Once you have decided that virtual care is a critical next step for your hospital, it is important and necessary to explore the environmental aspects of telehealth.

Here are previous blogs in this series:

Part 1 of 5: Pre-Registration & Telehealth Consent Strategy
Part 2 of 5: Step-By-Step business Case & Grant Funding
Part 3 of 5: Clinician Champions, Team Structure, & Training
Part 5 of 5: TOP 10 TELEHEALTH BENEFITS AND CHALLENGES CONCERNING HOSPITALS
 
Telehealth ebook: HOSPITAL TELEHEALTH TOOLKIT: A best practice Guide

“Start where you are. Use what you have. Do what you can.”

– Arthur Ashe–

Like many other aspects of healthcare, virtual care is continually advancing. MGMA’s insight article, “The newest trends in telehealth in 2020,” states, “Hospitals and practices are harnessing technology to improve clinical outcomes. This in turn has fueled more sophisticated technology, prompting healthcare leaders to learn how to fully maximize virtual care’s potential.” As an example, in Psychology Today’s article “AI Accurately Diagnoses PTSD Using Voice Analysis,” the NYU School of Medicine recently developed a tool that accurately diagnoses PTSD through voice analysis, which can be utilized efficiently through virtual care. Advancements in remote patient monitoring, artificial intelligence, and tighter cybersecurity measures are all vital developments in the delivery of superior virtual care. The key is to plan now to incorporate these advancements to build your virtual care program and related technologies as patient care needs and preferences continually evolve.

In part 4 of this series, we will deliver resources to help you determine the best physical location to establish your clinician eVisit room. We will present research-based, best practice guidance for optimal location strategy and how this can positively impact the overall development of your telehealth program. We will present 10 Key Elements to consider when designing your virtual care room, with an emphasis on delivering a “humanized” experience to patients. Guided by the American Telemedicine Association, we present best lighting and placement practices to deliver a natural look for patients. We will include an array of answers to questions such as:

  • Which specific teleconference cameras meet ATA’s requirements?
  • What are the Top 5 EHR Compatible, HIPAA Compliant Teleconference Software Solutions?
Your Guide to Strategic Location, Environment & Hardware Considerations
  1. Where will our clinicians perform an eVisit?
  2. Virtual Care Room Design
  3. Telehealth Tech and Tools
  4. Top 5 EHR Compatible, HIPAA Compliant Teleconference Software Solutions

Where will our clinicians perform an eVisit?

Telehealth consultation locations for hospitals vary based on convenience for clinicians, department priority, space availability, and considerations for future expansion. Some providers may also have the option of delivering virtual care from their homes due to stay-at-home orders or flexible working arrangements, while others may work offsite, at a central location within the hospital, or within a specific department for convenient access. In any case, environmental factors such as space needed and the types of consultation to occur--which all effect room design and location--must be outlined prior to choosing a workplace.

Use What is Available

According to “Telemedicine Workplace Environments: Designing for Success,” hospitals implementing a virtual care solution should consider converting existing spaces, rather than building a new space, for telemedicine. Unused office space, previous clinical exam rooms, or even a repurposed storage room, can be potential locations. In any scenario, if the location meets your requirements for space, lighting, ambience, ventilation, and has good proximity to clinical staff and hardware requirements, it should be suitable.

Location Strategy

Choosing strategic locations for telehealth positively impacts a virtual care program. For example, if you are implementing pediatric telehealth, consider visible locations within that department so that patients and clinical staff are consistently aware that virtual care is an option. You may also consider placing a telehealth consultation room near out-patient check-in to gain the most exposure. If your hospital has an overloaded ER, consider placing your telehealth within its vicinity so that patients know they can schedule an eVisit to check-in. This may to deter unnecessary ER admissions and give clinicians the opportunity to direct patients to more appropriate services. In any case, make sure your virtual care examination rooms are near clinical staff.

offsite locations

According to former AMA President Robert Wah in 2014, "Whether a patient is seeing his or her physician in person or via telemedicine, the same standards of care must be maintained.” For telehealth outside of the clinical environment, including those services administered from a provider’s home, many of the same best practices apply. ATA’s “Core Operational Guidelines for Telehealth Services Involving Provider-patient Interaction" further states, “Healthcare professionals providing telehealth services should (always) ensure? that workspaces are secure, private, reasonably soundproof, and have a lockable door to prevent unexpected entry. Efforts shall be made to ensure privacy so provider discussion cannot be overheard by others outside of the room where the service is provided.”

Virtual Care Room Design

10 Key Telehealth Room Design Considerations

  1. Acoustics & ambience
  2. Privacy & security
  3. Lighting options
  4. Furniture & equipment needs
  5. Equipment access & installation
  6. Heating, venting, & air conditioning
  7. Furniture and equipment layout
  8. Cleanliness
  9. Organization for obstacle avoidance
  10. Patient accessibility

Whether you are building a new telehealth space or repurposing an existing room within your hospital, it is a good idea to create a floor plan to help determine your workable space. You will want to configure elements such as office furniture and different types of equipment needed to ensure it is optimal for your eVisit needs.

If patients will be entering the room at any point, you will need to make sure there is ample space to navigate, especially in the event they have specific accessibility needs or are accompanied by medical equipment. You will want to provide adequate ventilation, filtering and heat control. Telemedical equipment, including lights, computers, and docking stations, all generate heat and can be damaged by dust particles. In addition, the space should be free of any distracting outside noise and the room acoustics should facilitate clear sound and two-way communication. Visually, a background with a brightly painted wall may not show well on camera and can be distracting, so be sure to paint the room in neutral, soothing tones or use a greenscreen. According to Vantage Technology Consulting Group in “Healthcare Design Question – What’s the Impact of Telehealth on the Design of Exam Rooms,” “We implemented green screen technology on a project for the Mayo Clinic where the doctors were in a different country and time zone but didn’t want to emphasize that fact to the patient. Essentially, this turns the telehealth room into a mini-production studio.”

Telehealth tech and tools

Lighting and Placement

According to American Telemedicine Association’s publication, Let there be Light: A Quick Guide to Telemedicine Lighting, which is a go-to resource for virtual care lighting and techniques, appropriate lighting is linked to patient satisfaction, which contributes to clinical engagement and reimbursement. Incorporating a natural look and feel through lighting and room design “humanizes” a virtual visit, which is important in promoting an overall positive experience, particularly for new or less familiar patients.

ATA suggests the following:

Lighting

  • Natural light – This is preferred; however, it is often impractical in a clinical environment.
  • Natural artificial light – This is recommended as it is an alternative to daylight, as it is a warm white light. 3200K-4000K lumens are optimal. Avoid lighting the space with colored lightbulbs or LED lighting, -- the blue hue causes an unnatural appearance.
  • Fluorescent – This is preferred if done properly. Use cool white to reduce heating. Use 3500K lumens at home or 5000K lumens in a commercial setting. Use lighting fixtures specifically designed for videoconferencing if possible.
  • Lamps – Useful to compensate for poor lighting or task lights.
  • Suggested color temperatures:
    • Shade 6500K
    • Sunlight 6000K Fluorescent 5500K - 4000K
    • Twilight 4000K
    • Incandescent (tungsten) 3500K – 3000K

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Lighting Angle

100% indirect lighting is recommended as it allows light to be more evenly distributed without creating hotspots. Multiple frontal light sources placed for vertical illumination at 35-40% above eye-level to create a 3D effect is recommended. Fill lighting can remove shadows and balance color. You will want to void downlighting, as it can create facial shadows. The graphic below provides an appropriate lighting design for a telehealth provider’s space.

Lighting Image

Video Conferencing Camera

According to American Telehealth Association, “internet-based video conferencing software programs should provide such services at a bandwidth of at least 384 Kbps in each of the downlink and uplink directions. Such services should provide a minimum of 640x480 resolution at 30 frames per second.” While there is a vast array of cameras that can be used for telehealth, we will focus on a few video conferencing camera options outside the camera native to your laptop or tablet.

Teleconference Camera Preferred Requirements

  • Frame rate between 25-30 per second
  • Resolution minimum 1280x720 pixels, preferably full HD at 1920x1080 pixels
  • Accurate colorimetry

Suitable Camera Options

TEVO-HD305_Telehealth_Camera

TEVO-HD30S HD 30x Zoom Telehealth Camera

  • 1920x1080 2.38 mega pixel
  • 30X optical zoom
  • Pan: 0-340° Tilt :0°~120°
  • IR remote control

 

conferencecam-bcc950

Logitech BCC950 Conference Cam

  • Full HD 1080p video calling up to 1920 x 1080 pixels
  • Rightlight™ 2 Technology for clarity in various lighting environments, even low light
  • 1.2x HD zoom
  • Integrated full duplex speakerphone with echo and noise cancellation
  • IR 3 m range remote control
  • Omnidirectional microphone with 2.4 m diameter range

 

c920-pro-hd-webcam-refresh

Logitech C920 HD Pro Webcam

  • 1080p/30fps - 720p/30fps
  • Built-in mic – stereo
  • Autofocus
  • Tripod-ready universal clip fits laptops, LCD or monitors

 

c925e-webcam

Logitech C925E Business Webcam

  • 1080p/30fps - 720p/30fps
  • Autofocus
  • Tripod-ready universal clip fits laptops, LCD or monitors
  • 78° field of view
  • 2 omni-directional mics
  • Integrated privacy shade
  • Supports H.264 with Scalable Video Coding and UVC 1.1 encoding to minimize its dependence on computer and network resources

 

ptz-pro-2-camera

PTZ Pro 2

  • Full HD 1080p 30fp
  • Autofocus
  • Smooth motorized pan, tilt and zoom ±90° pan, ± 35° / 45° tilt
  • 10x HD zoom
  • 3 camera presets plus home position button
  • Video mute/unmute LED indicator
  • Remote Control IR 28 ft (8.5 m) range
  • H.264 UVC 1.5 with Scalable Video Coding (SVC)

For more information on other exam specific cameras, check out page 29 of University of Missouri School of Medicine’s, Telemedicine Technical Assistance Documents - A Guide to Getting Started in Telemedicine.

EHR Integrated Teleconference Software Solutions

Top 5 EHR Compatible, HIPAA Compliant Teleconference Software Solutions

  1. Zoom for Healthcare
    • Price starts at $200 per month for up to 10 hosts
    • Epic integrated
    • *Zoom for Healthcare is primarily focused on teleconferencing features
    • Transcripts of recordings
    • Medical device integrations
    • Workflow features - Patient waiting room, in-app file sharing, collaboration features
    • Revenue cycle features - None
    • Marketing features - None
    • Security features – Follows HIPAA and PIPEDA regulations; offers signed BAA compliance for protected health information
  2. VSee
    • Price starts at $49 per month
    • EHR integrated
    • File transfer
    • Guest invite link
    • e-Prescription
    • Workflow features - Invite patients via email and SMS, patient self-scheduling, triage secure webchat, cancel Appointments (patient), intake chief complaint, post-visit survey, patient visit summary notes, patient portal access, provider scheduling, file / document upload to patient portal
    • Revenue cycle features - Pay online with credit card pre-authorization,
    • Marketing features - Custom subdomain, professional landing page, logo branding
    • Security features – BAA for HIPAA compliance, military grade 256-bit AES encryption
    • Support – Dedicated telehealth consultant, live provider training, live support
  3. Mend
    • Price starts at $49 per month
    • Mobile supported
    • EHR integrated
    • Workflow features - Third party workflows, scheduling, advanced notification settings, custom appointment types and routing, PredictiveIQ AI, patient self-scheduling, on-demand queue
    • Revenue cycle features - Payments
    • Marketing features - Post visit surveys, advanced reporting
    • Security features – HIPAA compliant
    • Support – Account manager white glove setup, live training
  4. Chiron Health
    • Price starts at $150 per month
    • EHR integrated
    • Workflow features - Unlimited live video visits, scheduling, automated appointment reminders, practice branded web application and communications, patient mobile apps
    • Revenue cycle features - Telemedicine eligibility verification, fee schedule customization, patient payment collection
    • Marketing features - Patient marketing, custom web page, marketing materials
    • Security features – Business associate agreement for HIPAA compliance
    • Support – Online training and help center access, live support, custom onboarding and implementation
  5. CareCloud
    • Price starts at $349 per month
    • EHR Integrated through CareCloud
    • Mobile Patient Portal App
    • Mobile supported
    • Workflow features - Automated email/text reminders
    • Revenue cycle features – Add on solution
    • Security features – HIPAA-compliant, secure cloud-based network
    • Support – Live onboarding and training

 

Anthony Delabano

Written by Anthony Delabano

With an unparalleled resourceful and systematic approach, Anthony Delabano (A-Train) continually innovates to bridge the gap between marketing and sales. In his free time, Anthony dedicates his passion driven ingenuity to his nonprofit, Foundation45, which gives hundreds of musicians and artists each year, a second chance at life through 100% free counseling services.