Design Intro for Telemedicine

Posted on April 20, 2012

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Telemedicine is the process of using technology to bridge a physical distance between patient and caregiver to achieve wellness. And for a couple years, I have been eagerly reading and peppering telemedicine practitioners with questions in an effort to find out the physical design requirements for successful telemedicine implementation. What does the ideal telemedicine space look like? What is needed to maximize its functional performance as a virtual exam room?

The short answer is:  it is too new to know. Telemedicine has been in implementation in some rural areas for over five years. However, telemedicine itself is still being optimized, so the spaces in which it takes place are currently of secondary importance; practitioners simply have not given it much thought yet.

Architects like me are both disappointed more is not known, and excited to help define what the ideal might be. I will share what little I do know right now about the design for telemedicine.

Telemedicine can occur in real-time like a video conference, or it can be “asynchronous”, which utilizes patient / caregiver consultation, analysis and treatment as discrete activities over several days via video recordings.

For the real-time version, current telemedicine implementation can involve something as primitive as a “COW”, or ‘computer on wheels’, with a video camera mounted on a pole.  This provides a webcam like experience where both patient and doctor can see each other simultaneously and carry on a conversation and exam. This apparently works well for certain care like dental, mental health, and dermatology exams.  Nothing is apparently needed spatially within the room.  Preferably, the room would have a neutral backdrop to see the patient and not distort color in the video, and the room should not have terrible acoustics that would garble a normal conversation.

For asynchronous telemedicine, architectural requirements are similar, depending on what kind of care is being administered.  A research abstract I read recently was from the Telemedicine and E-health Journal, May 2011 issue, which covered psychiatric consultations (PsychVACS is a HIPAA-compliant telepsychiatry program), although it can be used for lab and test analysis like pathology, cardiology and radiology.  Special thanks to Lisa Kilawee at Avera Health for providing me with the white paper.

In this case, a patient is interviewed by a researcher face-to-face, and the conversation recorded for later remote viewing and input by a psychiatrist; care is then administered through the patient’s primary care provider locally based on the specialist’s input. Requirements are similar to a standard video recording and possibly a bit more lax since the visual aspect is only important ‘on the front end’ when viewing the in-person patient interview; the rest of the process are typed notes—doctor to doctor—to help remotely direct care.

Highlights of the technical aspects of what is needed (IT capabilities, software, hardware, etc.) include:

  • High-quality compact video camera and an externally-attached microphone, mounted on a tripod (4 feet high and about 7 feet away)
  • Wide-angle lens adapter for camera (typical 9×9 exam room with standard room lighting ok), important to simultaneously capture interviewer and patient on-screen
  • Notebook computer with encrypted hard drive to receive video
  • External hard drive to archive CD / DVD-quality digital video, and allow secure remote viewing access
  • Three-monitor set-up for evaluations by psychiatrist, for efficient video and patient history review and note taking

According to the PsychVACs report, most consumer audio / visual products—webcams, video cameras, open source software—did not have adequate quality for video and / or audio to be useful in a clinical setting.  Emphasis was put on testing all components to ensure there is no weak link compromising the process since technology helps define success in this arena.

Design-wise, it seems disappointing to think there is nothing uniquely architectural about the telemedicine environment, at least not yet. Acoustics is a topic more prominant in healthcare, design so a consultation space / exam room design for ideal acoustics, lighting and “staging” of a telemedicine interaction is likely to evolve.  More to come.

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