Over the last several decades though there have been some technological improvements and “nice to have” advancements in telemedicine—inpatient platforms have remained relatively static. Comprised of expensive, unwieldy carts (or more recently the explosion of tablets as a cheaper alternative), this “mobile” philosophy has several intrinsic problems that limit its value to healthcare organizations:

To start carts are very expensive, ranging anywhere from $5,000 to $30,000, and are proprietary. This means that they are not open-source and organizations are locked into a vendor.  Support costs are expensive, and training of internal teams for management and upkeep is time consuming. Or worse, organizations have to pay the vendor to completely manage the equipment (cha-ching).

On top of hardware costs, software is also pricey. This is because Cisco, PolyCom and Vidyo carts (the 3^rd party video platforms that are the base of all existing telemedicine carts on the market) require the purchase of their video infrastructure—which can reach into the six-figure range. Next, layer on per user licensing and software patches and it really becomes a rabbit hole of costs. Tablet solutions are locked into these same expensive software considerations, despite the hardware price break.

The mobility of carts, long considered a benefit in telemedicine, is actually one of the biggest indirect drivers of cost for several reasons:

• Because carts must be moved around, there is a lot of physical damage to them over time, requiring ongoing maintenance and replacement
• Due to WIFI “dead spots”(notorious in hospitals), networking issues are a problem as carts are moved from place to place
• Carts are easy to misplace
• it’s common for carts to not work at all when they are needed—whether it’s a cable, the camera doesn’t work, etc.
• Because there are limited numbers due to cost, scheduling can be a challenge. For example, if you have 2 physicians who want to see 2 patients at one time on a unit, you are out of luck. Or, if nursing staff is busy, physicians need to wait for them to be transported, etc.

These things happen all the time, hindering patient care and dragging on nursing productivity…Because management of carts almost always ends up being the nurses’ problem.

Carts are simply not scalable…not from a technical, resource or cost perspective. As healthcare organizations continue to increase use cases, demand/need and value of telehealth in and out of the hospital, current cart solutions won’t cut it. We’ve seen that just with the need around the Covid-19 pandemic. Think about it: If your hospital went 10-20% telehealth or 10-15% of your physicians were remote…could you scale your program without friction with carts? The answer is no unless your system can throw millions and millions of dollars at it. Of course this still won’t solve the issue and most hospitals can’t afford to even try.

Vitalchat’s founders envisioned a solution that allowed a remote caregiver or family member, whether in the facility or off-site, could visit the patient in the room directly without any assistance from staff (including nursing or IT). If we could build that, we would have something scalable, manageable and low cost. First, we tackled the first few challenges by making Vitalchat turnkey. It doesn’t need any video infrastructure, the hardware is off the shelf (whether you buy new or repurpose equipment you already have), and the software is lightweight.

To make the interaction touchless, we built a patented “digital door knock” feature that both respects patient privacy while also allowing a caregiver to initiate a visit. Any other video platforms, even those that enable a caregiver to begin a video visit, completely miss the patient privacy aspect. Lastly, the management of the device is touchless. All software patching, upgrades and monitoring are done remotely so that there is no lift for IT or nursing staff.

Of course, all of this means that the old “mobile” cart solutions won’t work if an organization wants telehealth that will scale….because a cart, by definition, can never be touchless. It will always require management and doesn’t allow caregivers the autonomy to virtually round without that on-site management. True touchless telemedicine requires affordable fixed or semi-fixed endpoints in any space that telehealth is valuable.

Let’s all take a moment of silence for the passing of the telemedicine cart.