How telemedicine, SD-WAN helped two firms get back to work

Getting back to work in a pandemic

By mid-February, health officials were reporting an increase in COVID-19 cases in the United States. TrialCard, based in Research Triangle Park, N.C., turned to its crisis committee for the company's response.

The panel decided that 600 TrialCard customer service agents -- roughly 500 in its North Carolina headquarters and the remainder in the company's Kansas City, Mo., offices -- had to work from home. The agents help people get insurance coverage for expensive drugs that treat serious illnesses. TrialCard clients are drugmakers.

The company placed Ryan Van Dynhoven, the director of infrastructure, in charge of finding the technology that would meet HIPAA regulations for patient privacy and provide quality voice communications. Dynhoven chose a software-defined WAN appliance.

Vohra's situation was different. The company, based in Miramar, Fla., had roughly 300 private practice physicians under contract to provide wound and skin treatment to residents of 3,000 nursing homes across 27 states.

Layers of skin die with age, so the elderly are susceptible to life-threatening infections from even minor wounds. Vohra physicians treat roughly 5,000 patients a day.

Over several weeks, starting in the first half of March, Vohra replaced in-person care with telemedicine wherever possible. The switch let doctors see more patients, while removing an avenue for exposing an elderly patient to the virus.

"With COVID-19 being in place, this technology will prevent deaths and will prevent significant morbidity," said Dr. Japa Volchok, vice president of operations at Vohra.

At TrialCard, Van Dynhoven and his team were sending a preconfigured SD-WAN appliance, built by Silver Peak, to the home of each agent. Installation required plugging the hardware into a home router and connecting a Cisco IP phone and a computing device to the appliance.

The computer, which comes with a keyboard and mouse but no storage component, is only for interacting with TrialCard's virtual desktop application running on servers in its data center. Agents cannot store any patient data locally.

The SD-WAN appliance uses redundancy to reduce the chance of poor voice communications over the public internet. The device uses at least eight VPN-like tunnels connecting the agent's home to the TrialCard data center. If a connection fails or degrades, then the appliance switches to a more reliable connection. The system can withstand a packet loss rate of between 30% and 40% without dropping a call, Van Dynhoven said.

The setup is not cheap. TrialCard declined to say how much it paid for each device. But tech analyst John Fruehe said an SD-WAN appliance for home use could cost $1,000 or more.

Van Dynhoven acknowledged that less-expensive technology exists for stay-at-home employees; however, TrialCard needed high-quality voice communications.

"We have to make sure we don't lose that [patient] call," he said.

Vohra provides doctors with HIPAA-compliant video conferencing and record-keeping software that is accessible through their PCs. On the other end, nursing homes typically use a PC with a detachable video camera during sessions.

Just a few years ago, examinations through online video was a tough sell. People wanted the doctor in the room, even when it made no difference in diagnosis or treatment, Volchok said. Today, people see video conferencing on TV and also use it with family and friends. As a result, the stigma against telemedicine is fading.

"Surprisingly, the uptake [in nursing homes] has been a little bit easier than you might anticipate," he said.

Redesigned workplaces to remain

Vohra has changed its business for good, betting that telemedicine will drive future growth. TrialCard is less sure of how much its COVID-19 response will permanently change its business.

For now, it plans to have several hundred agents work from home for as long as six months at the beginning of each year when it hires an equal number of temporary workers. The additional help is needed because call volume soars as many people change insurance plans at the beginning of the year. The switch means a lot more consultations on maintaining drug coverage.

So, rather than jam everyone into existing offices, TrialCard will send permanent staff home to work and keep temporary workers in offices, Van Dynhoven said.

TrialCard's and Vohra's quick response to the COVID-19 crisis and ability to get people back to work has resulted in more flexible workplaces. As a result, they have more options to keep their businesses going through the pandemic.