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Telemedicine: Life, Death and AV?

AV professionals can't often say that their work involves life-or-death issues, but in the growing health care niche known as telemedicine, they can. In fact, ensuring high-quality, reliable video signals is a non-negotiable objective of every telemedicine project.

The company has also tackled unique telemedicine challenges, such as integrating other medical data into a conference, including time-synchronizing stored video with patient data, says Schmitz. Such an integration means adhering to security measures unique to health care (see: What Makes Health Care AV So Different?).

New York University used Rivulet products to save $48,000 a year on custom cabling to transmit video from ORs during special events, according to Rivulet. Similarly, HaiVision Systems has placed video-over-IP equipment in several high-profile telesurgery applications, including at Titan Medical in Canada, where its hai1000 network video system and Mako-HD H.264 codec were used to test Titan Medical's Amadeus robotic surgical system over Bell Canada's IP-VPN network (

Getting Market-Specific

The fact is, while conferencing systems and signal distribution technologies aren't unique to health care and telemedicine, there are AV solutions and providers tailored to the market. Two vendors in the health care industry, Kalamazoo, Mich.-based Stryker ( and Karl Storz Endoscopy-America in El Segundo, Calif., share much of the market in OR telemedicine systems, often doing their own integration. Karl Storz recently signed an agreement with Rivulet to resell the latter's HD video solutions.

CompView Medical, for its part, makes an AV equipment-management system, called NuBOOM, for upgrading ORs to telemedicine. NuBOOM has two 9-foot booms for positioning displays and holding cables and equipment, both AV and medical. Another product, DOCS, is an FDA-approved touch screen for viewing, controlling, and routing medical images.

Then there is the humble AV cart, an integrated AV system not particularly foreign to hospitals, which often transport other medical systems on such mobile carts. The cart is arguably the locus of telemedicine, a single platform for audio and video inputs and outputs sitting alongside medical instruments and ideally integrated for conferencing.

Because they're mobile, carts can make telemedicine more affordable by reducing the need for AV upgrades in every room. Carts also help with cable management by providing retractable bays, and their medical instruments sometimes work better than their traditional counterparts (one obvious example is a stethoscope, which can be amplified). While both Polycom and Tandberg sell videoconferencing carts for the health care market, a number of medical-equipment vendors do too, sourcing the conferencing components from well-known AV manufacturers.

While most carts are self-supporting on roller stands, GlobalMedia makes a new alternative, called the TransportAV, that attaches to a gurney. It comes with a pan-tilt-zoom camera and "soft" codec for conferencing, an echo-cancelling microphone, headset, military-grade laptop PC, and 3G air card for wireless communication, says Schoenbach. The system also comes with two other GlobalMedia devices: the TotalExam S-Video Examination Camera, which is the size of a small flashlight and meant to capture close-ups, and the ClearSteth electronic stethoscope.

The Road (and Road Blocks) Ahead

Those who serve the industry say health care customers are among the most high-maintenance an AV professional will ever encounter. Hospitals tend to be run by demanding people who work in stressful, high-stakes situations that are tightly proscribed by government policies and long-standing medical practices. This creates inertia that makes it challenging to introduce new technology that disrupts familiar workflows. Turnover is high, so the doctor who champions your project today could leave for another hospital tomorrow.

Yet telemedicine is revolutionizing health care by blunting the effects of time and distance, bringing medical know-how to more patients. Jonathan Linkous, CEO of the ATA, has an even more ambitious vision. He sees telemedicine becoming more seamlessly integrated with consumer information systems, as well as personal monitoring and drug-dispensing devices, in order to create an intelligent feedback loop between patients and medical expertise.

"What we're moving toward is something that will eventually allow us to read our own bodies," he says. "The computer itself will do a diagnosis and provide help. You could actually have implantable devices that could download the data on a daily basis."

Paul White of CompView Medical says better integration of AV and IT can bring huge efficiencies to hospitals, many of which have clinical data and medical-imaging systems that can't talk to each other, resulting in an excess of dedicated PCs and workstations. Even the caregivers' habits for repositioning surgical tables for particular procedures can frustrate AV consultants who are used to smoothing workflow inefficiencies.

"We just see so much waste every day," White says. "It's sad." Linkous echoes the point, calling health care's political and administrative status quo the biggest barrier to adopting new technology.

Though he recognizes the special opportunity AV has to improve lives, White cautions other integrators about the challenges of serving the health care/telemedicine market. "I had no idea it would take this long and cost this much money," he says of his experience moving from general AV to health care. "It's not for the faint of heart. It is a lot more time- and labor-intensive than you ever imagined."

Mauger says security fears often get in the way, and that he must sometimes convince customers it is safe to run conferences encrypted on the public Internet, rather than the dial-up lines they are more familiar with. In fact, some institutions have rules requiring the older connection methods.

Mauger says frequent and intensive interaction with health care end users is more important in this market than in other. "There's a lot more close interaction that needs to happen for a successful project."

David Essex is a freelance technology writer based in Peterborough, N.H.

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