NIH gives long-distance care

That's the task of a telemedicine project in the Information Systems Department at
NIH's Warren Grant Magnuson Clinical Center.

NIH set up the center in 1948 to bring patient care closer to its research facilities.
Now videoconferencing has put the clinic in touch with other research centers, and remote
doctors and their patients in touch with NIH experts.

"The plan calls for linking 41 general clinical research centers, most of them at
large universities," telemedicine engineer Glenn Mossy said. It eventually will reach
out to rural facilities such as Indian Health Service clinics.

Under the Virtual Clinical Research Center (VCRC) initiative, a telemedicine suite for
remote patient examinations will make its debut by year's end.

Long-distance collaboration on tuberculosis research also is under way between doctors
at NIH and the South Texas Hospital in Harlingen, Texas.

"We have done a number of intercampus transmissions" of telesurgery, Mossy
said. The project's fiscal 1998 budget is about $500,000.

So far, NIH surgeons have used the MedRover 9000 telemedicine system from AAC Inc. of
Dayton, Ohio, hosted on equipment from PictureTel Corp. of Danvers, Mass.

PictureTel's 4000 videoconferencing box can send video at 30 frames per second under
the H.320 industry standard, using an Integrated Services Digital Network adapter from
Ascend Communications Inc. of Alameda, Calif.

The system's 21-inch flat monitor has proprietary touch-screen controls and cards for
connecting to diagnostic audio and medical devices.

NIH has designed its own add-on to the MedRover 9000, dubbed the Baby Rover.

"As it stands, the MedRover doesn't have anything medical on it," Mossy said.
"It's a videoconferencing system in a box." But the Baby Rover, built by AAC to
NIH specifications, will have an assortment of cart-mounted electronic devices that
connect to the MedRover through a fiber-optic umbilical cord.

Telemedicine in the operating room could give less-experienced surgeons the benefit of
expert advice on tricky procedures, said Dr. Max Walther, senior resident laparoscopic
surgeon at NIH.

Walther said he has "virtually sat in on" many operations across NIH's ISDN
campus network--so far with less than complete success.

"It's OK," he said. "But what we've been looking at is the most
primitive thing that can be done. There is a two-second delay and a lot of dropout."
Walther said other hospitals can do more detailed transmissions from the operating room in
near-real time.

Mossy acknowledged reservations about the quality of VCRC's surgical video so far.

"The main difficulty is that it blurs when the scalpel and the laparoscopic
instruments really start moving," he said. "We know we can do it faster, but
this is an industry standard. We are judging its adequacy."

Developing a telemedicine suite to industry standards will make it easier to link to
clinics and hospitals with different hardware. South Texas Hospital is a case in point.

Dr. Steve Holland at NIH has approval to test new drugs against drug-resistant
tuberculosis strains and is working with Dr. Terry Lightner in Harlingen. Many of
Lightner's patients are too contagious or too poor to travel to Maryland, so Holland
monitors them via telemedicine.

The Texas hospital has videoconferencing equipment from VTel Corp. of Austin, Texas,
under a pilot by Healthcare Open Systems and Trials, a consortium of companies promoting
medical networking. Because both sites have standards-based systems, Holland can remotely
examine Lightner's patients.

One tele-tool is an electronic stethoscope from Cardionics Inc. of Houston. A
battery-powered chest piece with an infrared transmitter picks up heart and lung sounds.
The analog signal is digitized by a Dolby encoder for transmission, using software
developed by AAC.

Another Dolby encoder returns the signal to analog at the far end.

The audio signal travels over a 128-kilobit/sec ISDN connection separate from the
video, so there is enough bandwidth to carry heart and lung sounds.

Video compression has made it feasible for NIH to embark on telemedicine, even though
the present effort falls short of industry standards.

About the Author

William Jackson is a Maryland-based freelance writer.

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