Telehealth Equipment Enabling Successful Telehealth Encounters

1. Telehealth Equipment Enabling Successful Telehealth Encounters Endpoints, Protocols, Networks, Peripherals

2. Technology that Enables Telehealth Telehealth equipment can be defined into 4 categories. • Endpoints - video conferencing devices • Infrastructure - gatekeepers, bridges, recording devices, gateways, portals, provisioning servers • Networks – routers, firewalls, web content filters, data circuits, wireless networks • Peripherals – stethoscopes, exam cameras, spirometers, otoscopes

3. Before you consider purchasing equipment • You must know what protocol or protocols you will be using. Standard protocols are best. Who will you be communicating with? What endpoints or equipment are being used on the far end? What protocols are being used? Common Protocols • H.323 is a recommendation from the ITU telecommunication Standards Committee that defines the protocols that provide audio visual communications on packet based networks • Session Initiation Protocol (SIP)is a signaling protocol widely used for controlling multimedia communications sessions such as voice and video calls on IP networks. • Scalable Video Coding (SVC) is the name for the subset of the H.264 video compression standard that standardizes the encoding of high quality video • Successful telehealth encounters require compatible protocols or specialized equipment which translates protocols.

4. Endpoints aka Codecs • An endpoint, often called a codec, is a standalone device that can make and receive video calls. The term codec refers to the devices ability to encode and decode audio and video packets. • The best way to think about a codec is a telephone with the ability to do video. Endpoints come in many shapes and sizes. Some may be small enough to put on your desk and have their camera, speakers and screen all integrated in to one stand-alone device. Other endpoints are designed to be integrated into conference and classroom scenarios, with TVs, cameras and microphone spread throughout the room.

5. Hardware versus Software Codecs • There are 2 basic types of codecs • Hardware codecs – Hardware appliances with dedicated, processors, video cards and inputs designed for video conferencing applications. *Recent technology changes allow for some of these devices to be operated in a virtual server environment • Software codecs – Software that is installed on a device such as a tablet, PC or laptop computer. Software codecs utilizes the PC’s hardware resources to encode and decode audio and video packets.

6. Hardware Codec Advantages and Disadvantages • Hardware codecs • Conference room or telepresence systems and desktop systems • Pros Dedicated equipment with the resources that are designed for high definition video conferencing. Codecs with the appropriate number of inputs for multiple displays, cameras, microphones, amplifiers and content sharing • Cons Cost can be significant. Hardware codecs with multiple camera and microphone inputs can cost upwards of $15,000 to $20,000. Mobile cart based systems can cost in excess of $40,000 • Immersive telepresence units are large room based systems that can cost over $100,000

9. Software Codec Advantages and Disadvantages • Software codecs • Video conferencing software that is installed on PC’s tablets or smartphones • Pros Easy to deployand upgrade. Uses centrally managed infrastructure for account administration, automated provisioning lowers cost per deployment. • Cons Dependent on the processor, memory and video resources of the tablet, PC or laptop. May have limited functionalityif using tablet or smartphone versions. Requires additional infrastructure to provision and manage accounts.

10. Software Codecs and Device Apps

11. Telehealth Infrastructure Telehealth infrastructure: The critical components of a video based network that enable endpoint device registrations, route video traffic, traverse firewalls, provision endpoints, provide device and user directories and log call statistics. Infrastructure components include: Gatekeepers. Gateways Multipoint Conference Units (MCU or Bridge) Recording Devices Telepresence Management Servers Portals

12. MUSC’s Telehealth Infrastructure

13. Telehealth @ Home • New protocols enable home based telehealthprograms.Scalable Video Coding (SVC) and Real Time Communications (RTC) are enabling video to the home by addressing low bandwidth and technology support issues. • The home telehealth market is growing @ 3. 6 % annually • Industry growth has been fostered by an aging population, the prevalence of chronic disease, strengthening physician acceptance of home care and a continued movement toward cost-efficient treatment options from public and private payers. • EVIDENCE OF OUTCOMES IN HOME TELEHEALTH The Veterans Health Administration has found that an enterprise-wide home telehealthsystem is an appropriate and cost-effective means of managing chronic care patients in both urban and rural settings. Studies that compared data from the year before entering the program and six months post-enrollment show a 25 percent reduction in bed days of care, a 20 percent reduction in number of admissions, and a mean satisfaction score rating of 86 percent.

14. MUSC SVC protocol Infrastructure

15. New Browser based Video From Wikipedia, Real-time communication (RTC) is a new integrated communication medium designed to permit users to exchange multimedia content in real time. It is adopted by major browsers like Internet Explorer, Google Chrome, Firefox and Opera. Primarily designed to simplify and standardize the way we communicate. Has great potential to enable the delivery of home healthcare.

16. New Video Protocols = more choices • Recent advances in the development and refinement of protocols is resulting in significant changes to video conferencing and telehealth technologies. • Newer lightweight clients that require less bandwidth are rapidly changing the market • Browser based Telehealth is starting to impact the home healthcare sector.

17. Telehealth Peripherals • Integrated electronic medical peripheralsthat utilize live audio, video and network communications to enable remote health care. • A large percentage of telemedicine peripherals use videoconferencing systems for data transport. Many telemedicine environments are now looking towards newer solutions that gather and distribute patient medical information in real time and independent of videoconferencing networks. These solutions are used to transmit telehealth peripheral data as well as electronic medical records and images.

18. Networks The backbone of successful telehealth encounters • Successful high definition telehealth encounters can use up to 4 mbps of bandwidth per call • Appropriate and available network bandwidth is a fundamental requirement for successful programs • Competition for bandwidth results in poor call quality and or dropped calls • Telehealth programs require low network latency and available bandwidth • The use of private networks versus Internet connections is desired • The use of PSPN is highly recommended. • The use of private networksand encryption enables secure communications which meets regulatory and compliance efforts. • Private networks help protect our programs, care providers and patients by decreasing risks.

19. The biggest challenge in delivering successful telehealth encounters to rural sites.