This Month in Telemedicine – mHealth

American Telemedicine Association’s policy duo Jonathan Linkous, CEO and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Mobile Health
Mobile Health is making much more than a dent in the telemedicine industry; $161 Million has been dedicated to mobile health from 43 different companies in the last quarter. This is a drastic increase compared to earlier in the quarter when only $42 Million was dedicated to mobile health.

Currently the guidelines that involve mental health correspond with mobile health. ATA is currently in the process of doing an accreditation of mobile health care services online, and hopes to have it ready by early next year. This is a major step for ATA and for telemedicine. A Special Interest Group on mobile health is hosting a webinar on privacy and international applications in mobile health.

Telehealth Opportunities
A component of the Affordable Care Act, which is currently being implemented, says that those in the health insurance exchanges have to support essential health benefits. However, there is no basis in the regulation to not pay for a telehealth claim. It is all supposed to be provided and covered on the same basis as in-person care.

The CMMI, or Center for Medicare and Medicaid Innovation, continue to create funding opportunities either directly for projects or through the states. There is managed care within Medicare and Medicaid populations, most of the managed care plans have had the flexibility to use mobile health or other telehealth aspects. Hospitals have grown interested in home monitoring of people, and other aspects dealing with readmissions problems. Since Medicare cuts funding for hospitals not reducing their readmissions enough, many have grown more receptive of using difference health technologies such as mobile health.

Medicare Physician Fee Schedule
A major change that is expected in the new fee schedule for telehealth is CMS will use a much more open definition of rural health shortage areas that will allow telehealth to be provided on the fringes of rural areas.

Legislation
Harper Bill, H.R. 3306 is a very notable bill for mHealth and has many bipartisan sponsors. Telehealth for Medicare ACO’s, or Accountable Care Organizations, currently don’t have coverage for telehealth in metropolitan areas, where most of the ACO’s are. The goal is for ACO’s to have full flexibility of telehealth.

It will also have shared savings for reducing Medicare readmissions. This proposal gives hospitals the incentive to do better than their own benchmark, in hopes of saving money for Medicare. It is an opportunity for hospitals to have some sort of income, and it will ultimately be a positive thing for patients. It will also target home dialysis, hospice, and homebound patients. Mobile Heath can cover these kinds of patients at home, and have the same kind of in person physician assistance.

There are also several other bills that are pending and being discussed. The Step Act (H.R. 1832) was enacted in December 2011. This act expanded the authority for the defense department to require only one state license for health professionals to operate in any state. This model is also being expanded to apply to two others, the VA: VETS Act, H.R. 2001, or Vets affairs facilities and TELE-MED Act, H.R. 3077, or the Medicare population.

Finally there is also the SOFTWARE Act, H.R. 3303, which is Sensible Oversight for Technology Which Advances Regulatory Efficiency and has been proposed by Congresswoman Marsha Blackburn. This bill deals with the volume of applications that have flooded FDA for mobile applications.

Young Executives Depend More on Video

With the next generation of executives taking control over established companies, new changes are bound to arise. The 2013 Cisco Global Young Executives’ Video Attitudes Survey shows that many of these new managers are interested in video collaboration and plan on incorporating it into their business or company. Many new managers understand the benefits video can provide for their company, and some will not even consider working with other companies unless they use it as a tool.

The convenience of video conferencing is something that many young executives and managers are taking advantage of because it allows participants to read visual cues, “be there” without traveling, and have the ability to share content instantly. Constantly traveling in order to meet with clients or other people is time consuming and costly, not to mention frustrating when flights get delayed or cancelled. More organizations are shifting to visual collaboration as the technology continues to advance and creates interoperable and scalable solutions.

The data from the survey shows that many young executives plan on relying heavily on video conferencing to manage their business. Three out of five young executives say they will rely more heavily on video within the next 5 to10 years and 87% believe video has a significant and positive impact on an organization. These executives cite benefits ranging from enhancing the experience of telecommuters to saving money on travel costs and even attracting top talent.

Video collaboration is also an effective method of transferring information and connecting geographically dispersed people. It not only allows those within the states to contact one another, but it also opens up the global marketplace. Of the organizations surveyed that have less than 400 employees, 94% said they utilize video in order to break down language barriers in the increasingly global marketplace.

Telecommunication is a major appeal to prospective employees as well. In fact, 87% of respondents say they would choose to work for a video-enabled organization over a company that has not invested in business-class video communications. This is because organizations that invest in visual collaboration embrace the increase in technological advancement and are considered to be more innovative.

While video conferencing is a great tool for many companies, people are still wary of it. Survey respondents showed that their top five fears about video conferencing were: a messy office, personal appearance concerns, the inability to multi-task, the need to eat and some are not comfortable on video in general. However, as people utilize the technology more often, they will eventually become more comfortable with it.

The advancement of technology is rapidly increasing, and it is up to these companies and businesses to keep up. The new executives plan to do what they can to run successful companies, and telecommunication is a tool that will allow these companies to be successful.

Take a look at the slides below for more survey data.

An Audio Visual Prescription for Health

The Cohen Children’s Medical Center, a part of North Shore LIJ, strongly believes that art is a crucial aspect of children’s hospitals, as it creates an optimistic and constructive environment. This kind of environment allows children to open up their imagination and begin the healing process. As a result, they implemented an interactive virtual aquarium to entertain the children who are in the pediatric emergency waiting room.

The inspiration of this theme came from Long Island’s very own ocean and shoreline to create a familiar setting for young children, making them feel more at home rather than in a hospital. A hospital environment can be scary for young children and having interactive technology that makes them more comfortable can make their stay much more enjoyable and entertaining. By interacting with the technology and creating their own underwater world within the digital aquarium, children can gain a sense of control, something they may have lost by being in a hospital.

Rather than sitting in an intimidating waiting room, children can now be entertained with the virtual aquarium, and interactive “fish tank” that allows children to create their own fish, and then launch it into the tank to swim among the other fish other children have created. The fish are virtually fed, and swim among other sea creatures, such as turtles, larger fish and live among sea coral. Fish and shells decorate the floors and walls, and the CT scan also has fish painted on it. The renovations have made the hospital more appealing to children, making them less fearful of their environment. “Years of planning went into making the new facility child-friendly. Kids almost want to be here,” said Dr. Charles Schleien, Chairman of Pediatrics, in an interview with Newsday.

IVCi was contracted by North Shore LIJ and The Rockwell Group to install the system which is made up of six LCD panels, each about 55 inches wide, creating a fifteen foot screen. Six iPads are used to control what happens on the panels and allow the children to create the fish they want. The main audio comes from two speakers located on either side of the LCD mounting frame, creating as real of an experience as possible.

See for yourself with the demonstration below!

Digital Aquarium at Cohens Childrens Medical Center – Emergency Waiting Room from labatrockwell on Vimeo.

Video is Most Useful Tool to Oil & Gas Industry

As the need for collaboration grows, the video conferencing industry provides. Microsoft and Accenture have published survey results showing that the oil and gas industry has looked to video conferencing as a solution for major problems within the industry. Accessing information at anytime from anywhere is a key factor in business success, and having the ability to share data and communicate in real time provides major benefits.  As a result, the need for video collaboration in this industry is steadily increasing as workplace dynamics continue to change.

Approximately 200 oil and gas industry professionals including engineers, mid-level and executive management, business unit heads and staff, project managers and geoscientists, were candidates for completing Microsoft and Accenture’s online survey in order to determine how video conferencing has affected the gas and oil industry. Results show that the percentage of oil and gas professionals that are collaborating is increasing, and 35% have spent more time collaborating. Social networking has also become a major business collaboration tool as well, and is growing each year. Results of the survey also show that instant messaging and social networks are the most popular social media tools for business collaboration, and the usage of internal company social networks has increased.

Video conferencing has been a definite solution for the problems that this industry faces. Problems, such as a lack of skills and an aging work force, make it difficult for this industry to stay modern and keep up. Younger generations don’t have the skills and experience needed to maintain the industry. There are also issues with breaking workflow and challenges involving knowledge sharing. Video conferencing has allowed these issues to dissolve, as collaboration allows users to share information in real time and creates an outlet for easy communication.

While many companies find that video conferencing is a solution, about 30% of the companies surveyed are still hesitant about the technology and restrict its usage, leading employees to be weary of using social tools in the workplace. However, 40% of employees surveyed feel that there is not enough teamwork among employees and social tools drive collaboration. The survey has also shown that there are distinct differences between counties, sectors and genders relating to productivity.

Every company utilizes their tools in different ways. Some feel that video collaboration will make them more successful, while others may not. However, the majority of companies that participated in this survey have realized the benefits of video conferencing and are integrating it into their daily business routines, thus improving collaboration, speeding up customer response and assistance, and creating a new competitive advantage.

This Month in Telemedicine – July 2013

American Telemedicine Association’s policy duo, Jonathan Linkous, CEO, and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Medicare
Several weeks ago Medicare created its proposed rulemaking for the physician fee schedule, set to begin on January 1st, 2014. There have also been two major improvements proposed for telehealth. One is the expansion of the definition of a rural health shortage area. The purpose of this is to increase coverage of telehealth by allowing more areas to be considered metropolitan counties. This proposal will help the 104 counties that lost their telehealth coverage due to their lost status as a metropolitan county.

The second proposal would provide telehealth coverage for CPT codes for transitional care management services. With this process however, there are some difficulties. While there will be a website people can visit to find out if they are covered, it does not have direct yes or no answers, making it hard to determine coverage. Another issue is that eligibility for coverage is renewed yearly, meaning one year a person may be eligible and the next they are not.

Congress
In last month’s installment of This Month in Telemedicine, Linkous and Capistrant mentioned legislation that Congressman Greg Harper was working on. His bill is moving forward, and some changes were made in the process of finalizing it. “The effort is to really deal with the Congressional Budget Office and what they will end up saying about telehealth provisions” explained Capistrant. There have also been several proposals to get a savings estimate from the CBO.

  • To have a Medicaid option for high risk pregnancies. Two years ago ATA got an estimate that it would save Medicaid 168 million over 10 years.
  • Giving hospitals an incentive for doing a better job in reducing their number of readmissions. It would allow the hospitals to share in the savings and will pay for home monitoring and video.
  • Have Accountable Care Organizations currently under Medicare (which serve about 4 million beneficiaries) use telehealth the same way Medicare’s managed care plan does. Medicare has started an effort to experiment with bundling with hospital payments with post-acute payments. There has participation in almost 400 hospitals all over the country. The goal is to have those hospitals be able to use telehealth to deal with that post-acute care and not have the restrictions that are in Medicare’s statute continue to apply.
  • Allow home video to people who are doing dialysis at home. This will empower more home dialysis and yield savings.

Other Harper package provisions that have been added include: restoring coverage for 104 counties, provision to go for coverage for telestroke diagnosis country wide, as well as some provisions dealing with critical access hospitals that are in metropolitan areas. These hospitals will not be included in the health shortage area because it is a hospital.

States
There has been a lot of progress among the states with telemedicine. The Governor of Missouri has signed a bill that will allow a parody law for private insurance covering telehealth. Missouri is now the 19th state that has this law. The ATA is finalizing three of the state best practices for Medicaid uses of telehealth, as well as a final report of major gaps in each state about telehealth

The ATA Board just recently approved online, web-based mental health services. It is also interested in developing practice guidelines for teleICU, web based or online primary and urgent care services that are starting to be developed, and remote health date management on wounds and burns, according to Linkous. Telepathology guidelines are also being rewritten.

Fall Forum in Toronto
The focus of the Fall Forum in Toronto is to examine some of the problems that have recently been discussed involving telemedicine. A major focus will be reducing readmission rates in hospitals. “A big topic in every hospital, in not only this country but around the world, is how do you reduce the readmission rate within the hospital and there’s a lot of work that’s been done on this using telemedicine as part of the answer. Not as the answer, but part of it,” explained Linkous. They will also be covering issues such as Telehealth networks, and how you can make those networks sustainable, as well as how to engage customers. They will also be covering topics such as mainstreaming in health applications, or “apps” to be integrated into the healthcare system. Other topics include virtual care and provider services.

Video Conferencing Continues to Advance

Video conferencing has quickly become a major tool that many companies utilize. Cory Johnson of Bloomberg Television’s “Bloomberg West” talked with Cisco Senior Vice President Collaboration Technology Group, Rowan Trollope, via video about the adoption rate of video conferencing.

Trollope gave some insight into Cisco saying that about 38% of Cisco’s employees do not work at the same site as their managers; however,  it’s not really an issue  thanks to video conferencing. Video collaboration technology has allowed managers and employees to stay in touch with one another and chat about certain projects or simply to keep one another updated. Connecting via high video quality is just as productive, if not more productive, than in person interaction because video conferencing forces participants to sit down, discuss the issue at hand, and then find a solution.

Video conferencing has not only advanced the companies that utilize it, but the technology itself has also advanced, allowing users to collaborate on the go on devices such as cell phones, laptops or tablets. Rather than being limited to a conference room, users can participate in a conference via mobile devices due to the advancement in equipping such devices with cameras. Now, it is possible to make a video conference call just about anywhere.

According to Trollope, about 89% of Cisco employees work at home once a week, and are able to communicate with other employees and participate in meetings through telecommuting. It is very difficult to follow along on a conference call when there is no face to put to a voice. The quality of an audio call is simply not the same as a video call. When you use high definition video, it is much easier to follow the conversation and participants can focus on the task at hand as opposed to trying to figure out who is speaking.

While it seems that only large corporations would find a need for video conferencing, smaller companies and even individuals can utilize the benefits of video conferencing. Companies of all shapes and sizes currently use video conferencing as a key tool and are pulling for quality and reliable video conferencing devices to benefit their own business.

To see Cory Johnson’s interview with Rowan Trollope, check out the video below and see how Cisco has grown because of video conferencing!

 

The Newest Member of Production Teams

When thinking about movie production, video conferencing and collaboration is not usually the first thing that comes to mind. However, producer Jerry Bruckheimer agrees that thanks to video conferencing, producing films is much more successful and efficient. Rather than spending excess amounts of money on travel costs so directors, producers, and actors can be in the same location, video collaboration has allowed the flow of communication to be unaffected by the lack of physical presence. Bruckheimer certainly utilizes his Cisco TelePresence set up, and is in constant communication with everyone on his production team.

When making a movie, it is nearly impossible to have every member of the production team in the same location. As a result, video collaboration equipment is becoming the newest member of every production team. Directors and producers can work with their cast from across the globe, and work out final touches with editors in an instant. There is a large amount of data that is transferred throughout the film-making process, and Cisco TelePresence makes it easier to move around. The way that technology has changed the way films are produced is remarkable; pretty soon even movie theaters will be digital, and physical film will no longer be needed.

With this drastic change in technology, many people question whether it’s the best option, particularly in Hollywood when the director/actor relationship is key. Losing that in-person interaction is a difficult thing to replace, however the face to face interaction provided by video collaboration is helpful in establishing that relationship. Video conferencing has not only helped producers keep in touch with their teams, it has also helped choreographers teach their dance students, and even inmates going through arraignment.

The benefits of video conferencing are well known in the enterprise world; now they are making their way into other career fields as the technology continues to grow. Soon we will see the impact of video conferencing and collaboration in everyday life.

Check out the video below to watch Cisco’s interview with award winning film producer Jerry Bruckheimer, and see for yourself how much of a difference video conferencing has already made in the film industry!

Polycom’s Lync Keeps Getting Stronger

Polycom has recently announced its latest addition to its video collaboration family, the Polycom CX5500 and CX 5100 Unified Conference Station, a 360 degree panoramic 1080p HD video collaboration solution custom-built for Microsoft Lync 2013 and the first ever in the video conferencing industry. These stations are designed to create an around-the-table experience with a 360 degree camera panoramic view of the room, allowing all participants to engage.

Polycom has also announced that it has received Lync 2013 qualification for its Polycom VVX Business Media Phones, strengthening the partnership between the two companies by expanding Polycom solutions that are compatible with Lync products.

Why is this great for customers?

  • Easy to use. With Polycom CX5500 and CX1500, the operator has options that allows for easy usage. A new user interface and design system allows easy access to launch or join a call directly from a Lync user environment. Users can directly connect the CX5500 or the CX5100 via USB to a Lync-run computer. These two solutions can also be used with the Lync Room System, combining a 360-degree camera experience with touchscreen monitors and tabletop touch controllers.
  • Better productivity. The Polycom CX5500 and the CX5100 are placed in the center of the table, and therefore allow a natural conversation by engaging all participants simultaneously, with not only those sitting around the table, but other participants who are not. Both systems include 1080p active speaker video while displaying 30 frames per second at a 360-degree panoramic view. Conversations are clear with Polycom HD voice.
  • Financially beneficial. The Polycom CX5500 is both an HD video collaboration environment and a fully featured SIP conference phone, which ultimately reduces capital costs for organizations that require both systems. Since it is so easy to use, the company can also save on training and IT costs.

While desktop video has many advantages, it can become cluttered when connecting multiple groups of people. These solutions are great for organizations looking to extend their Lync application into a conference room environment. Contact us if you have any questions or would like more information on designing or installing collaboration room environments.

This Month in Telemedicine – June 2013

American Telemedicine Association’s policy duo, Jonathan Linkous, CEO, and Gary Capistrant, Senior Director of Public Policy, return with updates and new information regarding telemedicine.

Federal Policy Summit
On June 27, Linkous and Capistrant attended the Federal Policy Summit, a conference in which several issues regarding telemedicine were discussed. “It’s a great time to be having this Federal Telehealth Policy Summit, because we’re on the verge of an explosion of opportunities for telehealth, not necessarily things directly or specifically for telehealth but a lot of opportunities for change in the healthcare marketplace,” says Capistrant. Several key political figures attended the summit as well, such as Congressman Mike Thompson, Congressman Gregg Harper, and Congressman Glenn Thompson, all of whom spoke about telehealth and telemedicine. Each Congressman has contributed to the success of telehealth and continues to do so politically. Several pieces of legislation are currently in the works with the idea of positively changing telehealth in mind.

Four leaders of key federal agencies were in attendance as well. These leaders include the Health Resources and Services Administration (HERSA), the Federal Communications Commissioner, the head of the FDA on medical device and the leader in telehealth at the Veterans Affairs Department.

Along with these speakers, there were three different panels dealing with three specific aspects of telehealth. These panels include patient panels, health players and providers, and telecommunication providers. Other issues that are going to be heavily discussed include the FCC’s health care connect program and its opportunities such as the billion dollar funding opportunity that was previously discussed in last month’s installment of This Month in Telemedicine; along with the Nation Institute of Standards and Technology to review standards and guidelines.

Legislation
Congressman Harper is currently working on a bill that was planning to be introduced in time for the summit, however it is not yet ready. “The idea is to create a package that both Democrat and Republican congressmen and senators can line up and support and create the kind of political support through it that the congressional budget office will actually estimate the cost of it,” says Capistrant. The bill borrows most of the provisions from the Mike Thompson legislation to fit into existing payment innovations. There are also improvements regarding Medicare. This bill focuses on dealing with the 104 counties that lost their Medicaid coverage due to the fact that they are no longer considered metropolitan areas. The goal is to get Medicaid back into metropolitan areas and then accomplish the specific goal of getting Telehealth into the home.

The idea of this package is, “to have it ready for much more serious consideration later this fall when Congress has to deal with the physician payment reform issue” says Capistrant.

There has been previous discussion of a bill being put together by Congressman Nunes of California about allowing Medicare beneficiaries to be served by someone across the state line without that provider being licensed in both places. However, an early draft of the bill contained a doctor patient relationship requirement which the ATA opposes. This particular legislation has not yet been formally introduced.

Affordable Care Act
There are certain dates coming up regarding the Affordable Care Act.  On October 1, states will be offered state based health insurance exchanges, although actual coverage begins in January. The ATA estimates that around 14 million people will participate in that new coverage. There are also hopes that telemedicine will be a part of that coverage. January 1 is a very important day for Medicaid enrollment, as the ATA estimates that half of the states that will be opting in to expand Medicaid coverage. Key states such as Ohio and Arizona are still debating it; however if they do there will be an estimated 20 million people on the roll with Medicaid. At the end of the year there will be a “doc fix”, or a bill that is looked at every year called “The Sustainable Growth Rate Bill”. “Congress has pledged to really do something this year, of course they say that every year but this year they really mean it. Several members have told us that if they go through a change that telemedicine is going to be an important part of it,” says Linkous.

ATA Service Provider Forum
The ATA Service Provider Forum is a special meeting that will take place prior to the Federal Policy Summit. “There is a new group coming out of our industry council for industry council members. So many of our companies traditionally have been medical device companies, but now the world has changed,” says Linkous. There are many companies involved in providing direct services as well as specialty consoles to emergency rooms, monitoring services, as well provide web based consultations. This forum serves as a way to discuss this growing field, and will open for the meeting. The ATA Board has also approved exploring the idea of doing accreditation of online web based consultation services.

Company Profile: BE Aerospace

Video conferencing has drastically affected the way companies communicate and do business with one another. By switching to video conferencing, companies are saving time and money running their business. John Kolodziejski, Manager of Enterprise Telecommunications at BE Aerospace, talks about his experience with video conferencing, and the impact it has made on his company.

IVCi: Can you give us a brief overview of your video environment?
JK: We currently have 32 endpoints which are mainly Cisco C20s or C40s and in conference rooms or executive board rooms. All of our systems are dual displays so we can have a presentation on one screen and people on the other screen. We also have full Cisco infrastructure; TMS management system and gateways on the outside so we can get to external conferences. Our primary data center and corporate IT location is in Winston, North Carolina but we have systems in the Philippines, the US, England, Ireland, Germany, and the Netherlands.

IVCi: What were the business drivers that led you to implement video?
JK: Primarily to reduce travel costs, but it was also very important to be able to establish easy communication between our global sites. We need that instant face to face communication. We’re a huge engineering firm and have sites all over the world. For an engineer, it is more efficient to connect face to face with someone to talk about a part or a problem because they can have the physical part with them during the video call or explain the problem clearly. The clarity of communication is important. For our general managers to communicate with their remote sites, face to face interaction is much more effective than a phone call. When you’re on a phone call, you have a tendency to multitask.

IVCi: What has been the end user reaction to video?
JK: We have a wide range of acceptability. Some sites use it 40 hours a month, so almost a full week of usage, while others use it a couple of hours a month. Typically, if the executives don’t use it, the lower levels tend to not use it either and vice versa.

We try to work with site administrators to promote video conferencing more and some sites have tried to get the execs to jump on board. The Netherlands and Philippines were eager to use video and they use the daylights out of their systems. They’re talking to each other; engineers are sharing information and doing a lot of work. Our help desk also uses it a lot for training purposes.

IVCi: What was your favorite moment using video?
JK: Very early on in the adoption of video conferencing, a manufacturing site here needed to talk to a manufacturer in France about a problem they were having. Before video, our engineers would have had to fly over to France to meet with their engineers or vice versa, so you lose several days of productivity along with the cost of travel and other expenses. But with video conferencing, we set up a meeting and in three hours they had the problem resolved. They were able to see the part, draw up sketches, and they work it out. It would have been tens of thousands of dollars and cost significant production time had it not been for video conferencing.

IVCi: How has video grown within your organization and what does the future look like?
JK: It’s doubled since we first started the project in August of 2011. We started our initial project with endpoints for 15 sites and core infrastructure components. Since then we’ve grown to 32 sites and, as soon as we get our equipment shipped, we will be adding another site. Right now I’m adding almost a site a month.

We have probably 50 medium to large sites worldwide and we’re looking to put video in each site. Then we have a countless number of 2-3 man offices and customer embedded sites so eventually we’ll expand video there as well.

IVCi: Where do you see the most usage and opportunity for growth – room, desktop or mobile?
JK: Right now we use our rooms the most but we’re running out of sites to install video in so we’ll address desktop and mobile. We have experimented with Jabber and rolled out a test deployment about 6 months ago. The problem though, is that Jabber eats up bandwidth, and we need to keep the internal use of bandwidth available. Our engineers transfer huge files across our network and we need to keep bandwidth available for that, so we will have Jabber for desktop video but it will be an as-need basis.

IVCi: Do you have any advice for organizations implementing video for the first time?
JK: Pick a really good implementer, a good partner and don’t let cost be the driving factor of who you select. Good project management is key; it makes implementation a lot easier. From there, just make sure you really evaluate your needs and find what’s appropriate. Video conferencing is great but you have to really promote it with your users so you’re getting that return on investment.