Push Notifications


Starting with version 3.3.40, the SBR Health mobile applications support Push Notifications. This is a feature of the iOS and Android platforms that allows the SBR server to send messages to the mobile client even when the device is asleep or the SBR app is not running. Because the messages are sent via servers at Apple and Google, the battery consumption is very minimal.

Sone of the ways push notification can be used:

  • A patient checks in for a scheduled appointment or submits a request for an on-demand visit. If the provider has the application open, the device makes a ringing sound and displays the patient information as usual. If the application is in the background or the phone is asleep, the phone beeps and displays a notification. If the app is not running at all, but the provider has previously logged in from that device, a notification appears in the device’s notification area. In any case, with one click, the provider can answer the call.
  • A provider makes a virtual Rounding call to a patient. If the patient has the application open, a dialog box opens as usual asking if the patient wants to accept the call. With push notifications this can happen even if the phone is in the patient’s pocket.
  • A provider wants to call in a colleague for a consultation. Pressing the button for that colleague will cause his or her phone to beep and display the request even if the phone is asleep. Pressing a button for a specialty will try each of the on-call specialists, whether their phone is in the foreground or background.

Each user can opt in our out of push notifications and they can be turned on or off for an entire institution. And of course the SBR product continues to provide the previous notification methods, such as customizable email templates, pager alerts, and text messages.

Interpreter Services

We have partnered with InDemand Interpreting to provide interpreters within any SBR Health virtual visit.

Whether you are running an international medical program or serving a local population with limited English proficiency a single click gets you one of InDemand’s medically qualified interpreters within seconds.

No reservation or advance notice is required. You can call the interpreter before you connect with the patient or add an interpreter at any point in a patient visit.

To add an interpreter, go to the Requester tab to select the language from the 28 that are offered.

Within 10 -15 seconds an interpreter will be added to the call.

This feature is available to all SBR Health customers but does require establishing an account with InDemand. Contact your SBR representative for details.

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.

 

 

Mental healthcare without boundaries

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.”

The Mercy Way with Telemedicine

St. Louis’s Gateway Arch stands as the iconic monument symbolizing the westward expansion of the United States. Today, it might stand for the nationwide expansion of telemedicine for St. Louis-based Mercy, which is currently in the process of building a $90 million virtual care center along with a new specialty hospital and corporate offices.

At the core of Mercy’s vision for telemedicine is Mercy telehealth services in the Center for Innovative Care. We recently had the pleasure at being introduced to some of Mercy’s telemedicine leadership through a tour of Mercy’s SafeWatch TeleICU, an ambitious implementation across the Mercy healthcare system that connects 10 hospitals and 350 monitored ICU beds. Recognized as the nation’s largest single-hub electronic ICU program, Mercy is demonstrating to the world that telemedicine can and does save lives, lowers costs and improves how we deliver care today.

What impressed us most was that the speed by which the SafeWatch program was implemented, with the majority of the center being up and running in just 12 months and fully operational in 18! Now Mercy’s telehealth program is expanding beyond far beyond SafeWatch, under executive director Wendy Deibert’s leadership, and has expanded to over 75 telemedicine projects that span across the care continuum.

To learn about Mercy’s SafeWatch program and new virtual care center, visit Mercy’s Newsroom.

Healthcare Experience Design 2013 – Improving Communication for Better Health

Healthcare Experience Design 2013 is just around the corner, and SBR is excited to be back to join some of today’s most innovative designers, technologists, product managers, researchers, entrepreneurs, visionaries and dreamers in the healthcare space. Exploring the intersection of healthcare and design, HxD’s featured speakers include visionary game designer Jane McGonigal, ‘The Happiness Project’ author Gretchen Rubin, Kaiser Medical Director of Patient Education and Health Promotion David Sobel, MD, PatientsLikeMe co-founder Jaime Heywood and many more. All will address their burning mission for health, and the role design thinking plays in improving the quality of health service delivery and helping us achieve better health.

For The Impact of Virtual Health Delivery Networks on Healthcare session, SBR Health CEO Christopher Herot will present a case study on how video communication is being leveraged by some of today’s leading healthcare delivery institutions to support the virtualization of care delivery across health care networks to enable them to increase access, drive down costs and improve outcomes.

 

When: Monday, March 25th, 1:40-2:10 PM EDT                                                           Where: The Westin Waterfront, Boston MA, Commonwealth conference room

Visit the HxD website for more details on Chris’ Monday session, other speakers and the agenda for this year’s conference.

 

How cloud-based video is disrupting healthcare delivery

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 18th 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.