Video Conferencing Extends the Reach of Telemedicine Applications

The following commentary is provided by Nefsis regarding online meetings and virtual "collaboration environments " in healthcare and PACS.

More specifically, there are many examples of video conferencing in telemedicine expanding the reach of consultations to remote general practitioners, clinics and patients.

The Benefits of Telemedicine

Nothing quite takes the place of a doctor's reassuring bedside manner. There was a time when doctors actually went from house to house treating patients in the comfort of their own homes. Unfortunately, house calls are all but extinct, at least in the U.S.

Although technology cannot take the place of a visit to the family doctor, web and video conferencing are emerging as powerful components in telemedicine and telehealth initiatives worldwide. The integration of video conferencing into these programs has been able to help many patients, and has enabled doctors to communicate with specialists in order to make critical diagnoses faster.

Telemedicine is the use of medical information that is exchanged from one treatment site to another via electronic communications. The term telehealth is closely related to telemedicine. It describes remote healthcare that may or may not include clinical services. Both telemedicine and telehealth may comprise videoconferencing, transmission of still images, document sharing, e-health (patient portals for example), remote monitoring of vital signs, and some of the application areas noted below. Many medical specialty areas have taken advantage of telemedicine including: dermatology, ophthalmology, mental health, cardiology and pathology to name a few. According to some reports and studies, almost 50 different medical subspecialties have successfully used telemedicine.

The advancement of IP-based videoconferencing has helped to empower the growth and evolution of telemedicine and telehealth. According to The Association of Telehealth Service Providers (ATSP), in the next 10 years virtually all telehealth transmissions will occur using Internet Protocol, whether or not the transmissions happen over the Public Internet. As Internet capacity continues to grow, the ATSP expects that nearly all telehealth transactions will be accomplished via the Internet. It is especially important to both fields because it provides the real-time communication and interaction required in a doctor, or health provider and patient relationship. Some of the services that telemedicine enable or facilitate are:

• Continuing medical education for health professionals and special medication education seminars for individuals and groups in remote locations.


• Nursing call centers for referrals and patient services.


• Patient consultations: Audio, video, and data are shared between a patient and physician for the purpose of rendering a diagnosis and subsequent treatment plan.


• Remote patient monitoring uses special devices to remotely collect and send data to a monitoring station for interpretation. This could include checking vital signs, such as blood glucose or heart ECG. This is usually accomplished with specialty hardware devices and with integrated/fixed communications capabilities.


• Specialist referral services usually involve a specialist assisting a general practitioner in rendering a diagnosis. Videoconferencing enables the patient to see a specialist during a remote consultation accomplished in real-time, or the transmission of images, such as x-rays, along with patient data for later viewing. This is especially important for patients living in rural areas, or who are too ill to travel great distances to visit a specialist or clinic.


• Disease management is a relatively new telemedicine application. It refers to the on-going consultations between a patient and two or more multi-disciplinary practitioners whose intent is the treatment and management of long-term disease. This often involves interaction between medical, pharmaceutical and behavioral professionals on a single case. With the increasing aged population and subsequent increase in certain diseases such as type II diabetes, HIV, etc,, the disease management umbrella is expanding.


• Support services in campus facilities and remote offices. Healthcare is often rendered in a distributed office environment, and almost every process falls under privacy and other regulatory requirements. As such, nursing and support services are often the first to adopt secure telemedicine and communications-related technologies in order to reduce inter-office delays, improve the patient experience, and to reduce operational costs.

It should be noted here that telesurgery is an entirely separate subject that will not be addressed in this article. Telesurgery allows surgical procedures to be carried out without geographic constraints, and is reliant on specially-designed robotics and other computer hardware technology.

Video Conferencing and PACS

The field of radiology has made great use of telemedicine with thousands of images read by remote providers each year. Not only does video conferencing from a standard PC allow the real-time viewing of these images, even those from PACS systems, diagnosis can be rendered faster and no overnight shipping costs are incurred as a result.

Picture archiving and communication systems, or PACS as it is more commonly known, is becoming more prevalent in medical imaging. This term covers the use of computers and networks in the capture, storage and distribution of images. In the last decade, General Electric, Siemens and others have implemented PACS-related standards in their imaging equipment and supporting peripheral systems.

There are many web and video conferencing systems — including Nefsis Web and Video Conferencing — that are compatible with PACS and allow secure, ad hoc conferencing between remote practitioners that allows them to display medical images, charts, and other diagnostic results. That is not to say a conferencing system meets the PACS technical specifications for diagnostic purposes (which is beyond the scope of this article), rather it complements a PACS installation providing a secure online meeting environment to radiologists for consultations, collaboration, teaching forums, and so on.

Regardless of the field of medicine, telemedicine can prevent or decrease high travel costs, uncomfortable delays and family separation by bringing high-quality, specialized care to those who need it — regardless of where they reside. Instituting telemedicine into a health provider’s practice is fairly simple. The only equipment that is required is a standard PC with a high-speed Internet connection and a web camera.

Video Conferencing in Behavioral Health, aka Telepsychiatry

Psychiatry is emerging as one of the most promising uses of telemedicine, however the jury is still out on whether it will join the mainstream as a method or means of treatment. The American Psychiatric Association does support telemedicine, "to the extent that its use is in the best interest of the patient," and practitioners meet the rules of ethics and confidentiality. The APA has also expressed an interest in supporting telepsychiatry as a possible solution to shortages of specialists in rural areas in states such as New Mexico and Louisiana. And this actually makes perfect sense. In the more rural areas of the U.S. where there is no local clinic or alternative, mental health practitioners embrace telemedicine as a way to reach out to those in need.

Telepsychiatry's true calling may be the link it can provide between urban areas with a high concentration of psychiatrists and rural areas that are in need of specialists who can provide consultations to both other clinicians and directly to patients. Access is the real issue here. Geriatric patients, children, prisoners, military veterans and other groups that have either monetary or geographic barriers to psychiatric treatment could all benefit from adoption of telepsychiatry programs.

Large healthcare systems, such as state prisons, can also take advantage of the remote access provided by telepsychiatry. Many state prisons are located in small towns in very rural areas and as a result, have a difficult time recruiting psychiatrists. Utilizing video conferencing systems from the prison, the inmate population would have direct access to qualified specialists no matter where they are located.

In order for the widespread adoption of telepsychiatry, the programs must prove they are cost-effective. The decreasing cost of the technology, especially IP-based videoconferencing, will only help in establishing proof of cost-efficiency. Secondly, an increasing willingness on the part of Medicare to reimburse for telemedicine services would most likely result in increasing acceptance of services by third-party payors. Before this happens, standards of practice must be developed that are reasonable, fair and replicable.

At this point in time, there are no empirical studies that prove the benefits or support the establishment of a telepsychiatry program. Not enough studies have been done to date. The studies that have been done do support telepsychiatry as a means of conducting assessments and improving a patient's clinical status.

The emergence of IP-based web and video conferencing, accomplished by installing software on one server and providing access to other individuals on standard PCs with high-speed Internet connections, will undoubtedly add to the eventual widespread adoption of telemedicine, telehealth and telepsychiatry programs throughout the country and the world. As the cost of PCs and video conferencing software decreases, it will make traveling great distances for diagnosis and consultations a thing of the past – much like the doctor house call.

Requirements and Selection Criteria in Telemedicine

There are many web, VoIP and video conferencing technology alternatives. At the highest level, the broad classes of product include dedicated point-to-point hardware systems that may offer video only, and which are limited to two participants without the installation of video-switching equipment; IP-based conferencing services; and on-premise, IP-based conferencing software.

The latter two classes of solutions use the TCP/IP network protocol to connect two or more parties across remote locations (often called "IP-based"). This can be a mix of public or private Internet connections.

The following are the relevant, new capabilities introduced by IP-based systems:

• The ability to conference with more than two people at a time.


• The ability to include application, desktop and document sharing in the same session in conjunction with a videoconference.


• And most importantly, the ability to connect virtually any user, anytime, anywhere. Note: this is really a combination of using standard PCs and Internet connections, plus off-the-shelf (PC-based) video peripherals (i.e., no expensive video conferencing hardware and switching equipment required).

Some of the other major distinctions, and issues to consider, before choosing a video conferencing system are:

• Is the solution available as an online service, software, or both? In many cases, the IT director or CIO will have a policy preference for one or the other; or have a preference based on current network load and security-related details (see below)


• Can the solution connect users over separate Local Area Network (LAN) segments, the public Internet and/or private network? In most cases, this topic is never discussed explicitly. However, practice management software and teaching institutions have a long history of using broadcasting, peer-to-peer connections and other connection protocols that do not work over WANs and the public Internet. Though estimating is impossible, it is safe to say a large percentage of on-premise products cannot establish connections beyond their immediate LAN.

Of course, security is a major consideration in any healthcare-related installation. Almost all commercial conferencing solutions provide some level of security. The best products also include:

• Features that allow IT staff to set key length and encryption standards (SSL/TLS connections)


• Allow use of the customer's certificate


• Integrate with the customer's Public Key Infrastructure (PKI)


• Settings that force all conference connections to be SSL/TLS secured

Nefsis Web and Video Conferencing

Nefsis is an excellent example of a secure, multipoint video conferencing solution that meets these requirements. It is available has an online service, and on-premise software.

Nefsis is an IP-based solution that allows anyone with an Internet connection and a Windows PC to join a conference. Video conferencing is provided by off-the-shelf webcams and video devices. It has a full-suite of security features and IT controls, allowing complete flexibility in multi-office, VPN, public/private and wide area networks. Nefsis also uses standard URLs, a web-browser and Microsoft Office-style layout.

For more information, please click on of the links below or refer to the most researched links summary at the top of this page.

Nefsis Data Sheet (PDF).
Schedule a live demo.

The Future of Telemedicine

Software solutions like Nefsis will help to further the growth, acceptance and adoption of telemedicine initiatives. Keeping telemedicine costs low will enable providers to reach out to a broader audience, including those in rural regions and low-income patients who cannot afford to travel long distances for care. Once telemedicine reaches maturity, it's not unfathomable that bringing top-notch health care to those who really need it will be accomplished via video conferencing without the time delay and cost of traveling to a clinic in another state or country.

Additional Resources:

http://www.healthimaging.com
Picture Archiving & Communication System
http://www.atsp.org
http://tie.telemed.org