The Portable Doctor
As telehealth and telemedicine bring health care to new places, connectors play an important role.
As health care costs continue to rise, and many people — particularly those in rural or sparsely populated areas — encounter roadblocks to good health care, consumers are looking for viable alternatives to traditional doctor office visits. One of the more successful options is telehealth and telemedicine. One company that has been very successful in implementing these types of programs is Global Partnership for Telehealth. An organization whose affiliates include Georgia Partnership for Telehealth, Alabama Partnership for Telehealth, Florida Partnership for Telehealth, and Southeastern Telehealth Resource Center, Global Partnership for Telehealth is changing the way we think about connecting to our health care.
To get a better understanding of exactly how telehealth and telemedicine programs are established and operate, we talked to Lloyd Sirmons, director of the Southeastern Telehealth Resource Center.
Connector Supplier: The term telemedicine is becoming a household word. From Telehealth of Georgia’s perspective, what does telehealth or telemedicine entail?
Lloyd Sirmons: The term telehealth is a much broader term used to refer to areas such as clinical data sharing (e.g., radiology, electronic medical records, health information exchange, etc.). Telemedicine deals more with the use of technology to facilitate a patient to doctor interaction. Our goal here is threefold: To improve and promote the availability and provision of specialized health care services in rural and underserved parts of the world.; to educate and provide training and technical assistance to hospitals, clinics, and primary care providers to implement and achieve exchange of health of information; and to reduce the service barriers that exist for patients who live in rural parts of the world at a distance from hospitals and other medical facilities.
CS: When evaluating a location for the implementation of telehealth, what are the minimum or necessary requirements? Is available bandwidth a major criteria? Is the technology level of the patient or caregiver a concern?
LS: Bandwidth is one of the first things we test when looking into setting up a site with telemedicine equipment. You can have the best equipment in the world, but without consistent bandwidth, it’s worthless. The connection needs to be a steady and consistent (up and down) connection. Fiber is always the best option because it’s typically the most consistent. Most telemedicine consults can run smoothly on a 1Mb/s connection, as long as that consult is getting that entire 1Mb/s.
CS: What is a virtual office visit?
LS: A virtual office visit is one where a patient connects up with a physician through the use of technology, rather than in person. It’s a remote connection using a computer or some other technology that provides the patient the ability to interact with the physician remotely.
CS: What makes the equipment used in a remote diagnostic situation different from the equipment found in a doctor’s office or hospital setting? Is there special equipment required at the provider’s end?
LS: The equipment on the provider end will be different in some ways. It’s designed to communicate with a PC, so it will have connectors to connect to a PC, or some sort of technology device. For example, the stethoscope that we typically use is a Littman 3200, which has a Bluetooth radio for connecting to a PC. The otoscope that is used plugs into the PC via a USB cable, which gives the provider the ability to pass images, in real time, to the PC.
CS: What types of facilities most benefit from telemedicine, rural areas, nursing homes, correctional institutions, etc.?
LS: Early on, telemedicine was geared towards providing care to rural areas. However, it has proven to be a very useful tool in urban areas where access to care is just as difficult. Telemedicine is a great tool for any setting where clinical care is being provided, but it’s not a fit for all scenarios. Any setting where a patient doesn’t have to be transferred, or patients aren’t having to drive long distances is less suitable. Where we see the most use for our organization is mental health, school-based telehealth programs, and telestroke in hospitals.
CS: Are telemedicine services more apt to be supplied via the hospital level or the private physician level?
LS: We see both in our network. However, more hospital systems are realizing the benefits of implementing a telemedicine program and the cost savings it can bring to the organization downstream with increasing access to care and better workflows.
CS: How important is ease of connection? What are some of the methods of connection presently being used? USB, S-video, circular push/pull, threaded coupling?
LS: Equipment must be fairly easy to use. In our experience, if it isn’t, doctors will not use it. They have very busy schedules and don’t have the time to have to deal with equipment that is time-consuming or difficult.
In addition to the equipment described by Sirmons, a good telemedicine operation requires a basic telemedicine cart or hub. Carts designed specifically for school-based telemedicine programs typically are equipped with a digital stethoscope connected to a computer/hub via either a 3.5mm stereo microphone connector or USB connector, a patient examination camera to allow the physician to see the patient in real time, and a digital otoscope connected, like the stethoscope, to a PC using a USB connector. A hub or cart that is geared towards family-practice type applications would include the same items as those designed for school-based programs, but may also include other diagnostic equipment, like 12-lead digital ECG, USB ultrasound probes, and a digital spirometer. In addition to the connections mentioned above, a hub might also include a HDMI, DVI, BNC and S-Video Composite, microphone-in, and headphone-out ports.
A portable telemedicine cart is generally used for applications that require a telehealth assistant to physically travel to a specific location, such as those found in rural areas, retirement facilities, nursing homes, or remote job sites. Similar to the telemedicine carts mentioned above, these encapsulate the entire cart, including a tablet PC, a generous number of industrial grade USB ports, CAT 5 plug, HDMI port for transmission of video, circular audio ports for headphones or microphones, a serial port such as a RS232 port, and a VGA port for connection of an external monitor, in an industrial grade case. Note: Ports may deviate slightly based on region of the world the equipment is being used in.
“We are going through a major transformation in health care,” said Bernard J. Tyson, CEO of Kaiser Permanente, a major health care network based in California. “Because we were all-knowing, we built the entire health care industry where everyone has to come to us, but now we are reversing the theory where people have to come to us for everything, so we’ve invested billions in our technology platform.”
According to the American Telemedicine Association, there are now 200 telemedicine networks in the US, and more than half of hospitals in the US now use some form of telemedicine. In the EU, the vice-president of the European Commission, Andrus Ansip, said telemedicine is one of the key drivers of the development of the 5G network. In the developing world, telemedicine makes it possible for remote communities to access health care. The Global Telehealth Market has an expected CAGR of 29.8% from 2018 to 2023.
So, what does this mean to the patient, the equipment manufacturer, and the connector and cable assembly supplier? It means that, like with any other new or rapidly growing technology, there are going to be growing pains. The demand for equipment used in telemedicine has grown rapidly, as has the number of suppliers. There has also been a drastic increase in the need for mobile infrastructure equipment to support the demands of these virtual visits. This is good for connector suppliers, but it has also increased the number of players participating, which has created a demand for cheaper and even more sophisticated equipment.
In the US in particular, there are still lingering questions as to who is going to pay for these services. Presently, only 32 states and the District of Columbia have laws in place requiring insurance companies to reimburse doctors for services provided remotely, and even in those states there are questions about fees, types of services covered, and number of visits allowed. What we do know is that connectors are extensively used in equipment geared towards telehealth and telemedicine applications and the mobile infrastructure needed to support the demand, and that is not going to change.