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Take Two Streams: Streaming Video on the Rise in Modern Medicine

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Think about the obvious initial benefit for the surgeon (the manufacturing equivalent would be the field technician) as he or she performs “two-handed maintenance” while keeping abreast of key details on smart glasses or AR headsets. These headsets free up the wearer to avoid having to look away and use one or both hands to fumble with a laptop or tablet.

The bigger benefit, though, is what we covered under the training portion at the outset of this article: the ability to provide the supplemental services of a remote surgeon. This is not robotic surgeries from a distance, as those types of remote connections require zero-frame latencies (not yet available in streaming) for the surgeon to guide a robotic arm into tight cavities, but rather as a just-in-time coach or mentor watching through a low-latency video stream from a remote location.

Part of the challenge for effective just-in-time mentoring is synchronized telemetry. When discussing the operating theater/auditorium two-way use case, The Streaming Co.’s Kittow says that part of the challenge his team faced was that all production and live streaming were generated from a lead-lined theater. This meant that HD video signals from multiple angles, as well as from elected medical equipment such as X-ray, microscope, and CT scan units, had to be generated using cabling rather than Wi-Fi or wireless connections. This could have added interference with mission-critical equipment used by the surgery team.

In addition, there’s also the use of low-latency streaming and videoconferencing in real-time observation for critical patient care. An example of the criticality of video streaming for rural healthcare can be found in a recent article in The Roanoke Times. Author Luanne Rife speaks to David Cattell-Gordon, who heads up the University of Virginia’s Center for Telemedicine, located some 5 hours from the coalfields of southwest Virginia that are dotted with small towns like Big Stone Gap, Haysi, and Pennington Gap.

There have been more than 1,000 telestroke consultations in rural Virginia in the past 3 years alone.

“A stroke neurologist will tell you every minute you lose a million brain cells,” says Cattell-Gordon. “Time is brain. ...”

Cattell-Gordon discusses telestroke consultations, which Rife notes have taken place more than 1,000 times in rural Virginia in the past 3 years. An example of this in the article centers on the small city of Norton, when a potential stroke patient enters the emergency room of rural Norton Community Hospital.

“Within six minutes roughly, the [telestroke consultation] cart is in the room with the patient, we get the CT images, the neurologist looks at the images, and the camera is on,” says Cattell-Gordon.

Rife goes on to note, “The neurologist can see and question the patient, the same as if she is physically in the room, and determine if it’s an ischemic stroke, the type arising from a clot rather than a bleed, and then decide whether to push an antithrombotic drug with the potential to save the person’s life and limb.”

Health and Wellness and Virtual House Calls

One challenge, though, throughout the coalfields and large swaths of Appalachia, is the lack of mobile data coverage (4G) and in-home broadband. “If you have low broadband, you are not going to have access to educational resources, you’re not going to have access to the technology, to the remote monitoring and devices that matter,” says Cattell-Gordon, noting that people without broadband have a harder time getting healthcare and wellness advice. Some even have to drive to locations like their local Walmart in order to have Wi-Fi and broadband to send telemetry data or do video-based consultations.

The conversation around broadband and remote consultations brings up an interesting opportunity: Is it possible one of the next phases for rural telemedicine is the advent of virtual house calls by medical practitioners?

If the broadband issues are addressed—and Virginia is one example of a state trying to address the great disparity between fiber in Fairfax and the Washington, D.C., metroplex versus the parts of southwest Virginia that are still reliant on dial-up and very slow DSL—a virtual house call would allow doctors and specialists to see more patients than they could physically see in a day in the office at a rural health clinic.

In turn, this virtual house call approach, powered by low-latency streaming media, could have a positive ripple effect in suburban and urban areas. And the “house call” needn’t be constrained by physical geography either.

Parkview Noble Hospital in Indiana is one of a growing number of medical facilities that offer virtual house calls.

Gary Adkins, president of Parkview Noble Hospital in Indiana, has written about his experience using his hospital’s virtual house call service. A free app called Parkview OnDemand “will connect you to a virtual face-to-face visit with a physician using your smartphone or computer.”

Adkins notes that the average wait time is about 10 minutes and offers the caveat that problems like broken bones or cardiac issues still warrant an emergency room visit. But at $49 per virtual house call, the Parkview OnDemand service costs much less than a trip to the ER.

Even more intriguing, Adkins notes that Parkview OnDemand users need not be Parkview patients. “The service may be accessed by anyone age 18 or older,” writes Adkins. “Add to this the convenience of accessing the OnDemand service 24/7, from anywhere within the 50 United States, and suddenly minor illnesses while you are on vacation or your child is away at school and the value of virtual health is readily apparent.”

Because most of these virtual doctor visits are conducted on FaceTime or an Android equivalent, Adkins also notes the lower-than-average health risks for a family with multiple children. “For that parent of three children with only one being sick,” writes Adkins, “not only is the service quick, it also eliminates the risk of the other children catching something from other kids in the doctor’s waiting room.”

Clinical Trials

While most of this article has dealt with medical personnel interacting with patients or peers, there’s one unique use of streaming in the pharmaceutical industry.

Pharmaceutical companies’ biggest touchpoint with the general public is during the period of clinical trials prior to regulatory approval. And yet, it’s traditionally often been the hardest in which to engage doctors and patients, as it requires showing up at a physical location multiple times over the trial period.

ZubiaLive.net, an online live-streaming portal that aims to solve an ongoing information gap (“people seeking current health and wellness information can’t connect with those sharing it”), has expanded beyond its initial provider-to-public live-streaming model and into clinical trials. The company’s Clinical Trials Video Channel provides a centralized location where those participating in a clinical trial can interact in real time during live video streams.

Pharmaceutical companies conducting clinical trials have found it difficult to recruit participants, in part because of the need for in-person check-ins. ZubiaLive.net offers the ability for participants to check in remotely.

Zubia notes that clinical trials are often confusing for those who might benefit the most from them. “As a result, less people participate in trials and therefore better treatments take longer to get to market to those who need them the most,” the company states on its website.

The key market for the Clinical Trials Video Channel comprises clinical trial recruiters who need to increase participation in upcoming trials. “Live, interactive videos help simplify the trial process,” Zubia notes, “allowing viewers to interact in real-time through live-chat during a video broadcast.”

[This article appears in the September 2019 issue of Streaming Media Magazine as "Take Two Streams: Streaming in Medicine."]

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