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A Faster, Multimedia Internet?

June 1, 1998
by Polly Schneider
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A Faster, Multimedia Internet?

CONVERGENCE IS ON the horizon. Where voice, data and images have previously traveled down different transportation channels it is now becoming possible to send all types of information across a single communications medium at a lower cost. CIOs are talking about multimedia email where physicians could dictate clinical notes or attach video clips of a patient’s X-ray and send them on to a referring physician. Voice over IP and video over IP technologies are raising the possibility of interactive Web-based videoconferencing from home. In the not-too-distant future a patient cruising her HMO’s Web site for disease advice could click on an icon establishing a phone connection with an advice nurse and ask questions through a PC microphone.

For rural doctors, making long distance phone calls to a referring hospital over the Internet could cut phone bills by more than half; Internet telephony is now being offered by major telecom firms across the country for dirt cheap rates of seven cents a minute. Networking companies are investing millions into the development of technologies that will support a multimedia world, and cable and telecom carriers are introducing high-speed Internet access in test markets across the country. This is encouraging for healthcare in its quest to create a multimedia patient record that providers can access in real time, from virtually any location.

Examples of how telehealth and Internet technologies could merge are beginning to unfold in small ways across the country. Cisco Systems and Acuson Corp. have been staging high-profile demonstrations of an application for viewing ultrasound images remotely over the Internet. Using a Web browser, Acuson’s WebPro package allows users to pull an entire exam over the Internet or an intranet from Acuson’s ultrasound imaging system at the lab.

Telemedicine eyes the Internet

The DoD has several Internet-enabled telemedicine studies and projects under way. An Internet-based teledermatology system at the Walter Reed Army Medical Center in Washington, D.C., is in the process of rolling out to 11 hospitals and 41 clinics in the Army’s 21-state North Atlantic region. Using an inhouse-developed system, primary care providers will be able to send encrypted patient histories and digital photos over the Internet to a database on the Walter Reed server. Walter Reed dermatologists can then log on to a password-protected Web site and review cases, zooming in on images for more detail.

The main advantages of using the Internet, says Lt. Col. Ronald Poropatich, telemedicine director at Walter Reed, are broader distribution capabilities and cost savings from sending text data and images in the same electronic file: previously, patient histories were faxed separately. Poropatich says there have been no major performance issues yet with using the Internet.

Strategic Monitoring Services, Inc. (SMS) is a New York City-based disease management firm that recently won a DoD contract to provide Internet-based medical records, outcomes and patient education for chronically-ill lung disease patients. SMS uses a combination of telemedicine, home care and the Internet to manage its patients. Clinicians dial into an intranet to retrieve daily assignments and multimedia patient records, and to file reports at the day’s end, while patients are using Web TV to review disease and treatment information. "Truly interactive, data rich disease management is not yet there for the DoD or anyone else, but it is inching closer," says Gregory Muth, CEO of SMS.

Stanford Medical Center has been providing ISDN-based educational videoconferences to physicians at hospitals in Singapore and Manilla for several years and is now looking to pilot a Web-based program of prerecorded lectures and grand rounds to its Asia partners. Stanford has developed software for video streaming over the Internet to physicians through a secure Web site, according to James Bair, director of international medical services at Stanford. "They’ll be able to get very current medical information whenever they want."

Full speed ahead

The ticket to making telemedicine and telehealth viable over the Internet is finding more bandwidth. A heavily-promoted telecommunications service coming of age now is digital subscriber line, (commonly called DSL or xDSL) a broadband technology that uses the existing copper wire infrastructure to deliver transmission speeds of up to 8 Mbps downstream--much faster than ISDN at 128Kbps or a T-1 line at 1.5 Mbps and cheaper too. Cost estimates for DSL are ranging from $100 to $250 a month.

Unlike the circuit-switched technology ISDN lines use, DSL uses a dedicated, packet-switched connection found in frame relay, ATM or IP networks, according to Kieran Taylor, DSL product marketing manager at Bay Networks, Santa Clara, Calif.

"What makes DSL possible is it uses the same phone wiring of the network today but at a higher spectrum," Taylor explains. "It goes above the four kilohertz used for voice… and that’s what enables the multi-megabit speeds." Bay Networks offers DSL products that can deliver symmetrical or asymmetrical configuration--such as 7 Mbps down to the user and 1 Mbps up to the network, or 2 Mbps in both directions. Cisco Systems and 3Com also offer DSL products, as well as a growing contingent of smaller companies.