Holistic Approach Encourages Medical Technology Deployment

July 1999
By Maryann Lawlor
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Copper and fiber optic cables form electronic umbilical cord, distributing medical expertise and extending health care options.

Technology providers are responding to the growing demand for telemedicine services by combining individual strengths. Companies that specialize in integration are working hand in hand with medical personnel to determine preferences and needs and then are bringing this information back to hardware and software developers for implementation into products. Individually, these companies could only bring part of the solution to the medical community; together, they are helping to increase the use of telemedicine.

Telemedicine’s maturation and growth depend on technology designers’ ability to provide flexible alternatives for medical practitioners. Already inundated with advances in diagnostic and treatment technologies, health care center administrators are searching for telecommunications equipment that is easily incorporated into current facilities and that medical personnel can quickly learn to use. In addition, keenly aware that technology changes and improves at a fast pace, hospital administrators are requiring vendors to offer interoperable products.

While the future of telemedicine could include remote surgery and treatment, current medical personnel are already employing equipment used in many other business specialties. Information technology, designed and maintained by computer and integration specialists rather than hospital personnel, allows health care providers to offer enhanced services and to focus on medicine rather than computers.

A recent alliance between ViTel Net Incorporated, Vienna, Virginia, and GTE Government Systems, Chantilly, Virginia, is helping medical facilities take advantage of information technology. While the former produces the equipment, the latter applies its expertise in integration, support and marketing to introduce the benefits of sharing and managing information into the medical environment. Together, the team provides a comprehensive deployment package—everything from the initial requirement assessment to operational support services. In doing so, the team is capitalizing on what, in recent years, has become a booming business opportunity.

According to research conducted by the Association of Telemedicine Service Providers, activity grew 90 percent in this business sector between 1996 and 1997. Desktop systems dominate the growth, with more than 20 different vendors providing alternative systems. However, while more than 20 peripheral devices are in use, only a few of these items are employed widely, the survey of 141 U.S. telemedicine programs revealed.

The term telemedicine refers to the use of technology to supplement medical treatment capabilities and support medical facility personnel. Teleconferencing, enhanced with additional capabilities, allows simultaneous viewing of medical test results and records. This electronic collaboration is called teleconsulting and is being used in radiology, dermatology and other diagnostic specialties. When equipment is installed at a patient’s residence so that medical personnel can observe changes in previously treated conditions, the process is referred to as telemonitoring. And through telementoring, doctors worldwide can share their expertise with other physicians through telephony rather than travel.

This array of applications has left health care facilities with an abundance of options and opportunities. Although the technology has existed for some time, companies have only recently focused on packaging the items in a way that clearly demonstrates solutions the hardware and software can provide, Dennis Murphey, marketing director, health systems, GTE Government Systems, information systems division, says. The GTE and ViTel Net team’s purpose includes assessing the current inventory of information technology in medical facilities, determining how it is being used, working with health care personnel to understand their needs, and then incorporating these findings into product and system designs.

Murphey credits the U.S. Defense Department with many of the advances that have taken place in the civilian telemedicine world. Commercial entities are benefiting from government investment in research and development as well as from the lessons learned and technology developed from early programs.

“Telemedicine really started in teleconferences, first audio then video. The doctors would talk about protocol—how to handle a case—but there was no way to capture information. Once the conversation was over, there was no record of it. Now, they can bring in information on a disk and share it with others. Also, now the information can progress out to other locations,” he explains.

This is a step beyond the way information technology has been managed by hospitals in the past. Although medical facilities received funds to purchase equipment, they essentially automated existing procedures and did not look at processes to determine the most effective ways to employ technology. By working with medical personnel, GTE will show them the benefits of extending the use of information technology to improve current processes beyond mere automation, he adds.

The company is focusing on several key areas. First, GTE representatives study the way medical personnel use information. Second, they examine policies and procedures for information management. Third, health care providers experiment with equipment prototypes and offer their opinions and suggestions. ViTel Net then incorporates this input into further design of its equipment. Through this approach, GTE aims to instill both a sense of familiarity with and ownership of the equipment, resulting in quicker acceptance and increased use of the technology by medical personnel.

As part of the agreement, the two firms established an integration laboratory in Chantilly, Virginia. The facility includes a suite of ViTel Net telemedicine tools linked over a variety of low- and high-speed networks. The setup is a microcosm of conditions that exist in many health care organizations and helps medical center administrators see how the technology can be implemented over existing telecommunications infrastructures. The team plans to establish additional demonstration laboratories throughout the United States.

The laboratory features ViTel Net’s MedVizer, a multimedia visualizer; the MedVuLink, a health care information distribution management tool; and the MedVuNet, a network synchronization tool. MedVuNet provides multimedia information transfer capabilities between existing mainframe-based health care information systems and personal-computer-based multimedia clinical information systems.

One reason GTE chose to team with ViTel Net is the versatility of its products, a key ingredient in the customization of solutions for clients. The open architecture toolbox reflects 10 years of development efforts by ViTel Net. A layered approach allows customers to tailor the individual look and feel to different information environments.

ViTel Net benefits from GTE’s worldwide presence and network design and implementation expertise, according to Allen Izadpanah, president, ViTel Net. The team, which formed in January of this year, is still in its pilot stage. Full implementation has not yet taken place, he says.

“Telemedicine is not a product off the shelf. There must be a marriage between the developer, the systems integrator and the doctors, and all of them have to implement it. There are many pieces of technology, and no single company has all the pieces, but all have some of the pieces. So we say, ‘I do the best I do, you do the best you do, and we’re not trying to be everything to everyone,’” Izadpanah offers. The benefit of this arrangement to customers is that they do not have to reinvent the system every time something changes. This provides room for growth, he explains.

Dr. Russ Zajtchuk, vice president for advanced technology and international health, Rush-Presbyterian St. Luke’s Medical Center, Chicago, is working with GTE to increase the facility’s involvement in the telemedicine movement. A retired U.S. Army brigadier general, Zajtchuk was one of the pioneers of telemedicine during his tenure as commanding general of the Medical Research and Materiel Command, Fort Detrick, Frederick, Maryland.

“When I left the service, I needed a partner that I felt comfortable with. I like the way they integrate things. I don’t have to start all over again. They offer what they call a toolbox so we can pick what we need. It doesn’t mean we will use GTE/ViTel Net 100 percent, but we will heavily rely on them,” he says.

Through 20th century technologies, Zajtchuk predicts medical care actually will revert to the personalized care provided during the last century. “In time, there won’t be a choice. Telemedicine will be the only way for medical centers to survive. At one time, we had large hospitals. Now, they are all empty because so many of the procedures are conducted on an outpatient basis or people aren’t spending as much time in the hospital as they used to for the same types of procedures. Medicine is going back to the 19th century again, where doctors used to visit people in their homes. We will begin to do that again except now we will visit them electronically by using technology,” he says.

In addition to offering more personalized care, the integration of telecommunications capabilities into medical and research centers will extend expertise to locations that do not have access to specialized care. In fact, telecommunications technologies are allowing medical personnel to manage whole hospitals overseas by communicating with them on a daily basis through what Zajtchuk calls the “electronic umbilical cord.”

Zajtchuk believes that countries outside the United States are embracing telemedicine at a faster pace than U.S. facilities. “Norway is very advanced in telemedicine because of its national policy. They decided telemedicine is an important thing, and they’ve budgeted for it. It’s easier overseas because they don’t have the legislative and regulation issues we have in the U.S.,” he states.

Izadpanah offers that it will be one to two years before telemedicine is widely used in the United States, and he explains that Congress is now addressing certification and regulation issues. “As a country, we are careful about health care, and we should be. But we need to recognize that telemedicine offers benefits, so we need to move quickly to get things moving,” he says.

Despite some perceived reluctance, ViTel Net’s increased sales to United States’ health care facilities demonstrate that the tide may be turning. The company’s revenue has doubled during each of the last three years, and the percentage of these sales to U.S. buyers has also increased from 20 percent in the recent past to a current figure of 50 percent, Izadpanah relates.

However, legislation is not the only issue currently limiting the widespread use of telemedicine. Cultural changes in the mindset of medical personnel also affect the speed at which technology is accepted into the environment.

“A lot depends on the age of the doctors. In general, the older doctors are more reluctant, and the younger ones accept and use it more readily. However, there are older doctors who love it and younger ones who feel they are already learning so much that they don’t have time or energy to also learn how to use technology,” Zajtchuk says.

Addressing this issue is one of GTE’s goals. One approach is to work within medical schools to introduce the technology and its uses early. Continuing education is another tactic. At the crux of the matter, however, is demonstrating to all health care professionals that technology offers clear benefits. To identify specific items, GTE representatives are going directly to health care providers. “GTE is working on integration, system engineering and cultural barriers. We go to the medical personnel and ask them, ‘What problems keep you up at night?’ Then we discuss how information technology can solve some of those problems,” Murphey explains.

Zajtchuk believes this is an effective approach. “You have to put enough support up front and ask for input up front. In Bosnia, we put a lot of effort into training so they were comfortable with the technology and the techniques. You have to make sure the technology is solid. If medical personnel use it and it fails, the people lose interest in trying to use it again. Also, when you start to introduce this as a center, it doesn’t work. It has to be at the desktop and a distributed system. People don’t want to go a quarter mile just to use a system. It has to be convenient,” he offers.

Another benefit that must be emphasized is the savings in both money and time that can be realized by implementing a telemedicine plan, Murphey says. “If a piece of equipment costs, for example, $30,000, that’s a lot of money to a rural area where there’s only a few patients. But if you can show that the equipment can also be used for serving several satellite locations in treatment and training, then the cost of the equipment is less because it is serving more purposes, more customers. Also, if it doesn’t pay for a cardiologist, for example, to come out to an outlying area to see six patients a day in a satellite office, that same cardiologist can now see many more patients a day because there is no commute time involved. It saves time and money,” he explains.

Because the field is relatively new, there has not been sufficient time to collect adequate data to determine the amount of savings telemedicine will ultimately offer. GTE will be collecting and evaluating these kinds of statistics.

However, Izadpanah believes the capabilities provided by technology immediately improve the quality of service. Systems that ViTel Net now produces allow doctors to view X-rays and measure or zoom in on suspicious areas. This information is then captured and can be compared to X-rays taken at a later time. In addition, senior citizens as well as chronically ill patients will not have to visit doctors’ offices as often because their conditions can be monitored remotely, he explains.

Although many of the currently available technologies are only being used on a limited basis, Murphey predicts that within five to 10 years the equipment will be commonplace. “From the treatment aspect, a very small percentage of medical facilities are using this technology. It’s very expensive right now. We need to bring down the cost of the equipment and make bandwidth as cheap as a phone call. We are exploring communications capabilities to determine what can be done and at what cost,” he
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