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In recent years, video communications (e.g. videoconferencing and telehealth) capabilities have gone from being expensive, hardware-based resources to inexpensive, cloud-based resources. Now, the driver for wide-scale adoption in healthcare is not what this technology costs, but rather how smoothly and seamlessly it can be integrated into existing clinical workflows, IT systems, and business environments.

So how does one get started? Well, the first inclination may be to reach out to your local telecommunications or media services company. However, high-quality video no longer requires special hardware or expertise. You can now get high-quality, high-definition video on devices that you, your organization, or your employees already own (newer smartphones and tablet computers) and which many would-be patients/consumers now have or could readily obtain. As a rule of thumb, any mid to high-level personal or laptop computer sold in the last ten years is probably “video-conference” ready.

Here are two approaches: a “minimal” list of requirements and a recommended “ideal” setup:

	Minimal Requirements	Ideal Requirements
Computer	Any video and audio-equipped computing device or smartphone	Laptop or desktop computer (min. 1.8GHz Pentium i5/i7 processor and min. 4GB memory)
Camera	Built- in camera	External HD camera (e.g., Logitech HD Pro Webcam C920
Audio	Built-in audio	External speakerphone or headset such as Jabra Speak 410 or Plantronics Savi w740
Internet	DSL or 4G connection (Minimum 500mb/sec. upload/download speed	Home-type cable/broadband connection, with 1Gb/sec. upload/download speed and less than 50ms latency

Once you’ve got the requirements in place, the next step is to provision a video conferencing service. (Note: if you’re using a PC, think of the PC as a phone, and the video service provider as the phone company, or carrier.) Generally, you can purchase HD video conferencing from a service provider for less than $50/month. This would provide a fully encrypted, HIPAA-compliant solution. And, because many video service providers will sign business associate agreements, (check this out—hipaa or CFR?) eliminating privacy and security issues.

One such video-as-a-service (VaaS) provider is Connexus (www.connexusvideo.com), a solutions provider in both traditional as well as “new paradigm” video communications technologies. Connexus’ president, Jonathan Schlesinger, states that one of the most import issues to consider when utilizing video in telehealth is what happens if a call gets interrupted for technological reasons: What are the patient support and recovery procedures?

“You want to make sure you have good procedures in place in the event a call gets interrupted,” explains Schlesinger. “Therefore, while VaaS providers can get you provisioned with a service and started in virtual healthcare delivery in literally a few minutes, it is important to spend a good deal of time to put together a strategy for urgent psychiatry situations as well as routine therapy use.” Indeed, if a patient says they are suicidal and shuts off their connection, organizations will be liable and need protocols in place to handle situations such as these.

Resources to help

These service providers – and other organizations like them – provide high quality Video as a Service (VaaS), plus needed support.

Company	Telephone	URL	Uniquness
Connexus	800-938-8888	www.connexusvideo.com	Self service
ID Solutions	877-880-0022	www.e-idsolutions.com	Extensive support options
Quest	800-326-4220	www.questsys.com	Full healthcare data services
Yorktel	732-413-1839	www.yorktel.com	Custom solutions
Xtelesis	888-340-9835	www.xtelesis.com	Cost-effective solutions

From a technology readiness point of view, Amnon Gavish, the SVP Vertical Market Solutions at Vidyo (www.vidyo.com), talks about other important but less known technology related considerations. “One of the things we have seen is that the quality (defined as high definition and low latency) of video is much more important in mental health interactions than in other telemedicine scenarios, as mental healthcare encounters are typically much longer than a traditional 5-10 minute primary care or specialist interaction. These are longer consultations so key factors in the effectiveness of using video are supporting a smooth conversational flow and consistency of experience. If the experience becomes cumbersome and video issues affect the quality of a session, the effectiveness of the session can be compromised causing the physician and patient will lose interest in meeting in this manner.”

Gavish also cautions you need to ensure the patient on-boarding is quick and foolproof. One way to do this is to have the patient bring his or her home computer to an initial session, during which you can ensure it is properly set up to receive a telehealth visit. Another option is to ask your telehealth solution provider if their software can provide a single-click or web-based software installation and test process, so you won’t have to provide user support.

Whenever you’re going to work with a patient at home, Gavish advises that “you need to do an excellent job at teaching them how to select and set up their equipment and ensure they have adequate lighting and privacy to ensure a good-quality experience.” Because it is typical to begin a therapeutic relationship with a face-to-face encounter at the provider’s office, there’s almost always an opportunity to explain important requirements, provide educational materials, and help patients ensure that they’re ready to receive a telehealth appointment.

Utilizing cloud based video visit services minimizes your financial exposure. “There are enormous business advantages with VaaS as you are able to scale up with a very, very low cost,” states Schlesinger. “Putting together the brick and mortar infrastructure for that type of footprint would be cost prohibitive, but if an organization makes that investment later, the virtual practice will help them to determine where to locate based on the volume of calls they have made.”

Telemedicine has been a market with a bright future for a long time but there are barriers to adoption due to cost, ease-of-use and reimbursement. Christopher Herot, CEO of SBR Health, is an innovator in the telemedicine space, who saw these barriers as opportunities for disruption, and is making it easy to get started and scale e-Visit programs to deliver care more effectively, and with greater operational efficiency. SBR Health’s automated call and skills routing management solutions allow healthcare providers to increase patient accessto care, reduce costs and readmission rates and extend service reach by delivering care virtually through video visits. In this interview, Chris describes how cloud-based video solutions are revolutionizing healthcare delivery by seamlessly integrating into clinical workflows to connect patients with doctors, specialists and membersof the care team in real-time, at any location and using any device.

Q: What role does video play in patient engagement, and how is it being used today?

People have known that patient engagement is key if you want to bend the cost curve in healthcare. The US spends twice as much as the most developed nations in the world on healthcare per capita, and we rank 18^th in terms of life expectancy so clearly something’s wrong.

Until recently, there weren’t a lot of breakthrough ideas. One area that holds a lot of promise is applying things we’ve learned with online games and other interactive tools. We’ve learned what motivates people and that there’s no substitution for face-to-face interaction. What’s driving healthcare, more specifically health IT, these days is convenience and usability. With the widespread adoption of easy-to-use and low-cost video communications tools like Skype and Vidyo for both business and personal use, consumers are learning that real-time, interactive face-to-face communication is a very easy to use and efficient way to communicate and asking “why can’t I do that with my healthcare provider?”

Q: There’s a lot of excitement around the telemedicine bill referred to as the ‘Telehealth Promotion Act’ that proposes expanding reimbursement for telehealth services for federal programs and creates a federal standard for medical licensure in telehealth. How will this impact healthcare as we know it?

It’s time. There have been a lot of needless barricades in terms of using communication technology as a tool for conducting doctor patient visits but that’s only the tip of the iceberg. The real growth is going to come from transforming healthcare, not just automating, and doing away with the reimbursement, licensing and credentialing issues impacting telemedicine. Our theory is we can have a big impact on outcomes by not just automating traditional on-site visits but allowing people to interact in a more comfortable, frequent and less burdensome manner for both patients and providers.

Q: What have been the major barriers in using telemedicine, and do you think these can be resolved in 2013?

In the past, it’s been the reimbursement and regulatory issues. As far as technology, it’s been a cost barrier. Until late, there hasn’t been widespread consumer acceptance of face-to-face video communications. But now you have a whole generation of consumers raised on technology, and a generation of parents using technology to check on their kids.

Telemedicine has shown a lot of promise but as it’s required expensive equipment and highly trained people, progress has been slow. The future, call it telemedicine or something else, is letting patients and doctors connect with each other, regardless of location or device.

Q: The bill also includes incentives for hospitals to lower readmissions with telemedicine. What impact is SBR having on reducing readmissions? Are there any success stories you can share or relate to?

There was a recent meta-analysis done that looked at the impact of remote monitoring on the health outcomes of patients with chronic heart disease. By acquiring and transmitting real-time patient data to the care team, and creating opportunities for timely intervention, the remote monitoring programs were found to help reduce hospital readmissions and mortality rates, and also improve patients’ quality of life. The analysis demonstrated a high degree of variability with some interventions resulting in better health outcomes than others, so it’s too early to tell what the gold standard for clinical intervention is.

We’re just now at the point where we’re assessing the rate and process, and enthusiasm for adoption. What we do know is that both doctors and patients are looking forward to being able to more readily use these types of interventions.

Q: Do you anticipate more insurers will cover telemedicine in 2013? What is the argument for relaxing reimbursement constraints?

In my conversation with payers, they’re waiting for the data that indicates that they’ll save money or get better outcomes and not just a way for docs to get paid for something they used to do for free. More insurers are willing to pay on an ad hoc basis or to experiment. Everyone is waiting to see for the definitive results.

Q: Progress is slow but steady. As you’re on the forefront of change, what are your hopes and predictions for how telemedicine, particularly virtual visit programs, will help to advance and redefine care delivery today?

If you want to buy an airplane ticket, do your banking or find someone to marry you can use your cellphone, laptop, tablet, etc. The only thing you can’t easily do is use these same technologies to talk to your doctor. What I’m hearing from consumers all the time is that there’s a pent-up demand for bringing medicine into that same on-demand, low latency universe that we take for granted in every other part of your life. What’s been pleasantly surprising for us is a lot of the doctors are looking for ways to be more connected with their patients, and they really do care about providing a good experience for them. Contrary to how people look at doctors, there’s a feeling that medicine has become really impersonal, and what I’m happy to find is that doctors really want to do something about it.

Technology may allow us to deliver a more personal healthcare experience that will both make us feel better and get better.

Q: What is the easiest way to start using telemedicine, and what can I expect in return?

The implications for healthcare by incorporating video into the care delivery workflow are huge. By moving away from the expensive, hardware-based telemedicine systems to cloud-based video solutions that can be customized and require minimal change management, hospitals and healthcare systems are able to improve access to clinical resources, serve hard to reach patients, control costs, and improve patients’ health outcomes and overall experience. The world of healthcare is dynamic, and SBR Health is solving the problem of integrating telemedicine, specifically video, into clinical workflows to revolutionize care delivery to be more efficient and effective.

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