From the President...

Thank you for taking time to read this EDItion.  We're featuring a topic that will likely affect you or a family member at some point in the future - Telemedicine.  Please take a moment and read senior consultant Brian Murphey's brief overview of this important technology element of healthcare delivery.  Below are a few other "nuggets" about current events at EDI, Ltd.:

Revit up, BIM.  We're excited to announce that we've rolled out our first seats of building information modeling software.  In addition to providing better coordination and integration with design teams using these tools, we are developing new ways to plan and manage the complexity of advanced technology systems.

Top that.  After having one of our best years ever in 2007, we're focusing our attention on ways we can better serve our clients in 2008.  EDI is proud to announce the addition of R. Sheldon Tyndall, CPHIMS, as vice president, healthcare services.  Having previously served as a hospital CIO and senior IS consultant, Sheldon brings decades of leadership and experience from the owner's perspective and will expand EDI's technical service offerings to our growing list of healthcare customers.  Sheldon can be reached at styndall@ediltd.com.

Market this.  EDI welcomes Hank Sforzini as marketing specialist to the EDI team.  Hank comes to us from Nashville, where he recently completed a master's degree at Vanderbilt University.  Hank will be involved in marketing activities across all services and market sectors.  Give him a shout at hsforzini@ediltd.com.

Change now.  So much easier said than done!  Perched here on our hill alongside the Chattahoochee River in Atlanta, we are constantly looking across the horizon for ways to grow, adapt to market demands and create additional value for our customers.  In 2008 and beyond, EDI wants to be THE destination for design-driven technology consulting for healthcare, corporate and educational facilities.  If you have ideas about how we can accomplish this for you, please write me at khebblethwaite@ediltd.com.

Sincerely,

Kevin Hebblethwaite, CPSM

  EDI Welcomes Our Newest Team Members

Sheldon Tyndall, CPHIMS, Vice President of Healthcare Services
Sheldon brings 30 years of experience in the field of healthcare technology to EDI.  During his career, he has implemented, managed and directed information technology initiatives for healthcare organizations across the United States.  Prior to accepting a position with EDI, Sheldon was the Chief Information Officer for West Georgia Health Systems.  Sheldon also is president-elect of Georgia HIMSS.

Hank Sforzini, Marketing Specialist
Hank joins EDI with a master's degree from Vanderbilt University.  As the marketing specialist, he will focus on creating and delivering marketing campaigns for EDI's target markets including healthcare, higher education and corporate clients.  His prior experience includes marketing in the music and publishing industries.

[Insert name here]
Do you know individuals who might make a good addition to the EDI team?  We're looking for qualified candidates who can provide extraordinary client service in a technology-focused design environment.  If someone you know might be interested in working at EDI as a designer, consultant or project manager, we want to hear from you.  Please send an e-mail and/or resume to yourfuture@ediltd.com.  EDI, Ltd. is an Equal Opportunity Employer.  We maintain policies and practices designed to prevent discrimination on the basis of age, race, color, religion, gender, sexual orientation, disability, national origin or veteran status to the extent protected by law.

 

Medicine at a Distance
By Brian Murphey, CTS

On June 22, 1809, Dr. Benjamin Rush of Philadelphia, a signer of the Declaration of Independence and renowned early American physician, penned a reply to a letter he had received from a physician in Albany asking Dr. Rush's advice in the treatment of a patient.  Based on the Albany physician's description of the symptoms, Dr. Rush recommended a treatment regimen that included applying a paste of shoemakers wax to the patient's feet, feeding him garlic and then bleeding him.  Rush also suggested the patient refrain from drinking coffee.  The exchange of letters between these two physicians is an early example of Telemedicine.

Telemedicine, quite simply, is the practice of medicine at a distance.  The only technology available for this in 1809 was the written word carried by post or courier.  Fortunately, advances in technology have significantly improved the practice of telemedicine since Dr. Rush's time.  And luckily, treatment options have also improved.

Today, two physicians discussing a case might communicate using phone or e-mail, perhaps while simultaneously viewing radiological ../images or other patient data on a Web portal.  A surgeon in Atlanta can consult on a procedure taking place in an operating room in Dubai using a live, two-way video connection providing a view of the surgical field as well as patient vitals.

The first reference to electronic-based telemedicine in medical literature occurred in 1950 with the transmission of some X-ray ../images via a telephone line 26 miles from West Chester, Pennsylvania to Philadelphia.  NASA conducted early experiments with satellite transmission of patient data from remote locations in the early 1970s. Large university-affiliated hospitals followed with experiments and limited deployments of various telemedicine technologies throughout the 1980s and 90s.  But with the recent explosion in availability of high-bandwidth, wide area connectivity, technologically advanced telemedicine is now possible in almost any healthcare facility regardless of location or size.

The terms telehealth and e-health should not be confused with telemedicine. Telehealth and e-health are broader definitions which include non-clinical services such as education, electronic medical records administration and research.  Telemedicine is specific to the delivery of clinical diagnostic and treatment services.

Modern telemedicine comes in two basic flavors: real time and store-and-forward.  Real time telemedicine involves some sort of simultaneous interaction between the involved parties.  Remote examinations by specialists to aid a general practitioner (GP) in rendering a diagnosis are a common form of real time telemedicine.  The specialist in her office examines the patient located at a GP's office using a specialized video conferencing system.  The specialist can see and speak to the patient and GP while the GP can operate a tele-otoscope, tele-stethescope, endoscope or other diagnostic device connected to the video conferencing system to provide additional information to the specialist.  Remote examinations are most useful in rural settings where there are relatively few specialists - the remote exam may be the only way the GP can get a patient unable to travel, in front of a specialist.

Store-and-forward telemedicine usually involves collecting clinical data such as radiological ../images and patient vitals, then storing this data for later retrieval and assessment by a physician specialist.  Specialties that regularly use store-and-forward telemedicine include radiology, pathology and cardiology.  Picture archiving and communication systems, or PACS, are an important tool in store-and-forward telemedicine.  By integrating the PACS network with the wider campus network, physicians outside the hospital can retrieve and view medical ../images, enter assessment notation and calculations, and even upload historical ../images or ../images from other modalities for comparative review.

Interestingly, a properly integrated PACS network also facilitates real time telemedicine.  Provided sufficient network bandwidth and quality of service are in place, a physician can review dynamic radiological ../images originating from an in-process exam taking place at a remote clinic.

Other common forms of both real time and store-and-forward telemedicine include: web-based consultations - both patient to physician and physician to physician; remote monitoring of ICU patients in multiple facilities by a single intensivist; and supplementing the use of visiting nurses to homebound patients through automated collection and transmission of specific patient vitals for regular assessment.  In the developing world, telemedicine is increasingly used to provide general practice examination and diagnostic services to remote villages that have no other access to professional medical care.

The American Telemedicine Association (ATA) estimates that almost 50 different medical subspecialties now successfully use telemedicine.  With such a critical mass of clinical users, standards must inevitably follow.  The ATA has developed a draft document of core standards for telemedicine operations that addresses administrative, clinical and technical standards.  The ATA draft technical standards highlight the need for a fail-safe approach to the design and deployment of telemedicine systems and infrastructure.  Another draft standard, NFPA 99's new technology chapter also affirms the "life critical" nature of these network connections.  The modern healthcare facility must invest in sophisticated communication infrastructure that supports not only the high volume of data exchange that can be expected, but also the critical nature of this data. The basic telephone system and low bandwidth data network of the past will not suffice.

Investment in professional planning and design is absolutely essential to the successful deployment of telemedicine.  Since the very nature of telemedicine involves connections to systems and communication infrastructures owned and operated by third parties, there are serious integration issues that often fall outside the knowledge base of in-house personnel.  An experienced design professional, having worked with numerous healthcare organizations, also brings a broader perspective to initial planning and discussion.

Obviously, the technology and cost implications of telemedicine vary considerably depending upon the nature and degree of implementation.  However, that nature and degree are rapidly being defined for healthcare organizations by the combined pressure of both the marketplace and rising standards of care.  Soaring capital equipment costs and acute labor shortages demand telemedicine technologies that enable cost-effective sharing of equipment and labor resources.  Telemedicine technologies that not too long ago might have been considered too expensive and experimental, for example high definition video conferencing in the operating room and gigabit PACS networks, are now considered a requirement in any new or renovated facility.  These technologies generate efficiencies and improvement in patient care that are too good to be ignored and provide outlying communities with many of the services of the modern metropolitan hospital.

Brian Murphey, CTS, is a project manager and has been with EDI since 2000. His areas of expertise are in audio-visual design and acoustical consulting.

EDI's Recent Projects

Parkview Medical Center - Fort Wayne, Ind.
Children's Hospital of Philadelphia - Philadelphia, Pa.
Baptist Health - Jacksonville, Fla.
Delta Dental Insurance Company - Atlanta, Ga.
St. Joseph/Candler Health System - Savannah, Ga.

 

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