It was 1918 – World War I had just ended and the Spanish Flu epidemic was raging across Central Florida. In Orlando, a dedicated group of doctors and community members joined together to raise a 50-bed, non-air-conditioned hospital to care for the sick. Orange General Hospital opened with the mission of providing top-level care for all community members, and has done just that for the past 95 years.
While the mission for the organization hasn’t changed, Orange General Hospital has grown to become Orlando Health – one of Central Florida’s most comprehensive, not-for-profit hospital systems composed of six wholly-owned hospitals and two partnership hospitals. The 2,000-plus bed system serves nearly 2 million residents and includes Orlando Regional Medical Center, MD Anderson Cancer Center Orlando, and the Arnold Palmer Medical Center, which consists of Arnold Palmer Hospital for Children and Winnie Palmer Hospital for Woman & Babies. As a not-for-profit organization, Orlando Health’s top priority is the welfare of the community, and all excess revenues are used to benefit the community.
As more and more provider networks turn to accountable care organizations, a greater emphasis is being placed on telemedicine for care management. At Cisco Live 2013 this week, we’re seeing this trend manifest as the focus of many of our healthcare customers turns to improving patient access to care and transforming the clinician experience.
One such customer is Nemours Children’s Hospital. Today, Bernie Rice, chief of information technology at Nemours demonstrated how physicians and specialists are able to collaborate over distance to examine patients, bringing care regardless of where the patients are located. Through a series of demos, attendees witnessed firsthand the connection of a physician in a hospital directly to a patient at her home, as well as the interaction of physician, nurse and patient all located in three different locations.
The demo illustrated how a remote physician can listen to a heartbeat, receive vitals—blood pressure and temperature— and interact with patients through high definition video. Other capabilities include the ability to view ultrasound images, look into the ear canal and examine magnified images of skin.
The HIPAA Omnibus Final Rule, released January 2013, introduced some significant changes and updates. The 2012 HIPAA audits, performed by KPMG, concluded with some initial findings released by the Department of Health and Human Services (HHS) Office of Civil Rights, OCR. These two events may impact how you govern your internal organization and network for patient privacy and protection of PHI.
Here are nine network considerations to address in the new HIPAA landscape. I will discuss the first consideration in this blog.
HIPAA Audits will continue
The HIPAA Audit Protocol and NIST 800-66 are your best preparation
Knowledge is a powerful weapon―know where your PHI is
Ignorance is not bliss
Risk Assessment drives your baseline
Risk Management is continuous
Security best practices are essential
Breach discovery times: know your discovery tolerance
When entering a hospital today, you’ll find a familiar and reassuring sight: hospital staff dedicated to physically monitoring and comforting patients who are confused or agitated, at risk for falls, wandering, and so on. While absolutely necessary, having a patient under constant monitoring by hospital employees, or nonhospital “patient sitters,” can lead to skyrocketing costs. At times, hospitals are not reimbursed for these expenses, meaning patient’s families are asked to provide sitters at their own expense -- imposing a burden for working family members.
With this in mind, we asked a question: How can patient observation costs be reduced while still providing the necessary care and attention patients need?
Enter: Virtual Assistance
Using HD video and two-way communication, healthcare organizations can dramatically drop the cost of patient observation. With virtual observation, trained staff in a central location can monitor multiple patients, notifying hospital staff onsite just as quickly as if they were physically there. To sweeten the deal, a virtual deployment runs over the hospital’s existing network without high-cost infrastructure installations or updates.
Virtual Patient Observation
Providing Personal Attention
Park Nicollet Health Services, a nonprofit, integrated healthcare system located in St. Louis Park, Minnesota, deployed Cisco’s virtual patient observation solutions to solve several challenges they faced:
Continuous observation of patients deemed at-risk in the hospital’s fall reduction program
Management of staff for 1:1 observation of priority and less severe monitoring cases
Coverage of multiple rooms with limited nursing staff, maximizing quality of care
With Cisco IP Cameras and Cisco Video Surveillance Manager, Park Nicollet has deployed video patient bedspace monitoring over their existing network, adding a “second set of eyes” to their team. The deployment has increased bedside care time for Registered Nurses and enhanced the environment for care, which has been reflected in Patient Care Scores.
Watch below as Eric Paine from Park Nicollet discusses the deployment during one of our recent roundtables:
Used as part of the hospital workflow, the Cisco Virtual Patient Observation solution can also:
Reduce risk and exposure for patients and operations
Improve communications between clinicians and staff providing specialized patient monitoring
Enhance bedside response by providing the caregiver with more information
Learn more about how Cisco is moving healthcare forward and be sure to watch this webinar on Healthcare Security Force Management Best Practices.
Being able to participate at an American Telemedicine Association event in Austin, Texas has been a true highlight of 2013. The conference and its attendees were a-buzz with more remote monitoring devices than I knew existed, infinite possibilities to provide “care anywhere,” and a fantastic array of new connections in this growing facet of our industry. Thought-provoking conversations centered on convergence of healthcare and ICT, needs and opportunities for telehealth stakeholders, and telehealth’s impact on treatment and prevention.
A common theme throughout the event was the current state of the industry and how connected health solutions are creating pathways to transform healthcare. This includes things such as workflow optimization, provider and patient engagement, and new application opportunities in the field of care. Telehealth has the power to impact both treatment and prevention in healthcare, which is crucial to shifting the burden of healthcare costs down, and the ability to improve outcomes.
During the event, I was privileged to take part in a Market Watch panel, “Not All Telehealth Markets are Equal,” hosted by Frost & Sullivan. This panel consisted of representatives from companies focused on remote monitoring, video telemedicine, mHealth, and home healthcare. We discussed key differences and similarities between these top market verticals concerning challenges, business models, and future growth.
Each of the panelists were asked several questions:
What are the most innovative or transformative use examples of telehealth solutions you are seeing live in practice, which can impact change and outcomes?
What restraints and challenges are people facing out in the market now especially in terms of realizing revenue growth and potential for telehealth solutions? Why will the future be different from the past?
What are some best practices you have seen in getting patients engaged with mobile and telehealth solutions and actually driving behavioral change?
Would you agree with our (Frost & Sullivan) view of the importance of video telemedicine in leading markets in telehealth, and what realized uptake is being seen in practice currently and what other factors are important to make this work?
Innovative telehealth use
There is a great deal of innovative telehealth use, but one example I shared involved doctors recording patients’ visits (using Show ‘n Share) and sending a link of the recording to the patients after the fact so they can easily watch it again, and share with family and friends. This represents an innovative and different use of telehealth technology – it supports patients who are likely inundated with information during their visit and allows them to relive their consult remotely.
Restraints and challenges
Telehealth now encompasses so many different channels patients want to use to interact with their healthcare system – telephone, mobile, social, email, text, web chat, etc. This means health care providers and payers must invest in the proper operational infrastructure to support these consumer connection expectations. I gave the example of a patient with an illness, who wants to talk to a doctor remotely, and expects to be “seen” within 15 minutes. A payer or provider cannot expect to deliver that specific level of service unless they have a centralized infrastructure that is dedicated to operations. In order for this to be scalable, health systems will have to invest in elements such as contact center, unified communications, secure wireless infrastructures, and endpoints with solutions like Jabber and WebEx. These are just examples of some solutions that can be deployed in order to make telehealth work seamlessly to provide patients with the best remote care experience possible.
Many panelists discussed gamification and how it is becoming a tool to engage consumers, as it ties to human nature, competitiveness and camaraderie. I discussed this from my personal standpoint. Customer Relationship Management (CRM) is a strategy that healthcare should deploy more because many health systems are being asked to think and act more like retailers in-nature. Healthcare systems need to take a page from companies who have to know their customers well and respond. This requires a strategic shift in how they approach and interact with patients and families, creating an infrastructure that would allow patients and family members or loved ones to communicate and interact with their care professionals via the communication method they choose. A sophisticated CRM strategy and eco-system is necessary to manage this.
Importance of video telemedicine
To drive home the importance of video in telehealth and the need for more efficiency in healthcare, I highlighted the model for primary care. I noted that primary care itself could be more remote and centralized at the same time. This could be a market differentiator for the health systems that deploy such a model, because the cost structure would be significantly reduced. A key technology component that supports this is a call manager feature combined with remote video technology that looks at hundreds of doctors to determine who may be available at any given time. As telehealth and telemedicine technology begins to grow and be widely adopted, this will be even more important. In order for it to scale and cross organization boundaries, it must be interoperable with different devices and endpoints and be able to connect in any way possible.
One thing is for sure; telehealth cannot exist without the support and adoption of the clinical community. The only way to ensure successful adoption of new technology is hand-in-hand implementation that’s tailored to the desired clinical workflow and to ensure that clinicians are championing it across the organization.