Perhaps a shift really is happening in healthcare. Until now, healthcare—the industry most in need of fast, knowledgeable decisions—has been hamstrung by a critical need to also keep protected health information (PHI) safe for patients. Now two emerging trends and one fringe benefit are poised to transform health care.
The first shift is the emergence of telehealth. Instant messaging and video conferencing that are HIPAA compliant now allow clinicians and medical staff to interact with patients and each other rapidly, sharing necessary information to advance care decisions quickly. This can ultimately deliver faster and easier care for all patients, especially those who have difficulty traveling to care facilities.
The second shift is the steadily growing use of the Internet of Things (IoT). Through integrating technology like sensors, video conferencing, and data collection tools, medical professionals are able to perform better remote monitoring of patients, with alerts when vital signals fall outside a normal, tested range.
Dave Hennessy, Director of IT for Metrocare Services, a not-for-profit organization that serves more than 50,000 people annually across Dallas county, Texas, found that when he started at Metrocare in 2014, security issues were impacting care abilities. “Due to our concerns about HIPAA compliance, we had policies that made it difficult for employees to get email when they weren’t on our network,” he explains. Soon after joining Metrocare, Hennessy saw that a cloud technology option appeared to deliver sufficient security, while allowing the facility to leverage digital communications to revolutionize interactions with patients and staff. The solution happened to be Microsoft’s Office 365 suite.
The aforementioned fringe benefit is cost savings. Hennessy found that a $90,000/year encryption software Metrocare was using was rendered unnecessary by Office 365, so it was eliminated from the budget. The more impactful advancement, however, is Metrocare’s ability to perform telehealth services.
Fast, Compliant Telehealth Capabilities
Digital communications like instant messaging and video conferencing in Skype for Business allow medical staff to deliver fast responses to patients. Using the presence functionality in Skype, front-desk staff can see who’s available—nurses, specialists or staff in the financial department—to quickly answer patient questions. They also use instant messages to alert clinicians when patients arrive. Skype’s video conferencing abilities also enable easier collaboration for dispersed groups. “I recently spoke with one employee who had to drive two hours every week for a standing meeting,” Hennessy shares. After using Skype to join the meeting, the employee reports higher productivity from no longer needing a two-hour trip to join important conversations. Additionally, in instances where hospital staff aren’t pulled off-site, the time they would have spent traveling is now made available to patients on-site, or on Skype. “We’ll have a telemedicine unit in each of our primary facilities so that patients can be seen right away by the right specialist. Patients save time and hassles and our clinicians can devote more of each day to patient care when they don’t have to travel,” Hennessy explains.
The fact that Skype for Business offers a HIPAA business associate agreement helps medical professionals remain confident that their security and compliance needs will be satisfied, as Chris Holda, J.D., M.B.A., a VP of Information Technology at IHA a nonprofit multi-specialty group reports.
Holda also appreciates the real-world practicality of Skype in action. He recalls a time taking his own child in for care at IHA: “The pediatrician said she suspected my child had strep, and before she finished her sentence the medical assistant (MA) was in the room with a strep test kit. The pediatrician had instant-messaged the MA so that she didn’t have to leave the room to track down the test kit.” He continues, “Being able to instant-message staff to coordinate whatever is needed for a patient visit streamlines workflow and enables our providers to provide efficient, high-quality patient experiences.”
Integrated Tools Mean Simplified Patient Monitoring
Fred Cantor, Manager of Telehealth and Patient Health Coaching at Franciscan, embraces the challenges of empowering a staff of three critical care-trained monitoring nurses, three installation technicians and one scheduler providing care for about 1,000 patients. Franciscan offers a telehealth program for patients. Those who decide to participate receive a Honeywell LifeStream Manager* remote patient monitoring software. In 30-40 minute training sessions, FVNS equipment installers teach patients to measure their own blood pressure, oxygen, weight and pulse rate. This data is then automatically transmitted to LifeStream and flows into Franciscan’s Allscripts™* electronic health record (EHR) from there. Using previous data trends recorded during the first three days of program participation, staff set specific limits for each patient’s data. If subsequently submitted data exceeds these set parameters, a monitoring nurse contacts the patient and performs a thorough assessment by phone. When further assistance is required, the nurse may recommend a home visit by a field clinician or further instructions from the patient’s doctor.
Since implementing the telehealth program, overall admission rates have stayed below medical averages. In 2014, the CHF readmission rate was 4.4%, compared to the national average of 23%. The COPD rate was 5.47% versus a national average of 17.6%, and the CAD/CABG/AMI rate was 2.96% compared to the national average of 18.3%.
Microsoft Azure, growing both in IoT popularity and as a backend solution for health care, is delivering a similar connected telehealth experience for remote monitoring.
Care Innovations chose Azure as a way to help those with chronic conditions live more independently while reducing healthcare costs. They looked for a cloud solution that would work within its specified experience, including Microsoft technologies and Linux-based server infrastructure and open-source development tools.
“We looked at a lot of different providers for our datacenter needs,” says Michael Salib, Senior Security Architect at Care Innovations. “But we found that the cloud capabilities combined with Microsoft support really gave us the ability to not just build products but deploy them in a feature-rich environment that everyone was familiar with. This was true whether it was a software developer or a system engineer or someone that’s doing test and verification. Microsoft Azure became the platform of choice for many different reasons.”
The company had two solutions that it chose to migrate to Azure: Health Harmony, which collects patient data on tablets or smartphones, and QuietCare, which discreetly monitors patient activities through motion sensors installed throughout a residence or care facility. Care Innovations was able to support both environments on Azure by using infrastructure-as-a-service (IaaS) and platform-as-a-service (PaaS) offerings.
QuietCare, which is based on open-source technologies, runs on Linux servers on Microsoft Azure Virtual Machines. The QuietCare team was able to migrate a Python-based software stack running on Apache with a PostgreSQL data tier to Azure. As a result, it gained increased performance and the ability to dynamically change the configuration of servers as needed without redeployment. The Health Harmony solution also makes use of the Azure App Service and Azure SQL Database for its web-based software. Both apps take advantage of Azure Storage services and Azure Virtual Networks. In addition, Care Innovations used Microsoft Azure Virtual Networks with Site-to-Site VPN connectivity to securely migrate data to the cloud.
Using a variety of open-source tools integrated with the Microsoft Visual Studio 2013 development system, the company also has considerable flexibility building and deploying software. For example, it uses BitBucket, a code management tool, with Visual Studio to push updates to Azure. It also works with Release Management for Visual Studio 2013 to manage and track changes. And to streamline development as well as take advantage of a wide range of expertise, Care Innovations can quickly and securely set up accounts on Azure for developers working in virtually any location.
Care Innovations worked closely with the Microsoft team during the migration to Azure. Microsoft dedicated an Azure Cloud Solution Architect as a technical point of contact for the project. Through this white-glove involvement, the Care Innovations team gained a transparent view into architectural best practices to consider when adopting the cloud. Care Innovations also provided direct feedback to the Microsoft team to improve documentation. The collaborative and trusting relationship of shared responsibility played a pivotal role in the evolution of Care Innovations services.
The company, which monitors approximately 50 facilities and 4,000 residence rooms, migrated its existing customers to Azure. And with data and software accessible from almost anywhere, the new platform opens the door for Care Innovations to serve customers worldwide.
Telehealth is proving to speed traditional care while also affording especially affected patients, like those suffering bouts of nausea while undergoing cancer treatments, a way to get treatment or therapy without the rigors of travel. It has been reported to successfully lower readmission rates, while empowering medical staff easier access to patient records to facilitate better decisions.