Telemedicine takes doctors beyond borders

Advances in telepresence and visual application technologies will allow telehealth services to be accessed more widely and affordably than before, bringing specialist expertise to remote areas.

A recent Frost & Sullivan report on visual collaboration technology in healthcare shows reduced prices and improved quality are boosting the adoption of telemedicine video conferencing systems.

Using telecommunication and multimedia in healthcare is not a new development, but has been dogged by high costs, lack of trained technicians and interoperability issues, according to industry players.

However, Frost & Sullivan research analyst Iwona Petruczynik says the expense of telemedicine video conferencing systems is not a major barrier any more. “In the last two years, there has been a significant reduction in prices of equipment and a substantial improvement in endpoint functionality, especially video quality,” she said in a release.

The firm says telemedicine has undergone significant evolution, following advancements in video conferencing technology. ”Healthcare practitioners are increasingly adopting interactive video or video conferencing applications for providing enhanced access to healthcare as well as improving the quality of such services at lower prices across the globe.”

The most significant benefit of telemedicine is its ability to extend the geographic reach of medical care and provide access to medical specialists in remote and rural areas, according to the firm.

Andrew Graley, healthcare director at Polycom EMEA, says telemedicine has helped make healthcare service delivery much more efficient, allowing hospitals and clinics to provide faster care and transfer knowledge without physically having to move a person.

Bradley Arendse, business development director at Siemens SA, explains that telemedicine ranges from the simple transfer of data across an electronic platform, to higher-end services such as video conferencing between health professionals and the transmission of medical imaging in its true format.

“It allows a user sitting 1 000 kilometres away to manipulate the image as if they've just done it on a patient.” He says video collaboration technology has enabled clinicians to consult with colleagues in other hospitals around SA or in neighbouring countries. “Traditionally, this would have required the patient going in to see the professional for a second opinion.”

A big benefit of telemedicine is that it helps address the shortage of medical professionals. Arendse says in certain hospitals and institutions where there may not be a specific practitioner on site, these facilities can access a specialist physician through teleconferencing.

“It also allows collaboration between the medical physician and personnel on different levels, for example, a specialist physician can review and consult with nursing, radiology, or laboratory staff.”

Graley notes there's a lot of pressure on doctors, particularly given the limited number of specialists, like paediatric cardiologists or certain oncologists. They are also mostly situated in major cities, and absent in smaller, remote areas, he adds. “Telemedicine delivers expertise more frequently and with more accuracy over a virtual link, which stretches access.”

According to Arendse, many hospitals lack radiology specialists in particular for advanced procedures. “Often healthcare facilities have a radiology department, but it's not functional because there's no one there. Tele-radiology allows data to be sent from a smaller facility in the North-West, for example, to a radiologist in Gauteng, so they can examine and manipulate it and then report back to where the image was generated from.”

He says it also allows medical professionals the flexibility to review images from wherever they are. “So if a practice has one radiologist and they go away for a conference, usually reporting is not done until they get back. But telemedicine allows the radiologist to be at a certain place and still perform that function.”

The transmission of video involves extensive bandwidth and network requirements, and while this was a limiting factor a few years ago, Arendse says the technology now used in systems tries to accommodate areas experiencing bandwidth constraints.

Arendse and Graley say video collaboration technology has great potential in the teaching environment, both for professionals and students.

“In terms of education it's an excellent tool, especially for rural areas, as it's possible to link to sites without having to travel,” says Arendse. This enables for sharing of information, especially in academic hospital environments, he notes.

In addition, says Graley, medics in hospitals don't have to travel far to get the latest training and students can listen to a lecture or watch an operating procedure live.

“For medical students training to be surgeons, if a pre-eminent surgeon is teaching techniques used in open heart surgery, such as valve repair, students usually need to travel to see the procedure being done. Now the surgeon can broadcast the surgery and give students a view of the actual operation, the actual heart, and it's interactive - they can ask questions.”

Arendse says it can also be used at medical conferences for viewings of live surgical procedures or guided interventional techniques.

“So, for example, if a physician is demonstrating remote magnetic catheter navigation within a hospitals situation, where he steers a catheter guided by magnetic fields, which pull the catheter into the desired position, people sitting at a site thousands of kilometres away can see the procedure.”

In September, the Medical Research Council held the first Southern African Telemedicine conference in Cape Town, where health minister Aaron Motsoaledi said telemedicine is becoming increasingly relevant in the development of health systems.

He said it helps bridge the distance between well-resourced urban health services and resource-poor facilities in remote rural communities. According to Motsoaledi, between 1999 and 2000 some 28 telemedicine pilots have been rolled out in SA, with the number now standing at 86.

Also speaking at the event, deputy science and technology minister Derek Hanekom said telemedicine had the potential to revolutionise the way healthcare is practiced in SA. “It is not only an important technology tool, but also has enormous potential as a holistic solution, which incorporates business aspects and change management as well as healthcare.”

But challenges remain, and both Motsoaledi and Hanekom pointed to shortages in infrastructure, training and capacity.

“The promise of telemedicine has not yet been realised in SA,” said Motsoaledi. He noted that a departmental review showed only 32 of the 86 telemedicine sites were functional at the beginning of 2010. Some of the reasons include lack of coordination, leadership, staff capacity, inadequate budgets and inefficient use of available funds.

But the major factor contributing to poor performance, said Motsoaledi, was “the weak IT infrastructure and inadequate and unreliable connectivity, in many of the areas which we feel would benefit most”.

Graley, who also attended the conference, said one of the biggest debates was around the networks in place to support applications. This included discussions on national network infrastructure, not just for mobile but for dedicated internet services, and open standards to allow collaboration technologies to interface.

Hanekom noted that a lack of trained health professionals and the costs and distances involved in accessing healthcare are major problems in SA's healthcare sector.

To help address this, the Department of Science and Technology has invested about R15 million in various telemedicine projects in the past decade, according to Hanekom. It's also funded telemedicine trial initiatives in Limpopo, the Eastern Cape, KwaZulu-Natal and the Free State.

“The roll-out of the projects is answering questions about how to provide stable connectivity, adequate and cost-effective bandwidth, the training of staff, and the integration of telemedicine and other diagnostic tools into the system,” he said.

One example is a trial of the Cisco Health Presence system, which took place between the Universitas Academic Hospital in Bloemfontein and the Batho Clinic, in a local township, earlier this year.

According to Aggrey Rontloane, public sector lead at Cisco SA, it allowed medical staff at Universitas to interact remotely with patients at the Batho Clinic, using a combination of video, audio, and medical information over an IP broadband connection to create a virtual environment similar to that of a clinic or hospital.

“This was a live video, voice and data exchange where a patient can be remotely diagnosed by a clinical consultant or a specialist doctor at the Academic Hospital,” explains Rontloane.

Arendse says cost will always remain a challenge, in terms of healthcare budgets and generating funding for telemedicine initiatives.

He says this is linked to the fact that the actual image that has to be acquired for video collaboration has to be put into digital format, which adds to the pricing model. “This is often because the analogue system traditionally used to generate X-ray film now has to be made digital. This either requires some component to be changed or changing the entire unit generating the image, which both involve additional investment.”

But Arendse is positive about the future of telemedicine in SA, and anticipates greater adoption at all levels, as well as an improvement in services. “In areas where there are healthcare centres but specialists aren't available all the time, it's definitely enabled the spread of expertise to improve patient care.”

Often healthcare facilities have a radiology department, but it's not functional because there's no one there.

Bradley Arendse, business development director, Siemens SA

He adds it also saves the time, cost and effort involved in having to transfer a patient, who may have had to take time off work and travel extensively.

Graley says while expenses have put the technology out of reach for a lot of organisations, the benefit of quick and speedy diagnosis can actually help save in the long-run. Given the number of people you can treat using video, costs come down dramatically.”

In future, he sees unified communications increasingly coming to the desktop level in the healthcare setting and expanded services for out-of-hours care. Graley also foresees equipment getting smaller and deployment on a mass scale.

He expects greater adoption as costs come down and the technical and treatment benefits become more apparent.

“I've spoken to a lot of clinicians across the EMEA region and they're willing to accept the technology because it gives them good, high-resolution images and allows for effective collaboration.”