3 best practices for telehealth infrastructure
As more and more healthcare providers embark on telehealth strategies, CIOs and IT departments are discovering that it’s not as simple to set up and manage as originally expected.
Many pilot efforts have failed due to poorly designed network connectivity, complicated clinical workflows, confusing technology user experiences, unreliable equipment and lack of ROI in terms of clinical outcomes or financial benefits. In some cases, these problems aren’t discovered until the systems have been rolled out and the negative results are felt firsthand by doctors and patients. More than a few telehealth carts are sitting in storage closets because they failed to work when they were needed most — and the medical staff moved on to other alternatives.
As this technology matures, best practices have emerged that can help any organization minimize technology challenges, recover quickly from downtime and embrace the full benefits of telehealth, which can be summarized as doctors treating more patients and patients receiving better care.
Three of those best practices include:
1. Availability. Not to be confused with reliability, availability refers specifically to databases and systems being up and running and the invaluable role of the network. One of the first network-related considerations that must be addressed is bandwidth. Anyone who’s ever been in a video conference session where the person talking can’t be understood or their lips are out of sync with the audio can imagine how disruptive this issue could be during a telehealth session.
Depending on the codec that’s used, bandwidth requirements can range from .5 Mbps (up and down) to 2 Mbps (up and down). Hospitals and clinics located in rural areas may be restricted to less than 1 Mbps pipelines and therefore will need to pay closer attention to choosing efficient codecs as well as using QoS (quality of service) software that gives priority to voice and video over other data packets traversing the network. In some instances, it may be necessary to establish dedicated telehealth networks and to configure failover options should the primary network become unavailable.
One of the biggest availability oversights occurs during pilot tests where only three or four telehealth carts or stations are tested, and the network is taxed only a small portion of what it experiences when a live rollout of 20 or more carts and stations is implemented. Healthcare organizations need to take this into account ahead of time and monitor the scheduling of each session so adjustments can be made if bandwidth requirements change.
In today’s mobile world, Wi-Fi networks are another important part of the availability equation that come with their own challenges. Dead spots can easily be missed if pilot tests are performed in a controlled environment (e.g. data center), but the carts are used in basements with concrete walls or near medical equipment such as X-rays that can interfere with wireless signals.
A best practice is to conduct a thorough wireless network survey prior to the pilot, identify and address problem areas ahead of time, and conduct the pilot where the system will be used.
A final point about wired and wireless networks is that they are dynamic, which means that just because they work well today doesn’t mean that something can’t change tomorrow. The only way to ensure ongoing network reliability is to monitor your networks and set up automated alerts if key thresholds are crossed such as high latency or low signal strength.
2. Reliability. There are lots of components involved in a telehealth solution from which healthcare practices must choose, including monitors, video cameras, speakers, telehealth carts and medical diagnostic equipment. Piecemealing together a best-of-breed solution on your own increases your risk of missing the mark in a few critical areas.
At one end of the spectrum, healthcare organizations can procure consumer-based equipment, which may be price- and user-friendly but often lacks other important features such as security and dependability. At the other end of the spectrum are business-grade components, which are often purpose built for a specific industry. Choosing this option doesn’t automatically guarantee that clinicians and patients will be able to use it, especially if it’s complicated to use and training is not provided.
It’s strongly recommended that healthcare providers contact trade organizations and others within their industry — as well as peer organizations that have already implemented telehealth — to find out what others are using and get honest feedback on those technologies and services.
3. Maintainability. “The telehealth cart is down and we don’t know where to begin to fix it. Call the doctor and we will have to explain the patient’s condition over the phone. Contact transport service; we are likely going to have to ship this patient.”
This is the Achilles heel of telehealth. Are the cart and the infrastructure going to work when the patient is in the ER or when the doctor is ready to see the patient?
No telehealth solution works perfectly every time, but how quickly an organization can identify (proactive monitoring) and resolve problems is another critical component to the success of the solution.
When it comes to maintainability, one of the most important considerations is equipment failure, which always seems to occur at the most inopportune time (e.g. Saturday night). Having to wait for a part to be ordered will most likely require several days of downtime, which can be very costly and disruptive — especially for organizations that schedule telehealth sessions weeks in advance. In these instances, a best practice is to ensure a backup telehealth workstation or cart is available on premise.
Telehealth is coming
All that said, the global telehealth market is poised to expand from $14.2 billion in 2012 to more than $39 billion in 2018, according to a report from Research and Markets.
With that growth, CIOs should expect some growing pains along the way — especially for those who underestimate the cost and complexities associated with telehealth.
Peter McLain is vice president of telehealth for Yorktel.