Training Telehealth Foundations The session is an introduction to telehealth for site contacts and other staff at sites where telehealth is available. This document contains key information required to manage telehealth at a facility. It is meant as a reference for telehealth activity with more detailed information on telehealth standards, procedures and forms available at www.mbtelehealth.ca or by contacting your Facilitator-eHealth Solutions. This document will help you understand the following: What telehealth is The different event and connection types How to schedule a telehealth event How to access support for telehealth events How to connect and use the videoconference equipment How to connect and use peripheral equipment Best practice tips for: Facilitating a telehealth event Participating in a telehealth event How to access additional telehealth related information What is Telehealth? Telehealth is the use of information and communication technology to connect people to health care expertise at a distance. A secure, high-speed video link is used to connect a patient to health care professionals at another site within the province, within the country or even somewhere around the world. You are able to see, hear and talk to the person at the distant site in real time. For example, a patient is able to see, hear and talk to their care provider in real time on a television monitor within their local health care facility to discuss results from their last set of tests. Telehealth enables those living in rural and northern areas to receive much needed healthcare services while remaining in their home community and it also helps support health related education and administrative meetings. Telehealth technologies are continuously evolving and also include services such as Store and Forward, and Streaming but this course will focus on videoconference technologies only. Benefits of using Telehealth: Improved access to specialized services that may not be available in every community Saves the patient and the healthcare system the time, money and risks associated with travel
Allows for access to care while remaining close to family, friends and community supports at a time when added emotional and physical help may be needed Reduces the hardship and inconvenience of being away from work and home Provides access to continuing education for health care professionals Reduces administrative costs in relation to travel for rural health authorities Types of Telehealth Events Clinical Clinical events encompass a wide scope of activities. Generally, they refer to a range of client care. For example, clinical services may include the following: Specialist Consultations Follow-up appointments Client Teaching Case Conferencing Discharge Planning Education Examples of education events include Continuing Medical Education (CME), ongoing Nursing education and weekly Grand Rounds offered by the University of Manitoba which allow rural based health professionals to remain in their communities while continuing their professional development. MBTelehealth can also link outside of Manitoba for National and International events however, additional charges will apply. Administrative - Administrative events are held for the purposes of conducting meetings and interviews. Holding these types of events using telehealth reduces travel time for regional administrators and increases their ability to participate in multiple meetings in the province regardless of distance. Some examples of administrative users for the network include regional, provincial and national health programs. Televisitation - A televisitation is an event where a patient, who is on an extended stay in hospital, connects to a family member(s) in their home community. Connection Types Site to Site A direct connection between two sites Multi-Site 3 or more sites connected via MBTelehealth s multi-point control unit (MCU). Out-of-Province/Network* Involves connecting to a site in another province or outside of the MBTelehealth network. These connections can be either point-to-point or multi-point * Note: Charges may apply, contact MBT scheduler with any questions. Scheduling a Telehealth Event: Events can be scheduled in three way; through central schedulers, self-scheduling and selfregistration. With centralized scheduling, all requests are submitted using Clinical Booking Forms (CBF) for anything involving a patients and Non-Clinical Booking Forms (NCBF) for anything education or administration related. The CBF must be faxed (not emailed) because it
contains patient information and can be sent to 204-975-7787. The NCBF can be faxed to the same number or emailed to schedule@mbtelehealth.ca. Once submitted, the MBTelehealth Network Schedulers (schedulers) will respond to your request within 48 hours of receipt. To contact the schedulers regarding your request call 204-975-7714 or 1-866-667-9891 and select option 2. All requests must be received before noon on the day prior to the date requested however the earlier your request is submitted; the better the chances are that the requested site(s) will be available. Self-scheduling is done using the MBTelehealth scheduling system, ischeduler. ischeduler is a web-based telehealth scheduling application that allows MBT to give access to users to do their own scheduling of telehealth events. Self-registration allows users with basic access to the ischeduler application to add their site(s) to a previously scheduled event. The MBT schedulers can be contacted for all event modifications and cancellations unless they are same day changes. For same day changes, contact the MBTelehealth Service Desk to ensure that all participants are notified of the change to the event. MBTelehealth Service Desk The MBTelehealth Service Desk provides real time support for telehealth events. They can be contacted at 204-975-7714 or 1-866-667-9891 option 1 to provide assistance with anything related to your telehealth event. Service Desk Hours are Monday to Thursday 0730-2100 and Friday 0730-1700. Telehealth Equipment Camera A high-quality imaging device used to transmit near end images to the far end site Codec The main task of the codec is the compression of outgoing video, audio and data, the decompression of the incoming information and the transmission of this information between endpoints. The codec acts as the central processor for the videoconference system. Screen/Monitor Displays images from the near and far end sites as determined by the codec Remote Control Used to place calls, adjust the volume, navigate screens and select options. It controls all functions of the videoconference equipment Router When connected to an MBTelehealth drop, the Router provides a secure connection back to the MBTelehealth network Microphone (not shown) Is an input device used to send audio to the far end site through the codec
Most common equipment setups: Mobile Carts - Mobile carts have all 6 main components mounted on cart with wheels so that it can be used in multiple rooms for multiple applications within a facility as long as the room has a dedicated telehealth network drop. Fixed Systems - All equipment is mounted on a wall in a designated room. Mobile Fixed In addition to the Mobile and Fixed systems, MBTelehealth also uses Desktop solutions which can be designated hardware units or software that is installed on a PC or laptop and used with a web camera. Connecting the Equipment: Telehealth equipment connections involve plugging in a power cable and an Ethernet cable. For fixed and desktop solutions, this is usually already done. For mobile systems, the power cable is plugged into a standard power outlet. The Ethernet cable is plugged into a computer drop that is configured for use on the MBTelehealth network. These drops will be identified by labels (often MBT or telehealth) Once you have those two cables connected you can turn on your videoconference equipment. MBT Power and Data Note: Some units are connected to a power bar and some have a power button that controls the entire unit. Make sure the router, codec and monitor are all turned on before trying to make a connection.
The Remote Control Video Source Buttons The video source buttons on your remote control allow you to display images from video conference peripherals such as patient cameras, document cameras and laptops. The main camera button refers to the camera on top of the codec and is the default video source. You access the peripherals by pressing the corresponding video source buttons. For more information on video conference peripherals, see the Additional Telehealth Training opportunities listing on page 6. Mic Off The mic off button on the remote control is used to mute your microphone so that other sites cannot hear what is being said at your site. Most telehealth equipment is set to auto answer with the mic turned off; this means that your microphone will automatically turn off when someone connects to your equipment. This ensures that they are not able to dial in and listen to a conversation without a person at the near end site being aware. When your microphone is muted, you will see an icon on the monitor similar to this one: Pressing the mic off button will toggle the microphone on and off. Make sure your site is on mute before making a call and while receiving presentations; turn the mute off when you are ready to be heard. Camera Controls/Presets The Camera Controls and Zoom +/- buttons are used to change the view of your camera. Use these to ensure you are on screen for the far end site to see.
Camera presets are predetermined camera positions which are useful when images from different camera positions are to be viewed by the far end site. They are set up prior to the start of a telehealth event and are used to switch camera positions without having to manually move the camera. MBTelehealth recommends the use of 3 standard camera presets: 1. Sign The first preset is of a sign with the site name. This is an off screen camera view that allows users to move about the room without being on camera and identifies the sites that are connected. The equipment should always be set to the sign preset before connecting to an event. 2. Participant (Patient, Provider, Presenter) This preset is a close up view of the person or persons involved in the event. Whether it is the patient, provider or a presenter, when setting this preset, you want to ensure that the far sites are able see the person clearly. 3. Room Part of video conference etiquette includes making the sites you are connected to aware of everyone involved in the event. By setting a preset of the entire room, you can easily identify everyone in attendance and then switch back to preset number 2 as necessary. This preset is also helpful for question and answer periods. Note: See the quick reference guide included with your equipment for camera preset instructions specific to your videoconference system. Layout The layout button controls a picture in picture image of what you are sending to the far end site. There are five options for the location of the image; all four corners of monitor and turned off. You move through these options by pressing the layout button repeatedly. It is recommended that you always press the layout button after connecting to ensure you are constantly aware of what you are sending to the far end site. Selfview The selfview button is used to swap near end and far end images on your monitor. When you have a picture in picture view of yourself on screen and then press the selfview button, you will see that the near end image will appear in the big window and the far end image will appear in the smaller window. This is helpful for presentations where you have other people attending in the same room and also when using a patient camera so you can view the image you are sending to the far site more easily. Press the selfview button again to switch back to regular view. Connect/Disconnect Once you ve booked your site to site event, connecting to the other MBTelehealth site is as simple as pressing the Phone Book button and then scrolling through the listing until you find the site you are scheduled to connect to. You can quickly skip to the site you are looking for using the corresponding number key on the remote control. For example, if you are looking for Pine Falls, press #7 on the remote to skip to the P section of the phone book.
Once you find the site, press the green Connect button to place the call; press the red Disconnect button to end the call once your event is finished. For out of province connections, you will be given a dial in number which you enter by pressing the green Connect button and then typing in the number using the buttons on the remote control. You will need to enter the prefix 86 in front of the number in order for it to work. Far End Note: Incoming calls will be automatically answered with the microphone turned off. Taking Far End Camera Control allows you to move the camera at the far end site as well as control their video sources and presets during Point-to-Point connections. Before taking far end camera control, always request permission and explain why you are taking control. You may need to take far end camera control if: There is an unskilled operator at the far end. The operator requests that you take control. If the operator isn t able to facilitate the event at their end. During Multi-Point events, Far End control allows you to change how the far end sites are displayed on your monitor. As discussed in Connection Types, Multi-Point events are set up using voice activation to control the display by default. Pressing the Far End button and then the up arrow allows you to toggle through the screen layouts shown below: Pressing the Far End button again will turn off Far End control
Quick Reference Guides Quick reference guides are available for all types of MBTelehealth equipment. The guide provides site/equipment specific instructions regarding the following: Set Up Camera Presets Connecting to another site Layout changes Presentation display Etc Contact your Regional Telehealth Coordinator or email training@mbtelehealth.ca for more information on Quick Reference Guides Example Quick Reference Guide
Video Sources Each video source button on your remote control references a video input located on the back of your codec. The video inputs on the back of your codec allow you to connect various peripheral devices such as Patient Cameras, Document Cameras and/or Laptops to your video conference equipment for display to the far end site(s). The type of connection used depends on the peripheral device; the four types of cables used to connect peripheral devices to video conference equipment are identified below: RCA Cable - A standard type of cable used to transmit video signals between devices. It is used to connect the AMD patient camera, a document camera and a VCR or DVD Player to the video conference equipment. S-Video Cable or Super Video carries video data as two separate signals. It is used to connect the n_sight patient camera, or a document camera to the video conference equipment, it provides a higher quality display than the RCA Cable. VGA Cable Has a 15 pin connector that carries analog video signals. It is used to connect laptops and PCs to the video conference equipment. DVi Cable or Digital Video Interface is a video standard designed to maximize the visual quality of digital display devices such as flat panel LCD computer displays. The DVi connector is used on the Tandberg MXPs to connect laptops and PCs to the video conference equipment. Video Inputs There are multiple inputs and outputs located on the back of the codec. Identified below are the five video inputs that are used to connect peripheral devices for display to the far end site(s): Back of Codec Main Cam Aux Doc DVD/VCR PC/DVi or PC/VGA
Main Cam is the default video source. It references the Main Camera image on the top of the codec and is accessed by pressing the Main Cam button on the remote control. Aux or Auxiliary is an S-Video input used to connect and display images from patient cameras and document cameras. It is accessed by pressing the Aux button on your remote control Doc or Document Camera refers to an RCA input that allows you to connect Document Cameras, Patient Cameras, VCRs, and/or DVD players. It is accessed by pressing the Doc button on the remote control VCR The VCR input is an additional RCA input that allows you to connect Document Cameras, Patient Cameras, VCRs, and/or DVD players. It is accessed by pressing the VCR or DVD button on the remote control (depending on your remote control) PC/DVi or PC/VGA The type of connection you have depends on the model of video conference equipment you are using. Both of these connections are used to connect laptops or PCs to your video conference equipment with the difference being the type of connection at the back of the codec. Newer MXP models use DVi inputs and the Classic models use a VGA input. These inputs are accessed by pressing the Presentation button or the PC button on the remote control. Laptop/PC Connection A laptop can be connected to the videoconference codec so that a user can display PowerPoint presentations or documents for collaboration with other sites. 1. Plug in and turn on the laptop or PC 2. Connect either a VGA or DVi (depending on the codec) cable to the back of the codec; then connect the other end of the cable to the laptop or PC. 3. Press the Presentation button on the remote control (if no presentation button, press the PC button) 4. If your pc image does not appear, use the function keys (usually F5, F8 or F10) on your laptop or pc to display the image. 5. If you have others attending at your site, press the Selfview button on the remote control to swap images and display the image in the large portion of your screen 6. Once finished, press the Selfview button again to return the far end site image to the large portion of the screen 7. Press the Main Cam button on the remote to display your main camera image to the far end site
Patient Camera Patient Cameras are used to examine objects in fine detail. MBTelehealth has 2 different models currently in use; the AMD Patient Camera and the OnSight Patient Camera. Both are compact and lightweight handheld cameras can be used for many telehealth applications including dermatology, wheelchair seating or gait assessments. The camera can also be used to examine various areas of the body. AMD Patient Camera OnSight Patient Camera To connect and use a patient camera: 1. Plug in the power cable and turn the camera on 2. Connect one end of the s-video cable to the camera and the other to the Aux video input on the back of the codec 3. Press the Aux button on the remote control 4. Press the Selfview button on the remote control to swap images and display the patient camera image in the large portion of your screen 5. Manually zoom (physically move) the camera closer to the object until you have the desired image. 6. Freeze the image for review by the provided 7. Once finished, press the Selfview button again to return the far end site image to the large portion of the screen 8. Press the Main Cam button on the remote to display your main camera image to the far end site Electronic Stethoscope for Patient Site MBT uses the TeleSteth Electronic stethoscope to aloow health care providers to listen to heart and chest sounds during live interactive video conference clinical appointments. Electronic stethoscopes are not connected to the codec but are connected to the MBTelehealth network which allows them to work with the video conference equipment to provide information to the health care provider that is in addition to what they can hear and see through the video conference monitor.
To connect the TeleSteth device: 1. Connect an Ethernet cable to the laptop and port FE1 on the Cisco router, 2. Plug in and turn on the laptop. Then plug the wireless dongle into a USB port on the laptop 3. Turn on the stethoscope by pressing the Power button 4. Double click the TeleSteth icon on the laptop to launch the program 5. When prompted, enter the TeleSteth username and password (found on the bottom left corner of the laptop) then click Login 6. Click Ok. Once the software opens, click Host a Session and follow the instructions on screen to set up the stethoscope. Once completed, read the Session ID to the provider site. Other Peripheral Devices The peripheral devices listed below are available for use at specific sites. For more information, contact the MBTelehealth Training Coordinator or the Telehealth Coordinator at your site. Document Camera The document camera is used for showing paper copies, printed text/pictures, 3-dimensional objects such as a person s hand, and transparencies to the far end site. Otoscope - The digital otoscope is used for ear, nose and throat (ENT) examinations over telehealth. It has excellent imagery for lower sinus and upper throat examinations. VCR/DVD - Connecting a VCR or DVD player to your video conference system is an alternate method of sharing media with the far end site. Tips for Presenters/Facilitators Perform roll call/introductions at the start of the event. Include instructions for microphone muting and question and answer When asking questions direct them at each attending site individually to avoid multiple responses at the same time Use the far end button and the up arrow to display multiple sites on screen Use the self view button to display presentations locally
Tips for Participating in a Telehealth Event Once connected, use the layout button to see the image you are sending the other site(s). If you are not on screen clearly, use the arrow keys and zoom button to adjust the camera. Use the far end button and the up arrow to display multiple sites on screen Speak naturally as the microphone will automatically make adjustments so the other site(s) can hear you. Pause between speakers to accommodate slight audio delay Mute your microphone when you are not speaking to reduce background noise for other attendees Be aware of your scheduled start and end times. Ending late impacts other users who may be scheduled to use the equipment. Additional Information Additional information on telehealth standards, procedures and forms are available at: www.mbtelehealth.ca or by contacting your Facilitator-eHealth Solutions