How telepresence is targeting healthcare

It won't be long before patients are able to pop into a conferencing booth in their town or village rather than having to travel to see a specialist or even a GP, if companies such as network equipment giant Cisco are to be believed.

Although technology to allow remote diagnosis has been around since the 1920s, the prospect of high-quality telemedicine for the masses has meant the idea has attracted much more attention recently. Providers of the business-to-business videoconferencing technology known as telepresence claim the system has real applications in healthcare.

The theory behind telepresence is that it should create a conferencing experience so intimate, participants feel like they are in the same room as the people they are speaking to. Conferences take place in a purpose-built room where participants can see each other in life-size images on huge (typically 65-inch) high-definition plasma screens.

Telepresence rooms are usually built with the highest-quality audio and video, which is optimised for the room in question. However, the technology does not come cheap. Cisco's three-screen offering costs $300,000 (£150,000).

Most of the major networking vendors now have telepresence systems, and leaders in the health sector are starting to pick up on the benefits telepresence might bring to sparsely populated areas where qualified doctors may be some distance away.

Scottish leadership
Working in one of those areas, the Grampian region of north-east Scotland, the Scottish Centre for Telehealth (SCT) is using a telepresence system from Cisco tailored specifically for healthcare.

Known as "HealthPresence", the system consists of a small telepresence room, or "pod". The pod differs from the sort of telepresence room you might find in a business, in that it contains a range of medical equipment and a handheld camera. The medical equipment includes a vital signs monitor (which measures blood pressure, pulse rate, oxygen saturation and temperature), stethoscope and otoscope (for examining the ear).

The medical professional manning the booth sets up the conference call with the appropriate doctor and uses the medical equipment on the patient as directed. The equipment then sends the data and images gathered over the conferencing link in real-time to the doctor. The camera can be used to show the doctor close-up images of parts of the body. The detail is good enough to accurately diagnose eye, ear and skin problems in many cases, the SCT claims.

The SCT has installed the HealthPresence pod at the Royal Infirmary hospital in Aberdeen to evaluate whether accurate diagnoses can be given. For the time being, the pod is located along the corridor from the main A&E department at the hospital, in case there is an urgent problem. If the evaluation is successful, the pod will be relocated into another hospital some distance away.

The SCT has grand plans for HealthPresence. "In 10 years' time, we would like this to be ubiquitous and the standard method of treatment," says Gordon Peterkin, head of the SCT. "It will improve care significantly over time."

The organisation has been using videoconferencing for treating patients since the turn of the Millennium. It runs regular neurology, cardiology and dermatology consultations...

...over video. One of its objectives is to keep abreast of the latest technical developments.

Doctors working with HealthPresence were impressed with the system, but were keen to establish its limitations. Patients with minor injuries at the hospital are invited to first see the doctor using HealthPresence. They are then given the same consultation face-to-face so the doctor can check whether they are judging the situation correctly using the system.

"We are looking at [such issues as]: are we changing the management [of the patient's case] in any way? Do we get enough picture quality?" says Fiona Mair, one of the doctors at the Royal Infirmary.

Out of the 51 patients seen so far, the handheld camera was providing excellent images of patients' mouths and ears, says Mair. However, the stethoscope had provided less guidance, as she couldn't clearly hear patients' chests.

Mair says she would have been happy to carry out the majority of those 51 consultations remotely, and for the rest, she would have asked them to attend an appointment with a doctor in person.

The one thing that is missing is touching the patient, which can help with identifying the problem, says Mair. But she adds that, based on her previous experience of telemedicine, it "doesn't make a huge difference" for minor injuries.

Patients have been impressed. Mair says the centre has received mostly positive feedback on the technology, and the first patient to be seen responded with just one word: "Cool".

The SCT is aiming to evaluate 300 patients using the HealthPresence system, in order to form a statistically significant sample, before making a decision on its experiences. If it is happy with progress on both technical and clinical grounds, the HealthPresence pod will be re-located outside the hospital, probably in a hospital some distance away where medical expertise is scarce. And if that goes well, pods could be added in places such as supermarkets or pharmacies, or on Scottish islands where there is only one GP.

HealthPresence provides 1,080-pixel screen and lifesize images of both the patient and the doctor. Comparing telepresence with previous videoconferencing offerings, SCT boss Peterkin says: "It offers a better quality of picture and less latency. But the downside is, it's bandwidth hungry. We need to think about how we deliver the service if we can't get the necessary bandwidth."

A typical telepresence screen needs 5Mbps of bandwidth to run at its highest resolution: bandwidth that just isn't available in remote areas. "Part of the assessment is: how much bandwidth do we need?" Peterkin says.

Cost is also an issue. Cisco had paid most of the costs of the assessment so far, according to SCT. "We were looking for a partner to develop the concept," he says. "It's easier to get money [funding] for biomedical research. That's why we wanted a commercial partner."

The SCT has invested just £15,000 of its own money — half of the cost of running the pilot — while Cisco has stumped up the remaining £15,000 plus the cost of the booth and the networking expertise. Standard telepresence rooms cost from £50,000, although Cisco has declined to reveal the cost of a HealthPresence pod.