University of Maryland Medical Center has supported a rural health telemedicine program for more than a decade, primarily supporting behavioral health but recently moving into tele-ICU.

Several trends, however, are pushing the organization to expand telemedicine to better treat stroke, neurology, dermatology, cerebral palsy and other conditions and diseases, said John Kornak, director of telehealth at U-Maryland, during a session at HIMSS16.

An aging population of baby boomers will bring heavy nursing demands by 2020, and the need for intensivists is growing as the actual supply of these specialists declines. The nation has 6,500 intensivists and needs more than 25,000, Kornak noted.

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Despite these challenges, expanding telemedicine is not easy for many organizations, Kornak added. Organizational barriers include resistance to change, getting approval from decision makers and a lack of physician/staff training. “There’s not a lot of telemedicine training being given in schools of medicine today, but hopefully that will change,” he said.

Partnering with social services organizations can help telemedicine programs reach vulnerable populations, says Robert Zimmerman, a co-presenter and CEO of the Health Technology Access Foundation, which advocates access to technologies for small and mid-sized providers. He suggests asking Meals on Wheels and other organizations that regularly come to patients’ homes to talk about the benefits of telemedicine.

However, telemedicine and telecommunication companies themselves, because of business reasons, don’t always look to expand because some localities may not be cost-efficient. Kornak has been trying for three years to get a telecom company to provide Internet access for 300 people living on an island.

With physicians facing reduced reimbursements, Zimmerman believes an Uber-type of new industry will come to healthcare with doctors banding together to start offering telemedicine services to replace lost revenue from lower insurance payments.

At University of Maryland Medical Center, some physicians want to start offering telemedicine to keep patients out of the emergency department, and Kornak is helping to create a business plan and select hardware. He reminded physicians that telemedicine falls under HIPAA privacy and security rules, so stay away from free technology such as Skype, and go with vendors that must sign business associate agreements.

Stay away from unencrypted telemedicine platforms, as they will only bring new risks and liabilities, Kornak warned. Encryption standards should include FIPS 140-2, the Federal Information Processing Standard, as well as the American Encryption Standard.

In general, he added, bandwidth of 768 kilobytes per second is best, but some consultations can take 384. Resolution should be a minimum of 640 x 360 with a speed of 30 frames per second.

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