April’s This Month in Telemedicine by the American Telemedicine Association, hosted as always by Jonathan Linkous, Chief Executive Officer, and Gary Capistrant, Senior Director of Public Policy discussed state and federal updates, collaborations, and quality assurance.

State Licensure Remains a Hot Topic
Gary Capistrant went over the basic situation of licensure, including a proposal that would let Medicare recipients to (virtually) cross state lines for care but would impose a requirement that the patient and doctor have a previous relationship, i.e. an initial consultation in person has to occur. While some states do allow that a legitimate patient-doctor relationship can be established via video, this proposal does not recognize that and could be a “step backward” for telemedicine, plus require states to enforce a prior relationship where they hadn’t done so before.

“In terms of our principles on licensure, we want to be regulated the same as in-person services, not held to a higher standard or a lower standard,” said Capistrant. The ATA has set up a petition. Also, some states are deciding that telemedicine needs regulating but are doing so by treating it as a separate health service, even though telemedicine was already active under the current medical regulations.

State Activity
Three states have enacted full parity with private insurance: Mississippi, plus Medicaid and state employee benefits; Montana, including parity with private; and New Mexico. Connecticut and Missouri passed parity bills in Senate, which are now moving to their respective Houses. New York recently introduced a parity bill, and Ohio will soon follow suit.

ATA is finalizing state best practices guidelines for home telemedicine and remote monitoring, and in the works: school-based care, telemental health, and more.

Federal Action
A workgroup was recently announced, a joint effort between the FDA, FCC, and Office of National Coordinator. A report is due in January 2014 examining the overlap of some issues that are overseen by the various agencies, including consumer health devices, electronic health records, and clinical decision support.

“It’s a little bit of a mess right now in terms of the regulation and one of the reasons they have this is group is because there’s a little bit of uncertainty amongst the different agencies over who’s taking the lead on what,” explains Linkous.

Quality Assurance
A big area of activity for ATA is quality assurance, which, although it’s flown under the radar somewhat, is getting plenty of attention now. ATA’s next board meeting will see the approval of the organization’s practice guidelines for online video-based telemental health. “A very important role for ATA is to weigh in and try to get some meaning and some semblance of order to what’s happening,” says Linkous.

ATA’s board has also approved the move towards ATA becoming an accrediting body with the end goal of becoming a reliable information source for consumers. They’re also involved with some trade associations to improve consumer awareness. Linkous: “It’s important that consumers know that if you’re not getting access to telemedicine, you could and you should and you need to ask your doctor about it.”

Next year, look for a cohesive effort by patient and consumer groups to expand telemedicine, including physician communications, consultations, lab results, etc., which should all be accessible online by patients.

The Q&A: A Selection of Questions Asked & Answered

Q: Define telemedicine, telemedicine, etc.

A: I think we should come up with a contest to see who can come up with the most names that relate to telmedicine. E-consults, e-health, telemedicine, telecare, e-care, telepractice, remote care. About 6 or 7 years ago we had a board meeting in Chicago and we talked about changing the name of the ATA. We talked about what we should change it to…we spent about 3 hours of the board meeting [discussing this] so at the end, we just threw our hands up in the air and left it as it is.

We define telemedicine very broadly as providing healthcare to patients or consumers using telecommunications.

Q: How can companies assist ATA in the process of getting legislation passed?

A: ATA has a Circle Membership and Industry Council and we have corporate members representing anything from large, multi-national, multi-billion dollar companies to a small ma and pa [businesses], but all of them have a stake in this. And if there’s a large corporation that has a Washington office with a staff of people who are full-time policy people, yes, please let them get in touch with us. We’d love to talk with them about what they do. Or if you’re an organization that has a consultant online who does work in Washington, or if you’re a small company in another state and you have an area representative…it’s important that you get very active…There’s always things to do at the state level.

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

“This call may be monitored for quality assurance.”

How many times have you heard that throughout your life? The reality is, as technology continues to change at a rapid pace, the way we communicate with our vendors and service provides is rather primitive. When the cable bill arrives with the wrong charges (surely that never happens!), one has to pick-up the phone only to wait on hold for twenty minutes to ultimately get a resolution. Or maybe a recent purchase for a child warrants some technical support; again a phone call and wait time must be endured. At the same time, it can be very difficult to explain a problem to a support agent by merely describing it.

For years, there has been talk about moving video technology into a business to consumer world. But, what does this mean? Simply, customers could connect to the very same contact center they call now, but speak to the appropriate agent via video. The advantages of this are significant! Suddenly, all customer service interactions would benefit from everything video conferencing has to offer. The agent can work with the customer and gain a better idea of their understanding of a particular topic. Second, the customer can point the camera at the item being discussed (extra parts to a new toy that don’t seem to have a use) and immediately give the agent better insight into the issue. Finally, video could put a more personal face on what can seem like a very impersonal interaction.

While video contact centers have been a topic of discussion for a while, why is now any different? There is a convergence of several key market and technology trends that could make this idea a reality.

The Proliferation of Video, Everywhere
Video is truly everywhere. Consumers are already accustomed to communicating with family and friends over video. Whether it is via a social network, Skype, or another service, video has truly gone main stream. At the same time, many people are used to going to work and using video as a tool to complete assigned projects and tasks.

Mobile Devices
The explosive growth of mobile devices, such as smart phones and tables, has put multiple video enabled devices into nearly everyone’s pockets. A user can grab their phone and make a video call just as easily as a voice call. These devices have not only helped make video ubiquitous, they have also made video far more accessible than ever imagined.

Advanced Contact Center Technology
Even though most customer service interactions have been limited to voice, the technology driving these connections is rather advanced. Many organizations had implemented technology that allows them to hire the most talented support agents and place them anywhere. In addition, these solutions are able to route calls intelligently to both an available agent and the most skilled agent for the issue at hand. Customers have become far savvier and do not accept being transferred multiple times. Technology has helped route customers to the right person at the right time.

WebRTC
WebRTC has been discussed many times on this blog and the technology is one of the main catalysts of the video contact center. If a user requires help, the desire to spend 15-20 minutes downloading an application to their computer or smartphone is nonexistent. With WebRTC, one click could immediately initiate a video call right in their browser. With no downloads needed, the customer would get near immediate access. Unfortunately, there is no technology that can eliminate wait times completely!

As all of these elements come together, the promise of the video contact center is very real. The ultimate question comes down to the customers themselves. Will they embrace this type of interaction and will they push the vendors they do business with to implement this technology? What do you think? Would you welcome the opportunity to get support via video?

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.

The ABA TECHSHOW is taking place April 4-6, 2013 in the Windy City (Chicago, IL). Visit us at booth #614!

IVCi is partnering with Blue Jeans Network to showcase how video collaboration solutions can help law firms meet today’s legal challenges, such as geographically dispersed clients and timely access to subject matter experts, while helping minimize expenses.

In a previous article, we discussed how firms can use video to build client relationships, as well as, manage their ever growing case load by keeping in touch with traveling clients effortlessly through video enabled smartphones or tablets. Additionally, firms can use video conferencing to depose remote witnesses or interview difficult to reach subject matter experts without the time and cost associated with business travel.

Firms can also use video conferencing solutions to attract and retain top associates. Partners can interview potential candidates remotely so that only the most qualified candidates are brought in for further discussion. Plus, law firms can help differentiate themselves by utilizing the latest technology and making the firm more attractive to new recruits.

Additionally, partners and associates can attend meetings with remote offices and confer on any range of topics that would typically be discussed in a face-to-face environment.  Plus, attorneys can attend classes and seminars over video as part of distance learning courses to satisfy CLE requirements. This frees up valuable time and resources by avoiding travel to various firm or seminar locations.

Stop by our booth at ABA TECHSHOW for a demonstration and learn how video collaboration solutions can help your firm. Click here for registration information.

Additional Resources:
Video Conferencing Hits Legal Age

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.