System Upgrade: Telehealth Solutions
Video teleconferencing technology is used in the OR at Cook Children’s Medical Center in Fort Worth, Texas, to view a lab microscope image.
A 10-headed microscope transmits images from the pathology department to the OR at Cook Children’s Medical Center.
In an effort to reduce costs and drive efficiencies, many hospitals and healthcare systems have started implementing various telehealth solutions. These electronic information and telecommunications technologies, such as videoconferencing, media streaming, and wireless communications, can be used by clinicians to assess, diagnose, and treat patients. As telehealth changes the way healthcare is delivered, it’s also impacting the traditional space requirements within facilities, from exam and patient rooms to equipment storage areas and ORs.
Here are seven key ways that telehealth is affecting care delivery as well as the built environment.
1. IP convergence
A leading trend in healthcare information technology is internet protocol (IP) convergence. An IP is the format for how data is transmitted from point A to point B via the internet or other network. In IP convergence, all the information associated with technology interactions (called data packets) from various systems, such as a computer in a nurses’ station or a phone in a supply room, can utilize a single network (or cable) to transmit data. This reduces the amount of network equipment and storage space necessary, impacting how architects and engineers plan and design healthcare facilities.
For example, in the past, 10-by-12-foot or larger technology rooms were required on each floor of a hospital to house systems equipment, including servers, routers, uninterruptible power supplies, and batteries. With IP convergence, these systems can utilize a single cable for each device and, more importantly, can share the network switch (the electronic box that routes all IP data packets from point A to point B) that resides in the technology room, meaning less rack space is necessary to hold the equipment. Fewer network switches also reduces the cooling and power requirements, further reducing space needs as well as operational costs.
2. Smart TVs in the patient room
With the prices of healthcare-grade LED TVs continuing to decrease, more organizations are choosing to install them in patient rooms. These units have greater clarity and IP capability, which means the patient TV can be used for more than just entertainment. For example, a physician or nurse can share information via the TV without being in the same room as the patient, introducing telehealth into the space. Because these TVs are IP capable, there’s no need for bulky coaxial cables that were traditionally required for watching television. Instead, the TV can be treated as just another data location in the room that runs on the converged network.
3. Electronic medical records
Per federal mandate, digital health records of care provided must be maintained regardless of setting. This provides an opportunity for care to be delivered via telehealth, which can easily manage patient information, diagnosis, and test results as well as text files, photos, and digitally stored X-rays—no matter the location of the patient or caregiver. For example, by connecting mobile technology to a Wi-Fi network or plugging into a network data port at the hospital bedside, at home, or at a doctor’s office, patients can connect with their personal physician or a specialist anywhere and share communications that are stored in the electronic medical record.
4. Video translation services
Assisting patients with hearing disabilities can be challenging, but video technologies such as FaceTime and Skype that are supported by Wi-Fi, data connections, and IP communication are changing that. Now, a translator can be on screen to communicate with the patient via sign language and then speak directly with the nurse or healthcare provider. This trend is supported in the built environment through the installation of internet-connected smart TVs in patient rooms, while some organizations have battery-powered interactive displays supported by mobile technology that can be transported to rooms where those services are needed.
5. “Telesitter” applications
Healthcare providers are leveraging technologies to observe and manage patient care that once had to take place within an inpatient environment. Remote monitoring or “telesitter” applications have enabled patients, such as seniors who traditionally would have required skilled nursing care, to remain at home. The advent of voice-activated communication screens with cameras connected to the internet provides two-way communication between the at-home patient and a remote observer. Most units need only power and Wi-Fi and are the size of a picture frame, meaning they won’t take up much space.
Similar technology can be applied to intensive care units (ICUs), where clinical staff, such as specialists, internists, neurologists, cardiologists, or psychologists, might not always be available. Utilizing a centralized clinical staff collaboration room located on- or off-site, clinicians can remotely monitor patients without being physically present—creating what’s called an eICU. These set-ups feature multiple computer displays and cameras that connect with the patient’s monitoring and diagnostic equipment to provide real-time information to doctors and nurses. Likewise, the clinicians can use the same technology to submit treatment instructions and prescriptions to in-person staff in the ICU or order additional diagnostic tests.
6. Surgery consultations
Reviewing biopsy specimens during surgery traditionally requires a surgeon to leave the operating room (OR) to consult with the pathologist, while the pathologist may have to leave the lab unattended for up to 30 minutes to provide the consultation. Video teleconferencing technology instead allows surgeons to stay in the OR while the sample is sent to the pathology lab and reviewed remotely in real time. This technology enhances efficiency by improving patient safety, reducing the time the patient spends under anesthesia, and leads to quicker specimen diagnosis.
Additionally, pathologists specializing in specific diseases who are located at different campuses can be remotely consulted, providing a second opinion when necessary. Many ORs now have high-quality medical-grade displays permanently suspended around the surgical table for telehealth visualization with a consulting specialist, pathologist, or surgical team, while pathology labs may house microscopes that can transmit images directly to the OR.
7. Surgery education and training
The imaging produced from CT and MRI scans can now be integrated through computer software to generate a three-dimensional view of internal organs. The use of this 3-D video provides excellent virtual reality representations of anatomical features that guide surgeons as they make incisions, supporting minimally invasive surgery—a dramatic change from traditional approaches that required large surgical openings (sometimes larger than the organ itself) to reach the surgical location. These techniques can’t even be seen at the surgical table and are viewed on displays in the OR. This footage can also be streamed to other displays and computers or shared over an intranet, allowing it to also be used for medical training. Medical students now have more access to active cases that are rare and occurring in another location, without having to travel to be physically present.
A new world
Trends like IP convergence are enabling significant changes in the provision of healthcare services. Technology is facilitating more and faster communication between providers and patients, creating efficiencies in record-keeping, diagnosis, and treatment.
For example, with the assistance of a bedside nurse conducting an exam, an off-site physician can now view ultrasound images, listen to a patient’s heartbeat, or examine someone’s overall condition. Patients can now easily connect with an urgent care clinic via phones or mobile devices, allowing them to avoid in-person visits for minor injuries or illnesses, such as coughs, colds, bumps, and bruises.
Such advancements will require new ways of programming space to support necessary technologies, and could even create efficiencies that allow providers to introduce more revenue-generating services. It’s important that design partners are aware of these changes as they occur, to best serve clients in this technological world.
Steven Juett is senior associate vice president, clinical systems planner, at CallisonRTKL (Dallas). He can be reached at firstname.lastname@example.org. Darren Vican is vice president, service leader, global technology solutions, at CallisonRTKL (Washington, D.C.). He can be reached at email@example.com.