How Telehealth is Transforming Healthcare

How Telehealth is Transforming Healthcare

W h i t e P a P e r

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T i m e W a r n e r C a b l e b u s i n e s s C l a s s HoW TeleHealTH is Transforming HealTHCare

The emergence of telehealth – the use of telecommunications technologies to provide healthcare services and

access to medical information across distances – is having a dramatic and positive effect on the practice of

medicine in the United States.

For providers, the instant availability of digital patient records reduces the likelihood of diagnostic errors, speeds

the processing of insurance claims and promotes collaborative information exchange between remote practitioners

within rapidly consolidating healthcare practices.

For patients, the secure and accurate transmission of electronic records eases the burden of coordinating the

delivery of information when changing or adding doctors. But more importantly, telehealth is bringing faster,

better and more accurate care – even during emergencies that occur far from major medical centers – that is

enhancing and even saving lives. It is also widening treatment options to include “virtual” doctor visits from

home and remote in-home health monitoring, which are especially important options for a fast-aging population.

Telehealth has proven to be effective. A 2010 survey conducted for Intel found

that 87 percent of the U.S. healthcare providers that have implemented telehealth

systems are satisfied with their solution, believing it improves healthcare quality

because physicians have better access to patient data. It has also enhanced

records management, especially given the glut of acquisitions and mergers

that is consolidating the industry and increasing the size of many hospital

and physician networks.¹

For healthcare IT professionals, telehealth has vastly expanded their role in effectively and efficiently delivering

and managing vital health data, thereby propelling the move from reactive to proactive healthcare in the U.S.

Driven by government regulations, recent stimulus funding, industry consolidation and the maturation of

technological advancements like digital imaging transfers, healthcare IT is a booming industry. Further powering

this surge are state and federal regulations and industry-driven guidelines that impact the back office, such as

the administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPPA)

of 1996. Helping pay for telehealth implementations are provisions of the federal government’s stimulus package

(the American Recovery and Reinvestment Act of 2009), with providers earning incentives that further efforts to

implement telehealth systems.

Saving Lives – and Dollars – with Healthcare IT

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Another key trend is the move to accountable care, a phrase coined by Dr. Elliot Fisher of the Dartmouth Medical

School, which focuses on the relationship between quality of care and expenses. Studies have found that providers

who spend the most do not necessarily provide greater care, so implementing policies and procedures that control

costs while improving outcomes is further urging many providers to strengthen their healthcare IT systems.

With about 50 percent of the nation’s healthcare providers still on the telehealth sidelines,² the rapid expansion of

healthcare IT will continue as the administrative efficiencies, cost savings and enhanced patient benefits continue

to be realized. From digital imaging transfers to electronic healthcare record management, providers and patients

are eager to reap the clear benefits of telehealth.

Central to any successful telehealth initiative is a robust and scalable telecommunications network, which

provides adequate bandwidth to quickly and safely transmit the vast amounts of data required to make

telehealth technologies successful.

From digital imaging transfers to electronic

healthcare record management, providers

and patients are eager to reap the

clear benefits of telehealth.

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Network Essentials: Connectivity, Security and Communication

Traditional telecommunications technologies, such as T-1 circuits offered by incumbent telephone companies,

are proving to be inadequate to support the high-bandwidth requirements of telehealth services. These include

the transfer of digital images such as x-rays and MRIs, as well as remote access to healthcare information from

multiple sites and the secure transfer of electronic health records.

Secure, high-capacity and high-speed data networks are an attractive alternative for healthcare providers

who must ensure that bandwidth is adequate to handle ever-expanding telehealth needs. In particular, the

high-bandwidth requirements for digitized on-screen diagnoses and other real-time collaborations have made

twisted pair, copper-based networks obsolete; they lack the efficiencies of fiber-rich networks that can better

transmit and store digital images and records.

In particular, healthcare IT professionals must ensure that their telecommunications networks deliver enough connectivity to efficiently move digitized data; the security required to protect patient confidentiality and meet government requirements; and real-time communication and collaboration between doctors and even their patients as the paradigm of patient care options evolves.

Adequate levels of capacity in network connectivity are essential for burgeoning telehealth networks,

whether they are large-scale urban hospital facilities or small, rural doctors’ offices connected to a consortium

of like-minded physicians. Because telehealth – in particular, digital imaging transfers – requires significantly

more bandwidth, healthcare organizations must find communications providers who can offer sufficient and

reliable data transfer speeds beyond those of traditional telecom networks.

In addition, the critical nature of telehealth applications has prompted many healthcare organizations to install

primary and backup connectivity should an outage occur with the primary network. While organizations have

typically used separate carriers to gain network redundancy, many are beginning to use one carrier who can

provide divergent network paths or technologies (such as wireless and wireline access) that are routed to

independent hubs.

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With respect to security and storage, these necessary enhancements are driven by HIPAA, which mandates

strict protections and enforcement regulations for the privacy of patients’ health records. This extension of

HIPAA security and privacy requirements, outlined in the HITECH Act of 2009, has intensified the need for

managed secure connectivity services – like Managed IP Virtual Private Networks (VPNs), with encryption

– that secure the data while it is being transmitted.

Moreover, security and privacy requirements demand

that healthcare IT groups partner with an experienced

and capable telecommunications provider, who can offer

appropriate levels of managed security services that

meet and exceed HIPAA requirements. For instance,

with respect to virtual doctor visits with a home-bound

patient, electronic communication is subject to specific

security requirements. The vendor selected must be

fully compliant with these regulations, either through

software encryption or by providing VPN or another

form of secure network connection.

High-speed networks and telehealth technology advancements are enabling more and more physicians to

communicate – in real time – for a variety of collaborative applications. The most dramatic and important are

in the diagnosis and treatment of patients, especially those in rural settings, who may have difficulty traveling

to meet with a specialist or who may be in a life-threatening emergency. With the U.S. shortage of physicians

across all specialties estimated to quadruple by 2015,3 the need for “virtual” doctor visits is further heightened.

Other collaborative needs – such as physician-to-specialist consultations, computerized physician order entry

systems, intra-practice physician training sessions and administrative meetings – are driven by the rapid

consolidation within the industry. Thus, telecommunications-enabling videoconferencing is becoming an

essential service across many large, virtual campuses, as well as among varied campuses seeking to save

time and travel costs.

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Communication in Action

While the administrative and managerial benefits of telehealth are numerous and quantifiable, doctors

appreciate how the advance in technology enables them to provide better patient care.

Consider J. Scott Patch,4 a family practitioner in Yarmouth, Maine, a town of about 3,500 that is 10 miles

from Portland and over 100 miles from Boston. Dr. Patch is willingly embarking on a digital journey. He

is acutely aware of the benefits that telehealth brings to his practice, patients and insurers – especially

telemedicine (the clinical care of a patient from a separate location, via teleconferencing for consultations)

and home health monitoring to collect patient biometric data.

“As the country struggles to control the costs of healthcare, there is an increasing consensus that telehealth will play a significant role in reducing cost and improving access for patients,” said Dr. Patch. “As a family physician practicing in a state with a large rural population, I have seen firsthand the need and benefits.”

Dr. Patch offers televisits for a number of his patients who may not require an extensive physical

examination. This involves two-way communications via computer, along with services provided through

a secure, high-speed Internet connection. Rural patients use televisits to reduce travel requirements for

follow-up visits, a service that is especially appreciated during Maine’s harsh winters. Others may have

difficulty reaching his office due to age, disability or lack of access to transportation.

“Patients have ranged in age from 19 to 91, and have lived between five minutes and two hours away

from my office,” explained Dr. Patch. “It’s a solution that offers great benefits for everyone involved.”

Dr. Patch was one of the first healthcare providers to participate in initial trials of industry-specific

services from Time Warner Cable Business Class (TWCBC). At its core, TWCBC’s Healthcare Solutions

(HCS) is a secure, community intranet that links healthcare providers, administrators, vendors and of

course patients so that they may interact efficiently or in real time within a private, secure network.

As Dr. Patch is discovering, the future is now for telehealth applications. Based on his recent telehealth

trial, he found that 80 percent of his patients asserted that a video-based telemedicine visit was as

good as or better than a traditional office visit. They felt that interaction with the physician was not

compromised, and that the time savings and logistical benefits made televisits worthwhile.

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transfering vital records among locations

A provider who has implemented electronic health

recordkeeping (EHR) is AVITA Health System, an

Ohio-based organization that operates community

hospitals, several physician practices and other

related entities. According to Andy Daniels, Chief

Operating Office for AVITA, the system’s expansion in

recent years has accelerated the need for high-speed

Internet access among all AVITA locations.

“Without the added bandwidth and speed from the

cable network, our ability to transfer vital records

among offices would be hampered,” said Daniels,

who also uses the network for voice traffic and

patient room television. “We just grew too large

for T-1 services.”

Connectivity is Central to an Effective Telehealth Program

To ensure that all forms of telehealth are successful, physicians and other medical providers must select the right

telecommunications carrier. Ideally, the carrier and its services must be reliable, adaptable and user-friendly for

medical professionals, administrative staff and, of course, the patients being served.

Clearly, a priority for all healthcare entities seeking to achieve the best efficiency, quality of care and government

compliance is high-bandwidth connectivity. Healthcare providers who are implementing the latest clinical and

telecom service technologies are leading the transformation of the industry from a hospital-centered business

to a distributed-based model, which provides better treatment where the patient lives.5

When telehealth is implemented in a fully-connected practice, many issues facing medical professionals

– appointment no-shows, transportation problems for home-bound patients, collaborating in real time with

colleagues, providing more care for complicated cases, database management – can be vastly improved.

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Bandwidth for dedicated interconnectivity

Memorial Health Services in Southern California

is an integrated health system comprised of six

large medical centers and numerous smaller

remote sites. In an effort to be in full compliance

with HIPAA, as well as improve its overall

performance, Memorial Health Services created

a digital centralized patient care system that

enables healthcare personnel to access patient

electronic files from throughout its network

of facilities.

But doing so demands that the system be

operational around the clock. If connectivity is

lost, doctors and nurses may not have access to

critical life-saving information during a medical emergency or new patient treatment

orders may be delayed. As a result, Memorial Health Services switched its communications

provider to Time Warner Cable Business Class, which implements point-to-point circuits

with sufficient bandwidth for dedicated interconnectivity among its facilities. According

to Robert Busche, network architect, Memorial Health Services, “Time Warner Cable meets

our needs by providing us with reliable service to sustain our patient care system.”

This white paper includes references to websites created and maintained and services provided by third party entities not affiliated in any way with Time Warner Cable Inc. or any Time Warner Cable entity. Time Warner Cable provides this information solely for our customers’ convenience. Time Warner Cable does not control or guarantee the accuracy or completeness of information contained on any third party website nor does it endorse the views expressed or products/ services offered by the third parties. All users accessing any website referenced in this white paper will be subject to the policies of the owners/sponsors of the third party website. Time Warner Cable assumes no responsibility of any kind for damages that might result from use of the services or websites mentioned.

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Of 225 breaches of PHI affecting 6,067,751 individuals,

more than 60 percent were the result of malicious intent.


¹ Penn Schoen Berland survey of healthcare and IT professionals in the U.S. who play a role in determining telehealth adoption and implementation within their organizations, conducted on behalf of Intel Corp., 2010. http://www.ok.gov/odmhsas/documents/Future%20of%20Telehealth.pdf

² National Center for Health Statistics, Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates, Dec.2010 http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.pdf

³ Association for American Medical Colleges, Center for Workforce Studies, June 2010 https://www.aamc.org/newsroom/newsreleases/2010/150570/100930.html

4 Dr. Patch served as a paid advisor to Time Warner Cable Business Class for developing Healthcare Solutions and also was a trial user of these services.

5 The Insight Reports, Telecommunications, IT and Healthcare: Wireless Networks, Digital Healthcare, and the Transformation of US Healthcare 2006-2011 http://www.insight-corp.com/reports/telehealth.asp

6 U.S. Department of Health & Human Services, Understanding HIPAA, www.hhs.gov/ocr/privacy/hipaa/understanding

7 U.S. Department of Health & Human Services, Health Information Privacy Breaches Affecting 500 or More Individuals, www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html

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Privacy, Security are Essential Telehealth Elements

Perhaps the most critical and highly scrutinized component of a telehealth network is its ability to maintain data

privacy and security. As more networks are migrating to IP systems, the need for managed services, especially

secure storage and security solutions, is more important than ever.

According to the federal government’s HIPAA Privacy Rule, healthcare providers must abide by a set of federal

standards to protect the privacy of patients’ medical records and other health information. Moreover, the HIPAA

Security Rule establishes national standards for the security of what is known as electronic Protected Health

Information (PHI). Combined, these rules protect the privacy of individuals’ health information while allowing

covered entities to adopt new technologies to improve the quality and efficiency of patient care.6

If PHI is compromised or breached, healthcare organizations can face severe consequences, both financially and

to their reputation. According to the Breach Notification Rule of the HITECH Act, any PHI breaches affecting more

than 500 individuals must be reported and released to the public. The latest figures – covering the period from

August 2009 through December 2010 – revealed 225 breaches of PHI affecting 6,067,751 individuals.7 While many

of the breaches were the result of lost or stolen laptops or other equipment, more than 60 percent were the result

of malicious intent, which should encourage healthcare IT managers to further strengthen their security efforts.

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Next Steps, with Time Warner Cable Business Class

Clearly, the benefits of a telehealth system, in convenience, quality of care, cost reduction and patient satisfaction,

can be staggering for patients, providers and insurers alike. Much of that success is dependent on having the

right telecommunications network in place.

At Time Warner Cable Business Class (TWCBC,) our dedicated team brings knowledge and expertise to the

healthcare industry. As a partner who can answer your questions and help you navigate the choices and changes

that will occur over time, we offer an approach firmly grounded in the belief that technology should serve you

– not the other way around.

Thanks to our wholly-owned, fiber-rich, broadband network and suite of industry-specific Healthcare Solutions

(HCS), healthcare facilities of all sizes and locations are reaping the benefits of telehealth technologies. Our

technology is designed to enable you to connect and collaborate, in a secure manner that protects patient privacy

and meets all federal guidelines and mandates that are hastening the digital transformation of the healthcare

industry. The results will help you take better care of your patients and maximize administrative efficiency.

Privacy and security are hallmarks of our network infrastructure over which healthcare providers can exchange PHI

using encrypted VPN technology. These Managed Security Solutions, which are a comprehensive suite of fully-managed

perimeter security services including firewall and VPN capabilities, as well as antivirus, anti-spyware, content

filtering and intrusion prevention, ensure network integrity while preventing internal and Internet-borne attacks.

From highly secure VPN connectivity to video conferencing for tele-consults and other collaborative initiatives,

our technology is designed to help you take better care of your patients and help increase administrative

efficiency. Of course, all of our efforts follow the federal guidelines and mandates that are rapidly transforming

the healthcare industry.

Time Warner Cable Business Class Healthcare Solutions consists of several products and services that address the aforementioned areas healthcare providers are eager to have enhanced by their telecommunications network – connectivity, security and communication.

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TWCBC offers a range of solutions designed to help healthcare clients communicate and transact business

in a secure and compliant environment, with many applications and products delivered from our private

healthcare cloud. Specific Healthcare Solutions services include:

TWCBC Ethernet Solutions delivers mission-critical connections between locations, leveraging TWCBC’s wholly-owned fiber-rich network.

TWCBC Dedicated Internet Access (DIA) is our fiber-based Internet access service that provides a dedicated high-bandwidth link between a healthcare provider’s local area network and the Internet, thus providing a secure method for sharing files across sites.

TWCBC Managed IP VPN is a managed IP-based virtual private network (VPN) with encryption. Managed IP VPN provides medical facilities with high-speed connectivity to Time Warner Cable’s private healthcare cloud, as well as secure site-to-site connectivity among several remote facilities, each with access to numerous managed service applications.

TWCBC High-Speed Internet Access is our broadband Internet access solution. The service is delivered over our advanced hybrid fiber-coaxial (HFC) network to ensure a secure, efficient and always-on connectivity to the Internet.

Cisco WebEx Web Conferencing service for audio and video conferencing enables real-time data, video and voice interaction. It is ideal for physician collaboration for patient consultations, emergency room triage and in-home televisits for patient assessment or follow-up visits. It may also be used for continuing education classes or seminars.

TWCBC Cable TV service offers tailored video and music programming to make the healthcare environment more comfortable for patients, as well as access to training and patient education through Video on Demand (VOD). All programming is delivered across TWCBC’s unique cable plant infrastructure for a clear digital or high-definition (HD) picture for a reliable and high-quality viewing experience.

Business Class Phone is a multiline voice service that combines the option of keeping existing equipment and telephone numbers with the freedom to configure each line separately. Numerous options enable healthcare providers to choose features that address their particular needs.

Business Class PRI (Primary Rate Interface) is an IP-enabled voice trunk service that provides a flexible and affordable voice solution. This PRI product supports both standard and fractional configurations and can be delivered to address your needs, whether you are a growing group practice or a large healthcare network.

The key to ensuring these services are safe, reliable and consistent is Time Warner Cable’s wholly-owned,

high-speed, HFC broadband network, which TWCBC hosts, manages and monitors around the clock. TWCBC’s

unique network infrastructure provides unprecedented network bandwidth and the flexibility to scale as needed for

digital imaging, electronic healthcare recordkeeping and other modern healthcare initiatives.

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For more information about the suite of Healthcare Solutions offered by TWCBC and other technology advancements that are benefitting healthcare providers, feel free to contact a local representative. Visit www.twcbc.com.

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To find out more about Time Warner Cable Business Class visit www.twcbc.com.

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Products and services not available in all areas. Actual speeds may vary. Some restrictions apply. Time Warner Cable Business Class is a trademark of Time Warner Inc. Used under license.

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Technology

How Telehealth is Transforming Healthcare