Faced with a medical emergency at 1:30am in Enniskillen, Northern Ireland, where would you expect a radiologist to contact a consultant neurologist? In Belfast, perhaps? London, maybe? How about Brisbane in Australia? Impossible, you may think; but not with video conferencing.
This is not a scenario invented to promote the benefits of videoconferencing, but an actual event quoted by Dr. Victor Patterson of the Northern Ireland Teleneurological Service. And he should know for he was the neurologist in question. “It was 12-20pm over there,” he explains, “so I could treat the case as part of my normal working day.”
The teleneurological service being pioneered by Dr Patterson from Belfast’s Royal Victoria Hospital covers the whole of Northern Ireland which, as he points out, is largely a rural area where both patients and medical staff face extensive travelling time to reach or provide the specialist medical treatment and care.
Without it for example, the round trip from Belfast to Enniskillen, in the far south-west of the Province, takes 3½ to 4 hours during which time Victor Patterson could see another six or seven patients. Videoconferencing eliminates much of this wasted time while still allowing patients to receive high levels of diagnosis, monitoring and care. Each of the nine centres used by the Teleneurology Service is equipped with Tandberg or Sony units supplied and installed by Questmark Limited. The outlying systems are typically installed in District Hospitals such as those at Enniskillen and Omagh, or in community Centres. Some of the systems have recently been updated to the latest Tandberg 880s with a commensurate improvement in performance. The first units gave a very pixellated picture, but the new systems, together with improvements in bandwidth, now provide near-TV quality.
Starting in 1999 the systems were initially used for presentations to the hospitals since when their applications have been extended to include new patient referrals, and patients’ review. Typical neurological conditions handled include headaches, meningitis, epilepsy, multiple sclerosis symptoms, and strokes. Each centre has a specialist teleneurological nurse to allow a full and accurate examination to be undertaken at the far end watched by a consultant in Belfast who can question the patient; ask them to describe their symptoms and any previous history; and see them perform appropriate tasks. In addition relatives can be interviewed for corroborative information. From this a diagnosis can be made and a management programme for the patient devised.
To help in making the diagnosis the service has established a set of core signs in a patient including eye movements, facial power and tongue movement which the consultant neurologist can track via pre-set camera positions or by remotely-controlling the camera. In the Brisbane example, the patient complained of a severe headache. Via videoconferencing Victor Patterson was able to determine there was no neck stiffness; that eye movements, facial power and tongue movements were entirely normal as were arm and leg power. He could also see that there was no limb ataxia (unsteadiness) and that the patient could walk without significant unsteadiness.
As the CT scan had been e-mailed to him he had the necessary information from which to make a diagnosis and a course of action could be recommended. His view that this was not a serious problem was validated by further tests and examinations of the patient. The Brisbane example may appear to be an extreme case of the application of clinical videoconferencing, but, as Victor Patterson observes “ it shows the great potential it has for the future.” Nearer to home he quotes the case of a 40-year old man whose back pains could not be diagnosed as an orthopaedic complaint. The Teleneurology Assistant at the Tyrone County Hospital in Omagh arranged for the patient to be seen remotely by a consultant in Belfast who diagnosed a problem with the spinal cord. The patient was admitted to hospital almost immediately to receive treatment; without videoconferencing there may well have been a longer wait.
He is convinced its use will be extended particularly if two developments occur. The first is IP transmission which will eliminate the cost of ISDN. Indeed they are about to trial IP videoconferencing to overcome this drawback. The second is for the systems to become more intuitive and user-friendly i.e. to make them more sensitive to clinicians’ needs and ways of working. Essentially, this means making them computer-based.
“In selecting clinical videoconferencing it is important to find a reliable supplier as this critical application is not about providing boxes. Integrating the systems into a usable installation that meets the strict requirements of a clinical application is vital. Questmark have done this as well as providing on-going support and ensuring all those involved in the Service are properly trained. There is no doubt that clinical videoconferencing is making a major contribution to delivering a neurology service throughout Northern Ireland. Since its introduction we have dealt with around 1000 acute admissions, seen 800 people with epilepsy, 500 outpatients and 100 review patients.”
Dr. Victor Patterson,
Northern Ireland Teleneurological Service