Beyond E-health - Curando Nordic · ogy. It’s estimated that over 6 billion of these will support WebRTC by 2019, with over two billion individual users13. 13 Beyond E-health …

Beyond E-healthEmbedded Communications in Healthcare

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Contents

INTRODUCTION

THE RISE OF CONNECTED HEALTH

THE POWER OF EMBEDDED COMMS WITHIN HEALTHCARE

USE CASES

DRIVERS OF ADOPTION

OVERCOMING ADOPTION CHALLENGES

BENEFITS OF EMBEDDED COMMUNICATIONS IN HEALTHCARE

CONCLUSION

ABOUT TOKBOX

APPENDIX

www.tokbox.com 2

Education, hospitality, e-commerce, finance, and

many others are finding hyper-connected customers

demanding increased engagement and better service

experiences online.

Healthcare is far from immune from these shifting

customer expectations, and there is also the added

challenge of unprecedented growth in demand due to

an aging population and record numbers of chronic

diseases. Combined, these pressures are forcing

healthcare providers to reinvent existing care models

by increasing efficiencies while simultaneously raising

their level of service.

Thankfully, emerging technologies are finally

maturing to the point where this is possible. Digital

technology has seen explosive growth in the past

few years, becoming cheaper and more accessible

every day. Within the healthcare industry, this has

manifested itself across a range of services, from

home-health technologies and connected health

devices, to online consultation and collaboration.

By 2020, over 78 million consumers are expected to

use home health technologies, a dramatic increase

from 14 million in 2014.1

Embedded communications, powered by Web-

based Real Time Communications (WebRTC),

are one of the key solutions fueling this digital

revolution in the healthcare industry. WebRTC allows

healthcare providers to directly embed live video,

voice and messaging into websites and mobile

applications, making it possible to integrate real-time

communications into any context, including patient

data, health records or medical images.

In enabling embedded live communication between

healthcare professionals and/or patients at any

time and from anywhere, with WebRTC providers

can reinvent how care is delivered. Now a specialist

in Boston can provide secure, real-time advice to a

surgeon in San Francisco via shared X-ray screens;

a recovering addict can attend a video support

meeting in a familiar context; and a busy parent

can utilize an app that allows doctor and patient to

schedule appointments and review medical records

simultaneously.

This report explores the role of new technologies in

healthcare and how embedded communications are

fueling the e-health revolution.

78.5M

14.3M2014

2020

Number of consumers using home healthtechnologies globally:

Introduction

Beyond E-health // Introductionwww.tokbox.com 3

What is connected health?

Connected health refers to the use of technology to power healthcare remotely. Connected health solutions include home care, remote monitoring, virtual consultations, virtual therapy, telecoaching, and more. Utilizing these digital solutions, often powered by smartphones and other existing technologies, services can be offered outside of traditional healthcare facilities - making healthcare more accessible, cost-effective, and convenient.

The healthcare industry, which has traditionally lagged behind most others in terms of technology adoption, is waking up to the potential of connected health.

Beyond E-health // The rise of connected health

The rise of connected health

www.tokbox.com 4

Connected health is already growing rapidly, and is projected to explode over the next five years:

$20 billion $13.7 billionMobile Health Apps & Solutions Market

will be worth $20 billion by 2018.5The virtual consultation industry is

predicted to have revenues of $13.7 billion by 2018.6

Beyond E-health // The rise of connected health

100K+ 28%

158 million

62%Applications: Over 100,000 healthcare applications are

available for download today.2

62% of smartphone owners have used their phone in the past year to look up information about a health condition.3

By 2014, 28% of U.S. broadband households had used some type of virtual care communication tool.4

Video consultations are set to increase from 19 million per year in

2014 to 158 million per year by 2020.7

www.tokbox.com 5

Medical care will no longer

be confined to clinicians

in the clinic or hospital.

The ubiquity of digital

communication means

that many doctor-patient

contacts [will be] virtual and

deliver care to the patient in

their home.” 8

The digital revolution has transformed the way we behave and interact. We expect immediate access to information and tools wherever we are, at the tap of a device. This need for convenience is no different in healthcare, and by 2020 it’s expected that the majority of medical care will take place outside of traditional health facilities

The power of embeded communications

“

Beyond E-health // The power of embedded comms within healthcarewww.tokbox.com 6

This poses a significant challenge for healthcare professionals: they must satisfy

this increased demand for online care whilst still maintaining the same levels of

quality and trust offered to patients during in-person visits.

Enter WebRTC - the first plugin-free real-time communications technology for

the web. The true power of WebRTC lies in its ability to embed live video, voice

and messaging directly into the context of any website or mobile application,

enabling seamless in-app conversations. No downloads, third-party applications or

expensive hardware are required - just a connected browser or mobile device.

Whereas in the past, remote practitioners would have to switch between (often

non-secure) applications in order to talk and view X-rays or medical reports,

embedded communications allow these conversations to take place within the

same application as the content, in a fully secure environment.

Healthcare professionals can now speak virtually to each other or to patients

anytime and anywhere, all within the workflows and systems they already use.

This creates more efficient and accessible care that still retains both the medical

context and the human element that is so vital to healthcare.


What is WebRTC?WebRTC is a standard that enables plugin-free, Real Time Communications

(RTC) in the browser (audio, video and voice). WebRTC offers significantly

better video quality than predecessor technologies, up to 6x faster connection

times, reduced audio/video latency and complete customizability.


Embedded communications are powering

a range of innovative and effective medical

solutions from one-to-one conversations to

dynamic multi-party chats.

Beyond E-health // Use cases

Use cases

www.tokbox.com 9

Virtual visits

Patients can connect with physicians around the

world quickly and securely through virtual office

visits, all within the context of their existing workflow.

Companies such as Babylon and Maven are

significantly improving patient experience through

virtual visits - learn more on pages 18 and 19.

Support groups

Through online support groups, people can receive

support from peers or specialists from the comfort

and privacy of their own home through multi-party

video and voice chat. See how In the Rooms is

making this possible on page 21.

Specialist-to-specialist consultation

Clinicians can ask other specialists for real-time help

in diagnosis or hold a routine meeting that can be

enhanced by screen and content sharing. Learn about

Calgary Scientific’s remote collaboration solution on

page 23.

Beyond E-health // Use caseswww.tokbox.com 10

The healthcare industry is undergoing massive

change. From increased demand on resources

to changing patient behavior, there a number

of different factors at play that are driving

organizations to reinvent care models.

Beyond E-health // Drivers of adoption

Drivers of adoption

www.tokbox.com 11

DemandThe combination of longer life expectancy and an unprecedented increase in

chronic diseases, accounting for 87% of healthcare costs in America9, means that

demand for healthcare is at all-time high. If the system for delivering primary

care remains the same as today it’s projected that America will have a staggering

shortage of 90,000 physicians by 202510.

CostIncreased strain on healthcare systems is putting huge financial pressure on

providers. In the United States, healthcare spending is expected to reach $4.8

trillion in 202111, up from $2.6 trillion in 2010. At the same time, the cost of technol-

ogy is decreasing. Studies have shown that Medicare could save an estimated

$45 per visit if in-person urgent care services were replaced with a telehealth visit

reimbursed at the same rate as a doctor’s office visit.

Beyond E-health // Drivers of adoptionwww.tokbox.com 12

$2trillion

2010 2021$0

$4trillion

$5trillion

$3trillion

-90,000Physician shortage by 2025

BehaviorPatients are looking for more convenient and immediate solutions, in line with

consumer expectations across industries. At the same time, they increasingly trust

technology and are more accustomed to using it regularly, making them more

likely to adopt a connected health solution than ever before. A recent survey found

that more than 75% of respondents would like to use digital healthcare services12.

AccessibilityWidespread adoption of technology and access to the Internet are both key to

powering the embedded communications surge. A large percentage of the popula-

tion now own computers, tablets, and/or mobile devices that support this technol-

ogy. It’s estimated that over 6 billion of these will support WebRTC by 2019, with

over two billion individual users13.

Beyond E-health // Drivers of adoptionwww.tokbox.com 13

75%Welcome digital

healthcare

As with all innovative technologies, there are

barriers to adoption. However, the recent surge of

embedded communications within healthcare is

proof that these barriers can be overcome.

Beyond E-health // Overcoming adoption challenges

Overcoming adoption challenges

www.tokbox.com 14

HIPAA Compliance Insurance Coverage

Embedded communications platform providers understand that customer

and data security is a number-one priority and that regulations such as

HIPAA must be considered.

HIPAA, the federal Health Insurance Portability and Accountability Act,

aims to protect the confidentiality and security of healthcare information.

Connected health applications may involve the electronic exchange

of PHI (protected health information), which is protected under HIPAA

regulations. Therefore, when embedding live communications into

websites or applications, the platform providing the RTC capability must

be HIPAA compatible.

Using a secure embedded communications platform, such as the

one offered by TokBox, it’s possible to ensure secure connection and

encryption while conforming to HIPAA standards. Learn more about

TokBox on page 26.

Insurance providers haven’t always covered virtual visits. However, the

number of states offering reimbursement for telemedicine continues

to increase. According to the American Telemedicine Association’s

2015 report, 48 state Medicaid agencies now offer some type of

coverage for telemedicine-provided services. In addition, over the past

three years, the number of states requiring private insurers to cover

telemedicine-provided services compared to that of in-person (parity

laws) has doubled14.

In April 2015, another significant step was made when United

Healthcare, the largest health insurer in the US, announced it would

cover virtual video consultations using Now Clinic, Doctor on Demand,

and American Well as its first three partners - costing members only

their typical co-pay for a live virtual visit.

According to Wired magazine, “the decision by so influential a player

in the healthcare industry to telemedicine is the strongest sign yet that

the technology is entering the mainstream”15.

Beyond E-health // Overcoming adoption challengeswww.tokbox.com 15

Affordability Complex technology Lack of trust

With WebRTC, live communications can be added

to any website or application. It’s simple and

affordable to embed into existing workflows and

neither patient nor provider needs complicated

and expensive medical equipment, only their

smartphone or PC.

Unlike legacy technologies, WebRTC makes it pos-

sible to build applications that they are incredibly

simple to use. There are no downloads required for

the end user, and joining a video consultation can

be as simple as clicking a link or opening an app

on a smartphone.

Patient attitudes are beginning to change as

connected health becomes more widespread. A

recent study has shown that nearly half of patients

would be happy to speak to a doctor online16.

Beyond E-health // Overcoming adoption challengeswww.tokbox.com 16

Organizations are already seeing a range

tangible benefits of embedding communications

into their service offerings, improving efficiency

and outcomes across the board.

Beyond E-health // Benefits of embeded communications in healthcare

Benefits of embeded communications in healthcare

www.tokbox.com 17

Save time and money Maven

Embedded communications as a substitute for

in-person visits has the potential to dramatically

reduce costs for healthcare providers. Minor

ailments can be resolved quickly, cheaply and

just as effectively via a video consultation. The

average cost of a video-based virtual visit is

less than $50, which provides significant savings

when compared to costs for similar minor

medical needs treated at a doctor’s office ($80)

or urgent care facility ($160)17.

Maven, the first digital clinic for women, allows users to schedule virtual appointments with a range of

different medical practitioners. App users enter information about their medical request or question,

and are matched with a series of appropriate providers. They are then connected via live video to an

expert of their choice and can chat securely using their own device.

In the past, women have had to take time out of their schedules to make an appointment and travel to

a doctor’s office for a consultation for something as simple as a prescription question. Now they can

get the answer they need in ten minutes, without ever leaving home or the office. As well as saving

precious time, Maven users save

money; consultation costs have

dropped down to as little as $18.

Beyond E-health // Benefits of embeded communications in healthcarewww.tokbox.com 18

Babylon

Babylon is a virtual-health service enabling users to quickly and easily book video consultations

with their doctor and get specialist referrals, all through a smartphone. By using Babylon’s simple

mobile application, users can consult virtually with an experienced doctor in a way that suits them.

Users can also monitor symptoms and stats such as calorie burn, blood pressure, and vitamin

levels, and share these stats with their doctors, send in questions to be answered via messaging,

or even pick up a prescription. Features like these have led The Huffington Post to describe Babylon

as “the world’s simplest health service.”

One Babylon user explains how their

medical experience was improved by

using the application:

“I woke up feeling really unwell.

Usually I would have to compete for

an appointment when my surgery

opens first thing. Instead I booked a

ten minute video consultation at eight

o’clock and picked up a prescription

during my lunch break. Why would I

ever do anything else?”

Improve patient experience

Traveling to the doctor for a routine check-up can

often be inconvenient and stressful, particularly for

the elderly, those with chronic illnesses, working

parents, and those who live far from a medical

facility. Virtual check-ups improve the healthcare

experience by allowing a patient to remain in the

comfort and convenience of their own home, with

minimal disruption to their schedule.


The organization was originally founded by two individuals who struggled to get access to a paediatric

neurologist for a family member. Having experienced firsthand the associated cost and inconvenience of

having to travel to get specialist care, they hoped to give patients in similar situations access to experts

thousands of miles away via live video chat, ensuring the best outcome for the patient.

Vitality uses embedded communications within its web and mobile video consultation service, which

includes appointment scheduling and image and document uploading. Medical results should be not

determined by where an individual lives. Instead, patients can get the help and care they need wherever

they are, offering them true peace of mind.

VitalityImprove outcomes

Studies have shown clear examples of embedded

communications improving medical outcomes. A

Deloitte case study explains how a nursing and

residential home in the UK was transformed by the

introduction of live video. They introduced a two-way

secure video link, available 24/7, between patients in

210 nursing homes and clinicians based in a hospital.

An audit comparing these nursing and care homes

before and after the pilot found that the introduction

of video led to a 35% reduction in hospital

admissions, a 53% reduction in the use of Accident

& Emergency services, and a 59% reduction in the

number of hospital bed days.18


In The Rooms, the world’s largest social recovery network, allows recovering addicts to connect with others

across the globe. The service allows members to host and participate in forum discussions, post articles

and videos, and ask for help confidentially.

In order to provide the highest level of online support, In The Rooms chose to embed real-time

communications. This allows its users to enter virtual video meetings anonymously and connect with

other recovering addicts. By enabling remote access to live, personalized support, In The Rooms offers an

engaging experience to its users, bringing face-to-face support online.

In The Rooms is saving lives daily with

its online support groups, which allow

members to connect with one another

and create meaningful and supportive

relationships from the comfort of their

own homes. Members have benefited

enormously from the ability to virtually

connect face to face and to seek and

offer advice from others as though they

were together in the same room.

In The RoomsIncrease access to care

Through embedded communications, patients are

no longer restricted by mobility, ability to travel,

or geography. Instead, these types of limitations

are erased as patients can access the care or

support they need, no matter where they are.

With WebRTC, it’s never too late or too far to

provide needed care. Virtual support groups are

one example—through these groups, peers can

receive confidential help around the globe and

around the clock.


Within the healthcare industry, Revolve Robotics takes the complexity away from costly telemedicine

systems. Revolve offers medical professionals and patients a simple and more human way to connect

with Kubi, a telepresence robot that combines embedded

communications with powerful robotics.

Using a mounted tablet on a dynamic Kubi robot and the

easy-to-use Kubi Video app, users can turn a tablet into a

remotely controlled telepresence robot and attend virtual

consultations or meet healthcare professionals. The video app

enables high-quality video calls, and users are able to pan

and tilt by controlling Kubi via the web, giving them the ability

to experience the entire space and interact with others during

video calls.

Kubi robots enable a range of telemedicine use cases in

care homes, doctors’ offices, hospitals, and elsewhere. They

are pivotal in increasing efficiency for healthcare providers,

enabling doctors to provide care without travelling and

receptionists to virtually manage multiple waiting rooms

simultaneously, saving time and resources.

Revolve RoboticsImproved efficiency

With a current shortage of 45,000 care physicians

in the United States, improving efficiency is

more vital than ever.19 By enabling medical

professionals to be in multiple places at once,

embedded communications are enabling doctors

and healthcare assistants to help more patients

around the world. There are also financial benefits

for providers; a recent survey showed that 67%

of doctors indicated that telemedicine allows

them to earn more and treat minor ailments more

efficiently, and that it frees up time to schedule

additional video appointments when they have

lulls in their bookings.20


Calgary Scientific specializes in transforming enterprise-class software into web and mobile-enabled

platforms. Their latest offering for medical organizations, cloud-based medical imaging software called

Resolution MD, allows doctors and specialists to securely share, view, and collaborate over patient images

and reports from any computer or device.

Calgary Scientific aimed to create a true-to-life experience that enabled medical professionals to collaborate

as efficiently as possible and perform effective remote medical diagnosis. To accomplish this, they needed

to embed reliable, high-quality video communications to allow users to connect with other medical

professionals from any device.

By choosing embedded

communications, Calgary

Scientific was able to integrate

synchronous audio and video

communications seamlessly

into the context of rich medical

data so that healthcare

professionals could easily view

files remotely.

Calgary ScientificImproved collaboration

Through WebRTC, doctors can now collaborate

with one another regardless of location. With

screen sharing and on-screen annotation capabili-

ties, doctors can discuss and make annotations in

real-time as if they were in the same room.


Beyond E-health // Conclusion

ConclusionMedical care will no longer be confined

to clinicians in the clinic or hospital. The

ubiquity of digital communication means

that many doctor-patient contacts [will be]

virtual and deliver care to the patient in

their home.” 21

“

www.tokbox.com 24

The shift in behavior towards digital, on-demand services together with the

massive increase in demand for healthcare has created an unprecedented

challenge for the health industry. As patients seek to manage their own health

in convenient and flexible ways, and practitioners require greater flexibility and

efficiency, simple, robust and secure technology platforms have become critical.

Embedded communications, powered by WebRTC, represents one of the most

significant advances digital health has ever seen. It’s optimizing experiences for

both patients and practitioners, removing unsustainable workflows and inef-

ficient practices while enabling collaboration for radically improved outcomes

for all parties.

By integrating seamlessly into websites and mobile applications, embedded

communications are bridging the distance between patients and clinicians

and therefore is radically transforming the healthcare industry. From doctor-

to-doctor collaboration to peer-group support, the sheer variety and scope of

potential uses means embedded communications is a major leap forward.

Finally, with embedded communications, we have a solution that is secure,

simple and suited to the challenges of today, and tomorrow.

Beyond E-health // Conclusion

Conclusion

www.tokbox.com 25

TokBox, a wholly owned subsidiary of Telefonica, develops and operates

OpenTok, a global cloud platform for embedding real-time communications.

OpenTok allows companies to harness WebRTC to directly embed live video,

voice, messaging and screen sharing into web and mobile applications. This

creates a seamless learning experience where healthcare professionals and

patients can connect and collaborate in the context of their healthcare solution.

Through this scalable, customizable platform, businesses can incorporate any

type of interaction into their solution, from one-to-one chats to large-scale

broadcasts.

TokBox is trusted by leading healthcare organizations like Calgary Scientific,

2nd MD, Mobius Health, Babylon, Maven and more to provide reliable,

scalable and secure real-time communications experiences. With zero

infrastructure set-up required, simple documentation and development tools,

integration is quick and easy.

About TokBox

Beyond E-health // About TokBox

Benefits of using the OpenTok platform include:

• Fosters collaboration and interaction, increasing engagement between doctors and patients• Increases accessibility and reach• Makes telemedicine more affordable and cost effective• Easily integrates with existing workflows and healthcare systems

www.tokbox.com 26

Headquarters

501 2nd Street

Suite 310

San Francisco, CA

94107

Offices in

Sydney

New York

Barcelona

London

[email protected]

facebook.com/tokbox

twitter.com/tokbox

linkedin.com/company/tokbox

Contact us

1 Home Health Technologies, Tractica, 2015 report

2 Connected Health, Deloitte, April 2015 report

3 U.S. Smartphone Use in 2015, Pew Research Center, April 2015 report

4 Virtual Care, Parks Associates, 2014 report

5 Mobile Health Apps and Solutions Market, Markets & Markets, September 2013 report

6 Virtual Care, Parks Associates, 2014 report

7 Telehealth Video Consultations, Tractica, 2015 Report

8 Healthcare and Life Sciences Predictions 2020, Deloitte, 2014 report

9 National Center for Chronic Disease Prevention and Health Promotion

10 The Complexities of Physician Supply and Demand: Projections from 2013 to 2025,

11 National Health Spending Projections, CMS 2010 report, published by Health Affairs

12 Healthcare’s Digital Future, Mckinsey, 2014 report

Appendix13 http://disruptivewireless.blogspot.co.uk/p/blog-page_30.html

14 State Telemedecine Gaps Analysis, American Telemedecine Association, 2015 report

15 Video is About to be the Way we all Visit the Doctor, Wired Magazine, April 2015

16 Healthcare Delivery of the Future, PwC, November 2014 report

17 United Healthcare News Release, April 2015

18 Connected Health, Deloitte, April 2015 report

19 United Healthcare News Release, April 2015

20 American Well Telehealth Index: 2015 Consumer Survey

21 Healthcare Delivery of the Future, PwC, November 2014 report

tokbox.com

Documents

Beyond E-health - Curando Nordic · ogy. It’s estimated that over 6 billion of these will support WebRTC by 2019, with over two billion individual users13. 13 Beyond E-health …