Define the basic requirements for your telemedicine program...

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Define the basic requirements for your telemedicine program...

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.


Conflict of Interest Disclosure

David Smith

Has no real or apparent

conflicts of interest to report.

© 2012 HIMSS


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


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


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)


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


Telemedicine Technologies

• Store and Forward

– Asynchronous

– Transmission of medical images or biosignals for offline evaluation

– Examples: Tele-Radiology, Tele-Dermatology, Capsule Endoscopy


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


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


Telemedicine Components

• Data Transmission

– DICOM

– HL7 interfaces

– Fax, secure e-mail, web portals


Telemedicine Components

• Data Transmission

– DICOM

– HL7 interfaces

– Fax, secure e-mail, web portals

• Audio/Video Transmission

– IP video surveillance

– Videoconferencing networks

– Robots, personal video, telephone


Telemedicine Components

• Data Transmission

– DICOM

– HL7 interfaces

– Fax, secure e-mail, 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


Functional Components: Patient-Side

Mobile Video Cart

Video Endpoint

IP Camera

Bedside Monitor

Robot


Functional Components: Remote-Side

Home Monitoring

Video Tablet Biosignal Monitoring

Integrated Base Station

USB Camera


Functional Components: Management

Call Management

Content Management

Device Management

Border Security

Multipoint Bridge


Choosing the Right Platform

Define the basic requirements for your telemedicine program...


Choosing the Right Platform

Define the basic requirements for your telemedicine program...

• What are the delivery mechanisms?


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?


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?


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)


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?


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?


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?


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?


Designing Your Solution

Common considerations for deploying a telemedicine program...


Designing Your Solution

Common considerations for deploying a telemedicine program...

• Centralized versus de-centralized access to systems and tools


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


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


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 (e-mail, fax)


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 (e-mail, fax)

• Redundancy and downtime planning, system administration


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 (e-mail, fax)

• Redundancy and downtime planning, system administration

• Interworking support for multiple protocols (H.320, H.323, SIP)


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 (e-mail, fax)

• Redundancy and downtime planning, system administration

• Interworking support for multiple protocols (H.320, H.323, SIP)

• Compatibility with multiple manufacturers and entry points


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 (e-mail, 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


Video Platform Comparison

Technology Pros Cons

IP Video Surveillance

Videoconferencing

Personal Video

Higher image quality

Cost effective in large scale

Wireless, easily scalable

Feature rich

Best suited for 2-way video

Standards-based

Inexpensive

Suited for 2-way video

Easily accessible

Not suited for 2-way video

Higher bandwidth usage

Expensive

Not firewall-friendly

Lower image quality

Less secure


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)


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


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


Tele-Stroke in Action

NECN News Story

Source: New England Cable News broadcast, 19 Jul 2011


Tele-ICU Program Results

Measure Pre Tele-ICU Post Tele-ICU

ICU Mortality Rate 10.7% 8.6%

ICU Length of Stay (Days) 6.4 4.5

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


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


Questions?

For further information please contact:

David Smith

david.smith@umassmemorial.org

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