to focus on the feature you want to see may try your patience and that of your patient concern and maintain that focus. throat. Can you hold the camera steady enough for a freeze frame, or does the camera s design require repeated attempts? Where are the camera s controls? Are they complicated? Are they easily accessible? Do you have to use available light, or does the camera have onboard illumination? Does important feature to have for patients with darker complexions.) Questions to consider: - In order to document the telemedicine visit/consult, what kind of image capture software is available? - Will the solution integrate/work with a minimum of process steps? - Can you automate the process and attach DICOM headers to the images?

10 Customer Service: Problem A: I ve called, but nobody there can help me! Problem B: I m new here. How does this stuff work? If you are purchasing from a reseller, what is their relationship with the manufacturer? What type of support do they have from the manufacturer? After the equipment arrives, you will need to learn how to use it. What type of training is offered? Will the sales representative ever be seen again after the installation? These are good, fair questions that your vendor should be able to answer to your satisfaction. Some options for training should include: - On site installation - On site training - Manufacturer s training - On site at the manufacturer s headquarters - Regional training class - Is remote support or refresher training offered? - Is additional, advanced technical training available for BioMed or IT staff? In business, as in medicine, reputation counts. Ask the company for customer references. Contact?

11 Notes:

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