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
- 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
- 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
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 providerâ€™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
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 â€“ much like the doctor
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
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.
Picture Archiving & Communication System