Video Conferencing for Home Healthcare
Here’s a way to keep in touch with grandchildren on one hand and elderly parents on the other, while improving care and reducing travel. Use the network and video capabilities of a TV, tablet, phone or computer to connect caretakers and caregivers. The technology is available today and improving rapidly, but the choices are confusing due to the lack of standards and interoperability among systems.
In a Boston Globe article, Hiawatha Bray reviewed various video conferencing options that can support home healthcare. I summarize them here and provide links to video demos of each of the apps she mentioned, as well as apps I added.
Voice over Internet Protocol (VoIP) is an open standard that was made popular by PC-based video products like Skype, Google Chat, and iChat. (Here’s a review of all three.) Most VoIP products rely on broadband-connected PCs with speakers and a webcam. the once challenging setup is improving, and image and sound are now approaching HD quality. VuRoom even extends Skype capabilities to multi-user conferencing, which can be used to connect the patient to their family, professional caregiver, and physician all at once.
Commercial telepresence systems have come down in price, now only require broadband speeds of about 1 Mbps, and have become good options for great quality video conferencing on high-definition TVs in the home or home office. Examples include:
Home entertainment systems that add video conference capabilities focus on the consumer experience rather than business features. Examples include:
- Microsoft Xbox 360 with Kinect motion control system is good at providing a wide screen view that automatically follows the person as they move, and an interesting feature lets both people watch a video. For telemedicine applications, a physician could play a video, see the patient’s reactions, make comments, and address questions.
- Logitech Revue with TV Cam combines a $300 set-top box, which connects to the Google TV service, and a $149 TV Cam at 720p resolution.
Smart Phones & Tablets are starting to add front- and rear-facing cameras for taking pictures and movies and making video calls. Examples include:
- Apple FaceTime, which is available on the new iPad 2, iPhone4, and iPod Touch, is the clear leader in the mobile category, providing the best user experience with the easiest setup.
- Skype recently added a video chat application for iPad 2, which should make care providers happy. It can use either the front or rear camera. (Watch the video)
- Qik is shown in this video on the Android-based Sprint HTC EVO 4G phone. Unlike FaceTime, Qik does not require a Wi-Fi connection and can work over a fast cellular network.
HIPPA compliance for video calls? Isn’t that about as necessary as HIPPA compliance for voice calls, i.e. completely unnecessary? It seems that the ONLY reason to worry about HIPPA would be if the call is recorded and stored on a server, but in that case I’d worry more about the security of the server itself, or the personnel and systems (PC, phone, etc.) used to access it.
I see telehealth as such a benefit that a far greater issue, in my opinion, is extending its use by supporting whatever technology that consumers have already and are familiar with, although I have no problem with requiring that they download a **FREE** app or program if doing so is easy and doesn’t get in the way of the #1 objective of widening the reach of telehealth. But in the spirit of sharing opposing views, here are some related articles from different perspectives.
Why Skype is Scary
Is Skype HIPAA Compliant? If not, what is?
Skype and Online Therapy and HIPPA
Skype and HIPAA: Security Flaw Discovered
Is Skype HIPAA-Compliant?
Utilizing Skype to Provide TeleMentalHealth, E-Counseling, or E-therapy (supports my view)
A colleague on LinkedIn added this clarification to the HIPPA issue that I questioned: “As long as PHI [personal health information] is not involved via shared files or chat conversations, you are right; it is not restricted. That is also how legal counsel has interpreted the final ruling, but few articles reference this; it doesn’t support their agenda, smile. Those with financial interests [i.e. Cisco, Polycom, etc.] will continue to use rhetoric to their advantage. And, I agree with a recent Reportbuyer report: Telemedicine and M-Health Convergence Market when it notes that “telemedicine now delivered on proprietary devices is becoming obsolete”.
Our experience has been the healthcare provider determines what product and service is best based on the patient’s needs. There are a variety of different factors and limitations (health, financial, infrastructure, etc) the provider must consider before deciding what’s the best video communication solution. In most cases the healthcare provider is responsible for the expense of purchasing equipment or service. The patient already has enough issues to deal with and this minimizes additional responsibilities and burdens.
Another factor to be considered is encryption and HIPAA-compliance. While a number of products claim to be encrypted, do they meet HIPAA requirements?
Even after 14 years we still see a demand for POTS videophones, particularly in rural areas, which is primarily driven based on the infrastructure the patient has in their home. Desktop videophones, whether it’s POTS or our V2VIP TeleMed Bundle, provides ease-of-use, a level of familiarity and is not intimidating for the less tech savy. As long as it’s simple plug-n-dial the healthcare provider and patient embrace calling with a device that looks like a traditional telephone.
Shawn,
Thanks for sharing your positive experience with Vidyo. It caused me to check them out and write a new article, Extending Telepresence & Telemedicine to Patients’ Homes.
Hi Wayne. In answer to your question about Vidyo, we have used Vidyo at Mass General for physician-to-physician consultations for some time now with spectacular results. The cost for their HD-quality videoconferencing over best-effort, low bandwidth networks is a fraction of the traditional videoconferencing vendors, and there are a handful resellers offering Vidyo as a cloud-based solution. They connect easily to almost all H.323 systems and operate on many platforms, including PCs, Macs, Android devices and iPads. They are the VC engine behind Google Talk, have partnerships with HP, and recently inked a deal with Ontario Telemedicine Network, who will use their software SDKs and APIs to connect with patients in their homes.
http://www.informationweek.com/news/healthcare/mobile-wireless/231002922
Skype recently added a video chat application for iPad 2, which should make care providers happy. It can use either the front or rear camera. (Watch the video)
Vidyo promotes its own Video Conferencing solution, including patient/physician consultations. They compiled video testimonials featuring healthcare professional perspectives, but what about the consumer/patient perspective? How would you react if your doctor recommended using Vidyo for a monthly fee instead of supporting the video solution you already have and understand? Please reply if you’ve had experience with Vidyo and can rate it.
Dr. Sandeep asked about video conferencing solutions so he could do video calls with patients rather than traveling long distances. Here’s my response:
Google “Video Conferencing for Home Healthcare,” and you’ll find my March’11 article. It describes the benefits of popular options and includes links to video demos. You likely won’t be able to dictate what your patients use and must instead adapt to what they already have and are familiar with – or what their relatives already have, since they may have more influence and ultimately provide tech support.
The biggest problem you’ll have is that the various systems can only connect with users of the same system, so it’s important to understand who your patients are. If they’re young enough (under 65) and affluent enough (own PCs), you can probably use Skype. VuRoom even extends Skype capabilities to multi-user conferencing. That way you can connect with the patient, a family advocate, and a professional caregiver all at once.
It would be great if these systems worked together, but today that would mean using a Cloud-based service to transcode the video standards. Verizon told me they’re working on that, but I haven’t seen it yet and know of no other solution. I’m a huge fan of iPhone4 and iPad2, which come with Apple’s FaceTime. The camera can easily point to where it hurts, which is hard to do with a PC’s webcam. Thankfully, both also support Skype, so that would be my recommendation: 3G version of iPad2 with Skype, VuRoom and iChat.
Open Visual Communications Consortium (OVCC) is a lame attempt to solve the interoperability problem. I left the following comment on these two recent articles about OVCC:
1. OVCC targets videoconferencing interoperability
2. Consortium Pushes Videoconferencing Interoperability
Let me see. I sign up for a Cloud service so I can call mom or little Suzie or the office or to connect other companies on the same call. And I pay extra for that? Skype and VuRoom do it now. There are so many options (Polycom, Umi, Lifesize, Google Chat, iChat, FaceTime, Kinect, Qik, Tango, ooVoo, and others) but so little interoperability. Each has tradeoffs, and everyone wants to own the IP and dominate the market, so much so that none can. Robert Metcalfe must be cringing. Google “Video Conferencing for Home Healthcare.”
USAToday’s 5/21/10 artice, “The best options for video calling” adds two more options: Tango & ooVoo. Because they failed to mention interoperability problems among the many options, I added a reader comment pointing to this article on mHealthTalk.com.
Terrific Article and I love the way you link to the actual demo. In this high paced world ” seeing is beleiving”.
Vendors and resellers continue to struggle with the question, who is the decision maker. I suggest that very few actually incent seniors to make the move themselves. I have had luck in meeting with senior groups and explaining that “they are in charge”. They can decide to use video, Xbox, sign up for cruises, pick thier own doctors and remain independant. You know what? They believe it and act. When they act, the family and healthcare providers follow. What an interesting approach.
From my 3/4/2011 post, “I’ll Have My Robots Talk to Your Robots“…
Proprietary technologies from Cisco, Polycom and others will likely remain in a niche market, because mass-market telepresence adoption, like the phone system before it, depends on Metcalfe’s Law. Robert Metcalfe, inventor of Ethernet, stated that “the value of a telecommunications network is proportional to the square of the number of connected users of the system.”
That means free services like Skype and FaceTime, which rely on open standards, can provide value that increases exponentially as they scale to far more users. Yes, their video quality is limited by network speed, but they are starting to support HDTV resolutions as bandwidth increases. They also adjust resolution automatically to match network speed, so the same software can be used for low- or high-res video calls, depending on who you’re calling and where.
Now I ask…
Who will determine what video conference solution is used by the elderly? Will it be professional healthcare providers or family members? My guess is it will be the latter since empty-nested boomers are being pulled in two directions. They want to stay in touch with their kids and grandchildren while also keeping track of their aging parents — with the same technology. Smart caregivers will acknowledge this and adjust plans accordingly.
What do you think?
Proprietary technologies from Cisco, Polycom???? Cisco through its acquisition of Tandberg and Polycom work on very developed and mature standards (h.323, SIP, etc). Cisco’s first attempt to get into the telepresence market (2007 – 2009) was based on proprietary standards. The reason why most don’t interoperate with Skype is because Skype is the proprietary “island”. Lifesize had to extend its systems (which also are natively h.323 and SIP) to interoperate with Skype and still not all of their systems work with Skype. Microsoft people tell me that it will take months to develop Lync to interoperate with Skype.
Blue Jeans Network, OVCC, etc are the only chances this industry has to pure interoperability. Skype was never going to be free forever and now that it is in the hands of Microsoft, the FREE service will definitely end.
So then what? You are stuck paying for terrible video anyway. And believe me, if you have seen Tandberg, Lifesize or Polycom’s HD video conferencing, you will realize how bad Skype is (although getting better).
So…….paying for bad Skype video or paying for OVCC……….what’s the difference? You will be paying your service provider instead of Microsoft.