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Microsoft

Using Virtual Rounding enables providers to stay healthy and ensures they can continue to provide a high standard of care during the COVID-19 crisis.

rounding.png

As a Microsoft Teams Technical Specialist on healthcare, this week has shown me some of the real challenges facing some of the top healthcare clients in the US and around the world. From the very real challenges of optimizing telework, to finding ways to better optimize online diagnosis software, I was grateful to be comfortable at home, while our Healthcare workers are on the front lines of fighting COVID-19. In talking to my healthcare customer, I was humbled and astounded by the very real challenge of supply shortages that are plaguing our nation and how providers are putting themselves at risk.

 

The Problem

Currently in the US and many countries around the world, COVID-19 has been putting our providers at risk with issues such:

  • Worldwide shortage of personal protective equipment (PPE) such as masks, gloves, etc.
  • Healthcare providers being at risk from lack of PPE
  • Influx of patients with patient loads anticipated to keep climbing.

Note: This solution is a sample and may be used with Microsoft Teams for dissemination of reference information only. This solution is not intended or made available for use as a medical device, clinical support, diagnostic tool, or other technology intended to be used in the diagnosis, cure, mitigation, treatment, or prevention of disease or other conditions, and no license or right is granted by Microsoft to use this solution for such purposes. This solution is not designed or intended to be a substitute for professional medical advice, diagnosis, treatment, or judgement and should not be used as such. Customer bears the sole risk and responsibility for any use. Microsoft does not warrant that the solution or any materials provided in connection therewith will be sufficient for any medical purposes or meet the health or medical requirements of any person.

 

How Virtual Rounding may help

Hospital and emergency room providers make dozens, and often hundreds of “rounds” per day. These quick check-ins on patients are intended to provide a status check on how the patient is doing and ensure that the patient’s concerns are addressed. While rounding is an essential practice to ensure patients are being monitored by multiple types of providers, they represent a huge drain on PPE, because for each visit, from each provider, a new mask, and new set of gloves must be used. But…what if patients could still have frequent check-ins with all necessary providers, while not draining the hospital of PPE, and perhaps even exposing providers to less risk of exposure to COVID-19? Allowing for Virtual Rounding as an option may help reduce risk and drain on PPE.

Virtual Rounding relies on an easy concept. Most rounds will be conducted virtually, through a Microsoft Teams meeting between the provider and the patient.

Here’s how it looks to the patient:

  1. Each hospital/emergency room is set-up with a laptop or tablet with Microsoft Teams
  2. Before a new patient enters the room, the nurse or other staff will press Join Meeting.
  3. When the patient enters the room, they will see a meeting screen with only them inside. This screen will notify them when a provider drops in.
  4. When the provider drops in, the provider and the patient can engage one-on-one with secure audio and video. When they are done, the session will end, and the screen will go back to only the patient.
  5. Additional providers may drop in throughout the patient’s time in the room, and the patient will be notified as they drop in. If the meeting is ended on the patient side, providers can still ring the device to bring the patient back into the meeting.

     

    ipad-frame-png-1.png

Features on the device and the Microsoft Teams application are locked down to ensure no company information is available to the patient, and that the patient cannot accidentally share PHI.

Here’s how it looks to the provider:

  1. Providers are shown a list of rooms in Microsoft Teams, and are able to select a room to drop in on.
  2. Providers click Join Meeting. If the patient room is not already in the meeting, providers can click "Ask to Join" in the participants list to ring the patient room.
  3. Providers meet with the patient and then leave the meeting once complete.
  4. Providers can then select another patient to drop in on, communicate with other providers on the floor through Microsoft Teams, or follow-up with patients in-person if needed. 
    2020-03-30_16-45-42.png

     

    Interface can be customized to your needs or branding.

Features

  • A patient interface can block the patient from doing most anything besides talking to a provider who has “dropped in”.
  • An intuitive system for providers can be configured to match your hospital/clinic setup.
  • Security features maintain patient privacy and prevent inadvertent exposure of PHI data.

Impact

Providers are working under the assumption they could contract COVID-19. They want to help as many patients as possible before this happens. However, if we can disrupt the cycle of providers having heavy exposure to patients with active COVID-19 cases, especially in situations where they don’t have proper PPE, providers may be able to visit more patients.

  1. Through the use of Virtual Rounding through Microsoft Teams, providers may be physically exposed to fewer patients per day, which may limit their risk factors for contracting COVID-19 (and other communicable ailments) and could keep these providers able to care for patients longer.
  2. Through the use of Virtual Rounding in Microsoft Teams, the use of PPE may go down. This could ensure PPE remains in hospitals for crucial situations and help reduce future risks to providers.
  3. Through the use of Virtual Rounding in Microsoft Teams, providers may spend less time walking between patient rooms, increasing their efficiency during this time of increased demand during COVID-19.

How does it work?

  • Each "patient room" is setup with a Microsoft 365 account, and the device is logged into the Teams application (and ideally locked down with Intune MDM Kiosk policies).
  • Custom Teams policies are applied to patient room accounts to disable non-essential features.
  • Teams meetings are setup for each patient room account (with that account as a host), lasting a large amount of days (hopefully past the end of COVID-19).
  • Teams are created and available to providers for each building/site, with individual channels for sub-locations such as floors.
  • SharePoint lists are created and added to each channel as a tab listing the meeting join links.

Demo

 

How you can roll this out in your environment

Want to get started with this in your environment? The sample code and documentation can be found here. As always, we suggest you test scenarios out like this in a non-production environment and work with a certified Microsoft partner to build out an enterprise scale solution.

Providers must have access to Microsoft Teams to use this, and each room account will need a Microsoft 365 F3, E1 or higher license (free 6-month E1 Trial licensing is available during this time). Please see the documentation for more information and/or contact your Microsoft Account Executive.

 

FAQ:

What if the patient needs in-person care, such a temperature check, or blood test?

Microsoft Teams is not a substitute for these things, however, it may be used as a triage to determine if additional in-person testing is necessary. It also may limit the frequency of daily in-person check-ins by moving them to a virtual platform.

How can we ensure this solution is secure?

Microsoft Teams is a natively secure application; however, we are suggesting putting it in front of a patient instead of an employee. Microsoft Teams policies and Conditional Access policies should be implemented to ensure a secure patient experience. Please see the documentation for more details.

Is this HIPAA compliant?

Please see this link to learn how Microsoft 365 and Microsoft Teams offer compliance with HIPAA. Additionally, this solution is designed to prevent the patient from entering any PHI into the device to ensure full patient privacy.

 

Microsoft Health & Life Sciences Contributors:
Max Fritz
Manoj Shah
Tyler Durham
Sohil Sathyanathan
Tavis Hudson
Jim Erickson

Shelly Avery

10 Comments
Microsoft

Great work @mafritz!

Occasional Visitor

Really helpful.  I have shared with several CIO's this really could save lives.

Senior Member

This is very helpful, it is what we where missing specially for making it easier for the patient and the clinicians.  I will appreciate if you could share the manual configuration for those of us that already have the accounts created.  I'm referring to the following:

  • Configuration for the accounts that will be used as rooms - the configuration for locations and sublocations
  • Manual configuration of the SharePoint List

 

Occasional Contributor

Can the new M365 F1 license type, released April 1st, be used in this scenario? I’m assuming it would because of the new Teams First Line Worker value use rights, but wanted to make sure.

Frequent Visitor

We are reviewing this solution.  Thank you for any responses to the proposed questions.

Senior Member

Hi all,

 

I have reviewed the CreateTeamsAndSPO.ps1 in detail, although I don't consider me as a programmer, I think I have everything ok with my script.  After a lot of trial and errors, I still have some errors.  Here is one:

--------------------------

Add-AzureADGroupMember : Cannot bind argument to parameter 'ObjectId' because it is null.
At C:\Users\jabrams\Desktop\TEAMS Virtual Rounding\Santurce-CreateTeamsAndSPO.ps1:83 char:42
+ Add-AzureADGroupMember -ObjectId $teamID -RefObjectId $member ...
+ ~~~~~~~
+ CategoryInfo : InvalidData: (:) [Add-AzureADGroupMember], ParameterBindingValidationException
+ FullyQualifiedErrorId : ParameterArgumentValidationErrorNullNotAllowed,Microsoft.Open.AzureAD16.PowerShell.AddGr
oupMember

-----------------------------------------

 

I noticed that someone have flag this same issue indicating that the TeamID variable is called before defining it.  I think this is similar to what I have.

After the script is completed, this is what I was able to validate

  • The Teams Group is created
  • The Channels are created
  • The SPO link is added to the Channels - When I click on them, I received an error - page is unavailable... I looked for the list file on SPO and notice it have not being created
  • Teams members are not added to the group
Microsoft

Thank you @JoseAbrams , scripts have been updated. Please try again.

Microsoft

@Chris Shalda , the new F1 should work, but it has not been tested.

New Contributor

@mafritz We are testing this out and see some differences in your video.  How do we go about cleaning it up

  1. The bot is always visible to the patient.  The bot takes up half the screen.
  2. There is no join button for the patient room and we need to edit the meeting and click the Join Teams Meeting link
  3.  When clicking on the room link, it takes us to a web browser and then back to Teams when we click Open Teams.

Is there a fix for the above?  V2 should fix points 2 and 3, but having the Bot visible in the meeting is taking up valuable screen real estate.

Microsoft

@twexler, Correct, v2 will fix #2 and #3. #1 will be resolved in the coming weeks when the 30 minute timeout is removed, which is being worked on.