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ClearScale telemedicine app uses range of Amazon services

Creative Practice Solutions, a medical consulting company, called on ClearScale to develop a telemedicine offering that lets physicians conduct and record remote patient visits.

COVID-19 compelled a range of industries to retool their business processes, with healthcare as a prime example.

Creative Practice Solutions (CPS), a medical consulting company based in New York, needed a telemedicine application that would help its client physicians conduct remote patient visits and accurately capture billing information. CPS tapped ClearScale, a cloud professional services provider based in San Francisco, for the IT project. ClearScale, an AWS Premier Consulting Partner, used a variety of Amazon services to create the system. Healthcare ranks among the company's biggest vertical markets.

CPS was one of many healthcare organizations responding to the abrupt shift from in-office visits to telemedicine amid the coronavirus pandemic. Telehealth visits expanded 50% during the first quarter of 2020 compared with same period in 2019, according to the Centers for Disease Control and Prevention. That growth rate, while leveling off, is expected to remain substantial for the next several years. Grand View Research, for example, predicted the global telemedicine market, which it sized at $55.9 billion in 2020, will expand at a compound annual growth rate of 22.4% through 2028.

Project toolkit: Streaming, serverless and ML

ClearScale's telemedicine application, which runs on macOS, iOS and iPadOS, among other operating systems, interfaces with patients through their personal smart devices. The system lets physicians conduct virtual appointments using a medical coding application, BugMD, that ClearScale built for CPS in a previous project.

To create the telemedicine system, ClearScale wove together several Amazon services. Amazon AppStream 2.0, a desktop streaming service, lets CPS deliver its application's security to any number of physician users, ClearScale said. Amazon Connect, an omnichannel cloud contact center service, enabled ClearScale to bundle physician services such as medical billing, coding and telemedicine. ClearScale deployed AWS Lambda and AWS Fargate to provide the processing power for automated billing and video/audio streaming. Lambda is a serverless compute service, while Fargate lets organizations run containers on AWS' cloud platform.

Vyacheslav GorlovVyacheslav Gorlov

In addition, CPS wanted to save audio recorded during remote patient visits for billing purposes. BugMD already provided the ability to accurately translate the medical appointment notes a physician dictates and records after a patient visit. ClearScale built upon that feature for CPS so BugMD could record telemedicine appointments. The telemedicine application supports standalone telephony -- a virtual phone number provisioned for a physician via Amazon Connect -- as well as the telephony features of services such as Zoom, Skype or WhatsApp, said Vyacheslav Gorlov, senior solutions architect at ClearScale. 

Audio quality posed a challenge for BugMD's use in a telemedicine setting. With phone conversations, "you have 8 kHz of data only, the line is shared with other data, and dropped frames are the common issue," Gorlov said. "Processing of such audio requires tremendous compute resources and power."

ClearScale used the AudioKit.io framework, which lets developers add audio functionality to applications, to tackle the problem. AudioKit provides background noise removal and normalization and backfills dropped frames, Gorlov said. Those audio improvements take place on the physicians' devices. AudioKit's linear and AI-backed algorithms boost the audio quality enough for the Amazon services to properly handle the recorded appointments, Gorlov explained.

The telemedicine app sends BugMD's recordings of medical appointments to the cloud -- specifically, to an AWS Simple Storage Service bucket -- and encrypts the data at rest and in transit to comply with HIPPA.

The application then uses the Amazon Transcribe Medical service to convert English language audio into text. For appointments conducted in languages other than English, the application can use Amazon Translation in tandem with Amazon Transcribe to render English transcriptions, Gorlov said.

Matt DallmannMatt Dallmann

Once the transcription is created, AWS' machine learning (ML) algorithms process the text, extracting information on diagnoses, procedures and prescriptions for coding.

"A variety of medical coding rules and if-then scenarios were implemented to give the AI a head start on accuracy and ensure compliance for certain coding regulations," said CPS President Matt Dallmann.

Physicians can review the results of the ML text processing and send them on to insurance companies to receive reimbursement.

Benefits: Accuracy, administrative relief

The application's accurate rendering of remote patient visits has produced benefits on both the clinical and billing sides of physicians' practices, Dallmann said. The automation of medical coding saves time for busy practices that might see 20 to 30 patients back to back on any given day. "A lot of the time, providers don't have the bandwidth to document everything correctly," he said.

The goal is to take the physician out of the administrative process and just keep them in the clinical area, where they are the most comfortable and have the most experience and knowledge.
Matt DallmannPresident, Creative Practice Services

The steps required for medical coding and billing now only take 15 minutes, even for 8-hour recordings, according to ClearScale. Previously, that process would have taken, on average, four hours to complete, with the actual time depending on the duration of an appointment, Gorlov said.

Overall, the telemedicine app aims to keep physicians focused on patient care.

"The goal is to take the physician out of the administrative process and just keep them in the clinical area, where they are the most comfortable and have the most experience and knowledge," Dallmann said.

What's next: Data analytics

Other benefits may fall into place over time. CPS plans to analyze the data the telemedicine application collects. The data is anonymized, but patients can opt out if they don't want their data to be used.

Data analytics will provide the "big picture" regarding clinical outcomes and also help track viruses or medical conditions in various localities, Dallmann said. "My hope is to recognize patterns," he said.

2020 Top IT Project Award

SearchITChannel's 2020 Top IT Project Award

The telemedicine application ClearScale built for Creative Practice Solutions has captured SearchITChannel's inaugural 2020 Top IT Project Award.

The award was judged by the SearchITChannel editorial staff, in conjunction with industry experts. The ClearScale application was the top-rated project on four out of the five judges' score cards.

The winner was selected according to the following criteria:

  • Technical innovation
  • Challenges overcome
  • Process innovation
  • Creative partnering
  • Business benefits

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