SBR Health at Brigham & Women’s Hospital

 

As virtual doctor visits take off, debate over who should pay heats up

Melissa Bailey, writing in the new Pulse of Longwood column for the Boston Globe’s Stat News leads the piece with a description of how the SBR Health virtual visit platform is being used in endocrinology at Boston’s Brigham and Women’s Hospital. Not only does the patient love it, but the doctor says it’s improved patient attendance.

American Telemedicine Association Presentations

The 20h annual American Telemedicine Association conference starts tomorrow in Los Angeles and we are proud to announce that several of our customers are giving presentations this year:

Understanding How Patient Centered Design Improves Provider Adoption: Mayo Clinic and Mass General Hospital

Sarah Sossong, MPH
Director of Telehealth.
Massachusetts General Hospital

Steve Ommen, MD, Medical Director
Centers for Innovation & ConnectedCare.
Mayo Clinic

Neurosurgery-Aneurysm Virtual Visits: Linking Providers to Patients in Home Settings

Sarah Pletcher, MD, MA
Medical Director.
Dartmouth-Hitchcock Medical Center

Robert Singer, MD,FACS
Staff Physician.
Dartmouth Hitchcock Medical Center

Ellyn Ercolano, MS
Telehealth Outcomes Analyst
Dartmouth Hitchcock Medical Center

How a Major Urban Health System Leverages Telemedicine

Steve Dean, MS
Telemedicine Administrative Director.
Inova Health System

Theresa M. Davis, PhD, RN, NE-BC
Clinical Operations Director.
Inova Health System

Albert Holt, MD, MBA
Medical Director TeleICU.
Inova Health System

Rina Bansal, MD, MBA
Medical Director Telemedicine Institute
Inova Health System

Applying Care in Novel Models of Non-Acute Teleneurology

Adam B. Cohen, MD
Teleneurology Director
Inpatient Neurology Director
Massachusetts General Hospital

VillageCare

We would like to welcome VillageCare Wellness Innovations to our family of customers. VillageCare recently received a Health Care Innovation Award from The Center for Medicare and Medicaid Services Innovation Center (CMMI) to pilot “Treatment Adherence through the Advanced Use of Technology” (TAAUT). This program aims to increase patient activation and treatment adherence for people living with HIV and AIDS by providing a multi-faceted intervention involving a social platform for behavior change, virtual visits, text reminders and peer support.

From the VillageCare site:

VillageCare Wellness Innovations expects to improve adherence in the most cost-effective manner by delivering education and support through technology. Participants will be able to access a customized private social network, virtual video support groups, treatment adherence professionals for questions, and text messaging for medication and appointment reminders. In addition, peer mentors will provide one-on-one encouragement and mentoring for behavior change.

“VillageCare has long been a leader in care for people living with HIVAIDS in the New York City area,” says Emma DeVito, President and Chief Executive Officer for VillageCare. VillageCare developed the first comprehensive AIDS Day Treatment program in New York and since then, has continued to create effective and innovative care models. “We are excited for the opportunity granted to us to develop a new and innovative way to encourage adherence and wellness for those living with HIVAIDS.”

The overall goal of the program is to improve viral loads and CD-4 counts, thereby simultaneously improving health and reducing overall health spending for the population. VillageCare was awarded just over $8.7 million to create and operate this program for three years. CMS will be conducting evaluations during and upon completion of the pilot program. More information may be found by visiting www.villagecare.org.

The project described is supported by Grant No. 1C1CMS331353-01-01 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

Boston Globe on Telemedicine in Mental Health

Last week, the Boston Globe ran an article Virtual therapy expanding mental health care, that mentioned how two of our customers, Partners HealthCare and HealthLinkNow were using our product to provide virtual therapy sessions.

The article quotes Janet Wozniak, a child and adolescent psychiatrist who is the associate director of the Bressler Program for Autism Spectrum Disorders at Massachustts General Hospital:

For Wozniak’s patients, mainly children and teens on the autism spectrum with psychiatric disorders, simply coming to the office can be harrowing. So when the opportunity arose to take part in a pilot program for telepsychiatry, Wozniak was hopeful. She approached a few families she thought might be interested — ideally, those who lived far from the hospital and had some degree of “computer savvy.” All they needed was a computer or tablet with a camera, speakers, and Internet connection to download the hospital’s telemedicine software. Skype and other similar applications aren’t strictly compliant with HIPAA privacy rules and regulations, and so while some practitioners — like Carmichael, who alerts her patients to this potential drawback — do use Skype, MGH uses its own software.

The software cited is SBR Health’s ResourceManager.

The article also quotes Peter Yellowlees, Chairman of HealthLinkNow:

Anyone who’s used Skype, particularly for romantic reasons, knows that you can have very intimate conversations. The extra distance might actually allow more self-revelation,” noted Peter Yellowlees, a professor of psychiatry at the University of California Davis, who conducts research on online consultation services and uses video-conferencing technology in his own practice. “I’ve had many people tell me things on video that they wouldn’t necessarily share in person.”

We are proud to say that HealthLinkNow isn’t using Skype, they are using SBR Health.

 

 

ATA 2012

Pete Eggleston demonstrating SBR Health's applications at ATA.

This week we showed SBR Health’s applications in San Jose at the annual meeting of the American Telemedicine Association. As part of our recently announced partnership with Vidyo we set up our station in their large booth in the center of the show floor.

This year’s ATA was the largest ever and most of the attendees who came by our booth had active telemedicine programs that they were looking to expand. In order to do so, they were looking for a way to manage the workflow and create a straightforward experience for both patients and clinicians.

We look forward to following up with all of you who we met at the show.

Check here to get an inside look

SBR Health 2011: What We’ve Learned

As we start a new year, I looked back on all that we learned from the hundreds of conversations we had with doctors, patients and hospital administrators to pinpoint the top lessons that really stood out from 2011.  There was a lot of frustration with the fee-for-service model and the fragmented care that it engenders, but there were a few points of concern that surprised us that I thought I would share with our readers.

When we asked patients what they wanted from their doctors, we heard they wanted someone who would really listen, take them seriously, and didn’t keep them waiting. When we talked to doctors, we learned they were frustrated by patients who didn’t show up for their appointments, follow up with their treatment plans or take their medications. While it is often said that anecdotes don’t equal data, there are corresponding statistics on the sorry level of readmissions, which can often be traced to a lack of coordination among caregivers and the need for patient engagement.

As we looked into where video communication might help, we observed that video had two very different roles to play in medicine. The obvious role, as pioneered in dermatology and neurology, was using video as a diagnostic tool, for example looking at a photograph of a patient’s skin or observing his performance in a neurological examination.  The other role, which may be equally if not more important, was more of a consultative role to establish rapport and engender trust between the parties. Doctors refer to the “doorknob syndrome,” where the patient mentions the most significant problem as he has his hand on the doorknob to leave the room. As this is something that occurs most likely in person and least likely over the phone, video is more like being there in person. Video, like an in person visit, ensures a higher level of trust between the patient and doctor.

We also heard a lot from hospital administrators about “change management.” Doctors are avid consumers of technology, from surgical robots to smart phones, but they have little patience for tools that are supposed to help and instead create more work. Electronic medical records (EMR) are a case in point. Implementation of an EMR can cost millions (or even billions in some cases) but we have yet to encounter a health care professional who hasn’t expressed frustration with one. Enterprises everywhere need to deal with the high level of expectation conditioned by consumer IT, and health care is no exception.

When it comes to video communication, the technical requirements are pretty straightforward: high quality, low bandwidth, interoperability with existing systems, and straightforward user experience. While there may not be one technology that satisfies all those requirements at once, we at SBR Health see an opportunity in crafting a solution that combines the best of the available video technologies with applications that are compatible with the day-to-day workflow of busy clinicians, improve communication among clinicians, patients and family members, and enable more efficient and compassionate delivery of health care.

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Chris Herot is the CEO and co-founder of SBR Health. Prior to launching SBR in 2010, Chris was Chief Product Officer at VSee Lab, a provider of high quality, low bandwidth and low cost videoconferencing solutions to enterprises and governments. Chris has been a successful business and technology leader in several high growth companies, and directed the advanced technology group for several years at Lotus Development (now IBM) where he was responsible for video, mobile and real-time communications solutions.

Chris received his BS and MS degrees from the Massachusetts Institute of Technology where he was on the faculty of the group that became the MIT Media Laboratory.

Blog: herot.typepad.com

 

 

TEDMED 2011

The TEDMED conference took place last week in San Diego, but it has taken me this long to digest all of the content and follow up on all the connections I made there. The general theme of the conference can be summed up in two sentences: There are amazing advances coming in medical technology. These may or may not make it through the FDA approval process in time to save your life.

This was one of the few conferences where it made sense to go to every session. A representative sampling:
•    Eythor Bender of Ekso Bionics demonstrated an exoskeleton that allowed a paraplegic to walk.
•    Daniel Kraft showing what medicine can learn from other fields such as aviation.
•    Calvin Harley of Telome Health describing how we might halt the aging process by regrowing the DNA on the end of your chromosomes. (A Russian researcher on aging cautioned me that you might not want to rush out and start gobbling down the “nutritional supplement” quite yet  – remember Vitamin E?)
•    Architech Michael Graves now in a wheel chair, describing his frustration with poorly designed hospital rooms,
•    Lance Armstrong describing the decisions he and his doctor needed to make in treating his cancer.
•    Quyen Nguyen of UC San Diego, showing a video of a fluorescent dye that binds to tumor cells to make them more visible during surgery.
•    Diana Nyad describing her attempt to swim from Cuba to Florida and her encounters with box jellyfish.
•    Paul Stamets on medicines derived from mushrooms.
•    Gabor Forgacs of Organovo demonstrating an inkjet printer that was modified to “print” organs from a supply of cells.
•    Yoav Medan of InSightec describing one of the breakthroughs that did get FDA approval: a device that uses focused ultrasound to do surgery without making an incision in the patient.
•     Mehmood Kahn, Chief Scientific Officer of PepsiCo arguing that we needed processed foods (albeit of higher quality) if we were to feed the earth’s seven billion inhabitants. (Although e-Patient Dave tweeted that this does not explain high fructose corn syrup.)
•    Dean Kamen describing his frustration in trying to get FDA clearance for a robotic arm he developed for war veterans.
•    Nate Ball, an engineer and beatbox artist demonstrating how he makes all those sounds. On stage. By having Dr. Nguyen thread fiber optics through his nose so we could see an image of his vocal cords as he made various sounds.
•     Charles Pel of Physcient describing a new model of retractor that uses force sensors to back-off before it damages bones or tissue.

Next year, the conference moves to Washington, DC. In a move that can only be described as audacious, Jay Walker plans to double the size of the conference and take on the DC establishment. If anyone has the enthusiasm and resources to do it, it would be Jay.

Check out more photos of the event here.

Health 2.0

The Health 2.0 conference returned to San Francisco for the fifth year, with a record-setting attendance of 1,500 this time around. The zeitgeist continues to be that of information technologists eager to fix all the problems of healthcare. With 35% of doctors carrying iPads and 85% with smartphones, there is plenty of opportunity for technology, but this year, there was also a closer attention to payment models and to incentives for use, both financial and psychological.

In his keynote, Mark Smith, President of the California Health Care Foundation, said that while technologies such as the Internet had transformed banking, travel and research, medical consultations were still being done the same way they had for the past 50 years. However, it is not enough to provide technology. He stressed that he wanted to fund projects that incorporated financial models that would encourage use. He said too much of what he’s seen in the past resembled the Underpants Gnomes of South Park, with business models consisting of 1. Invent Widget, 2. ????, 3. Profits!

Smith said that the most important element of any new initiative was that it reduce costs, not just by shifting them around, but by reducing the “perverse incentives” that encourage volume above all else. Other opportunities lie in improving convenience to patients, rapid learning for providers on how to make sense of the increasing volume of data and enrollment for the uninsured. As an example of how this could work, he cited how Kaiser-Permanente’s introduction of Electronic Health Records reduced specialist visits by 25%.

There was plenty of innovation on display on the stage and in the exhibit hall, such as:
•    A heart rate tracker from Basis that you wear like a wristwatch
•    A web site from GoodRx that does comparison shopping for prescription drugs
•    Consumer health management and social media systems from WellnessFX, Numera Social, HealthTap and OneRecovery
•    GE Intel Care Innovations home monitoring and communication system.

One of the most interesting talks was from Alexandra Drane of Eliza. She used her company’s automated phone call system to conduct a survey of patients, asking them to rank the problems in their life in terms of how much those things mattered to them and how much they received support on those issues from the medical establishment. The ratio, which she called the Ostrich Index, was around 1.0 for typical medical issues such as obesity, but far higher for other sources of stress such as consumer debt. Furthermore, people with multiple issues with high Ostrich Indexes were far more likely to suffer from serious illness. Her message to the audience was that it needed to take a much broader perspective on issues that affected health and that “health is life, not what’s measured in the doctor’s office.”

Video-Enabled Language Interpretation

SBR Health’s initial customer was a large teaching hospital that approached us with an interesting problem. Like all healthcare facilities, it had a responsibility to patients who needed help communicating with their providers. State and Federal laws, as well as accreditation standards, require that patients with Limited English Proficiency (LEP) be provided with interpreters. Many of the smaller institutions deal with these needs by contracting with telephone-based interpretation agencies, but the larger facilities have their own cadre of trained interpreters who can be dispatched to meet in person with the doctor and patient.

Our prospective customer’s problem was getting the interpreter, doctor, and patient all in the same place at the same time. Too often the interpreter would go to the exam room to find the doctor was running late. Eventually the interpreter would need to leave for his next appointment, only to have the doctor arrive and be unable to proceed without the interpreter. This was enough of a problem when only three people were involved, but when an entire surgical team had to wait before they could obtain informed consent, things could get very expensive and potentially life-threatening.

The solution our customer sought was to move the interpreters to an outlying suburb where space was plentiful and have the interpreters deliver their services via video to where the doctors and patients were located. There was only one problem: the system needed to work at all times and all places, not just when everything was going normally in a wired-up exam room, but even after an earthquake, in a triage tent set up in a university parking lot. Furthermore, the system needed to be simple enough to be used on a laptop by someone with no training, but sophisticated enough to make connections to an interpreter without requiring the services of a dispatcher.  As we worked on implementing a solution for this customer, we validated our core premise that the success of any technology depended only 10% on the technology itself and 90% on how it was integrated with the organization’s workflow and protocols. Working closely with the Guest Services and IT teams, we first developed new workflows based on the desired operational model. Then we used rapid development techniques to prototype clinician and interpreter-specific interfaces, incorporating the desired workflow methodology into each. This allowed us to test the user interaction and ease of use, iterating as needed to create the optimal solution.

As our first customer realized, the ability to effectively communicate is paramount for optimum patient treatment, and in emergency situations, the delay of treatment or inaccurate information obtained by poorly communicated pre-conditions can result in patient harm, unnecessary complications, and in extreme cases, adverse outcomes.

We were able to addresses the shortcomings of remote interpretation services through the use of low-cost video technologies, any device/any network deployment, skills based routing, intelligent queuing, n-way video calling, and a video-based distributed call center. Now we are setting out to redefine how video is used across the Arc of Patient Communications™.