St. Luke's Health System, a nonprofit network of seven hospitals and five cancer-specialty clinics around Idaho, has implemented a telehealth project using Microsoft Lync 2010, a unified communications platform that allows users to participate in video conferences, instant messaging and Web conferencing.
Microsoft offers Lync as a stand-alone platform, as part of Office 365 and as an app for Android, Apple iOS and Windows Phone.
St. Luke's nutritionists and geneticists are using Lync to save patients an hour's trip driving to remote facilities, said Dennis Schmuland, chief health strategy officer for U.S. Health and Life Sciences at Microsoft.
The implementation by St. Luke's is part of a shift in telehealth, and health care as a whole, from solo providers and a fee-for-service model toward shared accountability for the cost and outcomes, as outlined in the Patient Protection and Affordable Care Act (ACA), Schmuland told eWEEK. The Supreme Court upheld the constitutionality of the ACA June 28.
"Now it's seen as a more-efficient vehicle to connect patients with the resources and multidisciplinary teams they need to improve their health and improve their outcomes," said Schmuland.
In addition to Lync, the telehealth setup consists of a battery-powered mobile cart, a Windows 7 desktop configured as a kiosk and an off-the-shelf high-definition Microsoft LifeCam Cinema Webcam, all for less than $4,500, according to Schmuland. Most entry-level telehealth platforms cost above $10,000, he noted.
Because cancer patients suffering from symptoms such as nausea need to be seen right away, affordable cost and allowing patients to consult with counselors sooner were key considerations in implementing the Tele-Cart, according to Kevin Mark, a member of the infrastructure and operations team at St. Luke's overseeing the project.
"That was actually a big driver for why we needed to get something out to these clinics at an affordable cost," said Mark. "It just seemed like the higher-end video conferencing systems were too cost-prohibitive for what we had available to us. We already had the Lync system in place."
Even as the telehealth platform reduced travel by at least an hour in Idaho's rural areas, patients still had to travel 30 to 40 miles on average for a genetic or nutrition consultation at St. Luke's cancer facility in Fruitland, Idaho, Schmuland noted in a blog post.
Some patients travel only a few minutes to get to a telehealth session at a clinic, and others drive about three hours instead of four hours, said Mark.
"We're not doing home health yet, but that's on the road map," Mark added.
By establishing its telehealth program, St. Luke's wanted the configuration to be "low-touch" so that clinicians could operate it easily without help from IT, said Schmuland.
"We've been able to create a controlled environment where nursing staff can literally roll in the mobile battery-powered cart; they power it on, and it will automatically log in to the system," said Mark.
With Lync, St. Luke's was looking for a Web conferencing platform without the audio choppiness of other products, said Mark. Lync also provides a more "resilient" Web connection than Skype for St. Luke's genetic-counseling sessions that can run for an hour, he said.
"That's not to say that [Skype] isn't a valid platform; it's just that we haven't been able to maintain a connection," said Mark.
In an early survey, 94 percent of participating patients have reported overall satisfaction with the program, according to Schmuland.
At St. Luke's Fruitland facility, about 42 patients participated. The telehealth program has reduced waiting times by about seven days, said Schmuland.
One challenge for the project was getting the power controls on one of the Ergotron cart's computers to work, according to Mark. "You're supposed to put the computer inside the cart and there are power controls on top of the tray to wake the computer up," said Mark. "We weren't able to connect it that way." The cart's troublesome design has since been discontinued, he said.
Instead, St. Luke's used a separate push button through a hole in the front of the tray, said Mark.
Overall, deployment of the Tele-Cart was simple, said Mark. "In terms of the IT perspective, we were able to deploy both the cart and the computer setup within a matter of hours," he said. "It's a repeatable model that was quick to deploy and doesn't require a lot of training and that seems to have worked pretty well."
Before a telehealth session, a nurse plugs the cart into a network port in an exam room; it connects to the network and allows patients to join a virtual meeting with a desktop shortcut.
St. Luke's plans to expand its telehealth project by implementing the platform at clinics in eastern Oregon. In addition, USB- and wireless-enabled medical devices such as digital stethoscopes and video otoscopes on the Lync platform will allow physicians to monitor patients remotely.
"We're testing a digital stethoscope that we hope will be able to send heartbeat signals over Lync," said Mark.
In addition to using Lync, St. Luke's would like to expand the Tele-Cart to work with Microsoft's SharePoint Web-collaboration software, said Mark.
"We definitely are looking at ways to leverage Lync beyond just the traditional video-based collaboration where we can enhance the patient portal experience and the community portal from a Web presence standpoint," he said.