Author Archives: Adam Kaiser

This Month in Telemedicine – March 2013

April 4th, 2013 | Posted by Adam Kaiser in Healthcare | Video Conferencing - (0 Comments)

This month’s telemedicine videocast from the American Telemedicine Association focused on a major change in the population tabulation that directly affects telemedicine reimbursement, as discussed by ATA’s CEO Jonathan Linkous and Gary Capistrant, senior director of public policy.

Federal Policy Changes & Activity
The hot topic was the re-designation of many counties from rural to metropolitan, which resulted in the loss of Medicare telehealth reimbursement. Due to a change to the Standard Metropolitan Statistical Areas, 97 counties newly designated as “urban” will lose reimbursement privileges because Medicare reimbursement for telehealth services is not available to populations in metropolitan areas. On the other hand, 28 counties will gain coverage because they are now designated rural.

While this is a setback for telemedicine and Linkous proposed two ways to deal with the situation: the first, to grandfather in counties that have been redefined as metropolitan; the second is to expand Medicare reimbursement for urban populations. “This really shows the need to do that,” said Linkous.

Also mentioned was the F.I.T.T bill (Fostering Independence Through Technology), which is sponsored by South Dakota Democratic Senator John Thune and Minnesota Democratic Senator Amy Klobuchar. The bill aims to establish a pilot program for home health agencies serving rural communities to use remote patient monitoring.

Capistrant and Linkous also discussed FDA regulations about medical devices, licensure and interstate health commerce, and the need to coordinate the various roles that the federal government plays in healthcare. Linkous points out the very real potential for backlogs—the FDA, Linkous says, has received 100 or so applications but can only process 20 a year.

“The good thing is there’s a lot of innovation in mobile health. The bad is it’s taking a long time to get through regulation, and, number two, you can’t get paid for it.” - Jonathan Linkous, CEO American Telemedicine Association

State Activity
They also discussed the ongoing issue of licensure, and the burden acquiring multiple state licenses places on telehealth providers. The Federation of State Medical Boards is proposing a form of state reciprocity but, Linkous points out, getting all the states on board could take a long time—a decade or more. He offered the example of the nursing compact, which was started 15 years ago and less than half the states have signed on to date. (The ATA has not endorsed any one approach).

Big Med Developments
Larger healthcare systems are seeing the potential business benefits of telehealth, and are looking to expand their footprint and brand by providing more services to a larger population. Linkous gave the example of the Mayo Clinic Care Network, an affiliation program. They have a goal of reaching 200 million patients by 2020, through both their own hospitals and the affiliation network by using “e-consults”, i.e. telemedicine. Cleveland Clinic also has an affiliate program. “It’s an interesting contest,” says Linkous, noting this is a business decision and cost-reduction tool. Mercy Healthcare is using telehealth for a broad range of services, including stroke, autism, and cardiac care, and they’ll soon be breaking ground for a virtual healthcare center which will house subspecialists and a teaching facility at their headquarters outside of St. Louis.

New Online Education
ATA will be launching an education service on their website with webinars, videocasts, and online courses, with many continuing medical education accredited. The organization is looking to develop a major educational center—online, of course—for telemedicine providers.

Annual Meeting
ATA’s annual meeting will be held in Austin, Texas, from May 5 to 7. For a free exhibit hall pass, click here to register and enter  the code VIPcomp13.

The next This Month in Telemedicine videocast is on April 23.

Enterprise Connect 2013 has come to a close and what an event it was. This was IVCi’s first year attending and exhibiting at the show and it was a fantastic experience that provided many opportunities for us to connect with our current customers as well as future prospects. In addition, the opportunity to see the latest technology and offerings from our partners was great. The event was jam-packed with great sessions, keynotes, exhibitors, attendees and more. Here is an overview of some of the key takeaways and messages from the event.

WebRTC
WebRTC (as previously covered here on Collaboration Insight) is a new browser based protocol that allows for real-time voice and video communication to occur right inside a web browser. WebRTC has gotten to be so big; the conference dedicated an entire track to the topic and every session was full. The reality of WebRTC is that not all browsers currently support it (only Google Chrome and the developer builds of Firefox) but the potential for it is endless.

At the end of the day, WebRTC will enable any browser to be a video client or endpoint on a communications network. In Cisco’s keynote, the example of a shopper on a website was used. They were looking for accessories and information on a his store  purchases. They simply clicked a link and a video session was initiated with an expert back in a video call center. No wait to download a client and no security issues with the install; it simply happened in the browser. When the standard is ratified and included in all browsers, the potential will be limitless! Cisco demoed a Jabber client built entirely in the browser, contact center agents could access their voice services right within the browser and more. It has to the potential to breakdown interoperability issues and extend enterprise collaboration to an organization’s customers.

Unified Communications
Frost and Sullivan presented a session at the conference in which they defined unified communications as “an integrated set of voice, data and video communications applications, all of which leverage PC- and telephony-based presence information.” UC was in full force at the conference with all major players showing their latest innovations. Both Cisco and Microsoft came with their entire vision. Microsoft presented their total solution from mobile devices (Android, iOS, Windows Phone) to tablets (Surface, iPad) to desktops and even room systems. The solution was elegant and worked as advertised. Microsoft has been pitching this vision for a while and it was great to see it fully realized. At the same time, Cisco showcased their Jabber solution which offers interoperability across all platforms and seamlessly integrates voice, video, data sharing, and more.

The key takeaway about UC is that the technology is very real and organizations are definitely implementing or looking to implement it in their current short term roadmap. Voice, video, and everything in between have converged!

The Cloud and Mobility
There was not a session that didn’t include a discussion around how cloud delivery and mobile devices would influence employees and technology. Even sitting in the sessions themselves one could see dozens of attendees taking notes on their iPads, checking email, and ultimately staying connected. The discussion of cloud, however, must be secondary. The user of the technology, how it can impact user productivity must be first. How it is delivered (on-premise, cloud, etc) is a decision that comes after.

Business Case
Perhaps the most exciting trend seen at Enterprise Connect was a focus on making the business case for the technology being presented. Certainly there was a large amount of discussion around the technology itself, the features, etc. But in many of the sessions, the business case for collaboration technology was continually presented. Some of the key messaging was around how these technologies can help move a business forward and help fulfill strategic goals. Additionally, simply deploying technology does not equal success. Organizations must see widespread adoption and employee satisfaction to really judge if the technology implementation was a success.

This Month in Telemedicine – February 2013

March 11th, 2013 | Posted by Adam Kaiser in Healthcare | Video Conferencing - (0 Comments)

This Month in Telemedicine

Each month, the American Telemedicine Association broadcasts This Month in Telemedicine, a webcast discussing news and topics in the telemedicine field. February’s webcast featured ATA’s Jonathan Linkous, Chief Executive Officer, and Gary Capistrant, Senior Director of Public Policy, discussing the growth of telemedicine and policy issues.

A deluge of demand, a raft of pending legislation, and licensing challenges—these are a only a few of the issues facing telemedicine.

Activity:
Telemedicine is undergoing an “explosion of activity,” says Linkous. The ATA estimates 10 million patients in the U.S. and Canada are now using telemedicine (the majority for radiology). Two trends he’s seeing: the involvement of patient groups, who are showing interesting and researching how telemedicine could be employed by their members, and the growth of “big med” across the country.

The ATA is anticipating the demand will only grow—possibly reaching 50 million patients in the next couple of years. The question is whether providers, telemedicine networks, and vendors will be able to meet the growing need for telemedicine services. Linkous calls this, “A serious issue we need to focus on.”

New Developments:
“We’re moving away from the fee-for-service model,” says Linkous. “We’re moving to managed care, accountable care, medical homes.” This is good news for telemedicine, he says.

New developments in telemedicine include specialty service providers—a group that’s appeared in the past couple of years. To help track this growth, ATA created a new service provider forum of private companies that provide direct services to patients.

Also, a few major companies are offering online consultations, including American Well and TelaDoc. And insurance plans are also expressing interest in the potential of telemedicine. Several major plans now reimburse patients for online consultations, but only in a few states so far. Some are offering the service as an add-on to traditional care for an additional fee. However, while patients can get prescriptions online, they won’t for controlled substances, in compliance with federal law. “You will not see that done,” says Linkous.

Issues:
With health care reform becoming a reality, a large number of people are expected to be added to Medicaid, and states don’t know how they’re going to accommodate the increase in Medicaid demand. The ATA sees telemedicine as an answer to that problem.

A big issue with telemedicine is licensing. Each state has its own licensing board. About 22% of doctors have licenses in more than one state, and the ATA estimates this costs $300 million per annum, paid to states for 2nd, 3rd, and 4th licenses. They’re looking to the model established by the Department of Defense and approved by Congress last year—their doctors only need to be licensed in one state. Several states have proposals to follow the D.O.D.’s lead, but that’s a cause for consternation for the medical boards, who are looking at a major loss of income if this licensing model is actually established nationwide.

For health systems and private companies that are telemedicine focused, health care provider licensing is a subject they’re following closely. “There are concerns that an agreement requiring approval by each state could mean years of delay,” says Linkous.

California Congressman Mike Thomas introduced a bill (The Telehealth Promotion Act) with the aim of increasing federal acceptance of telemedicine, which would include Medicaid, the V.A. medical system, and other federal health programs. The licensing model proposed with this bill is one where health care providers need only be licensed in their own state, and the patient’s location would be deemed irrelevant.

Policy & Legislation:
“We’ve never had so many bills introduced at state level,” says Gary Capistrant. There are 13 states plus D.C. that have legislation pending to mandate private insurance coverage of telemedicine services (15 states already have this as law). 11 states are expanding Medicaid coverage to ensure parity with in-person health care. He suggested the Thompson Bill might be segmented to smooth the commitment process.

States:
As of March 1st, 2013, California, Texas, and Vermont are the only states that have legislation for both private and Medicaid coverage; 14 other states have a legislated mandate for private coverage, and only Pennsylvania and Nebraska have it for Medicaid. But 24 states have proposals on the table for either are both. You can see the full list here. To help track state telemedicine information and changes, the ATA has set up atawiki.org—click on Current Events, or type in a state in the search box for the latest info.

 

The Yahoo! Fall-Out

March 7th, 2013 | Posted by Adam Kaiser in Collaboration | Industry News - (0 Comments)

The Yahoo! Fall-Out

Ever since Marissa Mayer, CEO of Yahoo! issued her memo calling back remote workers into the office and effectively ending telecommuting within the organization, countless stories and commentaries have been written. These responses have spanned from total disagreement to downright endorsement of the new employment practice.

The interesting thing about the announcement is that it appears to have started to influence other organizations to act the same. Just this week, Best Buy announced that they too would be ending their work from home program. This is particularly noteworthy because Best Buy’s initiative (announced in 2006 and called the Results Only Work Environment (ROWE)) was seen as a trendsetting program and applauded by many HR advocates.

In the case of Best Buy, the change in policy is not as stringent. Managers still have discretion to allow telecommuting but the employees can no longer make that decision. The question now is two-fold: will more companies follow suit and is this the right decision for a company to make?

Mayer noted, “To become the absolute best place to work, communication and collaboration will be important, so we need to be working side-by-side.”

To really understand if this is the “right” decision; let’s take a look at the different types of collaboration that occurs within an organization on a daily basis:

Spontaneous Collaboration:
This method of collaboration occurs when team members run into each other in the hallway and strike up a conversation or perhaps in the cafeteria grabbing a cup of coffee. There is nothing formal about it and it can happen in an instant.

Deliberate Collaboration:
With deliberate collaboration, teams may schedule a time for everyone to get into a conference room and hash out an important idea or project. This might be accompanied by white boarding or some other form of facilitated brainstorming.

Formal Collaboration:
Formal collaboration involves a scheduled meeting with a formal presentation structure. This could be a business review or strategy overview. The major difference between deliberate collaboration and formal collaboration is the presence of a formalized agenda with specific content to be presented.

When reviewing the three collaboration types noted above, what do you lose when your workforce is remote? Spontaneous collaboration is the victim here, at least to an extent. When workers are remote, they are not running into each other randomly and striking up conversations.

All is not lost, however, as many organizations who have implemented collaboration technologies, such as video conferencing, have installed “water cooler” systems that allow remote employees to connect in at will and see what’s going on. While this may not be as spontaneous as being there, it gets remote workers pretty close.

When looking at deliberate and formal collaboration, much of what occurs in these meetings can be recreated with remote workers. Formal collaboration sessions can easily connect in remote team members to view the formal presentation or even present themselves. Technology now makes it possible to easily present, no matter where you are. With deliberate collaboration, remote participants can view white boarding sessions and be involved in the brain storming process. Again this is possible thanks to the latest developments in cloud and collaboration technologies.

Whether the Yahoo! decision was the right call remains to be seen, but other organizations should examine the different types of collaboration that occur within their facilities and see what is most pervasive. Ultimately, it may be about both a technology solution and a people solution.

Learning the Cloud Way – Part I

March 4th, 2013 | Posted by Adam Kaiser in Cloud Services | Education - (0 Comments)

As cloud services pick up speed in the private sector, questions about security, cost savings, implementation and best-practice models have emerged in concert with its rapid growth and adoption. But are institutions of higher learning following suit? Cambridge, MA-based Forrester Consulting turned their focus on 12 universities in the U.S., the U.K., Australia, India, and New Zealand, surveying CIOs and IT directors for their July 2012 report “Cloud Bursts Into Higher Education.”

They found out how and why these schools are employing the cloud; plus they give some suggestions as to where the partnership between higher education and the cloud is headed.

So, how is Higher Ed approaching cloud services?

The Forrester study found that universities are adopting cloud services to boost productivity, and speed, budget, and scalability were the top three features university interviewees valued most about cloud services. But the study uncovered an interesting dynamic: professors and department staff are leading the way with cloud services at their universities, implementing cloud applications as needed, and circumventing the IT department. One side benefit of this autonomy is that IT departments can then focus their resources on other, critical IT tasks.

Echoing concerns coming from the private sector, universities are concerned about security. In fact, the report states “security is the No. 1 roadblock to cloud service adoption.” For schools, the two primary concerns are keeping research (intellectual property) and private student information confidential and secure.

The most common cloud adoption right now is the private cloud, with many of these schools keeping private information, like emails and research, on their private cloud, and “student-related information” on the schools’ servers. The report does note, however, that hybrid clouds are in use, and expected to increase. Additionally, as academic institutions partner up to offer expanded learning experiences, often online, expect to see a growth in the use of community clouds for sharing research and course materials.

Lastly, schools are looking to the cloud for cost savings; however, as cloud usage goes up so do costs. While several interviewees claimed significant cost savings with adoption of various cloud models, in one example the “expanded use of the services over three to seven years raised the cost of SaaS to nearly even with the cost of a perpetual license and on-premises deployment.” In other words, as academic staff and students become more familiar and comfortable with using cloud services, related costs increase, thereby erasing some of the gains.

Related Articles:
Learning the Cloud Way – Part II