August 1999

ISDN Network Brings Medical Advances To Remote Areas Of Texas

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 state’s first telemedicine video network to serve an area encompassing nearly all of the state’s 267,000 square miles.

Based on a successful pilot project with the Texas Department of Criminal Justice (TDCJ), wherein Madge’s video networking capabilities enabled UTMB to provide medical services to the TDCJ population, UTMB set out to address the state’s 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.

NETWORK COMPONENTS
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 Madge’s 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 network’s inception, more than 10,000 patients have been seen via video communications.

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 new technology.

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, UTMB’s advantage is readily apparent as the cost for placing traditional video calls over the PSTN is significantly greater than that for calls placed on UTMB’s 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 operation.

THE END RESULT
UTMB’s 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 UTMB’s 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 company’s Web site at www.madgenetworks.com.