Telehealth Technologies
Telehealth modalities and technology resources
Different Telehealth Modalities
Telehealth is a service that can be delivered in many different ways. It is not just a doctor talking to a patient by interactive video teleconference, it includes at least four different modalities:
- Store and Forward is the asynchronous transmission of images, test results, and other data. Generally, not in real-time; the images are read at a later date/time. This may include for example cardiology, dermatology, ophthalmology, pathology, radiology readings, or interpretation services. The Pacific Island Health Care Project (PIHCP) of Tripler Army Medical Center (TAMC) is the best-known example of store and forward telehealth services in the US Affiliated Pacific Islands (USAPI).
- Remote Monitoring is the real-time transmission of patient physiological or biometric data. Home monitoring for chronic disease management or intensive care monitoring of patients are examples of remote patient monitoring. Guam Naval Hospital has used remote patient monitoring to care for patients in their intensive care unit (ICU) who were not well enough to travel to Honolulu.
- Live Consultation is the most commonly thought of telehealth modality. This includes the synchronous services provided by live, real-time, interactive video conferencing. However, the services may be between patients and primary care providers (PCPs), patients and medical specialists; or between PCPs and specialists. Shriners Hospital for Children conducts routine live teleconsultations by video teleconference in most USAPI.
- Mobile Health or mHealth is communication and data or image transfer via mobile devices. It may include the use of a mobile phone app, or a video teleconferencing program. The Veterans Affairs Pacific Island Health Care System (VAPIHCS) uses tablets to provide telemedicine services to veterans in their homes in the US Pacific Island Territories; this is an example of mHealth.
Telehealth Technology Resources
Your equipment needs will vary depending on the type of telehealth consultations, modality, and specialty care to be delivered. For a detailed and unbiased review of telehealth equipment and applications please visit the National Telehealth Technology Assessment Resource Center’s (TTAC) website. TTAC is our National Telehealth Resource Center which is focused on technology. TTAC offers a variety of services including technology assessments, reviews, tracking the latest innovations, technical tool kits, and other information to help you select the appropriate technologies for your telehealth program. National Telehealth Resource Center Website.
Basic Equipment Needed for Telehealth
This is a curated list of equipment that has been successfully used to deliver telehealth in Hawaiʻi and the Pacific Islands. This documents some technical features to consider when purchasing equipment for your telehealth purposes.
NOTE: This equipment list assumes that you have broadband connectivity, a HIPAA compliant video conference application (e.g., Zoom, Vidyo, etc.), and any cables needed to connect devices that are not Bluetooth capable. Price ranges vary and were inflated during the pandemic because of supply chain issues.
For Use in an Office With Only One Provider Using the System at One Time
You will need a desktop computer or laptop. A tablet like an iPad can be used with a stand. You can use the camera on your computer, laptop or tablet but usually, these are not very adjustable. If you are using your computer, laptop or tablet, make sure to adjust the height of it to get the best camera level to reproduce eye contact during your telehealth sessions.
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Webcam
Description
A webcam can be used on your existing desktop or laptop computer. The webcam allows you to adjust the camera which can help make the eye to eye contact with the patient better. A webcam that has the ability to be attached to a portable tripod is more versatile.
Description: Quality webcam with HD 1080p at 30 fps. 90-degree field of view and 4x optical zoom. Tripod mountable with ¼ inch threaded hole.
Benefit: Wide-angle so can have 2-3 people on camera. Can combine with a supporting tripod.
Approximate Price: $70-200
Example: Logitech c930e or similar
Noise Canceling Headset
Good to use when there is only one health care provider in the telehealth session. Helps with clearer sound transmission and reception.
Description: Built-in unidirectional microphone. Reduces unwanted background noise for clear conversation.
Benefit: Has USB and 3.5 mm jack options.
Approximate Price: $30
Example: Mpow 071 USB Headset or similar
Additional Laptop/Computer
If you want to have the electronic medical record, web-based tools, etc. available during your telehealth session, you may want to set up a second laptop/computer. If you are using a telehealth application that allows multiple windows then you can connect to the session with your second laptop/computer and show visual aids while still maintaining video of you.
For Use When Multiple Providers Are Doing the Telehealth Session
Instead of the webcam, you can use a monitor/TV, mini computer/laptop, wireless keyboard, and mouse to outfit your telehealth room. This is especially a good set-up if you have several providers doing a consultation together.
For Use When Multiple Providers Are Doing the Telehealth Session
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Conference Camera
Description
All-in-one system with HD video. Plug and play with no software installation. Has remote to control functions.
Benefit: Small and easy to use.
Approximate Price: $300- 350
Example: Logitech Conference Cam BCC950 or similar.
Video and Audio for 4-8 People in Room
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Video Conferencing System
Description
Description: Comes with the Speaker/microphone unit, power hub, camera, and remote control. This unit has a pan tilt zoom HD 1080p camera with 10x zoom. Good for medium-sized conference rooms.
Benefit: Easy to use. Speaker is clear. Remote control for camera.
Approximate Price: $980
Examples: Logitech MeetUp video conferencing system or similar.
Video Conferencing System with Expansion Microphones
Description: Everything is included with the Logitech Group Standard. Includes two extra microphones and is better suited for larger conference rooms.
Benefit: Easy to use. Speaker is clear and extra speakers help with larger groups. Remote control for camera.
Approximate Price: $1,275
Example: Logitech GROUP bundle with expansion microphones.
Computer
You can use a personal computer such as a laptop or a desktop computer to connect your videoconferencing system to the internet. You can also use a mini-computer with a wireless keyboard and mouse.
Minicomputer
Description: Intel-powered NUC is a mini-computer that includes ports for extra storage and display (4k support).
Benefit: Its small size makes it ideal for mounting behind a TV. Multiple display inputs allow up to three displays connected through HDMI or VGA.
Approximate Price: $330 for 8 GB DDR3L with 120 GB SSD and Windows 10 Pro.
Example: Intel NUC NUC6CAYH, other options include the Mac mini or Dell Wyse at higher price points for example.
Monitor
Description: Exceptional 4K detail, with 4K UHD and Dolby Vision HDR. Smart TV with non-proprietary browser. Great color. Built-in sound control.
Benefit: Browser is non-proprietary so many apps can be used with it. Great resolution.
Approximate Price: $550
Example: VIZIO M-Series Quantum 55” Class (54.5” Diag.) 4K HDR Smart TV or similar
Most smart TVs work well as a video conference monitor. Stay away from brands that use proprietary browsers (e.g., Samsung). This can make using some websites and apps difficult or even impossible. Vizio and TCL are good smart TVs at reasonable price points.
NOTE: If mounting TV to a wall or frame, be sure to purchase adequate mounting hardware and equipment beforehand.
Wireless Keyboard and Mouse
Description: Bluetooth keyboard and mouse.
Benefit: Can be used wirelessly to control the computer during a session.
Approximate Price: $60
Wireless Noise Canceling Speaker
Sometimes it’s good to have a wireless speaker that clearly indicates when the microphone is on or off and is easy to mute.
Description: Easy set-up. Light-weight and portable conference call speakerphone. Has both USB and Bluetooth connectivity. 15-hour rechargeable battery.
Benefit: Red lights surround the outside of the speaker when the speaker is muted and green when on. Allows clear conversation.
Approximate Price: $90
Example: Jabra Speak 510 Wireless Bluetooth Speaker
Accessories to Consider
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Mini Tripod
Description
Description: Lightweight standard tabletop tripod. Is about 6 inches tall. Can be turned into a handheld “stick” for observation. Has a ¼” threaded hole to mount a camera. Includes a spring-loaded bracket to hold a smartphone.
Benefit: Can be used to hold webcam, cell phones, etc for stability.
Approximate Price: $10
Example: Tripod for webcam Fuguteck
Document Reader
Description: This document reader is portable. You can use this to show visual aids to patients. It also can take a picture of what you have drawn and you can use it to email the patient or upload it to your EHR.
Benefit: Easy to use and portable.
Approximate Price: $200
Example: Epson DC-07 Portable Document Camera
Floor Stand, CTA Digital Height-adjustable Rotating Gooseneck Stand With Attachable Locking Wheels
Approximate Price: $50