Telehealth TVs Position Intermountain for the Future of Virtual Care

The Salt Lake City health system recently launched 1,200 devices that provide in-room virtual care through smart televisions equipped with two-way cameras and special microphones. The technology can simultaneously connect with other providers and family members, along with the ability to screen-share images and data on the display.

When the doctor arrives in a patient's room at an Intermountain Healthcare facility, it's not necessarily through the door. These days, many physician visits occur on the patient's television screen. 

Operating in a fashion similar to the more familiar video carts often used in eICU settings, these in-room smart televisions are outfitted with the Hospital TV Carepoint device from Boston-based telehealth company Amwell. The device integrates a special two-way camera and microphone into the television set's functionality. It offers some advantages over the use of carts and opens the door to a new way of using telehealth to deliver care more efficiently inside the hospital, says Brian Wayling, MBA, assistant vice president of TeleHealth Services, at the nonprofit Salt Lake City-based healthcare system.

As hospitals explore new ways to grow the telehealth services they launched during the pandemic, Intermountain's experience offers a look into how it is using this equipment to position the health system for the future.

The Emergence of Telehealth Televisions

Intermountain Healthcare launched its telehealth services many years ago, Wayling says. Today, a team of intensivists and hospitalists works around the clock from a 20,000-square-foot telehealth command center, which opened in May 2019, bringing together technology and clinical service operations to serve the system's 23 hospitals. Each team has about 35 to 40 clinical members. The facility also houses a telestroke unit, as well as other personnel and capabilities.

"Initially, telehealth started as a rural solution," Wayling says. "It allowed us to extend our expertise out into the community. There's just simply no way that smaller, critical access hospitals or rural communities would be able to hire all of those individuals and have them available around the clock. But we found equal capabilities and need in urban environments."

The health system began piloting the TV system about eight years ago. Initially, the devices were set up in critical care rooms, but they are now also used in emergency rooms, med-surg rooms, and other areas of the hospitals. Altogether, 1,200 devices have been installed in 50 locations.

"We started deploying the TV kits because it was important for the critical care intensivists to have a single point of view to enter the room to make sure that they always have that consistent view," Wayling says. Televisions offer the advantage of being affixed to the wall, he says; carts move around and get bumped.

As the coronavirus pandemic took hold, this system also protected caregiver safety, he says, providing virtual access to negative pressure rooms, positive pressure rooms, and isolation areas.

Perfecting Audio and Video Capabilities

Since its initial deployment of the TV devices, one of the details Intermountain has worked closely to refine is the audio quality of the system.

While in some instances, there are only a few people in the room, "in a critical care or an emergency room, there are multiple people talking simultaneously," Wayling says. "It's really important to have a microphone that creates an audio 'cone' coming down so we can hear the most important people in that conversation. It doesn't exclude the backend—if there are hallway conversations happening—but we really try to focus the audio on those critical conversations. We spent a lot of time with ourselves and with Amwell perfecting the audio."

Another important feature is the pan, tilt, and zoom camera that enables the remote physician to move the camera into an ideal position and focus on whatever perspective or details best suit the situation.

Technological Advantages That Position the Health System for the Future

One capability that distinguishes the system that Intermountain is using now and advances the potential use of telehealth is the ability to add third parties to the screen, such as other physicians, interpreters, or family members. It also enables screen sharing.

Surgeons or infectious disease specialists can quickly conduct consults, local caregivers can join the discussion, and family members can be included or immediately summoned for a virtual visit if a dire situation occurs. "They can all join simultaneously so there isn't a need to have sequential appointments or elongate the visit," Wayling says. "They can consult at the same time and really engage in that immediate situation."

While this capability is a function of Amwell's technology, which is also available on its video carts and tablets, the "real estate" of the television screen enhances visibility for the patient, and enables them to clearly see multiple parties simultaneously, he says.

Viewing multiple parties on a smaller screen on a video cart, "makes it a little bit awkward," Wayling says. Plus, if a caregiver is sharing a diagram, x-ray, or lab result, "the TV kits obviously offer that nice resolution and greater real estate."

While the system is primarily used by physicians in the command center, "all of our technology has always been clinical program neutral, meaning that any clinician, cultural services, or any other service can use it to access those rooms and also collaborate with other providers," Wayling says.

The ability to bring multiple individuals together for a virtual collaboration is one of the advantages of this technology, Wayling says. That dynamic enables quicker, more efficient care that limits transfers and could improve outcomes, enhance the patient experience, and potentially reduce costs.

The Carepoint device connects "key players across the healthcare ecosystem to improve clinical and financial outcomes," said Ido Schoenberg, co-CEO and chairman of Amwell in a news release. "Streamlined, integrated connectivity between patients and informed, trusted providers is central to realizing this goal.”

By using smart televisions that are already installed in patient rooms, the technology also enables a health system to scale the solution more rapidly.

Cost is Similar to Video Carts

Wayling says the cost of telehealth TVs, including the television, special equipment, and installation of cable and networking is comparable to video carts. It also maximizes the functionality of the TV, which would be in the room anyway and prevents the need for two screens in one space.

However, there are other considerations that may make telehealth TVs a better long-term investment. Having equipment on the wall enables more flexibility when planning room layouts and allows more flexibility for placement of other furnishings and equipment.

In some situations, a cart might be a better option, he says. "Sometimes, a cart is actually more useful in a smaller space because you need to move it around and position it differently than a single point [of view]. Working with the caregivers and the physical size of the room is a really important consideration. In the end, the cost is very equivalent; there are just different use cases on how to best use which technology."

4 Lessons Learned

1. Knock. Early in the development process, the Intermountain team learned that providers shouldn't just show up on the television screen to enter the room virtually, Wayling says. Instead, their presence is now preceded by what Wayling terms as a "knock." A blinking light on the TV set alerts the patient or caregiver to "admit" the remote physician. "It was very important that we don't just jump up on the screen and have that caregiver suddenly appear without any notification."
    
2. Test Audio and Video Positioning and Quality. "The audio is very important, to make sure that [those] providing care at the destination site and the originating site can hear appropriately," Wayling says. "Positioning the microphone/speaker is very important as is the camera to ensure that you have that right point of view." Intermountain tested and validates these factors and brings caregivers into the room in advance to ensure equipment is placed correctly.
    
3. No EMR Integration. Intermountain intentionally decided not to integrate the electronic medical record with the monitors and telehealth platform. "There are a lot of upgrades going on with software all the time," he says. "Once you have that rollercoaster of updating one system, you have to update everything else and test. We were concerned about that."
    
4. Consider Construction Costs when Retrofitting Rooms. Retrofitting existing rooms requires electrical and networking connections, sometimes creating the need for drywall repairs and painting. Some older facilities may require additional construction challenges. "It becomes a slight barrier for existing locations," Wayling says.

Moving Into the Future

As new Intermountain Healthcare facilities are built and existing ones expand, "We're embedding the infrastructure for telehealth [televisions] into all of our architectural plans," Wayling says. While it is less expensive to run cables before drywall and painting, it is also positioning the health system for a new way of care delivery. "Telehealth has become an absolutely acceptable delivery mechanism for Intermountain and our caregivers."