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Technology Requirements in Telemedicine

Telemedicine TechnologyOne of the first topics to cover in any discussion of telemedicine is the technology required for telemedicine. The technology requirements for telemedicine are as basic or complex as the physician or organization chooses. A telemedicine setup will require a few basic needs and some choices. You will need: 1) a secure internet connection (broadband), 2) a video platform, 3) technology support. You will then choose whether to record your interaction (recording device) and chose your peripherals to assist in the visit. Below is a basic discussion of the requirements needed for starting a telemedicine practice in allergy and immunology.  

1. Most basic to a telemedicine practice is a secure broadband internet connection. The amount and speed of the internet connection will determine the video quality and amount and speed of data transfer. A basic business broadband connection should be sufficient at about 50-100 Mbps (Megabits/sec).

http://www.kumc.edu/community-engagement/ku-center-for-telemedicine-and-telehealth/about-the-technology.html
https://www.healthitoutcomes.com/doc/the-telehealth-spirit-is-willing-but-the-broadband-is-weak-0001
This video has some good basic information about internet connections and basic needs for telemedicine. 

2. The video connection and platform for a video interface is the next critical piece of a telemedicine infrastructure. There are a variety of different video systems available and the type you choose depends on the type of system and practice you decide to establish. The basic system is a direct to consumer system in which the patient uses home computer or app-enabled smart phone to communicate with the physician. These systems are usually offered through a third-party vendor. The second video option is a connection between two secure locations or computers. In this latter setting, the provider controls both ends of the interface and will use an already set up computer to communicate with the patients. This is a costlier solution and will require the patient to go to the site of the remote computer, usually at a remote health center.  

Curr Allergy Asthma Rep. 2018 Sep 26;18(11):60
http://www.telehealthtechnology.org/home

3. Equally critical to the hardware decisions in a telemedicine program is the support necessary to run a program. Qualified computer and technical support are necessary for any program to run well. The support can be virtual or in person depending on resources, but physician access at all times is critical. The support staff will be able to insure stable, secure internet connectivity. More importantly, they need to be available to help with technical and hardware problems which may occur during a clinic day to prevent interruptions to patient care.

https://www.healthit.gov/faq/what-are-technical-infrastructure-requirements-telehealth

4. Part of the video conference set-up will be a recording device, if necessary. Depending on the state requirements where you are practicing, there may be a need to record and save some or all of the interaction. Some video conference and prepackaged telemedicine systems will allow for recording and archiving of video. If this is not part of your system, then there will be a requirement for secure data storage (video or written visit documentation based on your local requirements). This can integrate with an EMR in some cases, depending on the EMR vendor.

https://www.healthit.gov/sites/default/files/playbook/pdf/telehealth-startup-and-resource-guide.pdf

5. Peripherals and video assist devices will be necessary depending on what you would like to accomplish during your visit and with your telemedicine program. These devices are not necessary to start a program and a good system will allow them to be added later. Many are now USB connected and will easily connect to an existing system. Some examples of peripherals are video otoscopes for HEENT examination, electronic stethoscopes to allow for cardiovascular exam and high definition video cameras to allow for visualization of a rash or skin lesions (dermascope). The telemedicine cart is one option to incorporate all of the necessary hardware. This rolling or mobile device is an all-in-one unit. It should have a computer with sufficient access, video equipment, power supply (battery to allow for mobility) and peripherals with storage. A mobile unit will allow telemedicine services to move within a clinic so that multiple rooms are used for patients. Costs vary widely based on equipment and capacity.

http://www.kumc.edu/community-engagement/ku-center-for-telemedicine-and-telehealth/about-the-technology.html

In summary, telemedicine technology can be stripped down to basic needs: broadband connection, video platform, tech support and possibly peripheral devices and capability to record video. The scale of this enterprise will depend on resources and location. A large academic or private hospital system will have significant resources in place, however a solo or small group practice may be able to still conduct telemedicine visits with a scaled back version of the same technology. Many decisions will be cost and potential use driven, while others will be based on coding needs and documentation. Personal comfort with exam and communication will also factor into a positive experience with telemedicine visits.  

These links are for research only. They are not endorsed by The American Academy of Allergy, Asthma & Immunology (AAAAI).

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