What’s wrong with telemedicine?

While studies have shown that successful use of videoconferencing and real-time communications can profoundly benefit patients and doctors alike, how do we define success?

Telemedicine has been in use now since the 80’s but due to complexity, specialized equipment, expensive network infrastructure and poor Medicare/Medicaid reimbursement policies, it remained limited to a small number of users. These challenges made it impractical to use televideo technologies for care delivery on a larger scale.

Today, low cost and ubiquitous technologies do exist that can facilitate a world in which videoconferencing has a place on the desk of every doctor, nurse and clinician. However, what is needed at the clinician level are applications designed specifically for the health care industry with televideo as a method of communications.

What does this mean?

As studies have shown that health care outcomes improve when truly collaborative communication takes place among patients, doctors and specialists, televideo is becoming more mainstream. But for televideo to be both successful and effective, televideo technologies must be user friendly, highly secure, low cost and fully customizable.

Is that all?

Fixing televideo goes beyond cost and complexity. While there are a number of innovative televideo technologies, there is still the problem of integrating televideo seamlessly into clinical workflow. The success of any technology depends only 10 percent on the technology and 90 percent on how the technology is integrated with existing workflows.

To deliver care successfully and effectively across the healthcare continuum, televideo must be mapped to existing workflows to improve patient and clinician use experiences and to minimize change management issues.

Change is good but it’s not always great.

To make televideo great, let’s start with improving the usability.



SBR Health Q&A: The mobile shift in healthcare

Everything is moving to mobile these days, and healthcare is no exception. Christopher Herot, co-founder and CEO of SBR Health, is a recognized business and technology leader who has spent years developing and evaluating video, mobile and real-time video communications solutions. In this one-on-one interview, Chris shares his thoughts and predictions for how mobile technology will transform the healthcare space and beyond. From how we buy care to keeping in touch with family, mobile’s intersection and influence on our daily lives is significant.

How have you seen this shift?

There was a time when every young ambitious professional had a day planner. The iPad is now the equivalent. It’s your phone, calendar, email, entertainment, and computer – your method of communication for everything. This has really transformed a number of industries. Retailing is now different. People can do comparison-shopping using their phone. It’s even changed travel to some degree. You can get your boarding pass on your phone and check into places on Foursquare. For the longest time, it looked like healthcare was not a tech-savvy field but this is quickly changing.

What role does mobile play in the healthcare space?

iPads are taking the medical world by storm. They’re just the right form factor for healthcare. Apple reimagined what you can do with a tablet and has provided for an entirely new experience. Doctors don’t want other tablets. They want the iPad.

Some thought early tablets failed in terms of usability based on size but Apple demonstrated it wasn’t just about size but more about the user experience. There’s something truly unique about being able to type medical information while looking at your patient. This increases physician-patient engagement.

What’s the benefit?

There’s proven clinical value. Tablets have given doctors better access to tests and other medical information. A recent study published in the Archives of Internal Medicine found that iPads help doctors be more efficient at ordering tests and procedures for their patients. My thesis is that iPads allow physicians to do more in real time and make healthcare more convenient.

The real and long-term benefit of mobile technology is in bending the cost curve in healthcare. This goes beyond getting doctors to accept lower fees and cut down on unnecessary tests. The bulk of the cost is to get Americans to stop eating so many donuts. The way you make people healthier is to make it easier and convenient for people to see their doctor. This will drastically cut healthcare costs.


The demand for mobile reflects where we’re at as a society. The doctor is not always in his office ready to take your call, and so many of us are on the go. Being able to get access to the healthcare system wherever you are – work, home, out and about – is really critical. To make that work, we have to be able to see the patient and share what we see with other people. Tablets are small enough to be portable but also have real data on the screen.

How will this be adopted?

It will happen fastest where the payment model is evolving away from the fee for service. You’re seeing this with concierge practices. Once you make it easier for patients and doctors to do a virtual visit, I expect the adoption will expand to other parts of the world. There are places like the payers and insurance companies who see this as a way to improve healthcare delivery. You’ll see this first in places that have the luxury of not having to worry about restrictions. Concierge and post-acute follow up are prime examples.

SBR Health is developing the technology that will enable videoconferencing and real-time communications to benefit patients and doctors alike. Healthcare outcomes improve when collaborative communication that’s convenient takes place among doctors, specialists and patients, and we’re working to make it as simple and secure as possible.

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.


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



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™.