Author Archives: Bob Higginbotham

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

eVisits vs. Hosted Visits: What’s the Difference?

A hosted visit is a virtual consultation between a patient and their PCP that occurs face to face, meaning that video teleconferencing systems leveraging high definition cameras and displays can be used to facilitate that interaction.

Virtual consultation between a patient & their PCP

Healthcare is a language all its own.  It has a unique lexicon that allows doctors, nurses, and staff to communicate with each other.  Pain can be dull or acute, fractures can be hairline or compound, and internal injuries can be ventral or dorsal and thoracic or abdominal.  All of this terminology matters a great deal in delivering care and in assuring positive patient outcomes.

Likewise, the world of healthcare insurance billing also has its own lexicon and intricacies and just as in the examples above, the terminology matters.  There are e-visits and hosted visits and synchronous and asynchronous care.  The technology required to facilitate these visits differs, security considerations may differ as well, and the amount of payment each type of visit receives may be different as well.  I will say that there may be some slight variation in these definitions depending on the state or locality and the insurance provider, but we want to give you a general overview of each so that when you hear the terms in the future, you’ll be able to quickly make sense of them.

e-visit

The e-visit is an electronic visit between a patient and their Primary Care Physician (PCP and/or another Qualified Health Professional (QHP).  An e-visit happens electronically via email or through a web based solution like live chat.  In either case, an e-visit cannot be held through traditional email that is not encrypted, as any private health information (PHI) could be compromised, violating HIPPA regulations.  Proper encryption needs to exist to facilitate e-visits.  E-visits can be asynchronous as in the case of email or synchronous as in the example of a live chat session.  As a caveat, if a QHP is the one facilitating the e-visit, they are required to have access to a PCP electronically as a resource during that visit.

Store and Forward

This is a type of telemedicine service that is typically used for interprofessional communication, especially between PCPs and specialists. “For instance, teleradiology relies heavily on store-and-forward technology to allow technicians and healthcare professionals at smaller hospitals to share patient x-rays for diagnosis by a specialist at another location.”  The nature of this collaboration and the necessity of the specialist to review data before reaching a diagnosis means that this typically is an asynchronous service.  Patients and specialists like dermatologists may sometimes have asynchronous visits if the patient is required to provide some type of data first for later review and evaluation/discussion.  The importance of a secure destination for the data being stored, as well as encryption on the lines of communications between parties involved are all paramount for protecting PHI here as well.

Hosted visit

A hosted visit is a virtual consultation between a patient and their PCP that occurs face to face, meaning that video teleconferencing systems leveraging high definition cameras and displays can be used to facilitate that interaction.  Due to the face to face nature of this visit, it is obviously synchronous; happening in real time for a fluid two-way communication between the patient and the PCP.  Again, the health care provider must use hardware or software solutions that meet the encryption standards developed by HIPPA to protect any PHI that may be discussed.

To sum up, E-visits and Store and Forward systems both require encrypted messaging using hardware and software that protects stored photos or personal data. This data could include information captured from wearable devices or sensors as well as patient history.  Hosted visits however rely on video teleconferencing systems to provide virtual face to face conversations.  The real time nature of these communications does not exempt them from encryption requirements protecting PHI, so the proper hardware and/or software strategies must also be in place to mitigate risk.

Knowing the difference between these services and the terminology used to describe them cannot only help determine the technology strategy for your facility or practice, but can also assure that the services are billed correctly for timely payment.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

 

Resources:

#1: https://evisit.com/what-is-telemedicine/#8

#2: http://onlinelibrary.wiley.com/doi/10.1002/pam.20590/abstract

#3: http://www.priorityhealth.com/provider/manual/billing-and-payment/services/phone-and-e-visits

#4: https://www.aurorahealthcare.org/-/media/aurorahealthcareorg/documents/patients-visitors/e-care-faq.pdf?la=en

 

 

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Misery Loves Company

We’ve all heard the term “Misery loves company.” It is typically used in a way that suggests that people who are unhappy like to be with other people that are unhappy or that people who are miserable wish others ill will. But what if “misery loves company” meant something else 33827079 - patient using digital tablet while reclining on hospital bedcompletely, and that understanding the phrase better could generate better patient outcomes in healthcare?

The answer to the “misery loves company” riddle, may have just been solved. Recent research has shown that a group of brain cells called “mirror neurons” may play a key role. They are activated when we experience emotions ourselves, but also when we watch others go through an emotional state. The vicarious experience actually makes the mirror neurons fire in our brains creating a similar emotional state in us. It is the physiological manifestation of empathy, and it also helps explain why film and plays may be so cathartic and riveting.

From a healthcare perspective, knowing this is a huge benefit, especially from a facility’s visitors policy perspective. Creating ways for patients to have positive interactions with their friends and loved ones can have a direct impact on their health, recovery, and ultimately their happiness.

“So during and after a visit from a loving and cheerful friend or relation, mirror neurons will stir similar positive feelings in the brain of the person in the hospital bed, lifting their spirits and making them feel better.”

In fact, Dr Matthew Ratcliffe of Durham University goes even further to assert that,

By being with someone who has a smiling face — such as a hospital visitor — mirror neurons motivate a similar response in our own brain, leading us to make a similar gesture and even directing us towards a similar emotional reaction.”

So creating ways for patients to interact with family and friends and lowering the barriers to those interactions can have an impact on the patient’s happiness as well as how they perceive their medical condition. Given that a happy patient is a satisfied patient, and currently more and more healthcare payments are being tied to patient satisfaction and positive outcomes, it is to the healthcare provider’s advantage to find ways to lower the barrier to these interactions. Many hospitals have already expanded their visitation hours to better accommodate patients’ family and friends. Chris Clarke, who oversees the Tennessee Hospital Association’s Center for Patient Safety relays that “There is a renewed focus on patient-focused care that means better engaging with patients’ families.”

Visitation policies only go so far as they only apply to family and friends who can physically make it to the physical location. However the absence of a loved one can likewise have a negative effect on the patient’s recovery.

“Meanwhile, friends failing to turn up for a visit could actually be bad for the patient.

Not only are they deprived of the benefits of loving contact but their feelings of rejection activate the very areas of the brain that generate the sting of physical pain.”

-Daniel Goleman, author of Social Intelligence: The New Science Of Human Relationships

This is where technology can play a key role. High definition video conferencing systems, installed in patient rooms, offer another way for patients and their friends and family to connect. Given that the mirror neurons respond to observing the emotions of a patient’s visitor, the video component is actually key in generating a positive emotional state.

Video conferencing provides the experience of an in person visit, eliminates the awkwardness that can sometimes accompany a traditional phone call, and most importantly, can leave the patient feeling just as happy as they would in the case of an in-person visit due to the brain’s physiological reaction.

The benefits of video conferencing in remote patient diagnosis, increased access to specialists, and to higher quality care in rural areas have been well known for some time. However, there is an additional benefit to these systems in the case of providing communication between patients and loved ones in their time of need, resulting in better patient satisfaction.

It seems that in a scientific sense, misery does indeed love company, not to spread the negative, but rather to replace it with the positive.

HealthAV is revolutionizing the way healthcare facilities and doctors are delivering care. TeleHealth Services and Avidex divisions of Telerent Leasing Corporation, are pleased to announce the emergence of HealthAV, excellence in Healthcare Professional AV design and system integration services. Connect with one of our Account Executives today to learn more.

healthcare

Resources:

#1: http://www.dailymail.co.uk/health/article-410783/The-proof-visiting-people-hospital-really-does-good.html

#2: http://www.forbes.com/sites/brucejapsen/2013/07/02/patient-satisfaction-hits-physician-pay/#53b7241e133f

 

#3: http://www.fiercehealthcare.com/healthcare/hospitals-expand-visiting-hours-to-accommodate-patients-families

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Wear Your Heart on Your Sleeve

“For when my outward action doth demonstrate The native act and figure of my heart In compliment extern, ’tis not long after But I will wear my heart upon my sleeve”

-Iago in Shakespeare’s Othello

When Shakespeare first penned the words “I will wear my heart upon my sleeve” in 1604, he meant them in the way we are all familiar with today. That someone who wears their heart upon their sleeve is so open and transparent in their wants, desires, and thoughts and that it is easy to know these things just from looking at them and speaking with them. 58312743_sHowever, in a technological twist of fate, those words may be truer in a literal sense today than they ever have been before all due to a very interesting category of products: wearables.

When most people think of wearables, the most common example that comes to mind is most likely Fitbit. Considering that Fitbit has 19 million registered users and that there are 29 million registered Fitbit devices in over 50 countries that makes sense. Fitbit revolutionized personal fitness tracking, and in doing so, opened up the door for some amazing opportunities to increase the quality of care in telemedicine.

There is a consensus that telemedicine is more efficient than traditional office visits, saving wait and travel times, offering quicker access to healthcare professionals, and reducing costs of services. Given all this, why is there still some hesitation by some providers and patients to utilize telemedicine? One reason is that there is still a perceived advantage to being in the room with a physician. The physician can actually check vitals and get potentially important information on blood glucose levels, blood oxygen levels, heart rate, breathing, blood pressure, etc while there with the patient. However in today’s connected world, technology, especially in the form of wearable, embeddable, and even ingestible connected medical sensors, all of this data can be gathered instantly remotely as well, and presented to the physician in real time while they conduct the appointment through a high definition video feed.

If you missed our previous blog on the variety of sensors out there in the marketplace today for remote healthcare, you should take a look at it here just to catch up. Technology has moved at an amazing pace, and to come full circle, is bringing Shakespeare’s “heart on your sleeve” analogy to its technological manifestation.

There is a brand new category of wearable clothing being developed that integrates sensors right into clothing to track biometric data. Textile electronics are allowing computers to literally be woven into the clothes we wear, and yes, some of these sensors are even woven into the sleeve to track heart rates.

The Institute of Electrical and Electronics Engineers (IEEE), an organization known mostly in the past for internet standards and protocols, has taken an amazing role in these endeavors and “dedicated chips have been developed for health care monitoring, diagnosis, and treatment.” The IEEE has even shifted its tagline to relate the greater role of the internet in our daily lives and continued health. They now summarize their mission as Advancing Technology for Humanity. Sounds like a common goal.

Given all this, technology is in place today to maximize the efficiency of providing remote services without compromising the quality of care. Wearables and other medical sensors, used in combination with telemedicine can assure that both patients and physicians are confident in the diagnoses being made and the treatments being provided because all of the important data needed to make good decisions is available to them…remotely.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: https://www.fitbit.com/

#2: http://expandedramblings.com/index.php/fitbit-statistics/

#3: http://blog.avidex.com/up-with-telemedicine-down-with-healthcare-costs/

#4: http://blog.avidex.com/deliver-better-care-be-more-sensor-tive/

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Are You Putting your Patients on Blast?

You are already a bit nervous. You are having a very personal medical issue that you find a bit embarrassing. In fact, you are even a little nervous about talking to your doctor about it. You sit quietly in the examination room after your vitals have been taken, awaiting the arrival of the physician. As you sit on the examination table, you hear the physician say “hello”. You quickly realize however that he has not entered your room but the one next door. You can’t help but listen in as he discusses your neighbor’s maladies in great detail. Your curiosity turns to apprehension as you realize that if you can hear them, then they will be able to overhear your conversation with the physician as well.33824120 - female doctor sitting with patient on hospital bed

If you have ever been to the doctor to discuss a sensitive medical issue, you may identify with the anxiety of the patient above. How would your anxiety level and perception of the doctor’s office change knowing that everyone was able to hear what you assumed was going to be a private conversation protected by the doctor patient relationship?

There has been a lot of discussion in healthcare and on this blog about the Health Information Portability and Privacy Act (HIPPA) and its implications with regard to security of patients’ electronic data and communications. However, HIPPA covers all healthcare communications, including oral communications. That communication could be between healthcare professionals or between doctor’s and their patients, and in all cases, HIPPA privacy rules apply.

Protecting oral communications can be tricky, and some may argue that it is difficult at best. HIPPA specifically refers to communications breaches that can be “reasonably prevented”, which is a rather vague standard to meet. However there are some simple solutions and steps to take that can definitely meet that recommendation.

Healthcare providers that are designing and constructing their own facilities can easily promote construction techniques that minimize something called the Sound Transmission Class, or STC. There are multiple techniques that can be used in construction that involve everything from decoupling sheetrock from studs, building interior wall all the way to the hard cap ceiling as opposed to just above the acoustic grid, and using acoustic treatment materials on walls and other hard surfaces.

For smaller healthcare providers and independent physicians building a new facility from the ground up, or doing an extended tenant improvement to an existing space is just not possible, feasible, or cost effective. In these cases all is not lost. Many turn to technology as a viable and less expensive option to create speech privacy. They do this in two different ways via a sound system. One way is very intuitive but the other may be something you are unfamiliar with.

Many healthcare facilities utilize music in waiting rooms and examination rooms. The purpose is two-fold. First, there is a psychological calming effect proven to be associated with certain pieces or styles of music, and putting patients in a state of relaxation can have a positive impact on the quality of care. Secondly, having a base level of music in the background can potentially obscure other conversations in nearby areas that may have been easily heard if the space was completely quiet. An added bonus of these type of sound systems is that they can also be used with local paging systems to call physicians, nurses, or even patients.

There is another type of audio system that can also be used increase speech privacy and it typically goes unnoticed. In many cases having music in an area where a doctor may be trying to evaluate a condition or explain a delicate treatment to a patient can be counterproductive. IN these cases a sound masking system may be your best bet.

A sound masking system uses speakers that typically face upward into the ceiling spaces. Instead of playing music, they play a sound similar to airflow. This base level of white noise acts as a barrier to other sounds traveling through the same space and masks them. It reduces sound transfer and the intelligibility of speech and as such, increases privacy. Think of it as a pair of noise cancelling headphones for your healthcare spaces.

At the end of the day, as healthcare providers, you want your patients to feel safe and comfortable with their doctor patient interactions. Investing in technology to increase speech privacy not only helps you avoid potential fines that may result from a HIPPA audit, but more importantly protects your patients and makes them feel secure and at ease with you as their healthcare provider. Isn’t that really the end goal anyway?

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: http://bok.ahima.org/doc?oid=59139#.V8RvGPkrLIV

#2: https://en.wikipedia.org/wiki/Sound_transmission_class

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Calling in Sick

When you think of a school nurse, you may imagine a cheery, young health professional whose day consists of waiting for the random child to come into the nurse’s office nee6539946 - smiling nurse sitting and working at her computerding their temperature taken, maybe aspirin for a headache, or a skinned knee from the playground cleaned and bandaged. Perhaps if the child is deemed sick and potentially contagious, the nurse may call the child’s parent(s) to come and pick them up from school. The stakes in these instances seem relatively low, so it is no wonder that when faced with budget cuts, schools look at the full time registered nurse as an unnecessary expense. They may instead train someone in the office on basic triage and transfer the responsibility for minor ailments to teachers as well.

But are the savings worth the true cost?

The truth is, the role of the school nurse has changed dramatically over time. According to a recent cost-benefit study of school nursing services,

“During the past few decades, several major changes in our society have greatly increased the demand for school nursing services, including a rise in the number of students with chronic health conditions and mental health problems, an increase in the number of students with special care needs, and improved medical technology. As a result, school nursing services have expanded greatly from their original focus of reducing communicable disease–related absenteeism to providing episodic care, managing chronic health conditions, caring for students with disabilities, promoting health behaviors, enrolling children in health insurance and connecting them with health care providers, tracking communicable diseases, and handling medical emergencies.”

Given this, if today’s educational environment and student needs require access to a nurse’s presence at school and the financial state of the school or district cannot support a full-time nurse, what is a responsible school to do?

Today 45% of schools in the US have a full-time nurse, yet only 25% have no nurse at all. So what are the other 30% of schools doing? They either have a part-time nurse or they share a nurse between multiple schools or campuses.

Sharing a nurse across multiple schools can be challenging. In districts where the schools may be close geographically, there is time spent traveling back and forth and given Murphy’s law, I could almost guarantee that in emergency situations, the nurse is most likely at the wrong campus when the event occurs.

In more remote or rural areas, where the district may be a whole county or multiple counties, travel between campuses on a day to day basis may be physically impossible. In these situations, if the school cannot afford dedicated nurses, they either opt out of having a nurse altogether or parents just have to hope their child only needs a nurse at school on Tuesday.

So whether you are a school that currently shares a nurse looking for more efficiency, a school that has opted out of a nurse altogether because there are not sufficient funds and sharing is nearly impossible, or even one of the 45% of schools that currently has a full-time nurse but may be forced by budgetary cuts to reconsider that cost, there is something you should be looking at… telemedicine.

Telemedicine can greatly increase the efficiency of sharing a nurse between schools by eliminating the need for travel between locations. In districts with schools that are close together, this eliminates the time and expense of traveling constantly between locations. In places where schools are far apart, this may mean access to a nurse where none was ever available before.

Telemedicine allows schools to make a small one time investment in video teleconferencing technology like high definition cameras and video monitors to facilitate real time, face to face conversations between students and nursing professionals. Enhanced systems could also utilize relatively inexpensive biometric hardware like heart rate and temperature sensors allowing nurses to collect current vitals from the students that they are looking at and talking to, greatly increasing the quality of care prescribed.

The ability to record and store these nurse-student encounters also provides the district a record of mental health counseling and medical treatments. When combined with access to the students’ Electronic Health Records (EHRs), this also helps mitigate any liability the school or district may have in providing these healthcare services to students.

Telemedicine in the school nurse’s office may just be the way to help schools with full-time nurses reduce costs without sacrificing the health of their students, a path to increased efficiency and better quality of care in schools that share nurses, and a way for those who could never afford a nurse to get access to one. Given that the health of our children is at stake, it’s definitely an investment worth making.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: http://archpedi.jamanetwork.com/article.aspx?articleid=1872779

#2: http://www.nasn.org/Research/CostBenefitAnalysis

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Why You Should Medicare about Alternative Payment Models

Early in my career, around 1995-96, I was selected by Vice President Al Gore to sit on a senatorial/congressional Sub-Committee to talk about reimbursement for “video teleconferencing for medicine.” I remember Senator John D. “Jay” Rockefeller, IV, the chair, telling us all in the first meeting that “one day, this will be the biggest thing in medicine.” After putting the first “payment plan”11280389_s legislation in motion for telemedicine, we are all still waiting for his statement to come true! Today, at last, we are a few steps closer to his famous statement…

“Simplicity is the soul of efficiency.” –Austin Freeman

If this quote is true, and I believe it is, it is not surprising that telemedicine had a slow start when it was introduced to health care. The technology itself has never been overly complicated, however navigating the ever winding web of HIPPA compliance and the insurance systems payment models stifled any growth that telemedicine was poised to show early on.

As of late, that has all started to change. Many technologies now actively address patient privacy, encryption, and secure data storage that mitigate any potential threats to the security of patient’s medical information. Many states are also now passing legislation to make sure that telemedicine services are paid by insurance companies just like in person visits would be. And the Centers for Medicare and Medicaid Services, (CMS), have put quotas into place for services that need to be billed using Alternative Payment Models (APM).

What is an APM exactly and what is the purpose of promoting them?

“All alternative payment models (APM) and payment reforms that seek to deliver better care at lower cost share a common pathway for success: providers, payers, and others in the health care system must make fundamental changes in their day-to-day operations that improve quality and reduce the cost of health care.” –CMS

The take away here is that better care at a lower cost requires “fundamental changes” in the way healthcare providers run their operations. And as we all know, change is never easy. There must be some promise of reward to drive it forward, which is why APMs are so important. They provide the pathway for change by providing stronger incentives to do so.

Telemedicine services fall squarely in the wheelhouse of APMs as they promote physician efficiency, improve access to and potential quality of care, and can be provided for a fraction of the cost of face to face visits. It is for these reasons that CMS is aiming to grow payment of services paid through APMs to 30% of all services by the end of this year (2016) and to 50% of all services by 2018. The 2018 goal also links 90% of all payments through all payment models to quality of care, not just a fee for a service.

No longer will patients be paying for “time” in front of a medical professional, but their care and the payment of it will be more directly linked to the value of the service provided. Providers will be incentivized for providing the best quality of care in the most efficient manner possible or they may not be paid at all.

The question then is not whether or not healthcare practices and facilities will be substantially affected by APMs, but rather if they are ready to provide services like telemedicine that fit the bill. With the amazing advantages in technology like those in Web RTC and several technology grant programs being offered today, there really are very few reasons that forward thinking healthcare organizations shouldn’t be ramping up their telemedicine services ASAP.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: https://www.cms.gov/

#2: https://innovation.cms.gov/initiatives/Health-Care-Payment-Learning-and-Action-Network/

#3: http://blog.avidex.com/breaking-through-the-telemedicine-payment-barrier/

#4: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-01-26-3.html

#5: http://blog.avidex.com/just-browsing-webrtc-for-healthcare/

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Up with Telemedicine. Down with Healthcare Costs.

I hate paying too much for anything. Just ask my family and friends. When I need gas, I will drive out of my way to save three cents and use my rewards card to get three Telemedicinemore, saving a total of six cents on every gallon. My vehicle holds 16 gallons, so I saved less than a buck, 96 cents, searching for a cheaper place to buy gas.

When somebody asks me why, my instinct is to say “because I saved money!” But in reality, did the extra driving really save me anything?  Is going to the first place that has gas, paying a buck more, really that bad? To me it is, and that is why I do it. It makes me feel better.

In the health care world, we compare prices, talk about deductions, worry about our out of pocket…when in reality, we just really need to go see the doctor because we are not feeling good and have a need. We just need to go to make us feel better!

We rely on the government and insurance companies to keep the cost down…any way possible. So then why don’t they allow telemedicine to be paid when we want to use it? Why can’t I feel better at my place of employment, my home, a retail center? Why do I have to go see my doctor as HIS place, and not at mine?  We know that studies show that using telemedicine drives the cost of service down, but why won’t EVERY company provide coverage for it?

The debate has gone on long enough…time to man up and do what is right and cover the service. At least that is my feeling, because it makes me feel better. Sorry, low on gas, got to see who has the best price today and fill it up!

If there is one thing that the implementation of the Affordable Care Act (ACA) has shown us, it is that despite driving down costs of care, insurance premiums have continued to rise. It seems that just leveraging buying power by adding new consumers into the market place has not made a positive impact at the actual patient level when it comes to costs. The average total family healthcare premium has risen to about 23% of median income in employer provided plans. Even in the analysis of a handpicked plan on the insurance exchange, an example you could argue shows the best possible scenario, healthcare costs have essentially failed to decrease nationwide.

Considering that the tax penalty for NOT having healthcare is only 2.5% of income and that an individual can now buy insurance AFTER an event requiring treatment it is not surprising that many are threatening not to buy healthcare until it is needed. That would create a downward spiral, where less people paying in means costs continue to rise. Combine that with the fact that millions of people are being added into the existing medical system. Doctors’ time now becomes a rare commodity, and the perfect storm for ever-rising healthcare costs is definitely brewing. That is unless we deliver care more effectively in a way that costs less and creates efficiencies in how we use our doctors’ time.

Telemedicine drives down the cost of delivering care. It’s not in dispute. Whether you are a patient seeking a remote consultation, a provider needing access to resources from another provider like a specialist to read an MRI, or a hospital looking to reduce readmissions and potential fines, telemedicine is the answer. Studies show reduction of costs in all these areas and more.

Traditional concerns about the potential reimbursement of telemedicine and the privacy and quality of care delivered of remote services are quickly fading into the background. Legislation has and is continuing to assure that telemedicine will be covered by insurance plans and that healthcare facilities. Technology hardware and software providers as well as web-based communication platforms are delivering HIPPA compliant encryption to assure the privacy of patient information. Remote sensors of the wearable, implantable, and even ingestible variety are enabling physicians to gather, store and analyze biometric information to deliver state of the art care.

The environment for rapid adoption of telemedicine has never been better, especially given that most Americans are now comfortable with receiving care this way. People talk to their grandchildren, support highly technical products, and conduct multi-million dollar deals over video teleconferencing today. Why wouldn’t they conduct their routine healthcare visits in the same manner? The answer is that they would, they just need to be paired up with providers embracing the technology. Given that, a small investment in today’s technology is the perfect way to not only find new patients, but also to help drive down the cost of care long term, which helps everyone.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

 

Resources:

#1: http://www.usnews.com/news/blogs/data-mine/2014/12/09/workers-are-spending-more-of-their-income-on-employer-health-insurance

#2: http://kff.org/health-reform/fact-sheet/analysis-of-2016-premium-changes-in-the-affordable-care-acts-health-insurance-marketplaces/

#3: http://www.americantelemed.org/docs/default-source/policy/examples-of-research-outcomes—telemedicine’s-impact-on-healthcare-cost-and-quality.pdf

#4: http://blog.avidex.com/telemedicine-a-428-million-silver-bullet/

#5: http://blog.avidex.com/the-telephone-bill-you-actually-want/

#6: http://blog.avidex.com/just-browsing-webrtc-for-healthcare/

#7: http://blog.avidex.com/what-is-it-and-why-is-it-good-for-healthcare/

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Telemedicine: It’s Rocket Science.

Two things I want to get out there today: First, I wanted to be an astronaut when I was a kid (come on, so did you); Second, I use the phrase “it’s not Rocket Science” all the time.astronaut on laptop

But, working in the world of telemedicine, I am working in rocket science, as NASA was one of the first organizations to create “links” from their rockets and space shuttles to their mission control in Houston. They developed many of the technologies used in current day telemedicine many years ago…and they are still helping to generate new ideas in this market sector today. Read on to learn more.

As for the astronaut thing, after a few rides on the “whirly bird” at the state fair, you will know why I will never go into space! I like the ground, the stationary feel underneath my feet, way too much!

Imagine you are in a rural area and fall ill. You are just over 200 miles away from the nearest doctor. What do you do? You could drive if you felt well enough, or if it was an emergency you may call 911 for an ambulance or a helicopter to rush you to the hospital.  Now imagine that those 200 miles between you and the doctor are straight down, because you are an astronaut in low earth orbit.

This is the position NASA found themselves in back in the 1960’s at the dawn of manned space flight. In fact, before they sent people into space, they had to develop a way to send biometric data back from animals in orbit to assess how their circulatory and respiratory systems would work without gravity.  This technology was later put to use to monitor the astronauts themselves while in orbit.

Fast forward to 2035, the year in which Matt Damon’s character Mark Watney is stranded on Mars in the new film The Martian. Even though it’s a fictional account, the ability to communicate data like the biometric data Matt Damon’s character transmits back to NASA is very real.  In fact, it only takes from 4 to 21 minutes to send data back depending on the relative position of Earth and Mars in their orbits.  The Mars rovers currently transmit data regarding their Mars explorations back to earth.  It’s a sophisticated relay that starts with the Mars rovers transmitting to the Mars orbiters during an 8 minute window each day as they pass overhead, and then the orbiters relay the data back to earth at a much faster data rate than the rovers themselves can achieve.

Today, in the year 2016, a year firmly planted somewhere in between the history and the fiction referenced above, NASA is using video teleconferencing to connect doctors on earth to astronauts in orbit on the International Space Station. They have continually improved their systems to address the challenges of latency and data loss that a wireless transmission of this great distance can be subject to.  They use their systems to provide real time access to doctors as well as to allow the astronauts to see and talk to their families and to educate students who want to learn about life in space.

Given their history of innovation in this space (no pun intended) it is no surprise that NASA is not content to stop at video alone and is continuing to push the envelope.

“The focus of current agency efforts have expanded beyond the original mandate of telemetry and remote communication to encompass new “smart medical systems” that are designed not simply to communicate and diagnose ill astronauts—but also to provide physicians on the ground with the ability to remotely provide limited treatment options.”

NASA has also worked with the National Space Biomedical Research Institute and a key member of that association, Baylor College of Medicine, to develop advanced ultrasound technology to not only accurately diagnose things like illness and potential bone loss, but they also have the ability to focus and aim the ultrasound in a way that it can even stop internal bleeding in an emergency.

As you can probably imagine, these innovations can all have implications terrestrially as well, meaning that comprehensive remote treatments on Earth are probably not that far away.

Telemedicine will soon enable physicians to perform initial diagnosis, verify that diagnosis with physical patient data collected by remote diagnostic equipment including sensors, perform remote monitoring during treatment and recovery, and finally deliver after care and follow up.

So although telemedicine may have started as rocket science, today it is making remote care incredibly efficient and easy, not only in space, but also right here on Earth. Thank you NASA.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: http://www.nasa.gov/content/a-brief-history-of-nasa-s-contributions-to-telemedicine/#.VvDndOIrLIU

#2: http://www.nasa.gov/mission_pages/station/expeditions/expedition19/earth_day.html

#3: http://blogs.esa.int/mex/2012/08/05/time-delay-between-mars-and-earth/

#4: https://vsee.com/blog/nasa-chooses-vsee-telemedicine-video-conferencing-iss/

#5: http://www.prweb.com/releases/2015/03/prweb12562316.htm

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Just Browsing: WebRTC for Healthcare

When my kids were younger, we would watch “Finding Nemo” time-after-time-after-time because they thought it was one of the best animated movies made. I used to sit with them and watch too, laughing just as much as they did at all the great parts: Bruce the shark trying hard not to eat any little fish; all the seagulls squawking “Mine, Mine, Mine” and Dora, the fish that has no long term memory, and, when presented something shinny and new, she goes with reckless abandon to see the new thing.WebRTC

I relate to Dora…put something new and exciting in front of me and I am all over it. I love new gadgets, new things that might make my life easier and less stressful. But having been in this technology space for 23 years, new sometimes means not ready for prime time.

So when WebRTC was released, I did what I always do: looked at it, tried it and said to myself, “when it’s been here a while, I’ll buy into it.” Well, I think I was wrong. My normal Dora gave way to the safe, stuffy traditional video modes I so hang on to for the past 23 years!

WebRTC is real, it’s here and it works. If you are looking for ways to get into the Telemedicine space at an entry level, WebRTC might be a good way to start small and grow big. If you have been unlike Dora…doing the same thing year after year because it’s tried and true, look into WebRTC as a possible breakout solution for you.  You might just say “Mine, Mine, Mine” when you are all done looking!

Expensive hardware. Special software plugins.  Application downloads.  Varying system requirements. Limited hard drive space or system resources.  Lack of interoperability.

These have all historically been considerations that technology managers in healthcare had to deal with to successfully implement a telemedicine strategy to provide remote healthcare services to their patients. Quite honestly, for some healthcare facilities, they also acted as a barrier to entry based on the cost or the technical resources of the facility.  The costs of acquiring hardware and developing a comprehensive and secure telemedicine strategy seemingly outweighed the potential benefits telemedicine provides.

Enter WebRTC. Web browser Real Time Communications.

In short, WebRTC is an open source platform that leverages a communication application built into PC web browsers like Opera, Chrome, and FireFox and into mobile operating systems like Android and Apple OS.

This takes the term “just browsing” from a term to describe casual interest to one of serious business. If you have been daunted by the technical considerations of video teleconferencing in healthcare, here is why you should be excited about WebRTC.

It’s “skinny”. WebRTC uses a skinny client software integrated into the web browser.  This eliminates the need for valuable system resources to be used to store large proprietary application files.

It’s browser based.  WebRTC does not require any specialized hardware or require the user to download special applications.  It runs on existing computers and anyone utilizing a browser that supports WebRTC has access.

It’s secure.  WebRTC is subject to existing browser security protocols and data encryption is a mandatory feature. “WebRTC is currently regarded by some to be one of the most secure VoIP solutions out there.”

It’s open source. Interoperability has been a major issue with proprietary teleconferencing solutions, one that has been difficult to solve, so much in fact that many are giving up on it altogether. WebRTC is not a proprietary, branded piece of software. It is an open source project which means many interoperability concerns are a thing of the past.

It works with legacy investments. For those with an existing video teleconferencing solution, many legacy hardware solutions, like those from Polycom, are supporting expansion of their systems through WebRTC. This allows facilities to leverage all the QOS and enhanced security features of those systems while providing easier expansion in new facilities and access to remote patients via WebRTC.

In short, if you’re aware of the benefits telemedicine offers to your facility and are looking for a resource light, easy to implement, and secure solution that will work across browsers and with existing dedicated hardware, you need to look at WebRTC. Then the next time a patient needs a remote check-up or some aftercare, they can get access to it by “just browsing”.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: https://webrtc.org/

#2: http://webrtc-security.github.io/

#3: http://www.excessionevents.com/blog/interop

#4: http://community.polycom.com/t5/The-View-from-APAC/Why-WebRTC-is-key-to-unlocking-mass-adoption-of-video/ba-p/51639

 

 

 

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com

Telemetry. What is it and why is it good for healthcare?

Telemetry. It’s a word I had heard many times, but it was usually closely associated in my mind with rockets and space shuttles.  To be honest, the first time I heard it used in relation to healthcare I was a little taken aback.Telemetry photo  In fact, it caused me to look up a word I thought I knew for a formal definition. This is what I found:

Telemetry is an automated communications process by which measurements are made and other data collected at remote or inaccessible points and transmitted to receiving equipment for monitoring. The word is derived from Greek roots: tele = remote, and metron = measure.

In the light of that definition, the immediate impact of telemetry on healthcare, especially telemedicine came clearly into focus. In fact, looking further down the page of search results for telemetry, I noticed several results for a Telemetry Nurse as well, further solidifying an immediate link between the two disciplines.

If you run a hospital, you are most likely already very familiar with what a Telemetry Nurse does, but here is the description as posted by a University that offers degree programs for nurses.

Telemetry nurses work with patients that require special monitoring, including those recently released from the intensive care unit of a hospital. The patients they work with are often at high risk for complications, so RNs in a telemetry unit must carefully review equipment and data to detect potential symptoms of distress or danger.

Given that this type of physical on-premise equipment has been used in hospitals for quite some time, telemetry is not in any way actually new to medicine at all. However as technology advances, the applications for telemetry become wider and wider.

With the proliferation of internet connected devices and sensors, or the Internet of Things (IoT), telemetry extends beyond the on-premise, state-of-the-art equipment inside the nation’s hospitals and effectively becomes available wherever the patient may be. In fact the problem is no longer collecting the data for interpretation. Now the challenge becomes sifting through irrelevant data to find the important pieces, as well as securing that data to ensure the privacy of all that health information as it streams from a sensor through the internet, and to the nurse or physician it is intended for.

Think about the trends in technology today. People are already using telemetry in a personal way to manage wellness. They use Apple Watches or Fit Bits to track their steps and heart rates, track sleeping habits, and even set REM sensitive alarms to assure that they are always morning people. Companies like Google are even going a step further. Currently they have filed several patents on a glucose sensing contact lens, that not only tracks blood glucose levels, but also connects to the internet and smart devices, as well as includes a heads up display for the person wearing it to see the data from the lens right on their eye!

Now imagine taking all of this telemetry data and being able to share or save it right to your Electronic Health Records so that your physician has access to it to help determine the best care to give. Some say it’s comforting, others think it’s a bit scary, but in either case, it is objectively valuable to the care provider on the other end. If you consider for example some of the tragedies we have seen befall collegiate athletes because they collapse during a game from an undiagnosed condition, could it not be argued that telemetry may have reported some objective data beforehand, even though the athlete wasn’t noticing any symptoms themselves?

These are some of the encouraging promises of big data and healthcare. People like to focus on the negative side sometimes; that the insurance companies may get this data somehow and then deny insurance based on the figures. But on the flip side, your physician could be getting the data and proactively address a potentially life threatening condition as well. The risk of the first may be more than negated by the benefit of the second.

The point is that telemetry has in fact been here for a while in the ER and ICU, but now, in the new connected environment, just like a video conferencing system connects doctors and patients remotely for appointments and check-ups, telemetry connects the biometric data your body produces day in and day out to a physical data log. This allows that same physician to prescribe better treatments during those appointments and even to proactively help you manage your health long term.

I heard someone on a medical program state that “the first person to live to 150 has already been born.” IT is definitely something to ponder, and given the state of medical technology, it doesn’t seem like an outlandish claim. I can’t help but think that telemetry will play a huge role in the active management of personal health, transforming the doctor patient relationship from one of “break-fix” to a true collaboration that gives us all the ability to live long and healthy lives.

Avidex AV is revolutionizing the way healthcare facilities and doctors are delivering care. Their 20 years of experience is being leveraged to drive down the cost of care while promoting positive healthcare outcomes. Is your organization looking for a new kind of technology partner? Connect with one of our Account Executives today to learn more.

Resources:

#1: https://en.wikipedia.org/wiki/Telemetry

#2: http://www.jacksonvilleu.com/resources/career/telemetry-nurse-job-description-salary/#.VruC_PkrLIU

#3: http://blog.avidex.com/next-stop-the-ioh-will-there-be-an-internet-of-healthcare/

#4: http://blog.avidex.com/the-doctors-watch-just-stole-my-medical-records-and-other-strange-tales/

#5: http://diatribe.org/google-secures-patent-glucose-sensing-contact-lens

Bob Higginbotham

About Bob Higginbotham

Bob Higginbotham, CTS-I, CTS-D, is the Avidex National Manager of Healthcare AV. Bob has spent his 30 year career in leadership positions in the AV industry including extensive design and build work in healthcare facilities. He owned and operated a successful AV business in Texas with multiple offices in several cities where he managed a staff of over 100 employees. Bob has served as a technical consultant for a major AV manufacturer, led the technical sales team for a national video conferencing provider and provided technology auditing services for several private education facilities. He has a unique working knowledge of audiovisual technology as well as multiple certifications in audio engineering, acoustics, AV design, CQT system commissioning and video transmission systems. Bob holds a BA in communications and has recently served as board chair for a large private school. He brings his years of technical knowledge and leadership experience to Avidex where he leads the national healthcare AV team. Contact Bob at bobh@avidexav.com