Making Complex Telehealth Simple by Pete McLain When a Massachusetts-based health system hired Yorktel Consultancy to assess its disparate video communications and telehealth solutions, the service provider discovered the communications industry was stuck at an inflection point. According to a report from Tractica, telehealth video consultation sessions will increase from 19.7 million in 2014 to 158.4 million per year by 2020, making it a $34 billion market. Telehealth and video communication technologies have each been around more than 40 years, but most often as disparate systems used by different people within an organization. Over the past five years, however, advances in Internet bandwidth and technology, combined with lower technology costs and increased demand for video services that enable more natural communication, have driven an explosion in adoption of these systems. Previously, corporate videoconferencing users rarely crossed paths with telehealth users and their systems weren t connected to one another. However, in today s collaborative work environment, healthcare organizations recognize multiple benefits of deploying enterprise wide solutions that synthesize hardware, software and human labor resources and improve productivity. Yorktel s recent engagement with one of the largest healthcare systems in Central Massachusetts serves as an excellent example of the opportunities and pitfalls that forward-thinking organizations face as they work to reduce IT silos and use technology more strategically. Despite the trend toward open, cloud-based computing, there are still several challenges preventing many healthcare organizations from realizing consistently effective video communications.
CUSTOMER BACKGROUND INFO AND TELECOMMUNICATION GOALS The healthcare system comprises four hospitals spread across eight campuses located in Clinton, Fitchburg, Leominster, Marlborough, Southborough and Worcester. Its 12,000 employees include 1,600 physicians and 3,000 registered nurses. A study conducted by the client revealed that between the corporate and clinical sides of its business, it was using five different video platforms. In an effort to maximize user adoption and minimize costs, the organization wanted to consolidate its telehealth technology on a single platform. Recognizing a need for assistance in developing a comprehensive strategy that would address these challenges and meet both its corporate and clinical telecommunication needs, the healthcare system contracted Yorktel Consultancy. OBSTACLES AND PITFALLS SLOWING DOWN: UNIFIED VIDEO COMMUNICATION PROGRESS The telehealth video market is in the midst of a major groundswell. According to a report from Tractica, telehealth video consultation sessions will increase from 19.7 million in 2014 to 158.4 million per year by 2020, making it a $34 billion market. However, a closer look at telehealth reveals that there are and will continue to be telehealth casualties along the way. In 2015, telemedicine kiosk provider, HealthSpot, which touted partnerships with RiteAid, Kaiser Permanente and Cleveland Clinic, abruptly shut down. Additionally, American Well, a telehealth provider with $150 million in investments is reportedly suffering from low video usage. When user workflows aren t taken into consideration and workers are expected to conform to the technology rather than vice versa, unnecessary layers of complexity are introduced. This hinders productivity and most often leads to video and telehealth systems being underutilized or abandoned altogether. As a consultant advisor, video managed services provider and trusted partner to dozens of leading healthcare providers, Yorktel recognized the challenges and pitfalls inherent to the task of seamlessly integrating video conferencing and telehealth systems and saw an opportunity to address the gap with expert services. Pitfall #1: Proprietary APIs The goal of unifying corporate videoconferencing and telehealth systems entails much more than a one-to-one integration between the two technologies. Each of these systems is also integrated with other mission critical business systems and applications. On the clinical side, for example, the client wanted its Philips ecare Manager telehealth
software integrated with its Epic EHR (electronic health record). At the time of the assessment, however, Epic didn t offer an API (application program interface) to Phillips. Vidyo had been a leading on-premise platform choice for healthcare systems to integrate Epic and ecare, but its proprietary API has limited interoperability with the client s Cisco and Polycom video systems. Another problem with using proprietary APIs is that it s expensive. Continuing with the status quo would have required extensive customization to make the client s many disparate legacy video systems align with their corporate, clinical and educational workflows. As the healthcare system continued to grow scaling its communication systems in the future in such a complex environment would have been a logistical and financial nightmare. Pitfall #2: Failure to Consider all Workflows in Advance Another key step in the assessment entailed helping the health system develop a long-term view and market strategy for video conferencing and telehealth. Various departments on both the corporate and clinical sides of the business were engaged to help Yorktel consultants gain a comprehensive understanding of how video was being used to optimize employee workflows. As is often the case with healthcare systems that grow through mergers and acquisitions (M&As), the client s video technologies weren t aligned with the health system s workflows. For example, corporate used Skype for Business for videoconferencing while the clinical side of the business used a variety of technologies from Cisco, Microsoft and Polycom, just to name a few. It was next to impossible for an HR or payroll manager to set up a video session with a clinician or share a computer screen to have a conversation. Healthcare is driven by workflows. The way an ICU uses technology and interacts with patients is much different than the workflow for practitioners in pediatrics or behavioral health. When user workflows aren t taken into consideration and workers are expected to conform to the technology rather than vice versa, unnecessary layers of complexity are introduced. This hinders productivity and most often leads to video and telehealth systems being underutilized or abandoned altogether.
Pitfall #3: Neglecting the User Experience Another common problem that often arises when an organization either fails to properly plan an implementation or inherits technology via M&A is that users don t know how to use the technology. In some instances, employee training is a quick resolution. At other times, however, the video conferencing or telehealth system configuration may also need to be updated. For instance, if a user is required to dial a number and use a keyboard and mousepad to enter a PIN or type in an IP address, there s a high probability people are going to forget a step along the way. This leads to frustration and an aversion to using the system in the future. Keeping the user experience top of mind throughout an evaluation or implementation and reducing the number of steps and clicks to make things work is a must. Pitfall #4: Supporting the System with Internal IT Resources Only Like any computer or server, videoconferencing and telehealth systems require ongoing updates (e.g., firmware, security patches) and maintenance to function properly. Additionally, when a user experiences a problem connecting and requires assistance, there s often a short window during which the problem can be resolved before the session is abandoned altogether and Plan B is implemented. During the assessment of the healthcare system client s video environment, Yorktel discovered that several legacy systems offered no remote access and management capabilities. That meant that any time users had a problem, they had to track down an internal IT person and hope the person could quickly fix the problem. The assessment also revealed that the client was behind on system updates, making them more vulnerable to performance problems and cybersecurity attacks. Also, while the client s IT staff was knowledgeable about computers and networking equipment, very few had experience managing video and telehealth systems. This resulted in long periods of downtime whenever a problem arose. DEFINING THE 4 PILLARS OF A TELEHEALTH STRATEGY Yorktel Consultancy worked directly with dozens of key stakeholders over a two-month period to assess the customer s video communication install base, examine use cases and identify best practices. At the end of the assessment, Yorktel defined four solution must-haves for the telehealth strategy:
1. Ease-of-use. The solution should be easy to use for corporate users, clinicians and patients alike. Without it, systems won t be used. 2. Seamless integration. It should seamlessly integrate with the organization s other IT and medical systems, including electronic health records (EHR) and unified communication (UC) platforms. 3. Interoperability and external reach. The solution needs to work with all standards-based systems and to extend the customer s external reach. Plus, it must also support mobile/byod participation. 4. Support implications. On the operational side, it must support self-service and full-service models and remote monitoring on the corporate and clinical sides of the business. CHOOSING A SINGLE PLATFORM TO INTEGRATE MULTIPLE VIDEO SOLUTIONS After helping the client develop an overall telehealth strategy, Yorktel Consultancy identified 24 specific features the new solution had to address to meet the healthcare system s requirements. Once those criteria were established, Yorktel identified the top platform vendors to be considered (see figure 1 below). Keeping the user experience top of mind throughout an evaluation or implementation and reducing the number of steps and clicks to make things work is a must. Yorktel evaluated seven on-premises, hybrid and cloud platform products, including: BlueJeans Enterprise Video Cloud, Cisco Spark (hybrid), Cisco Meeting Server (on-premises), Polycom RPP with RealConnect (on-premises), Vidyo (on-premises), and Zoom (cloud). Each of the products was measured against the 24 criteria listed in figure 1 above.
To ensure a comprehensive evaluation, Yorktel considered the healthcare system s corporate requirements separately from its telehealth requirements. YORKTEL S 4-PART SOLUTION SUMMARY At the end of the evaluation, Yorktel s team made the following recommendations: 1. Choose a global, standards-based platform. In its final solution viability ratings, Yorktel found that Cisco Spark achieved a good rating in meeting the client s corporate requirements, and an excellent rating meeting its telehealth requirements. Cisco Meeting Server and Univago (powered by Pexip and Cisco) were the only two platform products to earn an excellent rating in both categories. 2. Use extensible APIs. While both Cisco and Univago platforms similarly meet the corporate video and telehealth requirements and have extensible APIs for integration, Cisco s on-premises solution (Cisco Meeting Server) would be more complex to implement and manage on an ongoing basis. Univago s hybrid platform as a service offering, on the other hand, would be not only simpler to implement, it would also be more easily scalable and better positioned to continually evolve with the market. 3. Implement a hybrid support model. For this health system, like most others, telehealth support needs vary widely. On the corporate side, it may be acceptable for next-day service if a conference room camera freezes up. In clinical settings like intensive-care units (ICU) and emergency rooms, however, every minute of downtime could potentially be life threatening, so a much quicker service time is needed. Accordingly, Yorktel recommended a hybrid model that could provide appropriate response times across the organization, which included a combination of self-support and fully managed support options. 4. Take a multi-phase deployment approach. Due to its size and scope, Yorktel helped the client prioritize the telehealth project into four parts: a. Immediate (0 to 6 months) After finalizing proof of concept (POC), plan service implementation and establish support processes for UC and collaboration services. b. Short term (6 to 18 months) Implement Cisco Meeting Server, plan ICU and Epic integrations and ramp up level 2 and 3 support teams. c. Midterm (18 to 36 months) Integrate voice services and recording, plus plan for resiliency and redundancy. d. Long term (36 months+) Evaluate the evolution of the telehealth system, including the influences and impacts it has on the health system s collaboration needs. NEW CAPABILITIES THE HEALTH SYSTEM ANTICIPATES Some of the benefits Yorktel foresees the client will experience post-implementation, include: End users can meet with anyone (internal or external): On a standards-based video system Clients using SIP (session initiation protocol), SIP with Microsoft extensions (i.e., MS-SIP) or the H.323 protocol Anyone connected using a browser and WebRTC (web real-time communication) or audio
Through native integration with Microsoft Skype for Business (S4B), end users can collaborate with the entire Microsoft unified communications stack. Native audio conferencing. A self-serve environment delivered to end users via their browsers. Access to a 24/7 service support line. To help the client achieve its business outcomes cost effectively and with minimal disruption, Yorktel recommended the four-phased approach and outlined the key steps within each phase, beginning in phase one with a proof of concept (POC) over a four-to-six-week period. Deployment of the new solution and retirement of the legacy solution will take place over a three-month second phase. Each phase will include support processes, workflows and user training. At the end of phase three (18 months after POC), Yorktel will review the client s capacity, make continual service improvements, evaluate support desk size and adjust to match support trends and provide ongoing training and awareness. Long term (phase four), Yorktel will evaluate the evolution of corporate videoconferencing and telehealth to ensure the client s collaboration needs continue to be met. Ease-of-use. The solution should be easy to use for corporate users, clinicians and patients alike. Without it, systems won t be used. FINAL ASSESSMENT: FOCUS ON THE USER EXPERIENCE AND WORK WITH AN EXPERT After assessing the client s video and telehealth technology at each of its eight campuses and uncovering the problem areas mentioned earlier, Yorktel proposed a four-phase plan to correct the problem. Recognizing that consolidating the client s technology down to a single provider wasn t financially feasible, Yorktel recommended a hybrid cloud platform strategy that will enable the client s multivendor solutions to work together, while at the same time, simplifying the user experience. A final benefit and one of the most important is that the platform will serve as a conduit enabling Yorktel to monitor and manage the client s systems, ensuring optimal performance and security as the healthcare system continues to grow.