By John Vitale

While increasingly anticipated by consumers, telehealth still presents significant reliability and security concerns for healthcare providers. Patients and families expect access to medical professionals through videoconferencing technology these days, and healthcare IT professionals are now tasked with finding and implementing innovative solutions to respond to this demand. The value of effective telemedicine solutions has been clearly demonstrated, with numerous studies illustrating the positive impact to both an organization’s bottom line and the quality of patient care it delivers.

A recent evaluation of Emory Healthcare’s eICU in Atlanta, for example, highlighted the program’s success in the third annual “Evaluation of Hospital-Setting HCIA Awards” report by Abt Associates. Emory achieved $4.6 million in savings over a 15-month span and the program allowed healthcare providers to leverage telemedicine to remotely monitor ICU patients continuously and intervene more quickly when needed.

The audit also demonstrated a 1% decrease in the rate of 60-day patient readmissions, as well as a 9% increase in the relative rate of discharges to home health, suggesting Emory was discharging patients with less need for institutional post-acute care after their eICU stay. Results like these underscore the fact that broader adoption of telemedicine is on the horizon. Security and reliability concerns continue to be obstacles that have made the implementation of effective solutions elusive for many healthcare providers, however.

Challenges to Adoption

An upsurge in telemedicine adoption has been matched by an equally sharp increase in healthcare data breaches. According to Protenus’ Breach Barometer year-in-review report, more than five million patient records were exposed through data breaches in 2017 alone, underscoring the need for healthcare professionals to make data security a top priority.

Lack of reliability in consumer-facing videoconferencing systems also hinders widespread adoption. A Sage study reports nearly half of executives estimate their existing telemedicine solution fails 15% of the time but 70% of executives consider reliable connectivity to be a “must have.” This is like walking outside your house every morning to drive to work knowing that one day a week, your car won’t start—but you don’t know which day it will be. How can you rely on your car?

With considerable liability linked to telemedicine adoption, healthcare providers may be reluctant to rely too heavily on their current system or to make the leap and install a new solution if doing so might expose them to serious patient safety and privacy risks.

Acute Setting Roadblocks

Telemedicine adoption in acute care settings is even less common, as it presents another unique set of challenges in an environment where the stakes are higher than those in many other clinical settings.  In emergency situations, clinicians and health technology management professionals need to be completely confident in the reliability of their equipment. Clinicians don’t have the time to troubleshoot a downed system, nor is it their job to do so. They need to focus on the patient and leave technical concerns to experts tasked with that responsibility.

Traditional vs. Cloud-Based Infrastructures

The only surefire way to ensure that you choose the right solution, of course, is to carefully research all of your options and weigh the risks and benefits associated with each. One major area of focus in your research should be cloud-based vs on-site infrastructure deployments. A common misperception among healthcare providers is that on-site solutions provide more robust security when it comes to protecting patient data and safeguarding against breaches.

This is simply no longer the case. Cloud technology is maturing rapidly and can provide multiple levels of security needed for increased protection of patient records— obviously a paramount concern among healthcare providers.

Security

Many organizations focus their security efforts at the barrier of the public space (the Internet) and the private space (their private network). These are important areas on which to focus, but it is equally important to ask yourself: “If someone gets through my security barrier, what can they do once they’re inside?” A multi-level approach to security is the best way to ensure that information security and patient privacy are achieved even in the case of a breach.

For example, if you’re going to install a videoconferencing system solution on the wall in a patient room, how does that device help to ensure that a hacker can’t use it for malicious activity? Traditional off-the-shelf videoconferencing solutions that have been installed for healthcare use are passive in design, which allows these systems to receive calls from anything that can get to it.

While these systems do employ good security measures, most are designed to keep intruders from penetrating the security barrier from the public space. Once the main barrier is penetrated, little can be done to prevent those devices from being compromised. It’s a bad practice to assume what works in the conference room will work in a patient room.

Cloud-based solutions have many benefits for scalability and functionality but also have benefits on the security question. For example, a cloud solution can be a public facing resource enabling connectivity to public sources that would talk strictly with the cloud. Internal resources can then securely interface with these external entities without the need to create a path into the private, secure network. The cloud solution becomes your new security barrier.

Through my hands-on experience, I know how important it is for healthcare providers to be aware of the security threats they are up against. In today’s environment, determined hackers can infiltrate a system that is not purpose-built for the healthcare environment through vulnerable points in a typical videoconferencing system. Hospitals that implement systems not specifically designed for healthcare environments need not worry if a breach will occur, but when. To help, Yorktel employs hacking subject matter experts to develop our multi-layered approach to security to protect patient data, and constantly update security features to address potential vulnerabilities, ensuring the integrity of the platform’s infrastructure.

To prevent breaches, healthcare professionals must look beyond entry-level, consumer-facing solutions that may be prone to hacking and consider solutions that take a direct, multi-layered approach to security. Cloud-based telemedicine solution providers can take measures to contain a breach through an added layer of security, preventing the malicious party from accessing or exposing valuable patient data, mainly by denying them access to your protected environment in the first place.

It is too important today to deliver outreach to the public space so the practice of locking down and restricting communication is prohibitive to enabling the services patients need. This doesn’t mean any cloud provider can deliver this level of service. Look closely at the architecture and measures a cloud provider is offering to fully understand what they bring to the table. Not all cloud solutions are the same and it’s up to you to make sure you understand how the cloud solution will help you protect your environment.

Reliability

Reliability is an equally serious concern, especially in high-risk situations where telemedicine solutions play a vital role in driving positive patient outcomes. In many use cases, telemedicine can act as an effective supplement to on-site medical care. For example, many hospital networks throughout the country are experiencing shortages of intensivists. A tele-ICU (or eICU) solution can help alleviate problems caused by caregiver shortages, yet healthcare providers are hesitant to integrate solutions because of the level of performance required to care for patients.

The potential for equipment failure and the complexity of some systems are barriers to more widespread adoption. These are concerns that can be remedied with a purpose-built solution and adequate technology training. Those two elements can ensure that any equipment failure can be quickly and efficiently resolved with no interruption to the delivery of quality care.

A telehealth platform’s reliability is dependent upon several factors: being designed for the environment in which it’s being placed, high reliability for maximum uptime, rapid serviceability to resolve issues quickly and easily without interruption to patient care, and a sophisticated capability to monitor and manage the entire platform. Effectively combining these critical elements allows healthcare providers to confidently focus on patient care, rather than operating the technology.

Telemedicine solutions developed specifically for healthcare environments mitigate risk and improve reliability of the services when compared to commercial products designed for the conference room. To put this into perspective, if a camera stops working in a conference room, users shrug off the inconvenience and connect via an audio call—but if a camera fails in a patient room and the issue can’t be immediately resolved, the consequences can substantially impact the level of patient care that’s expected.

Adopting Telemedicine

Patient care begins in the hospital, so the burden of telemedicine adoption lies partially upon healthcare providers to effectively integrate telemedicine into various clinical workflows. Adopting telemedicine assists hospital systems in reaping the widely-known benefits associated with telemedicine solutions, including financial savings, reduced readmission rates, addressing doctor and specialist shortages and above all else, improving patient outcomes. With a Sage study of C-suite level executives reporting that 87% of non-adopters claim telemedicine is a medium to high priority over the next few years, the benefits very clearly outweigh the risks.

As healthcare professionals conduct exhaustive research in determining which telemedicine solution will best benefit their hospital or healthcare system, they must be aware of the security and reliability risks associated with selecting a traditional consumer-grade platform and consider solutions purpose-built for the healthcare environment to best protect patient data and improve overall patient satisfaction and health outcomes.

John Vitale is senior vice president of product management for Yorktel. Questions and comments can be directed to 24×7 Magazine interim chief editor Chuck Holt at cholt@medqor.com.