Remote image access expands services.
Expanding care delivery beyond the "four walls of the hospital" spawned the rise of the integrated delivery system. Accessing clinical information from remote locations once again is expanding the services offered by healthcare institutions.
Remote access to clinical information is not a new phenomenon in the healthcare industry. The technology for telemedicine and picture archiving communication systems (PACS) has been available for years. But, some colossal failures with the early implementation attempts of these digital technology wonders have handcuffed a heavy load of "baggage" to the terms telemedicine and PACS.
The baggage carried by telemedicine and PACS conjures up images of multimillion dollar systems resembling the space ships from the movie "Star Wars" along with the problems faced by the crew in the summer blockbuster movie "Apollo 13."
Although telemedicine and PACS technologies have taken more than their fair share of criticism in the past few years, most healthcare professionals acknowledge that these technologies have the potential to greatly expand care delivery.
Several staff members from the University of Southern California and a host of vendors are working to unload the baggage from applications using remote image access technology. The USC staff acknowledges that their technology developments will have to dispel the bad reputation that telemedicine and PACS has earned over the years.
"We don't even use the word PACS anymore. There has been so many failures that it has become a term that means failure," said Frederick George, a professor emeritus of radiology and of radiation oncology at USC.
USC is not taking on the challenge alone. In late 1993, USC formed the Advanced Biotechnical Consortium (ABC) to merge the skill sets of several organizations and more than a dozen vendors. The ABC members collaborate on bringing new technology to the care delivery process. George had the initial idea for the consortium and is currently serving as the consortium's first executive director. ABC participants and contributors include:
* Advanced Visual Systems,
* All Star Telecom,
* Apple Computer,
* Children's Hospital Los Angeles,
* Cisco Systems,
* Doheny Eye Institute and Hospital,
* Eastman Kodak,
* Fore Systems,
* General DataComm,
* Jet Propulsion Laboratory at CalTech,
* Knobbe, Martens, Olson and Bear,
* LAC+USC Medical Centex,
* Langdon Wilson,
* Loma Linda University Medical Center,
* Norris Cancer Hospital,
* Northrup Grumman,
* Picker International,
* Sun Microsystems,
* University Hospital,
* USC School of Medicine, and
* Whittaker Corporation.
In the latest phase of the ABC project, USC implemented the ATM Video Server 2000 (AVS-2000), which is a product of Whittaker Corporation, Simi Valley, Calif. The AVS-2000 is a real-time computer system optimized to handle storage, retrieval and distribution of image, video and audio data for multimedia applications. The AVS-2000 will serve as a storage device for standard digital images and complement other projects previously completed by the consortium.
George plans the Whittaker AVS-2000 to play a critical role in the development of new revenue-enhancing opportunities. "The Whittaker repository lends itself to shared utilization," George said. USC may use the AVS-2000 as a utility that healthcare providers could pay to use as an image archival system. "We are leaning toward payment or reimbursement by transaction," he said.
The Whittaker system supports the use of asynchronous transfer mode (ATM) networks, a factor of great importance to the USC ABC. In August, the USC campus went live with an ATM backbone. Network users of the campus connect their workstations to the backbone via an ethernet network, according to Rod Zalunardo, USC executive director of information support services and administrative director of the USC ABC.
"Some of our member hospitals had some apprehension about ATM," George said. "They couldn't predict the impact of going to an ATM network because most people lack experience with ATM systems. They were also concerned that putting in a new network might compromise the existing network."
Bringing technology from other industries to healthcare
Other ABC projects include the application of technologies from other industries to the healthcare industry. The first major ABC project was the development of the VOXAR system. VOXAR demonstrated that the defense industry's target-recognition algorithms could be successfully reapplied to the examination and delineation of human organs and structures with overlapping tissue densities using digital medical images. The system uses a Cray T3D massively parallel supercomputer at the Jet Propulsion Laboratory (JPL) of CalTech to provide the "horsepower" for the three-dimensional images. The "headpower" for the project was provided by a team from Northrup Grumman, USC and JPL.
Providing access to servers via the Internet
USC implemented a wide area network (WAN) in August 1994 to allow communications between facilities.
"At the time, we wanted to keep the big picture in mind," Zalunardo said. "Docs on and off campus needed to be able to communicate with each other. We wanted a network-based solution so we could put our resources on the network. We decided that the Internet might be a good way for people to get to our services."
The Internet connection spawned the development of the Virtual Academic Medical Center (VAMC), a World Wide Web home page. USC developed a proprietary Web browser to access the resources on the VAMC. "Traditional Web browsers don't interact with other devices on the network. They only interact with the server. Our browser can interact and control the Cray server that is at the JPL facility. Our image capture devices and workstations are connected to the network," Zalunardo said.
The Doheny Eye Institute and Hospital already is making use of the Web connection. "An eyecare IPA can dial into the Internet via ISDN lines and connect to Doheny eyecare center to upload digital images," George said.
For example, following the completion of a retinal scan, the ophthalmologist at the remote facility can make an electronic referral to a specialist at Doheny. A Doheny specialist can consult on the case and send a reply via e-mail to the ophthalmologist at the remote facility, George said.
"ISDN lines are fast enough to transmit still images," George said. "But, there are problems using ISDN lines for viewing full-motion and consultation video simultaneously. You can use compression techniques if the image will be used for consultation only, but not for diagnostic images."
Whittaker no stranger to healthcare industry
Although primarily known as a defense contractor, Whittaker Corporation is not a newcomer to the healthcare market. To the surprise of many, Whittaker's track record in the healthcare market goes back more than 20 years.
In the early 1970s, Whittaker owned and operated some of the nation's first health maintenance organizations (HMOs). Although these HMOs were later sold to Travellers, Whittaker continued to build, manage and staff all the U.S. military hospitals in Saudi Arabia throughout the 1970s and 1980s, according to Jim Schultz, director of business development for Whittaker.
"The defense industry parallels the healthcare industry," said Thomas Brancati, Whittaker president and chief executive officer. "Like the defense industry, the healthcare industry is concerned with quality and cost issues."
In the early 1990s, Whittaker divested all health-care-related businesses, only to dive back into the healthcare market in April 1995 with the acquisition of Hughes LAN Systems (HLS), now called Whittaker Communications, Inc. "About 30 percent to 40 percent of HLS' business was healthcare related," Schultz said. HLS has provided solutions to about 400 hospitals, he added.
In addition to the products and services offered by the former HLS, Whittaker is targeting the healthcare industry with the company's ATM Video Server 2000 System (AVS-2000). The system is designed to handle storage, retrieval and distribution of image, video and audio data for multimedia applications.
Whittaker is betting that the healthcare industry's increased use of electronic information will spark sales of the AVS-2000. The system's capabilities lends itself to telemedicine applications because the AVS-2000 supports ATM networks and multiple storage devices, such as magnetic tapes, optical disks, magnetic disks and global shared memory.
Aside from the healthcare industry, Whittaker also is targeting Fortune 1,000 companies, government institutions and motion picture entertainment companies.
Share the network to offset costs
Telemedicine applications demand a fast network. However, if the cost of implementing and maintaining a high-speed network prohibits you from making the investment, perhaps USC has your solution.
During a telemedicine test between Los Angeles and the Pacific Rim, USC offset the costs of maintaining the ATM network by partnering with an oil company conducting seismic tests in the region. USC and the oil company reached an agreement regarding network usage and then arranged to send data back to the United States via the shared network.
USC is now searching for a potential partner to share a network in the motion picture industry. Numerous motion picture companies digitize their film and video so that it can be transferred via networks to other regions of the nation where the movie is edited.
Telemedicine opens doors to licensure and malpractice issues
Crossing the state lines of Kansas, Texas and South Dakota via telemedicine networks presents a challenge. Out-of-state physicians must be licensed to practice medicine in these states before making consultations via telemedicine networks, according to Phyllis Granade, an attorney with Kilpatrick & Cody, an Atlanta-based law firm.
"In response to those actions, the Federation of State Medical Boards has drafted some model legislation," Granade said.
The legislation proposes the establishment of a physician registry for physicians wanting to practice via telemedicine. If the legislation passes, it would result in shorter applications and reduced licensing fees for physicians wanting to practice in other states via telemedicine, Granade said. The Federation is hoping that state medical boards will individually adopt the use of this physician registry system.
Physicians practicing telemedicine across state lines are vulnerable to malpractice lawsuits in multiple jurisdictions. For example, in a hypothetical situation where a Tennessee-based physician consults via telemedicine on a case where the patient is in Georgia, the physician may be sued for malpractice under Georgia, Tennessee or Federal laws, Granade said. However, the patient would be able to sue the physician under one, but not all three jurisdictions, she said. The patient would have the choice of filing the suit in the jurisdiction where the courts are most likely to award damages.
These liability issues mean that physicians may have to increase their malpractice insurance coverage to include suits filed in other jurisdictions, which may result in higher malpractice insurance rates, Granade said.
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|Title Annotation:||Technology Information; includes related article on Whittaker Corp and telemedicine|
|Publication:||Health Management Technology|
|Date:||Nov 1, 1995|
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