Designing a teletherapy platform for speech language pathologists

In March 2020 our clinic was faced with a tough decision. Schools throughout the country were starting to close due to the pandemic. In order to continue to serve our clients we knew we would need to adopt teletherapy. The question was - should we use an off-the-shelf solution or should we build a platform to meet our needs?

We evaluated various HIPAA compliant video-calling and telehealth solutions but found none that truly seemed to provide what we were looking for. Fortunately, we were in a unique position in that we already had an in-house team of developers working on our own proprietary internal EMR (electronic medical record) system.

In early March our development team started work on a teletherapy platform which, as of June 2020, has now hosted over 10,000 sessions. At the core of the platform are the following guiding principles:

• - It must be safe, secure and HIPAA compliant
• - It must be easy to use for both the patient and the therapist
• - It must work across a variety of devices and operating systems
• - It must work even in rural areas with poor Internet connection speeds

This post will be a deep dive into the design and features of our teletherapy platform - as well as the thought process that went into each part. Throughout the process we leaned heavily on feedback from our SLPs and iterated quickly on their complaints, suggestions and ideas. We required them to rate every session and additionally they provided us over 12,000 words of direct, actionable feedback in an internal survey we ran in April.

UPDATE (2/1/2022) The next generation of this teletherapy platform is now available to everyone through Ambiki.

Table of contents

• Scheduling an appointment
  • How it works
  • Email notifications and calendar invites
• Joining the session
• In the session
  • The room is tailored to the viewer
  • What does the patient see?
  • What does the SLP see?
  • The whiteboard
  • The resource library
  • Green screen
  • Screen share
  • Click beacon
  • Reactions
  • Animated emoji
  • Interactive word games
  • Chat corrections
  • Transfer homework files
  • Record audio clips
  • Billing notes
  • Detailed call history and call quality stats
• The teletherapy platform for SLPs

Scheduling an appointment

Apart from the teletherapy room itself, we knew that the functionality for scheduling the appointment and booking the teletherapy room was going to be crucially important to our SLPs. At Sidekick, we strive to build our systems to reduce SLP paperwork and overhead so that they can spend their time focusing on what matters - their patients. Thus we knew if our therapists ended up getting bogged down in the tedious tasks associated with scheduling appointments they would have less time for preparation and less time for actual sessions.

How it works

First, the SLP sets their availability including start time, end time and lunch break. This feature also allows the SLP to block specific days or times when they are not available (e.g. if they have a dentist appointment or want to take a day off).

Once the SLP has set their availability they can send their personal calendar link directly to their patients. The patient can then use that link to book their own appointment.

Conversely, there may be situations where you don't want to give your patients the ability to book their own appointments. In those cases, the SLP can book the appointment for the patient either by using the same calendar view (pictured above) or a more flexible form view (pictured below).

Email notifications and calendar invites

As soon as the appointment is booked an email is sent to the patient which includes the date and time of the appointment as well as the link to join the room. Additionally a calendar invite is sent to the patient and SLP so they can easily add it to their personal calendar app. A reminder email is also sent to the patient 15 minutes before the session starts.

Joining the session

On Sidekick's teletherapy platform joining a session is as easy as clicking a link. That's right - no apps, no accounts. Sidekick's teletherapy platform is browser-based and works across a wide range of platforms and devices. The patient only needs to have a modern web browser, a web cam and a microphone.

When the appointment is booked the patient receives a link to their individual and secure teletherapy room. If they visit the link prior to the session start time, they will see a countdown as well as a link to test their equipment.

Once the session begins they will automatically join the room. Sidekick's system will run a quick check of their equipment to make sure the patient's device is ready (i.e. web camera and are microphone plugged in and enabled). Then, the session starts!

In the session

The room is tailored to the viewer

At Sidekick we have patients who span a wide range of diagnoses and conditions. When designing the interface of the room itself we wanted to ensure, for the patient, that the user interface was simple and uncluttered. As many patients can be easily distracted the guiding principle for the patient view was "less is more".

Additionally, many therapists requested the ability to hide or show various elements on the patient's view for them. For example, some patients would get distracted by seeing their own video stream while others would become obsessed with the time remaining in the session and start counting it down. Our platform allows the SLP full control to show/hide the elements visible to the patient.

What does the patient see?

The patient's view is dominated by a large video of the therapist. If the therapist is using a whiteboard or sharing their screen this will change to a split screen view to feature both. The patient's view also includes a box in the top right and a lower toolbar, both of which can be dragged anywhere on the screen. There is also an eye icon in the top left allowing the patient to toggle on/off these two elements.

The lower toolbar includes:

• - The time remaining in the session
• - A button to view the participants in the call
• - A custom timer (if started by the SLP)

The top right box includes:

• - The patient's own video
• - An area for transferring/receiving files (i.e. homework)
• - A button to expand the chat (and notify the patient if they received a chat message)

What does the SLP see?

The SLP's view includes many more features and tools they can utilize in their session. The remainder of this article will explore the unique features available to the SLP.

The whiteboard

With Sidekick's whiteboard you can draw, add text, add emoji, as well as choose from over 30 shapes such as animals, vehicles, etc. The SLP can also save snapshots of the whiteboard. As we'll show later, these snapshots can serve as a sort of visual history of what you worked on with that patient.

Our therapists utilize the whiteboard for many different and creative uses: playing games (like tic-tac-toe), emoji stories, and more!

The resource library

Our SLPs have created a library of over 600 high quality resources that are available for you to use during the session. The resource opens right on the screen and includes all of the functionality of the whiteboard, allowing both you and the patient to jointly annotate the slides with drawings, text or shapes.

Our search allows for easy discovery. Find materials by skill, theme, age level, and more!

With a library of high quality resources at their finger tips, therapists are able to cut down on preparation time. Patients love the interactive nature of the resources - such as being able to draw on the slides.

Just like the whiteboard, SLPs are able to save snapshots as they work on the resources with their patients. These snapshots are then available at the end of the session on a "call details" page, creating a visual storyboard of your session.

Green screen

SLPs love green screens. There are thriving Facebook and YouTube groups dedicated to the many unique and creative uses for green screens in speech therapy sessions.

Our platform comes with over 30 pre-loaded backgrounds hand selected by our SLPs. You can also easily add your own custom image.

Many therapists struggle on other platforms with their green screen. Typically one's home office doesn't have the same ideal lighting of a movie studio. However, our highly configurable green screen controls allow therapists to find the perfect settings for their particular set up. Say goodbye to pixelation around the edges, hair blending into the background and other issues commonly experienced on other platforms.

We even offer a free green screen playroom where SLPs can test their set up.

Screen share

Screen share is one the most popular features of our platform. SLPs tend to use this feature almost every session. Share materials saved on your computer, use resources such as Boom cards, or watch a YouTube video with your patient. Our platform even allows you to share the audio track of the resource. When sharing your screen the patient will still be able to see your video, allowing you to model proper mouth and jaw placement.

Click beacon

Many SLPs who are starting out in teletherapy request being able to give the patient control of the mouse on their screen so that the patient can interact with an activity (such as a Boom card).

As you have seen above, our resource library allows both parties to interact with activities simultaneously. However, there are cases where you want to screen share something that is not in our library (a Boom card, a PowerPoint file on your computer, etc.). Unfortunately, for security and HIPAA compliance reasons we can not give the patient access to your computer to control the mouse.

Think of it this way - if you owned a clinic, would you allow patients in the waiting room to go behind the front desk and start using your clinic's computer. No way! That would be a clear HIPAA violation. This is the same thing. Allowing a patient remote access to your computer, which contains PHI (protected health information) is a very questionable practice. You can't control where or what your patient clicks on.

Instead, we invented a new feature that allows you to get visual feedback on your patient interacting with the screen (through a click or touch) without giving up access to your computer. We call this feature "Click beacon". The patient's click or touch is shown to you on your screen and then you can interact with the activity accordingly. For example, imagine you have two letters on the screen - A and B. You ask the client to click on "B". You'll be able to instantly see if they click the correct one. This feature gives you the benefits of interaction while preserving the safety and security of the private data stored on your computer.

Reactions

Want to praise your patient for doing a great job on an activity? Need to draw your patient's attention back to the screen? Try one of our "Reactions". These short (3-5 second) animations include sound and the kids love them.

Fireworks, ninjas, rainbows, bubbles - there are a lot to choose from. The platform even includes dice that you can roll and use as part of a game or activity.

Animated emoji

Sometimes you need to do something fun (or a little crazy) to keep the session light for your patient. Our platform offers animated emoji and face filters you can use to interject some life into a tough session.

Interactive word games

Choose from one of many pre-loaded word lists or add your own. This game allows the SLP or patient to spin the wheel. Collect points as you practice your word list.

Chat corrections

Our chat tool includes a first-of-its-kind correction tool. If the patient sends a message with a spelling or grammatical error the SLP can easily correct it in the chat interface. Sidekick's platform will then automatically add colorful annotations to the mistakes and corrections. This is a great tool for patients who are working on language. It helps them to visualize their errors. Many patients struggle when they are only corrected audibly, they need to clearly see the mistake for it to register.

Transfer homework files

Some insurance companies require that you send and track homework for your patients. Our platform makes this super simple. Send the files to your patient (or receive their completed files) right in the teletherapy room. The transfers are also recorded on your call details page so you can easily track what you previously sent to a patient.

Record audio clips

Sidekick's platform allows you to easily record an audio clip of your patient's audio track (up to 10 seconds) and tag it with the word or phrase said. These clips are then available at the end of the session allowing you to track your patient's progress over time.

Billing notes

Write your progress note in real-time during your session.

Once your session ends your note will be all set to send off to insurance or keep in your patient's file.

Detailed call history and call quality stats

After a session is finished you have full access to a page which details everything you ever wanted to know about your session. Start and end times, device details, call quality, a chat log, a timeline of events, saved whiteboard and resource snapshots, saved audio files, and more!

The teletherapy platform for SLPs

As you can see, Sidekick's platform is uniquely tailored to meet the needs of speech language pathologists - and we are just getting started. We are releasing new features every week and love getting feedback from SLPs on what to improve and which new features to add next.

If you are looking for a teletherapy platform specifically built with the needs of SLPs in mind send us a message!