Gernot IW Duncker
Head of University Clinic and Polyclinic for Ophthalmology
Clinic of the Medical Faculty
The costs-driven structural changes in the health service sector are a major challenge for hospitals and clinics. The concentration and networking of hospitals is called for to attain greater utilisation of the capacities of facilities and location-independent availability of specialists.
State-of-the-art digital telemedicine systems are improving data communication and documentation at Martin Luther University in Halle-Wittenberg, Germany. I have been working with digital telemedicine systems since 2003 and am fully satisfied that, alongside special medical capabilities, University Clinic Halle-Wittenberg also has the latest innovative technologies in the field of telemedicine and medical technology. When we decided to adopt telemedicine systems in 2003 we chose a digital telemedicine solution in the form of mobile flexible trolleys in our OR areas. The systems are deployed in daily clinic practice for research and teaching, as well as for case-related communication between physicians, in particular to get a second opinion during surgery quickly. In my view, one of the strengths of the telemedicine solution is the fact that our existing medical technology systems (eg, those in ophthalmologic microscopy) can be integrated easily and flexibly. Therefore these diagnostic images are available to the respective colleagues and students in real time at their workstations using our existing IT data network. An important factor when choosing and planning the deployment of a particular telemedicine system was the fact that the manufacturer had to be in a position to take into account our special needs as a university clinic and our individual workflows, designing and installing the system accordingly. The last thing we wanted was “something off-the-peg”.
Functions of telemedicine in the OR
There are three functions – all used practically every day –that we have come to appreciate in the OR. First, the possibility to present various forms of visual information (ie, live camera images and screen content from diagnostic devices) on the monitors in the theatre. The operation of the system is very simple thanks to a central touchscreen, and is usually performed by a nonsterile nurse. The system also allows us to access documents and data from the electronic archive (eg, the initial diagnosis by referring doctors or laboratory results).This saves us a lot of time as we no longer have to wait for someone to provide us with the desired information in the form of a paper printout or the like, and all this during the surgical intervention.
Broadcasting from the OR
Secondly, digital video broadcasting within the IT network has proved to be extremely practical. I am frequently requested by colleagues in the OR to put forward my opinion if there are any issues to be discussed. In the past this meant that I had to break off whatever work I was doing and go to the operating theatre. Which was a considerably time-consuming process each time. Now I can simply call up the latest images and diagnosis-relevant data from the theatre on my normal PC in real time and then decide whether my personal intervention in the theatre is necessary or not.
Telemedicine as a teaching tool
Thirdly, the telemedicine system allows for simple editing of the material from the camera sources in the theatre onto a normal DVD, allowing for the presentation of interesting cases for medical teaching and also at external congresses. Ever since then, digital broadcasting and the presentation of live images from surgery have also been possible at our regular congresses and symposia. Recently, over 300 ophthalmologists and scientists have been able to follow four operations simultaneously on two large screens thanks to the state-of-the-art digital media technology in our auditoria. In this respect, an interactive “conference” between the theatres is also possible. While the surgeon in one theatre may be seen and heard on the large screen explaining what he is doing, the operating surgeon in the next theatre can place a “broadcast request” with a member of staff from our media technology department. The media technology personnel then display a text message on screen, for example “OR five would like to broadcast”, with the effect that the current camera images from theatre five may be shown in the auditorium if asked to do so by the speaker in the auditorium (Figure 1).
As the installed telemedicine system is also used for these symposia, we now make considerable savings compared with previous symposia as there is no need to rent costly devices and technicians for these two days, which results in a clear cost benefit for us. The system in the operating theatres is taken care of on a day-to-day basis by the head of the medical technology department, and the media technology/building technology department is responsible for the use of the system in the auditoria; support is also provided through regular servicing and maintenance by the manufacturer. New operating techniques and new medical products can now be presented to a large audience with top-quality images and sound. The operation is broadcast on a large screen in the auditorium and may be commented on live from the OR. Questions from the audience are also possible. In this respect, true interaction is achieved, lending the scenario a very natural touch. There are no costs for any special cables as our state-of-the-art technology uses the existing IT network.