Healthcare is video’s ultimate use case

When people think of communications technologies – whether unified communications, wireless, or video – they are inclined to assume that the applications are “horizontal”, in that there is nothing industry-specific about them. But that isn’t true in healthcare, which is one reason why this industry is setting the bar for video. No one knows this better than Dr. Ed Brown, chief executive officer of the Ontario Telemedicine Network (OTN), one of the largest telemedicine networks in world. “Telemedicine still uses predominantly big hardware and conferencing platforms,” says Brown, in conversation with Telemanagement. “We have had them in hospitals – a regional teaching hospital would connect to smaller community hospitals to support different specialties. That’s the traditional use. We have patient hand-held exam cameras. Now tele-homecare is emerging.” In fact, the OTN is on the hunt to acquire a provincial web-based videoconferencing solution for OTN members. The plan is to integrate OTN’s Portal and Personal Telemedicine Solution with desktop videoconferencing. “We have current vendors of record like Polycom and Tandberg,” says Brown. “These companies and their resellers have developed integrated platforms for mobile carts – standard video conferencing hardware on ergonomic platforms integrated with medical devices.” The OTN uses Cisco Systems for its virtual private network (VPN), which runs on the eHealth Ontario’s Ontario Network for eHealth, or “ONE”, network. “We used to fumble to make a video connection happen,” says Brantz Myers, director of healthcare business development at Cisco. “It was a separate system, and to make a video connection happen you had to be physically bound to a room and know ISDN numbers or IP addresses. Not anymore.” Video enters the healthcare mainstream Myers says that video in healthcare is in a transitional phase. Some vendors are trying to be all things to all people, and are leveraging the pervasiveness of the web to plug any computer and camera into a video connection. But healthcare has specific requirements. “OTN has unique challenges,” says Myers. “How do you bill for remote services? And how do you make sure you are getting the best, safest use of the technology? For example, OTN has a tele-stroke program, which allows patients who have had a stroke to be evaluated by a neurologist. This could make them candidates for a new clot busting drug that, if administered within 90 minutes, can reverse the damage. This is huge. But the video has to be of a good enough quality to know that this is a clotting, and not a bleeding, stroke. If it’s the wrong one, and you give them an anti-coagulant, you’ll kill them.” Normally articles on video in enterprise environments cover shortened sales cycles and reduced travel costs, not life and death issues. But of course healthcare is a life and death business. The network has to be up, and the technology has to be reliable. If someone is a little orange, it would be good to know if it’s because they’re jaundiced, and not that the colour calibration is off. These sorts of scenarios make regulators nervous, which is one reason for the delays in larger adoption. The demand and the technology are there – all that’s needed are the processes. “We have put the remote, primary care use scenario in the hands of the regulators for review,” says Myers. “Then we go to market. At present Cisco has a number of different video product trials, such as with National Health Services in Scotland.” The challenge is that, in effect, video in healthcare must be certified as a type of medical device, which adds a level of complexity not seen in other industries. But Canada should be able to emulate Cisco’s joint effort south of the border with health insurer UnitedHealth Group Inc, which is aiming to create a US-wide network for video medical imaging between health care providers and patients from remote locations. For Dr. Brown, a huge advantage to having video as a component of telemedicine is in home care. “Tele-homecare is an enormous story that the healthcare system needs to hear about,” says Brown. “Chronic disease management is enhanced with remote coaching and support. Patients do better, and there are reductions in hospitalization. This will be a very important technology.” The greater challenge comes in more dynamic clinical settings, where different specialists and support staff need to be at the right place at the right time. “Scheduling is an enabling piece for us,” says Brown. “We have to make sure the supporting infrastructure and the business processes are in line. We can have professionals at two sites, patients, nurses – there can be a lot of moving parts. It’s too much to ask health professionals to organize all that. So, we built in a call centre for referral scheduling.” Things can get complicated when videoconferencing is expected to be a reliable and pervasive resource. The OTN had to automate scheduling and write some software to support the process. It is now moving to a portal model that will have web-based self-scheduling. “Videoconferencing platforms can be expensive doorstops,” says Brown. “We need to build processes around the technology so that health care providers will use them.” And if done right video should end up saving taxpayers a whack of dough – not a bad by-product of saving lives. The important thing, and both Brown and Myers seem well aware of this concern, is to make sure that we get the most out of the money invested. “If you spend a dollar on a video system for healthcare, do you then save two, or three, or four dollars? Spending that first dollar has to be well understood,” says Brown.

Healthcare is video’s ultimate use case

News | 08/28/2009 2:45 pm EDT

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