Remote Interactive Viewing System Provides Clinical Assistance, Education
By Randall D. Alley, BSc, CP  Until we can discover how to make time stand still
or successfully have ourselves cloned, our ability to see and treat
patients will be limited by the amount of time we have in the day
and our restriction to being in one place at a time.
As the head of Clinical Research and Business Development for
Hanger P&O's Upper Extremity Prosthetic Program, I am
constantly looking at creating innovative and technology-driven
ways to elevate patient care, improve clinical outcomes and further
education. One of the issues that always frustrated me was an
inability to be available to all of the practitioners and patients
who needed assistance. Hence, the idea for the RemoteConsult™
system was born.
I approached a Silicon Valley computer technology company with
the idea to develop an interactive digital video capture system
that could be used in the O&P field. The RemoteConsult system
consists of a high-resolution digital video and still camera with
remotely operated pan, tilt and zoom, a video monitor for local
viewing, a video server and controller, a video capture card and
Windows-based software, all combined into a mobile unit that can be
sent to a location of choice. Once the practitioner has set up the
unit in the patient's room (which simply requires plugging it into
a wall outlet and a phone line, DSL or cable modem, and powering it
up), a remote prosthetist, therapist, doctor, or team of
consultants can access and control the camera via a web
interface—from around the globe.
One of the most valuable aspects of the system is its video
capture ability. It records each session in high-resolution so that
it can later be used for clinical justification, practitioner
education or progress reporting. It offers the opportunity for
distance learning in either a lab or clinical setting without the
remote location having to purchase expensive equipment for
real-time conferencing.
The system is configurable for slow dial-up modems or high-speed
DSL and cable modems, to accommodate different practices with
different types of Internet connections. It utilizes streaming
technology, so that only changes occurring in the picture are
redrawn, rather than continually refreshing all the data—thus
allowing faster frame rates when using a slower dial-up
connection.
The Upper Extremity Dilemma
 The RemoteConsult system will address two areas
common to upper extremity prosthetics: the average practitioner's
limited experience with, and the standard practice's limited
exposure to, complex upper-extremity prosthetic cases. This problem
is better known as "the upper extremity dilemma," because most
practitioners receive a modest upper-extremity education in school
and are expected to gain expertise in the field.
Due to the small number of individuals requiring upper extremity
prosthetic services, these practitioners seldom receive the
training they need to develop the confidence and experience
necessary to properly address the complex physical, psychological
and psychosocial needs of the individual with upper limb absence or
loss. So it often becomes a case of trial and error, with the
patient frequently experiencing frustration and a lack of
confidence in the local practitioner.
At this point, a consultant is often called. However, some
consultants want to take ownership of the case—perhaps
because of time constraints involved with successfully performing
their duties within the budget agreed to, or in order to apply
their own methodology to the patient's rehabilitation—and
will seek little input from the local staff.
These situations may solve the immediate problem for the
short-term. However, often they do not allow for adequate sharing
of knowledge and ideas, which stimulates innovation and improves
the industry as a whole. They lend little in the way of
practitioner education, practice reputation, or patient loyalty to
the local practice.
Perhaps the most endearing quality of the RemoteConsult system
is its reliance on the local practitioner to perform the clinical
work with the gentle assistance of "helping hands" from afar. It
can be argued that there is nothing like hands-on, and while this
holds true, in many cases there are distinct advantages for the
patient, the local practitioner, and the consultant in remote
servicing.
Benefits
Education: One of my goals was to provide opportunities for
education and empower the receptive practitioner to learn in a way
more conducive to independent clinical practice. By compelling the
local clinician to provide the hand skills in casting and
modification imperative to memory retention and skill acquisition,
we are not only creating practitioner confidence, we are helping to
create a bond with the patient that is crucial to a successful
outcome and positive practitioner/patient relationship.
Time: Prolonged scheduling delays may be a thing of the past
because this system can be shipped anywhere in the US in one day,
or anywhere in the world in two to three days. This allows for more
timely assessments and other clinical services, and a more
satisfied patient.
Cost: Flying in a consultant for several days can be extremely
expensive, as travel costs and per diems can add up quickly. With
merely the cost of shipping the unit and the consultant's hourly
fee, rather than a day-long or multi-day commitment, the
RemoteConsult video capture system can save thousands of
dollars.
Accessibility: One of the biggest advantages of the
RemoteConsult system is the ability for a specialist "to be in
several places on the same day," hence helping to assist patients
in need in far greater numbers than possible with direct
visitation. In addition, this allows patients and practitioners
alike greater access to specialists who might not normally be
involved in a case due to time limitations and scheduling
conflicts.
It is important to look at the RemoteConsult system as an
assistive tool that can supplement a consultant, rather than
replace him or her. It provides key benefits not possible with
direct clinical intervention for a fraction of the cost, and most
importantly, the local community retains the patient bond while
still providing expert clinical care.
On the Horizon
The RemoteConsult system is currently in its beta testing phase
and has performed successfully on each of its several clinical
sessions throughout the country. Its next iteration will be
significantly smaller and lighter and will allow the integration of
voice-over-net technology without a large drop in video frame rate.
It is projected to become a significant teaching aid and
cost-saving tool for Hanger P&O's Upper Extremity Prosthetic
Program and will allow their staff practitioner's access to the
clinical expertise of the national specialists who currently spend
a majority of their time traveling between practice locations. Randall Alley, BSc, CP, is head of Clinical Research and Business Development for Hanger P&O’s Upper Extremity Prosthetic Program and chairman of the Upper Limb Prosthetic Society of the American Academy of Orthotists and Prosthetists (AAOP). He can be co 
Table Of Contents - September 2002
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