"Unified communications" was a buzzword of sorts in mobile health a couple of years ago, but today it mostly remains an unrealized goal.

One company trying to move the healthcare system closer to true unified communications is Revation Systems. The Bloomington, Minn.-based vendor unifies many forms of communications on a computer desktop and is helping to lower the cost of entry to telemedicine, though it hasn't yet delivered it all to a single mobile device.

A recent InMedica report predicted that the global market for telehealth services would reach $6.28 billion by 2020. "Please, let's hope that's not the case," Revation CEO David Hemler told MobiHealthNews this week at the fifth annual Health 2.0 Fall Conference in San Francisco.

It's not that Hemler is against growth in remote healthcare services, it's that he believes telehealth technology costs too much. Historically, telehealth has been limited to fixed, point-to-point connections and specialized videoconferencing equipment, with store-and-forward content delivery a notable exception. Either way, technology dissemination has been limited.

Revation believes it can deliver "medical-quality" service on consumer-grade devices such as standard PCs, tablets and smartphones over normal broadband Internet connections and mobile networks instead of requiring multiple, specialized devices and dedicated communications infrastructure. The lower cost creates a lower barrier to entry and thus a wider potential market, according to Hemler.

Revation's roots are in the financial services and banking industries, but the company entered healthcare about a year ago with a product called LinkLive Healthcare.

The system facilitates videoconferencing with consumer-grade webcams, secure file transfers such as a PDF of a patient record, VoIP telephony, secure e-mail that meets HIPAA privacy standards, secure screen sharing—including the ability to share some telemetry data—instant messaging and text messaging.

Healthcare organizations install the LiveLink software on their computers, providing a control panel resembling a typical IM window. Users can drag and drop people from their contact lists and groups into a conference, dial calls with a single click or send text messages to cell phones. Hemler said that a conference can handle perhaps six to 10 simultaneous video streams over a typical home or small-business broadband connection. Large health systems with heavy bandwidth can have greater capacity.

All communications are time stamped and logged.

There is purposely no integration with electronic health records, and Hemler pins the company's early success in healthcare partially on the fact that participants can continue using their existing EHRs. LinkLive Healthcare is XML based, and Hemler said the ability to transfer records in Continuity of Care Document format is "on our roadmap."

Patients can connect through a Web portal after installing a small piece of communications software. A mobile client is "in development," according to Hemler.

Hemler likes to talk about "presence," either in terms of individuals or as part of a group, such as members of a care team, a clinic or a hospital department.

One early customer, Minneapolis-based Fairview Health Services, uses LinkLive Healthcare to create what Hemler calls a "virtual call center" that locates clinicians and other members of care teams to provide "dynamic" care coordination, according to the Revation CEO. The system brings in multiple parties by video, phone or IM, or any combination. If the patient isn't the primary caregiver, case managers can engage family members, specialists, coaches and home-care caseworkers, creating virtual versions of the kinds of clinician "huddles" that the Joint Commission is encouraging.

"The world for us starts with a chat," Hemler said. "We think physician-to-physician communications is a huge element of this," he adds.

Fairview wants patients in the clinic for first visits, but is just fine with telehealth for follow-up care. The health system is not reimburse for this service, but, according to Hemler, the hospital uses the system to manage cost rather than generate revenue, which works because physicians are employees and Fairview is incorporating the technology into its Accountable Care Organization plans. Caregivers can gather information faster and reduce test duplication.

Hemler says it takes an average of 45 minutes for one of Fairview's 52 language interpreters to get to a site when they're called. Interpretation by videoconference cuts out the travel time and makes the employees more efficient. In some of its hospitals, Fairview has deployed PCs in the emergency department and on carts that can move into patient rooms, and has actually handed over the responsibility of engaging interpreters to Revation. Revation also calls in Fairview's outside an interpretation service if an in-house interpreter isn't available for a patient's preferred language.

Revation is marketing its communication suite to other clients for "virtual" medication therapy management. Much like the Fairview interpreters, therapy managers, therapy managers, typically pharmacists with advanced Pharm.D. degrees, don't have to travel from clinic to clinic, so organizations can make more efficient use of a limited supply of Pharm.Ds.