CASE: Brain Saving Technologies, Inc. and the T-Health Institute: Medicine Through Videoconferencing.
On average, every 45 seconds, someone in the
United States suffers a stroke, the third-leading
cause of death as well as the leading cause of permanent
disability in the nation, according to the American
The first three hours after a stroke are critical to a patient’s
survival and recovery. For instance, depending on the
type of stroke suffered by a patient, certain drugs can vastly
improve the patient’s survival and chances for full rehabilitation.
Those same drugs, however, can be deadly if given to a
patient suffering another type of stroke. Due in part to a
shortage of specialty physicians trained to accurately diagnose
and treat stroke victims, not all U.S. hospitals have the
expertise and equipment to optimally care for stroke patients,
particularly in the critical early hours.
The new Neuro Critical Care Center, operated by Brain
Saving Technologies Inc. in Wellesley Hills, Massachusetts,
will begin to connect emergency-room doctors at a number
of suburban hospitals in the state with a remote university
hospital that will act as a ‘hub’ with on-call critical-care neurologists
who can assist in making remote diagnoses and
treatment recommendations for suspected stroke patients,
says Stuart Bernstein, CEO and chief operating officer at
Brain Saving Technologies. The connection occurs through
a visual-communication workstation that can connect via IP,
high-bandwidth communications, or private leased line. The
workstation allows the remote specialists to examine and talk
to patients, and collaborate with on-site doctors to improve
timely diagnosisof strokes and optimize treatment options,
“Our purpose is to provide member hospitals with a major
hospital stroke center, 24 by 7,” Bernstein says. CT
scans—digital images of patient’s brains—can also be transmitted
from the member hospitals to the Neuro Critical Care
Center specialists to improve diagnosis of the patients, he
says. The images are seen simultaneously by doctors at both
locations so that they can collaborate. The technology can
also help train emergency-room doctors about what characteristics
to look for on the CT scans of stroke patients.
A key component of the Neuro Critical Care Center’s
offering is the Intern Tele-HealthCare Solution from Tandberg,
which provides simultaneous audio and video transmission and
bidirectional videoconferencing and image-display capabilities
to hub and member hospital doctors. Emergency-room doctors
can wheel the mobile Tandberg system to patients’ bedsides,
Tandberg’s medical video-communication products are
also used in other telehealth applications, including situations
where doctors need an expert in sign language or a foreign
language to communicate with patients or their family members,
says Joe D’Iorio, Tandberg’s manager of telehealth.
“The technology provides real-time visibility and collaboration
to help assess patients’ well-being and facilitate real-time
interaction,” he notes.
Doctors have long had a tradition of holding “grand
rounds” to discuss patient cases and educate aspiring physicians.
The centuries-old practice certainly has its merits, but
medical leaders in Arizona want to improve, update, and
broaden it to include a larger list of health care practitioners,
such as nurses and social workers, regardless of their locations.
So the Arizona Telemedicine Program (ATP) drew on its extensive
use of videoconferencing equipment to develop the
Institute for Advanced Telemedicine and Telehealth, or the
T-Health Institute, to facilitate a 21st-century way of teaching
and collaborating across disciplines and professions.
“Its specific mission is to use technology to permit interdisciplinary
team training,” explains Dr. Ronald Weinstein,
cofounder and director of the ATP. “Now we’re opening it up
to a far broader range of participants and patients.” The
T-Health Institute is a division of the ATP, which Arizona lawmakers
established in 1996 as a semiautonomous entity. The
ATP operates the Arizona Telemedicine Network, a statewide
broadband health-care telecommunications network that links
55 independent health care organizations in 71 communities.
Through this network, telemedicine services are provided
in 60 subspecialties, including internal medicine, surgery,
psychiatry, radiology, and pathology, by dozens of
service providers. More than 600,000 patients have received
services over the network.
Project leaders say the goal is to create much-needed
discussion and collaboration among professionals in multiple
health care disciplines so that they can deliver the best
care to patients.
“It’s the effort to be inclusive,” Weinstein says. “Medicine
is quite closed and quite limited, but we’re counting on
telecommunications to bridge some of those communication
gaps.” The institute is essentially a teleconferencing hub that
enables students, professors, and working professionals to
participate in live meetings. Its technology also allows them
to switch nearly instantly between different discussion groups
as easily as they could if they were meeting in person and merely
Gail Barker has noticed that participants who don’t
speak up during in-person meetings often become much
more active in discussions held via videoconferencing. Perhaps
it’s because they feel less intimidated when they’re not
physically surrounded by others or because the videoconferencing
screen provides a buffer against criticism, says Barker,
who is director of the T-Health Institute and a teacher at the
University of Arizona’s College of Public Health.
When used poorly, videoconferencing can be stiff and
dull, just a talking head beaming out across cyberspace
without any chance to engage the audience. But Barker and
others are finding that when the technology is used in a
thoughtful and deliberate manner, it has some advantages
over real-life sessions because of its ability to draw more participants
into the fray.
“It’s literally a new method of teaching medical students.
It’s a novel approach,” says Jim Mauger, director of engineering
at Audio Video Resources Inc., a Phoenix-based
company hired to design and install the videoconferencing
equipment for the T-Health Institute.
The T-Health Institute uses a Tandberg 1500 videoconferencing
system, and its video wall has 12 50-inch Toshiba
P503DL DLP Datawall RPU Video Cubes. The video wall
itself is controlled by a Jupiter Fusion 960 Display Wall
Processor utilizing dual Intel Xeon processors. The Fusion
960 allows the wall to display fully movable and scalable images
from multiple PC, video, and network sources.
Although Weinstein was able to articulate this vision of
interprofessional interaction—that is, he could clearly lay
out the user requirements—implementing the technology to
support it brought challenges, IT workers say.
Mauger says creating a videoconferencing system that
linked multiple sites in one video wall wasn’t the challenging
part. The real challenge was developing the technology that
allows facilitators to move participants into separate virtual
groups and then seamlessly switch them around.
“The biggest challenges to making this work were the
audio isolation among the separate conference participants
as well as fast dynamics of switching video and moving participants
to meetings,” he explains. He says his team also encountered
other challenges—ones that affect more typical
IT projects, such as budget constraints, the need to get staffers
in different cities to collaborate, and the task of translating
user requirements into actionable items. “It’s necessary
to have someone there on-site who understands all the complex
parts of the project,” he says. “Someone who is not just
meeting with people every now and then, but someone who
works with them on a daily basis.”
Barker, who teaches in the College of Public Health at
the University of Arizona and is a user of the system, led
a trial-run training session at the T-Health amphitheater.
She met with 13 people, including a clinical pharmacist, two
family nurse practitioners, a senior business developer, two
program coordinators, a diabetes program case manager,
and an A/V telemedicine specialist. For that event, Barker
says the biggest benefit was the time saved by having the
facility in place; without the T-Health Institute, some participants
would have had to make a four-hour round trip to
attend in person.
Now the system is opening up to others in Arizona’s
health care and medical education communities. T-Health
Institute officials say they see this as the first step toward a
health care system that truly teaches its practitioners to work
together across professional disciplines so that they can deliver
the best, most efficient care possible.
“We think,” Weinstein says, “that this is the only way
you’re going to create coordinated health care.”
CASE STUDY QUESTIONS:
1.From the perspective of a patient, how would you feel about being diagnosed by a doctor who could be hundreds or thousands of miles away from you? What kind of expectations or concerns would you have about that kind of experience?
2.What other professions, aside from health care and education, could benefit from application of some of the technologies discussed in the case? How would they derive business value from these projects? Develop two proposals.
3.The deployment of IT in the health professions is still very much in its infancy. What other uses of technology could potentially improve the quality of health care? Brainstorm several alternatives.