Beyond the Telemedicine Cart

The telemedicine cart is an indispensable component of any telehospitalist program, putting the virtual hospitalist ‘in the room” with their patient, even though they may be physically located miles away. With the collaboration of a bedside facilitator like a nurse or physician’s assistant, the telehospitalist can use the cart to evaluate patients remotely, converse with others in the hospital room, and “loop in”?other providers, specialists, diagnostic teams, even pharmacists.?

There are a number of telemedicine carts suitable for telehospitalists’ use on the market, most of them with similar configurations and feature sets. A typical cart incorporates:

·???????An upright, wheeled stand with an integrated touchscreen and processor, or alternatively a tablet dock

·???????HIPAA-compliant video and audio communication

·???????Backup battery

·???????Wireless connectivity

Once a telehospitalist’s “visit” is complete, the cart is easily moved to the next patient’s room, thanks to the wheels.?Some carts are even remote-controllable for greater flexibility.?

While telemedicine carts are an integral part of Symbian Health’s telehospitalist service, we recognize that they have potential shortcomings, such as:

·???????High cost

·???????Maintenance needs due to their being moved frequently

·???????Networking issues such as WiFi “dead spots,” which are common in hospitals

·???????Management and scheduling challenges, especially as the number of carts in a hospital and telehospitalists using them increases

As a result, Symbian Health is keeping an eye on the future, with the new care demands and technical capabilities it may bring. Two developments that have caught our attention include telemedicine headsets and integrated telemedicine rooms.?

Telemedicine Headsets

Early on, Google recognized the potential healthcare applications of its Glass augmented?reality headset.??Before Google pulled the plug on the first-generation Glass, users were experimenting with telemedicine applications of the Glass, such as enabling doctors to interact remotely with home-bound patients and their home caregivers, or providing virtual support to doctors and nurses in rural or other isolated hospitals. Although Google will no longer support Glass after Sept. 15, 2023, a new upgraded version (Glass 2) is expected to be introduced in 2024. The Glass 2’s detailed features and capabilities are not yet known, but its introduction is likely to spur renewed interest in telemedicine applications.

Meanwhile, other companies have been developing their own versions of the telemedicine headset, such as Hippo Technologies’ Hippo Virtual Care Headset. With Hippo’s headset, remote clinicians can see and hear the patient and bedside care provider via a high-definition camera and advanced audio mounted in the headset. The headset wearer can assign control to the remote clinician, enabling them to control the camera in real time, including zoom level, lighting, and record functions. Hippo’s Virtual Care software platform allows the remote hospitalist or other specialist to observe and collaborate in bedside examinations or consultations from anywhere in the world.

Integrated Telemedicine Rooms

An integrated telemedicine room has telemedicine tools such as video cameras, microphones, and display screens already built into the room. An integrated telemedicine room can be more convenient to use than a cart, and some of the equipment (such as the TV monitor) can be used for other purposes when not needed for telemedicine.?

However, the integrated telemedicine room is the costliest solution on a per-room basis, and can involve time-consuming architectural design, as well as construction work. The infrastructure requirements extend beyond the individual room, to include the network, building services, and power distribution.

These requirements put integrated telemedicine rooms beyond the reach of many hospitals, particularly smaller and/or rural hospitals. However, such hospitals have a potentially cost-effective alternative to purpose-building telemedicine rooms, i.e., retrofitting existing rooms for telemedicine.?

Virtual Visit, developed by Virginia-based startup Vitalchat Telehealth, is an example of such a retrofitted telemedicine room solution. Vitalchat’s software-based solution makes it possible to equip any room with telemedicine functionality, using the company’s proprietary hardware or existing in-room screens or other legacy hardware—even carts—as endpoints. The software gives inpatient and outpatient providers easy access to critical data in high-and low-acuity settings.

Takeaways

Neither of these technologies has been widely deployed yet in a telehospitalist context, but they have enough promise to deserve continued watching. Each has potential advantages as well as disadvantages.

Telemedicine headsets have the potential advantages of low cost, flexibility, and ease of operation.??However, unlike integrated telemedicine rooms, they do not allow the patient to see or interact with the telehospitalist on a video screen.??

The telemedicine headset’s limited interactivity is likely to be more of a drawback in some situations than others. Some patients seem to generally prefer interacting with the telehospitalist directly via audio/video (AV) link. A direct AV link may also be more appropriate to certain types of patient-telehospitalist interactions, such as end-of life conversations.

As a result, we do not expect either telemedicine headsets or telemedicine rooms to prevail over the other, nor replace telemedicine carts entirely. As observed earlier, some telemedicine room solutions, like Vitalchat’s, can even re-purpose existing carts as endpoints. For the foreseeable future, telemedicine headsets, rooms, and carts will probably coexist in the market, while allowing each hospital to choose the technology(ies) that best meet its needs.