The human touch of telemedicine: A primer on secure, reliable, patient-centric telemedicine solutions

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The global telemedicine field is growing dramatically every year, with an increasing array of solutions to meet the needs of providers and patients alike.

A study entitled "Global Telemedicine Market Outlook to 2018" noted that the telemedicine industry, which stood at $ 14.2 billion in 2012, is expected to grow at a compound annual growth rate of 18.5 percent from 2012-2018. From a regulatory standpoint, this expansion will intensify as telemedicine initiatives align with the goals of the federal government and Accountable Care Organizations (ACOs) to reduce healthcare expenses and improve quality of care to patients. All this is further impacted as millions of potential new patients access the exchange system legislated by the Affordable Care Act (ACA).

Finding the right solution for your healthcare organization can be daunting, given the unique needs of your practice and patients and the complexity of the technology, not to mention licensing, regulatory and reimbursement issues. How then do caregivers find a reliable, secure telemedicine platform that can be flexible and utilized in a variety of healthcare settings? And, given that the cornerstone of care is human connectivity, is it possible to maintain a personal touch with patients while utilizing what is perceived as impersonal technology? As the global telemedicine field grows, how can we create an experience that incorporates flexible, secure technology that also offers good bedside manners?

Telemedicine Evolves
Telemedicine provides patients with immediate access to cost-effective, efficient and speedy care. Whether used to manage chronic illnesses, monitor patient conditions in areas where specialty care is not available, or triage victims in an emergency situation, telemedicine applications provide significant advantages for patients and providers alike. Research shows that the field is poised for impressive expansion, and at the same time consumer trust in telemedicine is gaining traction too. According to new research by Deloitte, 75 million – or one in six– "virtual" doctor visits will occur this year alone. Cisco's 2013 Customer Care Experience Report for Healthcare noted that 76 percent of patients select virtual access over human interaction with their care provider because it saves them time – both traveling to and from an appointment, and missing work. In addition, virtual access also allows for diagnosis and treatment when face-to-face care is geographically challenging in rural areas.

Given the anticipated growth, and the proliferation of telemedicine platforms from which to choose, there are a number of factors that healthcare organizations must consider carefully when reviewing these solutions.

Security in a Mobile World
When physicians' forward medical records from their tablets or patient insurance data is accessed from a smartphone, this confidential information can be intercepted and compromised. A telemedicine system that incorporates security measures such as unique user passwords, encrypted data and secure patient records storage is key to preventing a data breach.

he rise of Bring Your Own Device (BYOD) has increased these risks significantly, since physicians are using their own mobile devices for both work and personal purposes. In fact, Cisco's study cites that 9 in 10 Americans employed in the healthcare industry use their personal smartphones for work, and 40 percent of those mobile devices are not password protected. In a 2012 Comscore Study, 60 percent of physicians reported using mobile phones on a daily basis, with 62 percent of those users indicating they need their device to stay in contact with their job. Tablet use, too, is on the rise, with 44 percent of surveyed physicians reporting that they used tablets every day.

Mobile communication proliferates in the medical field, yet realistically there is a large segment of healthcare providers that are not prepared to manage it properly for patient care. As physicians, it is incumbent upon us to be fully aware of these issues and focus on selecting technology that ensures protection of patient health information and patient privacy. In short, patient privacy requires security.

Military Grade Security = Patient Privacy
To ensure patient privacy, some developers of telehealth platforms are leveraging military-grade mobile security solutions. Overcoming the challenges posed by smartphones and tablets requires a comprehensive security strategy and knowhow, as well as a clear understanding of the security tools within the telemedicine platform. Essentially this means digging deep into the technology underpinnings, an undertaking that most physicians and hospital administrators do not have the desire, time or skill set to do.

A key component to a secure telehealth platform is ensuring that security extends past the device itself into encryption of the information being transmitted over unsecured networks. Security is vital to maintaining patient confidentiality and required by the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.

When considering a mobile solution to support telemedicine initiatives, an offering should:
- Utilize HIPAA-compliant messaging, voice and file transfer, and information storage, which enable physicians to consult securely with patients. Patient information must be stored in secure data centers that regularly conduct risk assessments and have policies in place for reviewing controls.
- Integrate with existing communication systems, such as email, SMS, applications and pagers, as well as mobile phones and tablets.
- Securely distribute and access sensitive information from a mobile device; transmit media over industry-standard 256-bit Secure Socket Layer (SSL) encrypted connections; and prevent access by unauthorized users or noncompliant devices.
- Leverage unique user identities, including user names and passwords; and authenticated and role-based access at both the physical and IT level.

Uncovering the Human Touch of Telemedicine
Another major challenge that telemedicine offerings must address is the perceived lack of personal connection with mobile interactions. Many offerings, perhaps, miss key ingredients that physicians require to provide effective care. How do health practitioners work within the virtual environment to ensure that their bedside manners remain warm and personal?

Step one is recognizing that in the online environment, personal interaction must take on a new meaning within the medium. Telemedicine applications take advantage of innovation by facilitating faster, more efficient connections between patients and medical providers. Practitioners and caregivers must focus on the notion that telemedicine applications can actually help them achieve a more personalized patient experience with a tailor-made solution.

Step two is seeking a vendor that truly understands physician needs. This is deceptively simple advice but decidedly difficult to find. Telemedicine vendors are IT folks, not medical providers. To ensure that physicians can provide the same personal touch whether in person or via telemedicine solutions, medical practices need to consider a technology partner that can work synergistically and truly understand requirements.
Collaborating with a vendor initially is an excellent way to ensure a high quality, reliable telemedicine platform that delivers personalized and compassionate care.
From a physician's perspective, a patient-centric system that promotes the "human touch" through technology should include:

- Mobile and web access to medical services anytime, anywhere and on any network-connected device.
- A simple user interface that does not intimidate patients or physicians alike.
- A robust yet flexible platform that can be configured for either home monitoring, direct patient-provider interaction, or a hub and spoke model.
- An inclusive platform, in this age of population health, that allows various physician groups to pool provider resources and toolsets so that clinicians can view various on-call rosters and manage patient volume.
- Picture upload capabilities to allow patients to securely share high-definition images of their medical issues, such as a bite or rash, using a mobile device or web app.
- A simple electronic medical record (EMR) system to allow doctors to see patients' records, and enables patients to produce an invoice for insurance claims.
- Multilingual patient care agents to assist patients with the consultation queue and provide additional support.

With the growth of the telemedicine industry, the opportunity is ripe for caregivers and providers to offer patients highly personalized quality care within a secure, reliable platform. The key is to find a solution that marries secure and scalable solutions; government-grade, locked-down security; innovative functionality that can scale and grow; and a patient-centric approach that delivers on the promise of technology without losing the human touch. In our increasingly connected world, it is imperative that the medical community remains at the forefront of change in order to continue to offer the highest quality care to new and existing patients.

Dr. Park is a practicing board certified emergency medicine physician at Wake Emergency Physicians, PA in Raleigh, North Carolina. He currently serves as the director of telemedicine for RelyMD, a direct-to-consumer telemedicine service. He serves on the board of directors for Wake Emergency Physicians and has served as their business development director.
Prior to Wake Emergency Physicians, Dr. Park was a core faculty member at Duke University Medical Center where he was an attending emergency medicine physician. While at Duke he served as the director of emergency ultrasound responsible for the education of residents with respect to bedside ultrasound for direct patient management. While at Duke he founded Ultrasound Ventures, a startup in the Research Triangle Park where he now serves as chief medical officer.
Dr. Park completed both his fellowship in emergency ultrasound and residency in emergency medicine at Alameda County Medical Center – Highland Campus in Oakland, CA. He received his doctorate of medicine at the University of North Carolina – Chapel Hill. Dr. Park received a bachelor of arts in economics at Columbia University.

Mr. Henggeler is a business leader with more than 10 years of international and domestic experience in financial and operations management, strategic planning, corporate development, and management consulting. For VirtuMedix at TeleCommunication Systems, Inc. (TCS), Mr. Henggeler is the General Manager with specific responsibility for P&L management, business development, go-to-market strategy, regulatory compliance, pricing strategy, and product development/management.
Prior to joining TCS, Mr. Henggeler worked for healthcare startup Ameritox, leading the corporate strategy/internal consulting group. His responsibilities ranged from leading product launches into international markets to product development for an innovative mobile application and the reorganization of the company's patient financial services department.
His career began on Wall Street as a portfolio and trading analyst and progressed to leading corporate strategy, planning, and finance teams. He also worked several years as a management consultant on projects in the Middle East and Africa, where he managed small and medium enterprise development projects working to increase competitiveness and institutional capacity. Mr. Henggeler earned his master's degree in international finance and business from Columbia University and his bachelor's degree in economics and political science from Drew University.

Resources: Subcommittee on Health and Technology, July 31, 2014 Hearing, "Telemedicine: A Prescription for Small Medical Practices"



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