When you get to the point of deploying equipment to your users and program, you will most likely have already selected the technology that you are going to be deploying and supporting. However, with any thorough technology assessment you should always have the deployment and support process in the back of your mind helping guide your decision making. You should always be considering how you will get the selected technology to the users, how you will support the new technology, how you will train users to use the technology and how you will work it into your budgetary process.
In the case of the patient exam camera Telehealth technology, a program essentially has two avenues when it comes to the technology selection. They can select an industry recognized model or select an off the shelf consumer product to modify to their programmatic needs. Knowing your users and potential use case for the technology, you will be able to make the decision on which avenue you will go down for purchasing. Each avenue brings its own budgetary considerations. If you decide to select an industry standard, you may initially be looking at a more significant budgetary investment but a potentially more reliable solution. If you decide to modify a consumer grade camera to use as a patient exam camera, you may be able to purchase more equipment but your program may suffer when it comes to the durability of your selection. You should thoroughly consider these elements during your technology evaluation and selection.
Planning
The importance of planning in the deployment and support process cannot be stressed enough. Thorough planning is imperative to a successful deployment process. It involves a great deal of up front work, but in the end has the potential to save you time and money and allows you to focus on your program implementation. The planning process requires you to know your program well and/or be willing to spend time assessing your needs. It requires that you develop a clear use case for the equipment that you are purchasing, based on a programmatic and technological assessment. Once you have chosen the most appropriate technology for your program, you will need to develop a plan to get that technology to the users, train the users, and support the equipment.
Needs Analysis
When you are thinking about adding patient exam cameras to your program, you need to take into account your users, existing systems and equipment currently in place, your programmatic need for the additional equipment and your budget to actually obtain the new technology.
Users & Clinical Workflow
Knowing the user population, their current clinical workflow and potential clinical workflow changes prior to deploying a new technology will help you best deploy and support the technology. Some things to consider:
- What disciplines will the users of this technology come from?
- Have these clinicians as a group been a part of the process involved with selecting and utilizing this new technology?
- Is there clinical buy-in and support for the use of this technology?
- How much time do the clinicians have to devote to an encounter with the patient?
- What types of technology are they already accustomed to as a group?
- What is the clinician’s level of comfort with technology in general?
- Is this a technology currently utilized by this clinical group or will this be adding a new element to an existing workload?
- By deploying this new technology, how will you be augmenting or improving an existing clinical workflow?
Use Case
Knowing the use case for the technology will help you develop the best plan to deploy and support the technology. Some things to consider:
- Do you have a specific program, specialty application, or group of clinicians in mind for this technology application?
- Is there an idea present that clearly leads to the development of a clinical program, or is this an idea that needs further development before a clinical program can be put into place?
- Will the users make use of this technology in an asynchronous, synchronous, or combined fashion?
- What additional adjunct equipment will be required to operationalize the patient exam camera model that you select?
- Will any additional staff be necessary to integrate the patient exam cameras into your program?
- What existing equipment will the patient exam cameras be used in conjunction with?
- Does the new model interface with the programs existing equipment, or will all/some new equipment need to be purchased?
- Does the integration of this new technology fall in line with any other planned equipment refresh?
Budget
With a technology selected and the users and use case understood, you will have the necessary information to create the most appropriate budget. For some organizations, these initial steps of use case analysis and budgetary estimation and analysis must be first completed before funding can even be secured. This will depend on the funding sources for your program. Regardless, the financial requirements of this purchase and deployment take thorough planning and mindful consideration.
In general your budget will have capital equipment, consumables, personnel, and training and support elements. Some specific things to consider:
- Equipment to be immediately used
- Associated consumables
- Equipment that will be maintained in stock
- Additional or new PCs or laptops if necessary
- Additional or new videoconferencing equipment
- Additional or new servers
- Additional or new space required to use additional technology
- Potential room lighting adjustments or upgrades necessary
- Costs associated with integrating the data with your EMR
- Replacement parts and/or units
- Additional warranties
- Upgrade plans
- Training/Demo units
- Assessment budget for upgrades as replacement devices are needed in the future
- Accompanying or adjunct software costs
- Accompanying or adjunct hardware costs
- Additional cables or converters that might be necessary
- Mobile platforms and/or carts
- Associated network-related fees
- Program development and program administration costs
- Additional staff costs
- Training space costs
- Training platform costs
- Training material development costs
- Actual and Potential servicing costs
- Shipping and handling related to repairs and/or replacement
Support Plan
You can use the elements that you have already budgeted for to help you further define your support plan. A support plan is very cyclical, and depends widely on the lifecycle of the type of technology that you are deploying. It starts with purchasing equipment, installing equipment, providing initial and ongoing training for users, supporting the equipment, updating and repairing the equipment, and then preparing for the next equipment deployment cycle.
Initial
You will have an initial investment in the purchase and installation of the new equipment, as well as training the users on the new technology. You may want to consider a pilot to see how the deployment goes and give your program a cushion to work out the kinks associated with any new program deployment. A pilot can aide you in identifying elements that you may not have known to consider and make concessions for them, and sometimes determining the future success or failure of your clinical program.
Warranty
Each manufacturer offers different warranties and warranty terms. It is essential to understand the terms for the equipment that you have purchased. Many organizations have biomedical technicians that service medical equipment used within their organization, but many of the patient exam cameras models will be voided if you attempt to repair the units yourself. You need to consider the price of the units that you are purchasing related to the estimated product lifetime when considering additional warranties for equipment that you purchase. Many of the electronic stethoscope units require that a unit be sent back to the manufacturer for repair, and therefore be completely taken out of use. This option is often inconvenient in a large organization or for a clinical program that depends on the equipment for regular operation. You might want to consider having additional back up units for use while damaged units are being repaired.
Training
Proper training in the use of the equipment may prolong the lifespan of the equipment, because theoretically users who know what they are doing will avoid misusing the equipment and leading to support issues. Also, having users who are trained in the use of the technology initially will reduce the amount of ongoing support that is required.
Ongoing
Deploying a technology into the field is like gardening. You work hard initially planning and preparing, then you plant it and hope for the best. Any good gardener knows without weeding and watering your harvest will be marginal at best. You need to plan for ongoing support for the technology in just the same way.
Upkeep/Upgrades
The technology that you deploy will eventually break and/or malfunction with repeated use. You can plan for this with an ongoing support plan. When considering ongoing support you have to remember all of the technology associated with patient exam camera use. You may have repairs, warranty related replacements, replacements that are not covered by warranty, and equipment updates to contend with. Consider:
- Associated software and firmware upgrades may need to be deployed
- Technology will age and need to be refreshed as part of its product lifecycle
Technology Refresh
Depending on your initial investment and the involved technology’s lifecycle, you will have to make some decisions surrounding a technology refresh at some point. Some of this technology is ever-evolving, with new units coming out every year, while others are more durable and may last longer. At times it will not be the actual patient exam camera technology or its associated technology that necessitates a refresh; rather, the role of the technology in the clinical program may change and require new technology to be considered and purchased. When considering a refresh, you have to decide:
- Will you refresh all the technology at once, or do it incrementally?
- Will you blend old and new technologies?
- Will you keep old technologies around after new ones are introduced?
- How comprehensive of a technology assessment will you conduct before selecting your next technology?
Purchasing
Once you have completed the extensive planning process, purchasing the equipment will not be difficult, assuming that you have been able to secure the budget you planned for. Each organization has different methods and processes that they use when purchasing equipment, but the good news is you will know exactly what you need to purchase in order to get your program operational. In this instance, included in the purchase process may be the hiring of new or additional staff or repurposing existing staff members. You need to allow adequate time if you need to hire new staff before a project can be operationalized, and you may need a contingency plan in the case you are not be able to find adequate staff. Also, as part of your planning process you need to consider your timeline for purchasing the necessary equipment so you receive equipment in a timely fashion and do not inadvertently stall the start of your program.
Working with Vendors
Many times you may be able to work with a vendor, possibly even forming a partnership, when purchasing and utilizing equipment for your program. Sometimes they may offer bulk pricing, demo units for trial periods, and special accommodations to serve your programs needs. It is best to approach vendors as partners, as you both have opportunities for gain in successful arrangements. Keeping open lines of communication to establish needs and provide feedback can be very useful to both parties. If you have a pending large scale deployment and know there is a technical change that stands between an existing technology and your ideal technology, don’t be afraid to approach a manufacturer with suggestions. If the changes will make their product better or more useful, some vendors are very open to working with your requests.
Deployment
Deployment of the ordered equipment should run smoothly with a thorough assessment and planning process having already taken place. However, there are some remaining considerations related to equipment deployment:
- Will you ship equipment directly to project sites or utilize a warehouse for staging and assembly?
- Did you budget for warehouse space and staff?
- Do you have an equipment tracking plan in place to keep tabs on the equipment?
- Is any assembly required before the units are deployed?
- Do you have the staff for the assembly?
- If you are shipping equipment directly to project sites:
- Do you plan on having existing clinical staff assemble the technology?
- Is the staff aware they are receiving the shipment?
- Is there space at the project site to receive, stage, and assemble the equipment?
- Did you plan training for the clinic staff to be able to assemble the equipment?
Once the equipment has successfully been deployed and installed, it is time to put the training and support plans into action and eventually start your program.