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ISDN Revolutionizes Multisite Network Consultation - University of Texas Medical Branch at Galveston - Technology Information

Health Management Technology - October 1, 1999

Video networking solution wins award for University of Texas Medical Branch.

For most of us, a visit to the doctor's office entails a short trip that often can be accomplished over a lunch hour. But for many Texans, especially those in the sparsely populated counties of western Texas, visiting a doctor can require hours of driving and cost hundreds of dollars in both expenses and lost wages.

The University of Texas Medical Branch at Galveston (UTMB), a major academic health center located in Greater Houston, recognized the need to provide reliable, timely medical care to families outside of urban areas. Working hand-in-hand with network solutions provider Madge Networks, UTMB responded by creating the state's first telemedicine video network to serve an area encompassing nearly all of the state's 267,000 square miles.

Firm Foundation

The foundation of the UTMB telemedicine network is a scalable integrated services digital network (ISDN) operating over leased T-1 lines. At the focal point is a Madge Networks Wide Area Network ISDN AccessSwitches Model 200 which, when networked with Madge ISDN AccessSwitches Model 20s stationed at remote clinics throughout Texas, makes videoconferencing as easy as dialing a phone.

Building on this foundation is equally simple because the scalable nature of the videoconferencing equipment enables the UTMB network to grow as new remote users, sites, and applications are added.

Although ISDN is not a new technology, it is ideal for the telemedicine project because it provides the necessary bandwidth, reliability, and quality of service needed for video applications. With ISDN, bandwidth is available for up to 23 channels for a total of 1,472 kilobits per second for each call. With the capabilities of the AccessSwitch dial plan, users at any site can videoconference with any other site without video or audio interruption. Also, the AccessSwitch enables all users to share access to a multipoint control unit (MCU) for multi-site telemedicine consultation.

Simple Interface

Once the technology was in place and real-world applications identified, the roll-out began. One application linked 12 remote sites to UTMB to provide medical care for special-needs children in areas where medical technology and expertise were not readily available. The solution included a virtual exam room with a video interface designed to be simple enough for medical personnel to operate so that the bulk of their time could be spent treating patients, not manipulating video equipment.

"When we set out to develop our telemedicine project, the goal was to maintain the same quality of care that UTMB has been providing since 1892," says Jake Angelo, manager of video operations for UTMB. "One option for us was to connect to an existing state-developed television network. However, this proved far too cumbersome and costly. The technical path chosen in our work with Madge has enabled us not only to provide quality medical care throughout the state, but also to do so in a way that is cost-effective for us, the local physicians and the patients."

As the telemedicine concept has expanded, its use has become more prevalent. Currently, UTMB maintains more than 19 remote clinics offering more than two dozen services, including general medicine, cardiology, orthopedics, dermatology, and pediatrics, among others. Since the network's inception, more than 10,000 patients have been seen via video communications.

Special-needs Benefits

Among the patients who have benefited the most from telemedicine are special-needs children; i.e., those children suffering from complicated illnesses such as spina bifida, cerebral palsy, traumatic brain injuries, metabolic disorders, and chronic problems caused by premature birth. At the outset, UTMB was linked to two remote sites, each specially equipped for such children and each hundreds of miles away from UTMB. In 1998, ten additional remote sites were added with minimal effort due to the scalable nature of the videoconferencing equipment.

While medical technology advances have dramatically expanded treatment programs in numerous fields, access to both new technology and the doctors capable of using these technologies has remained limited to hospitals based in major cities. The UTMB network enables doctors not only to treat and reach many more patients at remote sites, but also to impart their knowledge to local physicians for both ongoing care and assistance in diagnosing new cases. This "transfer of knowledge" ensures healthcare providers can maintain a continued standard of quality care by training them to utilize new technology.

The training aspect, called the "Open Gates Teletraining Institute," is a hands-on educational tool that relies heavily on the UTMB video network.

Through Open Gates, a faculty of more than 60 physicians, physician assistants, nurses, educators, administrators, legal experts, technicians, and information service personnel provides courses on the techniques and technology of telemedicine and distance learning to healthcare providers nationwide.

Control Costs

The video network infrastructure was designed to enable users at the UTMB hub to manage and control usage and operating costs. With the growth in telemedicine usage, UTMB's advantage is readily apparent as the cost for placing traditional video calls over the public telephone network is significantly greater than that for calls placed on UTMB's leased T-1 lines. Also, the scalable nature of the AccessSwitches enables new sites to be added without needing to reconfigure and/or rebuild the technological applications already in operation.

UTMB's telemedicine program continues to have a significant impact on the citizens of Texas by providing low-cost, technologically advanced healthcare services. Patient and physician travel costs often are minimized or eliminated. Parents who normally would be required to miss a day of work can visit satellite clinics close to their homes, eliminating lost wages and reducing family stress. Physician specialists at a single location can diagnose and treat numerous cases throughout the state and around the world.

According to Dr. Sally Robinson, a professor in UTMB's Department of Pediatrics and chief of the Special Services Division, "Telemedicine is an effective method to track special-needs children in remote areas. The enhanced communication during telemedicine sessions allows a more comprehensive and improved evaluation. I see a future that extends telemedicine support beyond children to all sorts of people who have chronic medical conditions in the community."

Endless Applications

Angelo continues, "The applications for telemedicine and overall usage of video networking are endless. In less than one decade, the concept has been created, built, tested, and proven to be highly effective. We've already seen growing enthusiasm for new applications, technologies, and equipment, and we're proud that Madge AccessSwitches and networking technologies have been an integral part of the video network that has led to this revolution."

The efficiency and simplicity of the video network architecture provides a clear path for expansion to meet the growing needs of citizens and healthcare professionals who can benefit from such technology. The current program at UTMB serves as a national and international model for blending expert, patient-centered care with advanced communications technology.

Ultimately, the efficacy of video networking and, in turn, telemedicine will be supported by new applications, such as commercial use by NASA and companies that operate offshore oil-rigs. For organizations such as UTMB, video networking will play an increasingly important role in patient treatment and communication, cost management, education and the creation of a competitive advantage.

In 1999, UTMB at Galveston continues to advance its video network. Adding an additional Madge Model 200 and several Madge Intelligent Switches, it has expanded operations to include five more telemedicine sites for pediatric care. The new expansion utilizes rural elementary schools as clinics with telemedicine facilities in or near the nurse's office.

UTMB is rolling out a pilot program to expand telemedicine to six rural nursing homes which is expected to considerably reduce the stress seniors experience in traveling for medical care.

Honored for IT Use

The UTMB video network has grown substantially. So successful has the program been that the institution was honored in Washington, DC, in April, by the Computerworld Smithsonian Awards committee for its innovative use of information technology. In addition, the institution has formed the new Center for Health and Distance Learning, an oversight committee dedicated to broadening community outreach for the network and maintaining efficiency for its use.

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