Telemedicine Demands Quality of Service From IT

Mary E. Shacklett, President, Transworld Data | 9/13/2011 | 8 comments

Mary E. Shacklett
Telemedicine was first used during the 1985 earthquake in Mexico. Its application was simple: via satellite, doctors provided voice-based assistance and coaching to Red Cross and Pan American Health Organization workers.

Since then, the Internet has expanded the possibilities for telemedicine to instant transport of images and x-rays, documents and instructions, voice-based coaching, and live video observation and interaction with patients who may be thousands of miles away from an attending specialist in a major medical center. The process even goes one step further: specialists in different areas of the country or the world have been able to perform minimally invasive surgical procedures remotely on patients by being able to operate via Internet-transmitted signals to robots in the operating room.

The benefits of cyber-medicine were directly felt by Michael Harrigan, a financial advisor who suffered a stroke while driving on an interstate highway in rural Wisconsin. As Harrigan retold his experience to the Milkwaukee Journal Sentinel, his face had felt odd and his breath had gotten short. He managed to pull to the side of the highway and call 911. Then he was taken to the nearest available medical facility -- a community healthcare center 22 miles off the highway.

“Paramedics from the town of Johnson Creek picked him up,” said Jacklynn Lesnia, vice president of patient services at the Watertown Regional Medical Center, which treated Harrigan. “In the past, he would have been treated by a physician in the ER (emergency room). Now, we activate our telemedicine protocols with a stroke alert over an Internet-enabled EMS (emergency response system).” The alert immediately goes over a secure T1 line to the University of Wisconsin Medical Center, which patches the alert through to a doctor who is a stroke specialist.

In Mr. Harrigan’s case, Internet-facilitated treatment resulted in a 90-minute window between onset of the stroke and treatment -- a “gold-level” response. “This is very important to rural healthcare centers because often victims of stroke don’t get to the ER soon enough,” said Lesnia. “Then, if you don’t have a stroke specialist on staff, there is a hesitancy to use stroke treatment medications right away, since they also have their risks. You want to run all of the tests first.”

With a telemedicine communications link, a specialist in a major medical center can directly interact visually and verbally with a patient in a rural area. This means that critical factors that frequently get lost in translation no longer do, because the specialist can see for himself what is going on.

The IT behind this medical immediacy consists of not only leasing and monitoring pipelines that are wide enough to transport heavy data over IP, but also a complex of failover mechanisms. So if one pipeline goes down or degrades, the communication can be cut over to another pipeline, in order to maintain constant uptime.

Central to this communications strategy is also the management of multiple ISPs (Internet Services Providers) in the process. Many sites insert network routing with advanced intelligence and then program these routers with business rules for a combination of both wireless and wireline service providers. These various providers can then be brought into the communications mix, depending on load balancing or failover requirements.

The message for healthcare IT is that communications strategies must be as well-funded and managed as application deployment, security, and data repositories. This is especially true in an era when more remote medical applications will be needed for underserved rural environments.

That message wasn’t lost on Michael Harrigan, who today is fully recovered from his stroke. “Time is a critical element in the treatment of strokes,” said Dr. Justin Sattin, the neurologist who worked over a dedicated telemedicine link to the clinic in Johnson Creek to treat Mr. Harrigan.

“Although there is new evidence that treatment can occur as late as 4.5 hours after the onset of stroke, the standard window of treatment is treatment response within three hours,” Sattin said. “If you delay beyond that, the chances for a successful outcome diminish by 15 to 20 percent.”

View Comments: Newest First | Oldest First | Threaded View
Mary E. Shacklett   Telemedicine Demands Quality of Service From IT   9/15/2011 1:44:58 PM
Re: telemedicine
Yes, Pedro, this is a multifaceted e-effort that is totally transforming healthcare.

 

Mary
User Ranking: Blogger
Pedro Gonzales   Telemedicine Demands Quality of Service From IT   9/14/2011 9:22:03 PM
telemedicine
IT department will play a more important role in the health environment with not just providing emergency services as this article indicated but much more. President Obama stimulus package includes supporting the adoption of electronic health records, so little by little telemedicine is becoming a more dominant in the field.

Let not forget that there are other technologies which include personal heatlh records, e-health, e-prescribing that are moving other aspects of healthcare into the electronic domain.

 
Mary E. Shacklett   Telemedicine Demands Quality of Service From IT   9/14/2011 11:25:27 AM
Re: Telemedicine Demands Quality of Service From IT
Hi Henrisha,

There are new medical apps being dispensed around the world that take advantage of the technology available--such as plain old telephone service and mobile  phones, This  allows laypersons to  administer to local residents with  the help and the coaching of medical professionals. It is "low tech" telemedicine , but it is nevertheless making an impact.

 

Mary
User Ranking: Blogger
nimanthad   Telemedicine Demands Quality of Service From IT   9/14/2011 6:33:24 AM
Re: An Incredible Challenge
Well, telemedicine lacks the quality or else IT hasnt done justice for the word TELEMEDICINE up to now. That is the sole reason why it has not kept up to its reputation it promised to be at the beginning. It really does need high attention of quality of service from IT and needs it to be fixed for a long term basis.
Henrisha   Telemedicine Demands Quality of Service From IT   9/14/2011 3:24:48 AM
Re: Telemedicine Demands Quality of Service From IT
It will be interesting to see what new developments will be made to make telemedicine more widely available all over the world. As demonstrated by Michael's story, this saves lives. When it comes to medical emergencies, time is of the essence. In fact, just a few minutes could mean either life or death for some of these people. IT in healthcare is something I believe deserves more focus.
zerox203   Telemedicine Demands Quality of Service From IT   9/13/2011 11:52:12 PM
Re: An Incredible Challenge
Unfortunately, as the medical field lags behind enterprise in general, it will likely be a couple of decades or so before stories like Michael's are commonplace.

Sara Peters wrote an article a couple of weeks ago about how new database sharing techniques were helping cut costs in the healthcare industry (http://www.enterpriseefficiency.com/author.asp?section_id=1134&doc_id=232865&piddl_msgorder=asc#msgs), and I was surprised - because the technology sounded a lot like the kinds of database sharing other industries had been using for years.

Likewise, this kind of remote medical care, not the remote surgery but the visual and audio aspect, sounds like something a lot of companies might use for communication across the country all the time. There are plenty of good reasons medicine might have to take it slow when implementing good technologies, but I can't help but feel that any lagging behind is as much because of a lack of proper funding and an overabundance of red tape - which is a shame, because as we can see from this story, there's plenty of life-saving potential for these technologies.

Mary E. Shacklett   Telemedicine Demands Quality of Service From IT   9/13/2011 4:02:23 PM
Re: An Incredible Challenge
Hi EyeTee,

 

I am happy to say that there has been some support (through stimulus  money  and other grants) for constructing an information highway  capable of  supporting throughput for telemedicine. That being  said, there is much more to be done--not only technologically, but also legally and from the operational and policy sides.

Because so much is  at stake, healthcare always  lags other industries--but it is good to see some headway in critical areas.

 

Mary
User Ranking: Blogger
EyeTee   Telemedicine Demands Quality of Service From IT   9/13/2011 3:52:44 PM
An Incredible Challenge
As IT professionals, we all know that there is great pressure to provide always-on, always secure service. It's part of the job.

But let's face it: realistically, let's say a corporate website of an average company went down for 10 minutes. People might get mad, or people may not notice, but long-term... it's really not going to be that big of a deal.

Telemedicine, as you mention, is a whole other thing. People's lives are literally at stake. I can't imagine how challenging it will be to deploy such implementations. If you mess up, there seriously are dire consequences.

On the plus side, I can also imagine this being incredibly rewarding: far more so than, say, simply making sure people are able to read the latest celebrity gossip.

Anyhow, I do believe that we'll see more applications of this within our lifetimes. Unfortunately, as the medical field lags behind enterprise in general, it will likely be a couple of decades or so before stories like Michael's are commonplace.


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