Telemedicine: Know why you're doing it
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Lineberger Cancer Center is one of 40 National Cancer Institute-designated Comprehensive Cancer Centers throughout the U.S. The center is involved in all aspects of cancer, from research to clinical trials to patient care. A key mission of the center is to be a statewide resource. “The problem is, we’re a pretty big state. How do you share resources in an efficient manner across the state?” he said. “Telehealth is a good solution for that.”
The center developed a virtual tumor board as an extension of its multidisciplinary approach to cancer care. A typical tumor board in a hospital can include physicians—radiologists, oncologists or others—pathologists, nurses, pharmacists and genetics counselors. “They’re all in one big room to discuss your cancer case,” Young explained. “There’s content that’s being presented, [whether it’s] radiology or pathology images [on a screen] or discussion of patient history that might come out of the EMR. And the group will discuss that patient’s care and what to do.”
Telemedicine would enable that presentation to a much larger group throughout the state. “That’s the idea behind the UNC telemedicine program. Our core mission is to do two things: First, to allow this tumor board to be spread out throughout the state of North Carolina, to any oncologist who needs to have that kind of consultation with our physicians. Second [is] the true telemedicine piece, where there’s a physician on one end of a video call and a patient on the other end, and we’re delivering care directly for that.”
This meant the program’s technology strategy needed to solve current problems as well as issues that might arise down the line—including ways to take care of legacy systems and accommodate future needs, such as tablet PCs and increased telepresence in home care environments, Young said.
The technology in place in the telepresence room includes two projectors in the front of the room. “Buy the brightest projectors you can afford and put those [in] first, then design the rest of the room around them,” Young advised. “The better the picture, the better the experience is for physician. That’s an obvious observation, but it’s important to keep in mind.”
The video bridge (Cisco MSE 8000 blade server platform) includes ample capacity to grow with the program. The telehealth system uses inexpensive Tandberg C20 endpoints. “The app has a very small footprint, and you can add your favorite HD [high-definition] television to that, and you’ve got an HD-quality videoconferencing setup,” he said.
Remote sites access the telemedicine system via the internet, and connect to the data center through an external facing video control system (VCS) for IP, tunneling through the firewall to the VCS that connects to the bridge, Young said.
Who’s using it? “We’ve had 400 hours of tumor board [virtual meetings] over the last year from variety of sites. … It’s an ad hoc kind of program where we’ll set up and let people dial in if they’d like to,” he said.
Moving forward, “We want the systems to be more physician-centric than they currently are, maybe right down to where a patient might be in a home healthcare environment, rather than always having to drive to a location."
Knowing how a telemedicine project will be funded is another crucial piece of the strategy, Young said. “So many programs start out with a grant program that’s never connected to strategic vision of the healthcare organization. While that might work great while the grant lasts, when the grant goes away, these programs end up having [a] tough time. … Align with the strategic vision to have more success after the grant goes out, or even getting initial funding from your organization.”