Brain saving technologies, inc. and the t-health institute: medicine

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

Heart Association.

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,

Bernstein says.

“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,

Bernstein says.

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

switching chairs.

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.