Home Telehealth – Assessment Guide

Technology assessment for home telehealth equipment is a fairly involved process. Assessing home telehealth involves more than simply assessing home telehealth hardware and software. For a comprehensive home telehealth assessment you need to evaluate home telehealth hardware and software against the use case for home telehealth monitoring in your organization. It potentially involves partnerships with vendors, payers, and patients. To complete a comprehensive assessment you need to determine program requirements, set goals for your desired services, complete a market review, assess the home telehealth hardware and software, and select vendors to partner with.

Determining Program Requirements

Experts say those that treat home telehealth as just another piece of equipment tend to have much lower success and sustainability rates. Before setting out to assess home telehealth hardware and software it is important to establish a clear use case for home telehealth in your organization. When thinking about a use case for home telehealth in your organization you need to really do an assessment of what you would hope to accomplish by adding home telehealth to your organization. Is it about: revenue, adjusting staffing levels, delivering superior care, better disease management, meeting regulatory guidelines, preventing rehospitalization, delivering more holistic care, helping elders age in place, or is it because you got the grant and now what are you going to do with the money. All of these lines of reasoning are common reasons to consider home telehealth in your organization. If you are thinking about revenue, you may get creative and think about cost savings but also cost avoidances. As you progress with your program you will learn how to better quantify the cost avoidances that home telehealth can bring.

Once you have established a use case for adding home telehealth to your program then you need to determine what clinical needs you will be addressing with home telehealth. As you determine your clinical needs and the disease states that you hope to address, you will gain a better understanding of the equipment that you will actually need to do telehealth. Knowing the equipment that is available on the market will help you fit the equipment to the clinical need. Use the TTAC Technology Overview (link) document to understand the current state of the hardware and software currently available on the market.

It is important to be cognizant of the users of the technology moving forward. You will need your clinicians to buy in to the use of the technology. Do you have staff that is comfortable with technology? Will the staff be able to teach patients how to use the technology? Will the staff be able to do technical troubleshooting of the technology should a problem arise? Will the staff be able to set equipment up in patient’s homes? It is also important that your patients feel comfortable using the technology that you plan on deploying. You may need to think about the patients’ comfort level with technology and may choose to have multiple options of hardware available for those with different levels of comfort with technology. Much thought goes into designing home telehealth technology to be user friendly and unintimidating for all users, but being cognizant of your patient population needs will help you make the best decisions for your program.

With a use case, clinical need, and user population in mind, lastly you must define the functionality you require from the hardware and software. This is about defining what you need the hardware and software to be able to do for your program. Do you require peripherals that can be used at the point care or can your users use peripherals at a fixed location plugged into a base station? Do you have communications restrictions that will not allow live video to take place, or do your clinicians want the ability to do live video and audio visits with patients. Does your patient population need added wellness tools that give a more holistic approach to care? Do you have multiple disease states that you wish to monitor or are you going to only monitor one disease state? Do you have a population that has limited eyesight, and will need audible messaging? Do you have bariatric patients that will need bariatric sized blood pressure cuffs? Do you have patients with limited mobility that will need a scale with handles for stabilization? Do you have complex data reporting needs, so much so that you will need custom programming to meet those needs? Do you have many patients that you will be monitoring at a time, requiring a graphical interface for fast and efficient viewing of data? Do you have staff allocated to address patient alerts as they arrive, or will you require the services of a call center? Do you have the ability to do a technology assessment on your own? Will you need to either hire a consultant for a technology assessment or work with a 3rd party vendor as an intermediary to help you design your program based on their experience in working with vendors?

Market Review

With your program requirements established you ready to see what hardware and software is currently being marketed by the vendors in the home telehealth market. In a traditional technology assessment you would be conducting subjective and objective tests on the equipment that you purchase, but with a home telehealth assessment you need assess the market at the time in which you are ready to purchase hardware and software. Because home telehealth is a program, as opposed to a type of hardware or a type of software, you have to modify your technology assessment.

Knowing the types of hardware and software that you will need for your home telehealth program you need to do a market review. The American Telemedicine Association (ATA) has a “Telemedicine Product and Service Directory” that may be very useful to you. It lists all of the vendors currently on the market by market sector, with links to the vendor and product websites. This may be a good place to start your pre vendor contact market research. It is important to understand a vendor and the hardware/software that they offer to the best of your ability before you are met with a marketing pitch from the vendor. Things can become very overwhelming in a hurry when a vendor starts their marketing pitch, and it can be very easy to forget your questions, concerns and program needs and just sign on the dotted line. As stated before, due to the highly competitive nature of the home telehealth market it may be difficult to find great much information by your own search methods without speaking directly to a vendor. It is best to narrow down the vast field of vendors to those that can meet your program requirements, before moving to the next assessment step.

Once you have identified the vendors that you believe can meet your program requirements, it is time to contact vendors. In this highly competitive market, many vendors may require a non disclosure agreement (NDA) before they can give you specific answers to your questions. Hopefully by the time you are contacting a vendor you are at the point where you can sign a NDA, because you will be at the point where you are ready to ask questions that you cannot glean from their product information sheets and there company website. In these sessions you will be further establishing if they can meet your program requirements.

Once you have determined if the vendors you have selected can truly meet your program requirements, it is time to narrow down the pool of potentials into a manageable number. You may find that only one vendor can meet your program need. It may be wise to keep in contact with a second choice as well to possibly conduct some further assessment with. At this point you are going to want to ask to get access to the hardware and software for a hands on assessment of the products. At this point you are already informed about the specifics of the hardware and software, but the point of a hands on assessment will be to confirm that things do what they are supposed to do and that this is truly the vendor you want to form a partnership with. Pay special attention to every aspect of your interactions to learn the true character of the business. Another especially important part of this pre vendor selection work is to obtain a list of current customers that can be contacted. Contact the customers, ask candid questions. Network with industry contact as well as seeing if you can make any informal customer connections. Use ATA (link) resources to network with members; speak with special interest group members. Utilize the Telehealth Resource Centers (link) knowledge of specific vendors, and also use them as a way to use networking to make informal customer contacts.

Hands-On Assessment

Once you have progressed through the steps of determining your program requirements and selecting a vendor you are ready for a hands on assessment of the home telehealth hardware and software. A hands on hardware and software assessment can be a fairly time consuming task. In this instance you are going to really be checking the features of the hardware and software against your program requirements and confirming that they will be able to meet them. You have already determined that they have the hardware and software capabilities that you are seeking, a hands on assessment at this point is really just a proof of concept.

Some of the options for a hands on assessment of the hardware and software will include: simply having the hardware shipped to you and using a testing environment account to work with the software while running tests internally, having a vendor come out with the hardware and a test environment software account, or having the equipment shipped with a test environment software account and meeting with the vendor via webinar or conference call for a thorough use explanations. You may encounter some hesitation on the part of the vendor at this proposal because they will want to make sure you have the proper information and training to make the most informed decisions about their product. Once you are properly trained on using the product or you have an expert on the equipment present with you, you are ready to being your assessment of the equipment.

In completing as assessment it is important to recreate use environments as close to reality as possible, that way it gives you the most realistic expectations of the product’s abilities. It is important to lay hands on all aspects of the hardware and software from setup, to power up, to shut down. Take notes and ask questions while you have the product experts present. If you were to find a gross incompatibility with your programs requirements that you were previously unaware of, make notes for later discussion. If the incompatibility is something that can be engineered around or fixed by the vendor, you may still be able to consider working with the vendor in the future. If the incompatibility cannot be mitigated, then you will need to abandon any plans for partnership with this vendor.

The functional hardware and software elements to assess are:

Hardware

Base Station
- Screen Type
  - Touchscreen
  - LCD
- Button
  - Type
    - Tactile feedback
  - Size
  - Location on hardware
  - Shape
  - Quantity
  - Color
- Power
  - Supply
    - Wired, must be plugged in at all times
    - Internal rechargeable battery
    - Battery operated
      - Type/size needed
    - On/off switch
      - Location on unit
  - Audio output options
    - Languages available
    - Speaker placement
    - Maximum speaker volume while maintaining sound quality
  - Microphone options
    - Built in
      - Placement
    - External
  - Video options
    - Content streaming
    - Live interactive
    - Camera placement
      - Fixed
        
        Distance patient needs to be from unit to be framed in video interaction
        
        Zoom available
        
        Focus
        
        Auto focus
        
        Manual focus
      - Movable
        
        Mounting options
    - Compatible with any webcam
      - Input options
  - Device input options
    - Number of ports
    - Types of ports
  - Communication options
    - Internal components
    - Ports for external components or adaptors
  - Messaging options
    - Unit turns on and alerts patient when it is time to interact with unit
    - Sleep mode when unit inactive for time period
    - Option to have messaging read to patient
    - Calendar
    - Instant messaging
    - Email
    - Activities
    - Connections to community, beyond healthcare, possible
    - Patient education
      - Streaming videos
  - Peripherals unit can interface with
    - Standardized interfacing available
    - Types
      - Blood pressure
      - Pulse oximetry
      - Thermometer
      - Blood glucometer
      - Laboratory testing
        
        PT/INR
      - Peak flow meter
      - Spirometer
      - EKG/ECG
      - Scale
      - VRI
      - PERS
      - Other
  - Kiosk
    - Can base station be used as a kiosk for multiple patient use
Peripherals
- Power supply
  - Battery operated
    - Type of batteries necessary
    - Can batteries be replaced
  - Internal rechargeable
- Messaging available directly on the peripheral
- Extra supplies required to accompany peripheral
- Extra modifications for additional patient limitations
- Button
  - Size
  - Type
    - Tactile feedback
  - Amount
  - Configuration on hardware
  - Color
- Communication options
  - Standardized interfacing available
- Output options
  - Wired
    - Cord type
      - Proprietary
      - Standardized
    - Wireless
      - Requires electronic tethering
      - Interference issues
      - Distance unit can be from pairing hardware
    - Ports available

Software

User Roles available
- Clinician
- Limited administrative
- All access role
Data Views
- Menu options
- Can the data be categorized
  - By patient
  - By patient group
  - By disease state
  - By clinician group
- Dashboard View
  - Is this the default screen view for clinicians
  - Are alerts that need action obvious
  - Are the associated symbols clear
Alerts
- Alert Parameters
  - Are parameters customizable to each patient
  - Can parameters be set for a patient group based on clinician preference
  - Can parameters be set by disease state
- Alert view
  - Options for addressing an alert
    - Check box charting
    - Free text options available
  - Ability to find associated patient information while viewing an alert
  - Alert categorization
    - Color coding based on parameters
    - By patient groups
    - By disease state
Clinical Documentation
- By exception
- Checkbox charting
- Free text options
- Can a clinician be alerted when documentation is necessary on patients
Messaging Options
- Is a library included with the software
  - Is the library organized by disease state
  - Is the library organized by symptomology
  - Are any streaming videos part of the library
- Branching logic
- Can messages to patients be customized
- Scheduling of messaging
  - Multiple messages in a day possible
  - Rotation schedule of messaging built in
Imbedded Communication Options
- Near real time customized messaging
- Live video and/or audio communications
  - Features within the software to control audio/video communications
  - Hardware required by the patient and user to conduct audio/video interactions
Reporting Capabilities
- Are there any built in customizable options of the reporting feature?
- Do you have access to raw patient data?
- Is there additional software for purchase with added capabilities?
- If you don’t see the reports that you will need for your program, does the vendor have options customize reporting for your program?
Interface
- Bidirectional available
  - Standards used
- What Electronic Health Records has the vendor already interfaced with
- Custom interfacing possible
- Is there an ability to interface with your billing or patient encounter software
Program Administration
- Can hardware be inventoried through software
- Interface for adding patients into the system
- Hardware upgrades pushed with software interface
- Data security
  - HIPPA compliant
  - Patient PHI encrypted
  - Server physical security options

Technology Selection

After you have completed the hands on assessment of the home telehealth hardware and software, you are ready to select a vendor or multiple vendors to partner with. Based on all the information you have gathered you are in the best position to make decisions regarding the equipment you will need for your home telehealth program.

You will need to select a vendor to partner with to purchase, or possibly lease, hardware and software from for your program. Hopefully you were able to select one vendor that can meet all of your needs, but you may be in the position where you need to work with two vendors to supply your home telehealth hardware. You may also be working with third party vendors for additional hardware or services.

It is important to know that depending on the size of your purchase you may have some bargaining power with the vendors you are working with. It may be uncomfortable to negotiate with vendors, but it could mean the difference between getting all that you want or most of what you want. Each organization will handle purchasing equipment a bit different, be sure and adhere to your organizations policy for the final purchase.