ISDN Network Brings Medical Advances To Remote Areas Of
BY BARBARA GRIMSGAARD
The University of Texas Medical Branch at Galveston (UTMB), a major academic health
center in the Greater Houston area, recognized the need to provide reliable, timely
medical care to families outside of urban areas. Working hand-in-hand with network
solutions provider Madge Networks, UTMB responded by
creating the states first telemedicine video network to serve an area encompassing
nearly all of the states 267,000 square miles.
Based on a successful pilot project with the Texas Department of Criminal Justice
(TDCJ), wherein Madges video networking capabilities enabled UTMB to provide medical
services to the TDCJ population, UTMB set out to address the states rural healthcare
needs in 1995. With the advantages of telemedicine firmly established by the TDCJ project,
a team of dedicated healthcare and information technology professionals created a network
that has increased access to medical care for thousands of people and lowered costs for
the end user.
The foundation of the UTMB telemedicine network is a scalable, ISDN network
operating over leased T1 lines. At the focal point is a Madge Networks Wide Area Network
(WAN) ISDN AccessSwitch Model 200 which, when networked with Madge ISDN AccessSwitch Model
20s stationed at remote clinics throughout Texas, makes video conferencing as
easy as dialing a phone. Building on this foundation is equally simple because the
scalable nature of Madges video conferencing equipment enables the UTMB network to
grow as new remote users, sites, and applications are added.
Although ISDN is not a new technology, it is ideal for the telemedicine project because
it provides the necessary bandwidth, reliability, and quality of service (QoS) needed for
video applications. With ISDN, bandwidth is available for up to 23 channels, for a total
of 1,472 Kbps for each call. With the capabilities of the AccessSwitch dial plan, users at
any site can video conference with any other site without video or audio interruption.
Also, the Madge AccessSwitch enables all users to share access to a multipoint control
unit (MCU) for multisite telemedicine consultation.
Once the technology was in place and real-world applications identified, the rollout
began. One application linked 12 remote sites to UTMB to provide medical care for
special-needs children in areas where medical technology and expertise were not readily
available. The Madge solution included a virtual exam room with a video interface designed
to be simple enough for medical personnel to operate, so that the bulk of their time could
be spent treating patients, not manipulating video equipment.
When we set out to develop our telemedicine project, the goal was to maintain the
same quality of care that UTMB had been providing since 1892, said Jake Angelo,
manager of information services, video operations for UTMB. One option for us was to
connect to an existing state-developed television network. However, this proved far too
cumbersome and costly. The technical path chosen in our work with Madge has enabled us not
only to provide quality medical care throughout the state, but also to do so in a way that
is cost-effective for us, the local physicians, and the patients.
TELEMEDICINE IN ACTION
As the telemedicine concept has expanded, its use has become more prevalent.
Currently, UTMB maintains 19 remote clinics, offering more than two dozen services
including general medicine, cardiology, orthopedics, dermatology, and pediatrics, among
others. Since the networks inception, more than 10,000 patients have been seen via
Among the patients who have benefited the most from telemedicine are special-needs
children i.e., those suffering from complicated illnesses such as spina bifida,
cerebral palsy, traumatic brain injuries, metabolic disorders, and chronic problems caused
by premature birth. At the outset, UTMB was linked to two remote sites, each specially
equipped for such children, and each hundreds of miles away from UTMB. In 1998, ten
additional remote sites were added with minimal effort due to the scalable nature of the
Madge video conferencing equipment.
While medical technology advances have dramatically expanded treatment programs in
numerous fields, access to both new technology and the doctors capable of using these
technologies has remained limited to hospitals based in major cities. The Madge-based UTMB
network enables doctors not only to treat and reach many more patients at remote sites,
but also to impart their knowledge to local physicians for both ongoing care and
assistance in diagnosing new cases. This transfer of knowledge ensures healthcare
providers can maintain a continued standard of quality care by training them to utilize
The training aspect, called the Open Gates Teletraining Institute, is a
hands-on educational tool that relies heavily on the UTMB video network. Through Open
Gates, a faculty of more than 60 physicians, physician assistants, nurses, educators,
administrators, legal experts, technicians, and information service personnel provides
courses on the techniques and technology of telemedicine and distance learning to
healthcare providers nationwide.
The video network infrastructure was designed to enable users at the UTMB hub to manage
and control usage and operating costs. With the growth in telemedicine usage, UTMBs
advantage is readily apparent as the cost for placing traditional video calls over the
PSTN is significantly greater than that for calls placed on UTMBs leased T1 lines.
Also, the scalable nature of the Madge AccessSwitches enables new sites to be added
without needing to reconfigure and/or rebuild the technological applications already in
THE END RESULT
UTMBs telemedicine program continues to have a significant impact on the
citizens of Texas by providing low-cost, technologically advanced healthcare services.
Patient and physician travel costs often are minimized or eliminated. Parents who normally
would be required to miss a day of work can visit satellite clinics close to their homes,
eliminating lost wages and reducing family stress. Physician specialists at a single
location can diagnose and treat numerous cases throughout the state and around the world.
According to Dr. Sally Robinson, a professor in UTMBs department of pediatrics
and chief of the special services division, Telemedicine is an effective method to
track special-needs children in remote areas. The enhanced communication during
telemedicine sessions allows a more comprehensive and improved evaluation. I see a future
that extends telemedicine support beyond children to all sorts of people who have chronic
medical conditions in the community.
Continued Angelo, The applications for telemedicine and overall usage of video
networking are endless. In less than one decade, the concept has been created, built,
tested, and proven to be highly effective.
The efficiency and simplicity of the video network architecture provide a clear path
for expansion to ensure Madge and its customers can continue to meet the growing needs of
citizens and healthcare professionals who can benefit from such technology. The current
program at UTMB serves as a national and international model for blending expert,
patient-centered care with advanced communications technology.
Ultimately, the efficacy of video networking and, in turn, telemedicine, will be
supported by new applications such as commercial use by NASA, and companies that operate
offshore oil rigs. For organizations such as UTMB, video networking will play an
increasingly important role in patient treatment and communication, cost management,
education, and the creation of a competitive advantage.
Barbara Grimsgaard is marketing manager for Madge Networks. Madge is a worldwide
supplier of data, video, and voice networking solutions, with special expertise in Token
Ring data networking, video networking, and managed network services. Madge delivers a
range of video networking products including the WAN AccessSwitch, an ISDN switch, IMUX,
and MCU in a single box, and Madge LAN Video Gateway (LVG) products which integrate ISDN
(H.320) video conferencing with IP (H.323) video conferencing technologies. For more
information, visit the companys Web site at www.madgenetworks.com.