Tele-Presence in Healthcare – COVID and Beyond

Healthcare has always been about collaboration. Telepresence makes it easier to work together for better patient outcomes.

Tele-Presence in Healthcare – COVID and Beyond

By Jeffrey Soble M.D.
CEO and Co-Founder of ASCENDHIT, Associate Professor at Rush University Medical Center

I Recently I had the pleasure of recording a podcast with Laurie Lafleur of Paragon Consulting Partners as part of their Integrated Informatics series. The episode is called ‘The Evolution of Tele-Presence in Cardiovascular Care’ and you can find it on Spotify or iTunes.

I’ve been interested in tele-presence for some time, and this podcast was a great opportunity to clarify my thoughts.

Importance of collaboration in healthcare

Collaboration has always been an essential part of healthcare, particularly complex care. Consider the longstanding tradition of bedside rounds, which not only promote education but also allow participants with a range of knowledge and experience to interact and collaborate in providing care.

The most effective healthcare collaboration integrates the perspectives of patients and families with their multidisciplinary caregivers. That team includes physicians, nurses, pharmacy, occupational and physical therapy, nutrition, respiratory therapy, and others. As healthcare has become more complex and knowledge more specialized, the size of the team has grown. The challenge of efficient, effective, and timely communication and collaboration has grown with it.

My own passion for this topic is driven by over three decades in clinical cardiology, imaging, and intensive care. In addition, as Vice-Chair for Cardiovascular Quality at Rush University Medical Center, I am responsible for safety and sentinel event reviews, and I run a regular Morbidity and Mortality conference. Rush has always prioritized quality improvement, so I’ve had the opportunity to work with and learn from senior leaders dedicated to improving outcomes.

Our collective experience is this:

In most situations where review identifies that a patient outcome might have been improved, there was a lost opportunity to communicate and collaborate before the suboptimal outcome occurred. 

Healthcare collaboration technologies

The collaboration landscape in healthcare is changing dramatically, driven first by technology, and more recently by COVID-19. Secure texting has been growing steadily in healthcare, and video communication has spiked since the onset of the pandemic.

Both are important advances in technology-enabled healthcare collaboration. However, in the areas of most rapidly advancing and complex care, they are just the first steps. For areas such as interventional cardiology, electrophysiology, interventional radiology, and critical care, tele-presence offers significant advantages over these basic forms of communication.

Components of tele-presence in health care

The main components of tele-presence include:

• Communication capabilities including notifications, secure chat, voice communication (VoIP or POTS), and face-to-face video. Communication mechanisms need to fit naturally in a busy clinical setting and consider the unique constraints of interventional environments. (e.g. sterility, location of equipment and personnel)
• Transmitting all the elements of the patient care environment in real-time. For complex care, this care environment might include any combination of multiple live streaming camera feeds (the whole room, specific locations such as the prep table for a procedure or the surgical field in an OR), cine/fluoroscopy, ultrasound, physiological and device monitoring.
• Camera feeds with remote pan/tilt/zoom control for the remote user.
• Convenient display of multiple simultaneous live streams, including on mobile devices.
• Access to relevant EHR and archived image information.

Benefits of tele-presence

Healthcare tele-presence enables a rapid response to unexpected circumstances during complex intervention or patient care. Multidisciplinary expertise is available instantly when and where it is needed most.

Imagine a complex catheter intervention where a suspected complication has occurred. With Livestream tele-presence, the proceduralist can instantly engage with other experienced and knowledgeable colleagues to make critical, timely decisions. This may include colleagues within their own domain, with complementary expertise, or with specific knowledge of the patient’s condition and history.

Even more beneficially, tele-presence allows the proceduralist to collaborate to avoid potential complications. He or she can get real-time expert support on technical aspects of the procedure at key decision points.

Although complications leading to harm are infrequent, they have an outsized effect on the patients and families impacted. Their financial impact on the hospital can be outsized as well.

Making tele-presence in healthcare a reality

The potential upside to tele-presence is large, but there are barriers to implementation. The main ones are cost, complexity, and achieving buy-in. Hospital administration, IT, and Biomed all need to be aligned.

Providers will easily appreciate the benefits in their daily practice, but ROI may be difficult to quantify. Current hospital analytics are not focused on infrequent, high-impact events, so there may be no benchmark to measure improved outcomes.

A further benefit for hospitals and IDNs is the more efficient use of highly specialized resources across locations.

To work in practice, tele-presence systems will need to

• be flexible
• use low-cost hardware
• have hardened security from devices to cloud infrastructure
• be intuitive for users.

Current technology can overcome all these challenges, and the age of healthcare tele-presence is at hand.