Enhance regional presence with videoconferencing.

Reach out to rural areas and offer continuing medical education credits through videoconferencing

How does telemedicine differ from distance learning? Although both distance learning and telemedicine make use of interactive digital audiovisual communication, it is important to make the distinction between the two types of sites. Distance learning classrooms make use of a lower bandwidth, using just half of the T1 line, according to R. Kevin Grigsby, D.S.W., L.C.S.W., the director of research and development at the Medical College of Georgia (MCG) Telemedicine Center in Augusta. A document camera may be used to show audiovisual resources, but no additional instruments are used.

On the other hand, a telemedicine system uses the full T1 because high-quality video is a key requirement and includes integrated medical telemetry that allows for the transmission of medically relevant information including real-time images seen through a series of scopes that have been specially adapted for use with a microcamera, Grigsby said.

The Pathway Health Network (PHN) is a regional health system linking health providers--from hospitals and clinics to physicians and therapists--to deliver high-quality, patient-centered care. Pathway currently includes five hospitals, their associated physician groups and a wide variety of community-based services, including a hospice and a visiting nurses association.

Deaconess Hospital in Boston and Deaconess-Glover Hospital in Needham, Mass., became the first two Pathway Network members to communicate using videoconferencing. Deaconess Hospital is an adult, specialty referral, tertiary-care facility and a major teaching hospital of Harvard Medical School. The hospital provides specialized medical and surgical services to patients who are then referred to their physicians and care providers for ongoing care and monitoring.

Two PictureTel System 4000s were purchased to strengthen relationships and enhance communications between network members. Other benefits today include:

* enhanced patient care,

* more efficient delivery of medical services,

* reduced travel and time savings for hospital staff,

* increased productivity, and

* enhanced educational opportunities/training.

Pathway will add more of its members to the networks based on funding. Besides group systems, Pathway is looking into desktop videoconferencing for tasks such as patient referrals, consultations and post-operative follow-up visits. Pathway hopes to extend videoconferencing to include:

* emergency room to emergency room support,

* emergency psychiatric consultation,

* network grand rounds,

* resident supervision at community hospitals,

* benefits consultations,

* recruitment,

* administrative meetings, and

* clinical research collaborations.

Crossing geographic boundaries--Looking to improve communications and information sharing between geographically disparate organizations, PHN opted for videoconferencing. Today it provides educational opportunities, clinical collaboration, follow-up examinations for patients, tumor conferences and connections to resources outside the network. ln the case of referrals and consultations, doctors can share X-rays, pathology slides and other tests to jointly review them. Some applications include:

Rare tumor consultation--A woman was brought into Deaconess-Glover hospital with symptoms of lightheadedness, dizziness and fainting. A computed tomography (CT) scan revealed a pancreatic tumor. A videoconference was held with an internationally recognized liver surgeon at Deaconess Hospital in Boston. Without videoconferencing, the diagnostic process up to the CT scan would have been the same as what occurred at Deaconess-Glover. However, since this was a rare tumor, they would have had to consult with specialists. Ultimately, the patient would have been transferred to Deaconess Hospital in Boston via costly ambulance transportation and additional tests would have been scheduled. Videoconferencing shortened the time between diagnosis and definitive treatment. It made the best people available for consultation, reduced the cost and the number of days in the hospital and kept the patient in her own community setting.

Tumor Board conferences--Deaconess-Glover uses videoconferencing for referrals, interactive consultations and educational sessions called "Tumor Board conferences." The conferences bring together personnel from both the Glover and Boston Deaconess hospitals to discuss case studies from different disciplines as they exchange data, including published papers and highlights of past experiences. Interns, residents, fellows and students benefit from these discussions. Specialists from both hospitals discuss patient cases and reevaluate prognoses during different phases of a patient's illness. Videoconferencing has brought the medical staffs closer together to form good working relationships, which ultimately will benefit patients and the quality of their care.

Continuing nursing education--Nurses at Deaconess-Glover have been able to tap into the educational resources of Deaconess Boston, including women's health issues, financial planning and dealing with the changes in healthcare from a nursing perspective. Besides an increased number of employee programs, morale is increased because people are able to stay informed and the approximate savings for 12 hours of usage is $10,580.

Georgia network focuses on distance learning

The Georgia Statewide Academic and Medical System (GSAMS), is one of the largest distance learning and healthcare videoconferencing networks. The Georgia Department of Administrative Services (DOAS) operates a communications network that can access cable systems, microwave systems and satellite dishes. A portion of this system is a telemedicine network that uses fiber-optic cable to link remote and isolated sites with secondary and tertiary care centers. Another portion of the system is a network of distance learning classrooms Iocated in colleges and universities, technical schools, K-12 schools, correctional facilities and special sites such as ZooAtlanta and studios of Georgia Public Television.

Both the Georgia Statewide Telemedicine Program (GSTP) and the distance learning network use the same fiber-optic telephone cable (T1) backbone. Both telemedicine and distance learning make use of videoconferencing and codecs (compression-decompression technology) developed by Compression Labs, Inc. (CLI), San Jose, Calif. Plans call for the deployment of a total of 59 telemedicine sites and more than 300 distance learning classrooms, MCG's Grigsby said.

"GSAMS is the network [of telemedicine and distance learning sites] and the Georgia Statewide Telemedicine Program is the system that provides access to medical care in remote and isolated areas," said Laura Adams, operations director of the MCG Telemedicine Center.

History of telemedicine in Georgia--The Telemedicine System began in 1991 with a single remote site at Dodge County Hospital in Eastman, Ga., and has grown to 41 operational sites. More than 10,000 distance learning encounters have taken place since the inception of the program, Grigsby said.

Through linking patients and their clinicians through advanced telecommunications technology, patients remain in their own communities while receiving specialized medical consultation. The MCG Telemedicine Center is linked to rural hospitals, medical centers, physician ofrices and correctional facilities.

In effect, the referring physician is able to participate in a tutorial with the consulting physician who is also a member of the School of Medicine Faculty. Category 1 continuing medical education (CME) credits are awarded to the referring physician for their participation. All of the consultations are recorded on Super VHS videotape. A review panel at the medical school reviews the tape to be certain that all of the requirements for the award of CME credit have been met. The continuing medical education unit at the Medical College actually awards the credit.

"The elimination of the isolation of the rural practitioner takes place," said Max Stachura, M.D., a neuroendocrinologist and the clinical director at the Medical College of Georgia Telemedicine Center.

Deaconess assists consultations with videoconferencing

Challenge: Increase communications and specialty consultations between physicians at Deaconess Hospital in Boston and Deaconess-Glover Hospital in Neeham, Mass. Need technology solution to facilitate rare tumor consultation, Tumor Board conferences and continuing nursing education.

Solution: Purchase videoconferencing system to facilitate videoconferencing for referrals, interactive consultations and educational sessions.

Vendor Chosen: PictureTel Corporation, Danvers, Mass.

CMEs offered via videoconferencing through Medical College of Georgia

Challenge: Decrease the transportation of patients when specialist consultations are necessary. Offer clinicians the opportunity to learn by remotely working with other clinical specialists. Remotely offer continuing medical education (CME) credits.

Solution: Establish connections between facilities with fiber-optic telephone lines (TI). Implement videoconferencing solution.

Vendor Chosen: Compression Labs, Inc., San Jose, Calif.