3 best practices for telehealth infrastructure

From the mHealthNews archive
By Peter McLain

As more and more healthcare providers embark on telehealth strategies, CIOs and IT departments are discovering that it's not as simple to set up and manage as originally expected.

Many pilot efforts have failed due to poorly designed network connectivity, complicated clinical workflows, confusing technology user experiences, unreliable equipment and lack of ROI in terms of clinical outcomes or financial benefits. In some cases, these problems aren’t discovered until the systems have been rolled out and the negative results are felt firsthand by doctors and patients. More than a few telehealth carts are sitting in storage closets because they failed to work when they were needed most — and the medical staff moved on to other alternatives.

As this technology matures, best practices have emerged that can help any organization minimize technology challenges, recover quickly from downtime and embrace the full benefits of telehealth, which can be summarized as doctors treating more patients and patients receiving better care.

Three of those best practices include:

1. Availability. Not to be confused with reliability, availability refers specifically to databases and systems being up and running and the invaluable role of the network. One of the first network-related considerations that must be addressed is bandwidth. Anyone who’s ever been in a video conference session where the person talking can't be understood or their lips are out of sync with the audio can imagine how disruptive this issue could be during a telehealth session.

Depending on the codec that’s used, bandwidth requirements can range from .5 Mbps (up and down) to 2 Mbps (up and down). Hospitals and clinics located in rural areas may be restricted to less than 1 Mbps pipelines and therefore will need to pay closer attention to choosing efficient codecs as well as using QoS (quality of service) software that gives priority to voice and video over other data packets traversing the network. In some instances, it may be necessary to establish dedicated telehealth networks and to configure failover options should the primary network become unavailable.

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One of the biggest availability oversights occurs during pilot tests where only three or four telehealth carts or stations are tested, and the network is taxed only a small portion of what it experiences when a live rollout of 20 or more carts and stations is implemented. Healthcare organizations need to take this into account ahead of time and monitor the scheduling of each session so adjustments can be made if bandwidth requirements change.

In today’s mobile world, Wi-Fi networks are another important part of the availability equation that come with their own challenges. Dead spots can easily be missed if pilot tests are performed in a controlled environment (e.g. data center), but the carts are used in basements with concrete walls or near medical equipment such as X-rays that can interfere with wireless signals.

A best practice is to conduct a thorough wireless network survey prior to the pilot, identify and address problem areas ahead of time, and conduct the pilot where the system will be used.

A final point about wired and wireless networks is that they are dynamic, which means that just because they work well today doesn’t mean that something can’t change tomorrow. The only way to ensure ongoing network reliability is to monitor your networks and set up automated alerts if key thresholds are crossed such as high latency or low signal strength.