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Do No Harm

Telecome Providers Prescribe Solutions for Health Care

Published November 11, 2004

When it comes to health care, communications solutions are simply a means to an important end -- saving people's lives. Successful sales partners in the medical vertical speak the language of the continuum of care, not just of technology. They also have their own version of the Hippocratic Oath: Provide the technical solution to help caregivers do no harm.

"The first perspective to take with these clients is how you can help with the overall goal of delivering better care," says Darwin Hale, health care director at AT&T Corp. "It's an ounce of prevention, because first and foremost it's about people's health."

As a group, these organizations are not just going to make a decision and hope it works," says Bill Caparo, CEO at CIMCO Communications Inc., an integrator and reseller. "They are a tight-knit group and they share information, have meetings, go to trade shows together, do their homework. The needs for hospitals are quite complex, and it's critical to have expertise when you go in there."

Caparo also says the landscape in health care can be challenging. "There are a lot of outpatient surgery centers and medical annexes, so it could be 30 to 40 locations for one customer," he says. "There's a large dependence on engineering from a network perspective, and on security and back up. You have to have a much greater well of expertise than a typical telecom company. They're a needy group of customers, so you also need a high level of service."

From the managed care organizations (a.k.a. insurance companies) to the country doctor in the rural Midwest, health care has a lot of stakeholders. The face of the medical industry continues to evolve as advances in medicine, technology and business pressures change. Agents and resellers should first understand how the space is trending before approaching a customer.

For instance, technology has historically been devided into two camps. "There's medical technology, for radiology and so on, and that is highly prioritized," explains John Fancher, group manager of health care marketing at Sprint Corp. "For basic IT, health care as an industry has traditionally lagged other industries in the percentage of the total capital budget devoted to it. They have limited resources, so where are you going to put your money? Into those things that affect care."

However, the line between traditional IT solutions (such as networking) and clinical technology is now blurring. "Technology now can be used to facilitate care," says Fancher. "Wireless e-prescriptions, on-the-fly note taking, and so on, are blurring the lines and creating opportunities.

Understanding how money is allocated also is important. A general rule is that 80 percent of a health care provider's time is spent on clinical duties, and 20 percent on administrative, Hale notes. Also, 1 percent or less of patients consumes 30 percent of the dollars available for care. "We're talking about the critically ill in that instance," says Hale. "Understanding how your technology impacts these ratios can be important."

An understanding of the multiple parties involved in a medical enterprise is critical for a telecom solutions provider to gain traction. "This is a tumultuous marketplace," says Hale. "Owners, pharmaceutical companies, device companies and managed care providers are part of it. Then you have the providers, and not just hospitals. There are nursing homes, clinics, doctor's offices and so on."

With so many players, there's a unique communications challenge inherent in the vertical. "They want to streamline operations, eliminate medical errors, offer better quality care and more affordable care," says Hale. "The ramifications of technology are higher in health care because people's lives are at stake. This is a community, and there are a lot of stakeholders, and patients and doctors are only part of it."

Efficiency needs and the economics of the business are distinctive too. "We have an aging society, with fewer providers, reduced or delayed reimbursements from insurance, and a changing balance of power," says Fancher. "There's no streamlined connectivity start to finish. Providers need revenue-cycle management, so they can more fully capture the services delivered, have better charging policies, improve the efficiency of submitting claims, bolster accuracy and ensure cash flow."

AT&T's Hale says the advent of HMOs has profoundly altered the landscape. "It used to be that you did the work and sent out the bill and insurance paid it," he says. "Managed services have changed the focus to efficiency, prevention and shorter hospital stays, and have created the rise of outpatient and home care. So what people wanted -- who wants to be stuck in the hospital? -- and what made sense came together. A would-be VAR or service provider needs to understand that history -- it's about how can they use applications, tools and processes to enable the care provider to achieve their goals."

Admitted To The Hospital

With the continuum of care and providers' business problems in mind, serveral applications and solutions fit the medical vertical today, including disaster recovery, mobility solutions, remote access and VoIP.

A significant area of opportunity is driven by the Health Insurance Portability and Accountability Act, or HIPAA, which prescribes privacy, data backup and security regulations for patient records.

"First, you must connect constituents appropriately, with security and disaster recovery built in," says Hale. "HIPPA is a guide and puts a wrapper around this topic. You have to pitch solutions in the context of who is interacting with whom and who has access to what and why."

For instance, HIPAA requires all text-based messages to be archived. Patrick Ferriter, vice president of product marketing at Zultys Technologies, which makes VoIP gear for business applications and markets it through VARs, says IP communications are uniquely positioned to fulfill this requirement. "Our system saves [ instant messaging] communications and archives it for seven years," he says. "The software runs on a PC that shuts down IM if the archive is full. It's automatic and streamlined."

Capraro touts a billing system as a differentiator in the context of HIPAA. "Billing is confusing and complex in medical centers, because they have hundreds of bills each month," he says. "It's difficult to control who is ordering phone service and who isn't. So our Web billing system is an automated system with real-time information, where they can change line descriptions or groupings themselves, and can run reports. Customer billing information must be kept private however, so we had our billing system HIPAA-approved before even going out to clients."

Disaster recover is another important area spurred by HIPAA. NovaStor Corp.'s COO Sean Walsh explains that everyone from large hospital conglomerates to university clinics to the thousands of doctors' offices out there are required to keep records for the patients' lifetimes plus two years. "Anything that touches the IP or phone networks need to be protected," he says. NovaStor offers, via agents and resellers, an online, remote data backup solution. "At one larger clinic, they had a hard drive that failed. There was a lot of information that had to be kept proprietary, so they couldn't send it to a disaster recovery specialist because the data wasn't encrypted," he says. "They couldn't get the drive repaired either becasue they couldn't guarantee that it couldn't be read. So these regulatory requirements can create Catch-22s. Our service is encrypted and your information is kept elsewhere, so they don't have to worry."

"We also provide the audit trail -- who touched it, who had access to it," he adds. "In lawsuits and proofs of response you need this evidentiary information."

Given the number of constituents in the medical community, another area of opportunity is in connectivity and data-sharing.

"They need core connectivity because they have geographically dispersed activities," say Fancher. "Connecting the hospital to external providers and to patients is an initiative. On the specialist side, there's a shortage of radiologists, so a telemedicine or imaging solution would help, to have people be able to read X-rays and diagnose across the country, instantaneously. This creates a new paradigm for the industry."

In fact, telemedicine is a rising area. Capraro says bandwidth requirements are increasing accordingly. "The requirements for reliability and uptime on the data side are equally important as voice, if not more so," he notes. "In remote areas, medical clinics are connected to the corporate hospital via data lines, for MRIs and X-rays, and they need to be able to share them in real time. They may be in the middle of surgery and neet a consult. So it's mission-critical."

Once the constituents are connected appropriately, Web services become an easy snap-on. "You have an infrastructure with different formats for how they talk -- there's a legacy infrastructure," says Hale. "So you can enable a portal and allow extranets to shara information, and you can take the legacy format and make it interoperable so they can leverage their existing investment. Security is inherent.

VARs and resellers should be thinking about the future, and today's infrastructure is going towards telemedicine and collaboration between physicians, as well as patient communications, and claims, enrollment and eligibility functions." One such Web-enabled application is e-prescriptions.

Zultys' Ferriter says his VoIP system is adaptable to major databases, with automatic scheduling. "Patients can simply enter an accounting code and find out if a prescription is ready or due," he explains. "So providers don't need to pay another person to handle this."

Mobility is an inherent characteristic of the health care workplace, with doctors, nurses, therapists and others constantly moving around the campus on rotation or on call

"A key challenge is the ability to locate people when everyone's on the move all the time; when a call comes in there could be eight different contact points," says Ferriter.

Zultys allows presence and call-handling rules, so the nursing station or the front desk can track down a care provider efficiently. "If a doctor knows he'll be at a meeting, but needs to take a call from a patient, the system can route that call based on presence and caller ID," says Ferriter. "There's also unified messaging, so a voice mail or fax can be routed to a Tablet PC, and also instant messaging."

Wi-Fi broadband wireless is revolutionizing the efficiency and accuracy model in hospitals. "The ability for a doctor to write prescriptions and be immediately alerted to allergies and drug interaction issues at the bedside is a big value," says Fancher. "And for orders, there's no worry about handwriting."

Colubris Networks Inc. provides an integrated Wi-Fi solution that integrates mobile health care services onto a shared, secure wireless LAN system. "Our WLAN network, for example, can prioritize and differentiate Wi-Fi signals to enable nurse call applications, such as voice call-backs to patients; immediate text messaging of patient location and need; and/or asset tracking and location of key hospital equipment, -- heart monitors and other expensive, portable equipment that tends to get stashed away by medical personnel -- so that they can retain access to the gear," says a spokeperson for Colubris. Colubris also is partnering with equipment vendors to form an interoperable "Health care EcoSystem," including voice services from Vocera, assetbased tracking applications from PanGo and solutions to provide various access levels to electronic medical records within large hospitals. In the not-too-distant future, wireless networks will carry real-time video from a medical procedure to display units in the operating room for review.

There's also a nursing staff shortage, and the ability to attract and retain these workers is key. One way to do that is to improve their efficiency. "In health care it's all about getting nurses closer and nearer to the patient more ofthen, rather than having to go to a centralized nursing station to do anything," says Tim Wise, co-founder and president of Advocate Networks, a channel partner. "For instance, there's a card you wear with an extension off the PBX, which provides a phone feature via Wi-Fi."

Wi-Fi and mobile devices make data more conveniently accessible and improve medical processes. "You can push data our to a BlackBerry

Clean Bill of Success

Success in selling the health care vertical is not limited to providing appropriate applications. It's also the approach.

"It's a slow sales cycle, and a difficult segment to break into someone who's new," says Capraro. "They're going to want to check you out pretty well and they want reference."

It will take a while if you don't have a track record. You could partner with people that already have connections within the hospital, or get accredited with an affiliate buying group. Most of all, you need a complete package, with the regulatory and disaster recovery scenario set up for your products. You can't win on price alone."

Wise, a Qwest Communications Internationa Inc. business partner, offers consulting on time-plus-materials basis, Qwest network services and telemanagement/inventory management for a monthly fee. He focuses on hospital systems and has taken an affilite approach. "The challenge within the health care environment is that it's a campus environment but typically one that stretches across a county, so there's a large local infrastructure," he explains. "They may have point-to-point circuits for the WAN. Given the complexity and density of that campus environment, a lot of clients have a hard time keeping up with everything they have. So we design management plans for them."

One customer win is VHA Georgia, a non-profit community hospital association that helps procure best-in-class services for its members. After showing $3 million annually in savings for the association, Advocate Networks was given a centralized procurement contract. "We were then able to leverage that success to other VHA regions, like Texas and New Mexico," he says. Another route is to position oneself as a trusted advisor.

"To be successful takes a lot of networking and word of mouth," says Kelly Williams, director of marketing at NovaStor. "It's an easily identifiable market via associations and conferences, and easy to target, but VARs really need an expert on staff to know the needs and the regulatory requirements. Also, many decision-makers in smaller offices are unsophisticated, so a partner can go in as an educator." Having a total portfolio also is attractive to these clients.

"Partners should look at the total needs of the health care provider," says Colubris' spokesperson. "This includes understanding the needs of each mobile application. Selling Internet access is not enough. Health care WLANs must be deployed for future growth. The key will be providing the WLAN and services to allow hospitals to offer customized patient care that reduces medical errors"

It's also critical to lead the discussion from a customer - centric viewpoint, and that requires speaking many languages. "In larger settings, you need to have a business relationship with the business people, the IT shop and the patient care organization," says Hale.

"There are three levels and you have to be able to navigate through them. It's not everyone that can speak finances, technology and health care."

Solutions providers that know the context are just what the doctor ordered. "Bottom line, it's about providing better and more efficient patient," says Wise. "These are mostly non-profits. So savings gives them the ability to invest back into medicine and the community."

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