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.

A couple of weeks ago I had the opportunity to sit in on a NASA Digital Learning Network program with a fourth grade class that ironically was located about fifteen minutes away from me.  Scott Anderson, a DLN Coordinator at NASA Marshall Space Flight Center, taught a module about Toys in Space. The program focuses on forces and motion and consists of an investigation of what toys will work in a microgravity environment (such as space).

Did you know that a boomerang actually works in space? It’s because the looping path a boomerang follows is actually the result of the uneven forces exerted by the air they travel through and not the influence of gravity.

For each segment, a short video of an astronaut using a toy, such as a jump rope, is shown to the class. After the video, the instructor gave a brief explanation as to why the toy did or did not work in space. In the jump rope’s case it is because of the law of motion; an object in motion will stay in motion until something (usually gravity) causes it to stop.

The instructor then poses the question to the class, what could be done to modify the toy to perform better in space? After a flurry of raised hands, the teacher selects a few students to answer the question. My favorite answer for the jump rope was magnet boots. When you jump up the magnets pull you back down similar to gravity (smart fourth grader!).

After the lesson is completed, the students have the opportunity to ask questions about the lesson or NASA programs.  For example, what animal has gone into space the most? The answer is the squirrel monkey although France did send a cat into space one time.

Overall, the program was extremely interesting and the kids were well behaved and actively engaged.  I learned a lot of interesting tidbits so I imagine the children learned a lot from the class as well.  It’s great to take a break from typical lessons and learning channels (or work day) and learn something new!

Watch the below video for a sample of one of NASA’s DLN programs where they connect Mission Control with students in Georgia.

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.

 

With the technology used in telepsychiatry becoming more reliable, inexpensive, and ubiquitous, there has been a corresponding increase in mental health professionals who are turning to remote treatments. In fact, psychiatry has been at the forefront of telemedicine use.

The general consensus thus far is that telepsychiatry is particularly useful for rural populations, children, the military, and those in institutions like prisons. In other words, telepsychiatry reaches people who otherwise wouldn’t have access to mental health services. (There is a severe shortage of child and adolescent psychiatrists). Telepsychiatry can also lessen some of the barriers often cited to obtaining mental health treatment, including cultural, shame, cost, and distance.

Many states, often in conjunction with state university medical and public health departments, have recently initiated telepsychiatry programs. The South Carolina Department of Mental Health established a program in 2007 to provide telepsychiatry in state hospital emergency departments. Also in 2007, University of Alabama’s College of Community of Health Sciences joined the Alabama Department of Mental Health (and others) to launch a telepsychiatry program, focusing on rural populations. New York State’s Office of Mental Health runs the New York Consultation and Telepsychiatry Program (NYCaT) aimed at children, and last fall West Virginia University’s WVU Healthcare received a government grant that will cover four years of telepsychiatry programs for an addiction treatment clinic. The Centers for American Indian and Alaska Native Health at the Colorado School of Public Health also run a telehealth program that includes mental health services.

That’s just a handful of examples, but they demonstrate the range of applications and growth of telepsychiatry. While the interest and investment is there, acceptance is by no means guaranteed. Here are five potential obstacles to telepsychiatry adoption.

Cost: States vary greatly in their definitions, approach, and regulation to telehealth (or telemedicine) according to a recent report from the Center for Connected Health Policy, State Telehealth Laws and Reimbursement Policies. While the majority of states reimburse telehealth through Medicaid; some do not, including Connecticut, Iowa, Massachusetts, New Hampshire, New Jersey, and Rhode Island, plus the District of Columbia. Amongst those that do reimburse, there is a wide range of what and who is reimbursed, and when.

Privacy: “Increased video-conferencing over public networks also creates the potential for unauthorized access to protected health information.” This is from a recent article in Current Psychiatry. The authors’ recommendations: use VPNs and encryption; train health professions in data storage and telemedicine ethics.

Legal: A provider must be licensed in every state they provide care. So a health care provider in one state that is conducting a telepsychiatry session with a client in another means they must be licensed in both states. There are 9 states, however, where the medical boards have instituted special telehealth certifications. As telemedicine becomes more common, look for this issue to become a hot topic.

Habits: Old habits die hard, and not every mental health care provider sees the value of telepsychiatry, or wants to invest the resources in training and adopting new modes of treatment. A study by the California HealthCare Foundation, which focused on telepsychiatry adoption in 7 emergency departments, found that in every case, there were initial problems getting support from involved parties, including doctors, nurses, and psychiatrists. From the study: “Some of the spoke sites felt that they had neither the time nor the energy to devote to telemedicine efforts.”

Lack of training or incorrect training: “Training is critical,” writes Mark Vanderwerf in his chapter Ten Critical Steps for a Successful Telemedicine Program. He recommends “layered” training, that is, training presented in progressive stages, and it should be formal to increase its perceived value. For the first level, he suggests course materials, a syllabus, registration, and testing, and even a certificate awarded to those who pass the course. The second layer includes on-site evaluations, and the third includes support and “refresher sessions.”

Boeing’s much anticipated 787 Dreamliner encountered a laundry list of problems which eventually led to the grounding of many of the planes. There are several different theories as to what went wrong and Boeing could have done better. Many have to do with the decision to embrace outsourcing and overall lack of supply chain management.

In a recent Forbes article, Jonathan Salem Baskin is quoted “It didn’t help that the outsourcing plan included skipping the detailed blueprints the company would have normally prepared, and allowing vendors to come up with their own. Delivered components arrived with instructions and notes written in Chinese, Italian, and other languages.”

With the plethora of video conferencing and visual collaboration technologies available it’s surprising that Boeing had this many issues coordinating and communicating with their remote teams. While we can’t know for sure exactly what went wrong or what Boeing did or did not do; we can offer some suggestions as to how organizations can utilize collaboration solutions to their fullest extend and help ensure a seamless supply chain.

A UC solution is a must to connect internal team members assigned to the project. These solutions can even allow approved external team members, such as suppliers, to connect easily. Features such as instant messaging (IM), screen and document sharing, and video conferencing are key components to keeping the lines of communication open. For example, if a supplier has a quick question about the design, he can quickly IM a team member asking the question or if the person is available for a quick chat. Quick video conferences or even formal meetings with video and document sharing can help ensure consistency and reliability among suppliers.

For more crucial aspects of the manufacturing process, such as discussing blueprints and inspecting components, an immersive visual collaboration solution that includes Datapresence (ability to see multiple sources of data) is necessary. Simply showing a single document while the video participants are minimized on screen will not provide the collaboration experience necessary for such critical aspects of the manufacturing process.

Solutions like Oblong or Cyviz combine video conferencing with the ability to share multiple steams of data in real time creating a true collaboration environment. Team members would be able to see detailed designs and prototypes of the outsourced components in addition to the supplier’s team. Both teams would then be able to communicate, give and receive feedback, and discuss any potential issues. By repeating this process with all suppliers, the organization can help ensure consistency among components. They can also connect and facilitate collaboration between the supplier of Component A which connects into Component B from a separate supplier.

Supply chain management is one of the most complicated aspects of any organization as it relies heavily on communication and coordination between two or more parties. By underestimating the importance of communication, an organization can run into problems similar to the ones Boeing faced. On the other hand, by providing both internal and external (supplier) team members with the tools and opportunity to effectively communicate and collaborate and organization can successfully manage all aspects of its supply chain.