Deploying the HTU
Deploying a Home Telemedicine Unit (HTU) to more than 750 patients is not as easy at it may sound. Several technical components have to be carefully orchestrated prior to the delivery and setup of the HTUs in the patients’ homes. Once the complex tasks of recruiting and randomizing the patients have been completed those randomized to intervention are processed by the IDEATel technical team. The data-coordinating center sends off the information for the patients randomized to intervention, via fax, to the technical team in the Department of Medical Informatics, Columbia University (DMI) and the installation team at American Telecare (ATI). Both begin preparing the HTUs for delivery and setup.

DMI Processing
The DMI technical team is responsible for creating all the relevant accounts for the patients and assigning the patients to the appropriate case manager. The patients are given a medical record number (MRN) on the New York Presbyterian Hospital Electronic Medical Records (EMR) systems, also known as WebCIS accounts. This MRN follows the patient throughout the project on several different applications. For example, the patient is assigned the same number on the CommuniHealth Diabetes Manager System as their medical record number. The ATI installation team will also use this number when they apply for Public Key Infrastructure (PKI) certificates for the patients.
While creating the patient profile on the CommuniHealth application, the DMI processor also assigns the patient to a case manager and a backup case manager; and sets the primary language for the patient, i.e. English or Spanish. The CommuniHealth processing simultaneously updates the ATI database, which is used by the DMI and ATI for identifying and tracking IDEATel patients. The DMI processor creates a Verizon Internet Service Provider Account (ISP) with a user id and password that is specific for the IDEATel project and sends the application for the new account to the Verizon provisioning group. The medical record information is then given to the New York Presbyterian Security Group for processing. The Security Group gives access to IDEATel patient(s) to a predefined set of clinicians who work directly with IDEATel project. Once the DMI processor receives confirmation that the ISP account(s) has been created this information is sent via fax to ATI installation team, who then begin the HTU configuration.

ATI Processing
The ATI processing involves some hardware, software configurations and direct patient interaction. Once ATI receives the fax from DMI they fax the patient information to the Regional Nurse Installers, who schedule the patients for installation and preliminary training. The ATI processors configure the HTU for ISP access and program in the station identification number assigned by the ATI database. After the ISP access is verified, the processor applies for the PKI certificate. The certificates include the patient information provided by the DMI processor, i.e. MRN. The ATI processor tests the unit thoroughly, checking the ISP account, the CommuniHealth account, the glucometer and the blood pressure meters. If everything is functioning appropriately, the HTU is shipped to the RNI, in the upstate region, or directly to the patient in the downstate region.
The downstate patients receive their HTU a day prior to installation via Adcom delivery services. The upstate patients receive their HTU on the day of installation via Regional Nurse Installer delivery. The installation takes a few hours and it consists of patient training on the glucometer, the blood pressure meters, and how to answer a video call. The session culminates with a live video visit conducted by the ATI processor in Minnesota, and the patient, with the assistance of the Regional Nurse Installer.

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