Mass. General Hospital revamps video gear; bolsters telemedicine program

Massachusetts General Hospital is revamping the video network it set up exclusively for diagnosing stroke victims with an eye toward offering new telemedicine services in other fields such as cardiology.

The hospital is switching from traditional room-based videoconferencing that has sustained its pioneering Tele-stroke Program for 10 years to less-expensive gear that is easier to deploy and supports more endpoints such as desktops and laptops.

The equipment delivers images of patients at 25 hospitals throughout New England to neurologists at Mass General who diagnose and prescribe treatment, says Shawn Farrell, director of the hospital's tele-stroke, tele-neurology program.

The hospital used Polycom and Tandberg videoconferencing systems that were state-of-the-art when the program started, but that are now too large, too expensive and too limiting, he says. After a review of what's available now from vendors including Polycom and Tandberg, MGH is installing a high-definition videoconferencing system from Vidyo, he says.

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He says many of the vendors he considered had features he needed, but Vidyo significantly beat them on price. Although he wouldn't say what he's paying because he's signed an non-disclosure agreement with the company. A Vidyo spokesperson claims the costs can be 10% of competitors because its system requires less specialized equipment and WAN connections.

The Vidyo system supports 1080p high definition images and is compatible with legacy systems, so an affiliated hospital that doesn't switch to Vidyo gear can still participate in the program, he says.

The gear also encrypts the video stream to meet privacy regulations and allows setting up multipoint conferences so other doctors can tap in for training purposes, Farrell says. The equipment supports simultaneous display of documents so doctors can view pertinent patient records and test results.

Stroke experts in the program can examine patients live to help determine whether they've had a stroke and if so what kind, he says. A stroke caused by bleeding in the brain is treated much differently than one caused by a clot, and it's essential that treatment for the clot type start within three to four hours, he says.

Emergency room doctors are not generally well versed in making such diagnoses, but moving patients to a hospital with an expert risks more severe damage, Farrell says.

Video images can give the experts subtle clues the ER doctor might miss. For example, some stroke victims suffer hemispheric neglect - failure to acknowledge one side of their body. A symptom of this could be a man who failed to shave half his face because he didn't realize he hadn't, which is something a non-specialist might miss, he says.

With the Vidyo equipment, Mass General can set up work stations within the hospital where doctors can go to perform remote stroke exams, and eventually perform them on laptops. It's technically possible to extend the conferencing to tablets and even smartphones, but both those options are off the table so far to limit where the doctors are located when they make their diagnoses to ensure they aren't distracted. "Tablets and cell phones are really bleeding edge," Farrell says. "We're going to have to wait and see what roles they have from the consulting physician side."

The tele-stroke program got a boost in 2005 when Massachusetts law allowed hospitals to be certified stroke care facilities if it met criteria including a neurologist being present. Regulations allowed a remote neurologist connected by a videoconferencing system, he says.

With a federal push to cut healthcare costs, MGH is interested in pushing remote diagnosis into other areas including cardiology, pediatrics and oncology. This will make more efficient use of doctors' and patients' time and could reduce the need for examination space that has to be paid for, Farrell says.

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