Tag Archives: VTC

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

The Role of Technology in Patient Satisfaction

There has been a recent shift in healthcare from a fee-for-service environment to a pay-for-performance model.  The shift is a good one in most people’s eyes as it focuses more on the patient and the actual results than it does the provider and their services.20984020 - happy couple looking at digital tablet held by doctor  The performance of a healthcare provider is now evaluated based on patient outcomes (70%) and patient satisfaction (30%) and payments are dependent on performance in both areas.  Due to this, healthcare providers are more focused on patient satisfaction, at least from a metrics standpoint, than ever before.  “In fact, more than half (54%) of healthcare executives say patient experience and satisfaction is one of their top three priorities.”  

So how is patient experience data gathered and reported?  Enter the HCAHPS survey.  What is that you ask?  “The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.”  It is a required survey in all hospitals now, and the answers patients give matter to the payments received.

There have been many studies on the impact that nurses and physicians have on patient satisfaction.  Nothing will ever do more for generating comfort than the human touch and a great bedside manner.  However, technology can play an important role in assisting the caregiver and increasing patient satisfaction in 3 important ways.

Reducing Anxiety and Pain

Nothing is more stressful than being in a foreign place where you feel alone and helpless.  Moving from the patient room to multiple locations in the facility for radiology, MRIs, blood panels and the like make the experience even more bewildering and uncomfortable.  Add to that a sterile white wall or ceiling with nothing to look at and an ear ringing silence and you have nothing to focus on BUT the procedure and itself and any pain and discomfort that may go along with it.

Audio visual technology has been shown to decrease patient anxiety in many procedures, with the combination of soothing sounds and visuals together being greater than the sum of their parts.  According to one study in this arena:

“The presentation of audiovisual stimuli during a medical examination, can reduce anxiety and consequently enhance the overall patient experience.  Visual and auditory stimuli decreased pain, stress and anxiety… reduced discomfort and distress…and  significantly increased pain threshold and pain tolerance.”

The other way to decrease patient anxiety through the use of technology may not be as obvious, but is just as valuable.  Patient Education Systems.  Nothing can assist the physician or nurse in explaining a potentially complicated medical procedure better than a short video or computer animation that can be accessed in the patient room on the TV.  Providing visual aides before a procedure to help the patient understand the upcoming treatment can greatly reduce fear of the unknown and give the patient peace of mind.

Providing Access and Control

Given how central the act of communication is to the human experience, there are many questions on the HCAHPS survey that ask about communication between the patient and staff.  Communication can have a profound effect on the impression a patient has of their care, regardless of whether or not their ailment is treated properly.  Patients also find some level of comfort in having some control.  Being hospitalized leaves many feeling helpless and providing some sense of control to patients alleviates this feeling.  In both cases providing the patient with access to both staff and information fulfill these needs.

If a patient has a direct line to the nurse’s station via the call button, creating a video call between the attendant and themselves they can take comfort in the fact that they can express their needs.  In cases where specialists may be shared between facilities, patients can also access staff for detailed questions and concerns remotely and efficiently without the barriers of travel time between locations.  Finally, access to information on treatments and control of entertainment options during down time also help provide access and control when needed.

Increasing Communication

Finally, technology also assists in providing more positive patient impressions at the time of discharge.  Patient Education Systems as described above allow patients to review discharge instructions, at home treatments, and follow up visit schedules at their leisure when they are most receptive to receiving the information.  It has also been shown that information is retained much longer and more accurately when it is presented both visually and audibly.  Training organizations like OSHA have long understood this phenomenon in promoting better understanding and retention of information.  In this case, it means the chances of readmissions also go down, and the digital nature of the information sharing also creates the added bonus of a record of communicating the information to the patient to mitigate any future liability as well.

As you can see, although technology will most likely never be able to replace the human element of patient satisfaction, it can greatly assist the healthcare practitioner in making sure their patients are at ease and are well informed both about the procedures they are about to undergo as well as how to best care for themselves once they are back in the comfort of their own homes.  Never before has bedside manner been tied in such a way to the payment of healthcare services, and a small investment in some assistive technology can make the difference in how a patient remembers the experience as a whole.

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://apihealthcare.com/sites/default/files/MC_CL_PAS_PPA_0000000001.pdf

#2: http://www.beckershospitalreview.com/quality/4-strategies-to-boost-hospitals-hcahps-scores.html

#3: http://www.medscape.com/viewarticle/811356_2

#4: http://www.hcahpsonline.org/home.aspx

#5: http://www.rufwork.com/110/mats/oshaVisualAids.html

Anthony Paoletti

About Anthony Paoletti

Anthony brings over 23 years of audiovisual experience and has worn nearly every "hat" in the industry; from Consultant to End User; Account Representative to Install Technician; Project Manager to Systems Engineer. Contact Anthony at apaoletti@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

Beyond Dial a Doc: 3 Tips for Next Level Telemedicine Systems

doctor on cell phone screenThe field of medicine is ever evolving. The first doctors walked from village to village to see their patients. In the old west, doctors dropped everything to saddle their horse, rode the range and got to their patient’s home as fast as they could. The invention of the buggy and then eventually the automobile allowed them to travel safer, faster, and farther. Today distance and time are no longer even factors. Doctors will appear on our TVs, phones, tablets and even our watches…just another step toward “quick and convenient” medicine. But simple and easy is not always the best medicine. Convenience is good…but quality is better.

In 2014, Dr. Phil McGraw and his son Jay raised over $21 million to help start Doctor on Demand, an online healthcare platform where “consumers can access in under three minutes a physician from a smartphone or a desktop.” It’s no surprise that with their combined audience of millions from The Dr. Phil Show and The Doctors, which Jay produces, that their “dial a doc” platform has generated a lot of buzz in the past several months.

It’s important to first acknowledge that the idea is not a bad one.  The Doctor on Demand system touts over 1400 physicians available to consult with patients and drastically reduces the cost of care.  With 64% of the population receptive to online medical care, it would be alarming if no one was making a mass market play for these dollars.

But can a large system like this offer the value that patients expect?  What is a medical clinic or hospital system to do in the face of this online competition?

There is hope, as the type of systems Doctor on Demand and others like it have put together, leave quite a bit of room for improvement.  According to Dr. Daniel Carlin, president of a health concierge service called World Clinic,

“Many of the big telemedicine companies are not care providers. They are marketing companies with big marketing budgets that have built a network of subcontracted physicians willing to receive a patient phone call. There is a broad range of quality among these doctors. This is not surprising given that the doctor earns, on average, $20 per call.”

Given all this, where are the opportunities for improvement?  What would a next level telemedicine practice look like?  To start it should focus on three main components.

Doctor Choice

Dive deeper into Doctor on Demand and you’ll notice that they tout “more than 1,000 doctors available for video consultants one or two days a week.” Of the 1000 plus physicians in the Doctor on Demand system, the website profiles 18 of them. Physician choice is not a part of the equation in these systems and a recent Harris Poll relates that 88% of consumers want to select their doctor and only 12% are willing to be randomly assigned one.

Personalized Care

Developing a system that has the ability to personalize care to the individual has innate advantages. The random “dial a doc” process is hardly an equation for a consistent doctor patient relationship. Even if the patient is cared for by a small team when 24/7/365 access to a single physician is just not feasible, the practice should be able to leverage electronic health records to deliver care with a broad/holistic understanding of each client/patient.”

Consistent Technology Experiences

Imagine a network of over 1000 doctors answering randomized calls forwarded to them by a system like Doctor on Demand.  Depending on where the physician is at and what device they pick up the call from, there is the potential for a wide swing in the quality of that consultation.  Everything from bad WiFi, poor cell service, or even differences in the quality of cameras on their devices can all adversely affect the calls.

Creating a system that utilizes high quality microphones and HD cameras in quiet, dedicated spaces with reliable high speed internet connections assures that the patient experience is consistent.  Developing a policy and set of standards for devices used by the doctors in remote locations can also help mitigate differences in the quality of care form call to call and patient to patient.

It is apparent that the future of healthcare includes the continued adoption of telemedicine in one form or another.  The opportunity for medical practices and healthcare systems is in developing systems that offer more value than their mass market counterparts.  Building a system that incorporates physician choice, that is patient centered, and delivers a consistent, high quality audio visual experience can make the difference between offering a random doctor on demand and offering a service and a doctor that is in demand.

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.doctorondemand.com/

#2: http://www.forbes.com/sites/zinamoukheiber/2014/08/06/dr-phils-doctor-on-demand-raises-21-million-as-telemedicine-heats-up/

#3: http://www.fiercehealthit.com/story/patients-increasingly-open-video-doctor-visits/2015-01-23

#4: http://www.forbes.com/sites/russalanprince/2015/03/30/the-limitations-of-dial-a-doc-telemedicine/

#5: http://healthland.time.com/2013/12/10/dr-phil-startup-brings-check-ups-online/

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