WHAT IS REQUIRED FOR SUCCESSFUL TELEMEDICINE SERVICES IN CLINICAL TRIALS?

by Edward Triebell—Recently, I published an article entitled, “THE QUESTION: WHAT EXACTLY IS “TELEMEDICINE?” and the next logical question is “WHAT IS REQUIRED FOR SUCCESSFUL TELEMEDICINE SERVICES IN CLINICAL TRIALS?”  The previous article broached this subject by discussing the importance and need of a quality data networkproviding a stable Internet connection, that without the network, telemedicine services cannot be achieved.  But what are the operating characteristics of that data network to enable telemedicine services?

THE CHALLENGE: WHAT ARE THE OPERATING CHARACTERISTCS THAT ENABLE AND ENPOWER SUCCESSFUL TELEMEDICINE DEPLOYMENTS

Video conferencing telemedicine really needs to be viewed as the deployment of a “high bandwidth (high speed) private telecommunications network with a focus on the “NETWORK” for successful operation and acceptable Quality of Service (QoS).  With clinical trials, this is challenging because the NETWORK is not owned by either the pharma/CRO or the vendor but uses public Internet Service Providers (ISPs) and mobile/cellular carriers with data services.  Where patients/subjects live may or may not have access to high speed Internet services.

It is reported that in the United States, geographically speaking, 99.73% of the population has access to Broadband Internet and the average home download speed is 6.70215 Mbps. ⁽¹⁾  While that sounds reassuring that the broad use of telemedicine is achievable, there are other factors that impact that reality, as follows:

• The average download speed is not typically the limiting factor to successful telemedicine services; it is the upload speed of an Internet connection.  And typically, the ratio between download speed and upload speed is on the order of 10x to 25x, implying that if the average home download speed is 6.70215 Mbps, the upload speed is on the order of 0.27 Mbps to 0.67 Mbps which is too slow for effective telemedicine services.
• Most telemedicine platforms require a minimal, continuous, stable connection speed of 1.2 Mbps and even higher connection speeds when multiple users are on the same telemedicine video conference call. ⁽²⁾
• In the US, roughly three-in-ten adults with household incomes below $30,000 a year (29%) don’t own a smartphone. More than four-in-ten don’t have home broadband services (44%) or a traditional computer (46%). And a majority of lower-income Americans are not tablet owners. ⁽³⁾
• The lack of familiarity of digital technology impacts both access to patients/subjects and their successful engagement in using digital technology in clinical trials and telemedicine usage.

THE SUMMARY:

The results then to the question, “What is required for successful use of “telemedicine” video conferencing services,” are the following:

• Effective and successful use of video conferencing as a telemedicine service requires a stable, continuous high-speed data service subscription either via Wi-Fi access or cellular data access.
• High speed data service or connectivity does not exist everywhere and that limits the ability and availability to use telemedicine as a viable solution everywhere and therefore, the deployment of telemedicine is driven by the NETWORK.
• Each service provider should have a recommended minimum upload/download speed to successfully use their video conferencing service.
• With the upload/download data speeds of both ISPs and mobile cellular providers, the upload speed is the limiting factor on successful telemedicine deployments.
• Assuming use of Wi-Fi, if a patient’s home environment has multiple devices and users in the home, all using the Internet during a telemedicine appointment, because of the upload speed, there could be significant challenges to a quality session.
• Assuming use of a mobile phone or tablet and cellular-only access, because of the nature of cellular coverage and capacity, stability of a telemedicine engagement may be challenging.

RECOMMENDATIONS:

• The success of telemedicine services is driven by the NETWORK – for each deployment, for each user, understand their access to high-speed data, whether via an ISP or mobile cellular carrier.
• Accomplish speed tests for each intended user of the telemedicine service, patients, clinicians, etc., using a well-recognized and respected service, like SpeedTest by Ookla to verify internet speeds during multiple times of the day.  (https://www.speedtest.net)
• If your vendor has not told you their minimal recommended requirement for continuous data speed, ask, or otherwise you’ll learn of problems during actual use.
• Each vendor uses video compression/video teleconferencing software for their telemedicine solution.  Unless they are experts in the complex development of video compression algorithms, then they have either licensed use from another company or they are using Open Source video conferencing software.  Understand who is their video conferencing software vendor and the testing and documented software validation process undertaken.  A great read about Open Source solutions is here:  https://www.goodfirms.co/blog/best-free-open-source-web-conferencing-software-solutions.
• Ask for the list of countries, cities and locations of their existing telemedicine deployments.
• Ask for copies of their help desk reports on their telemedicine deployments and the problems encountered.

Contact Info:  edward.triebell@healthcloudsolutions.org

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