Videoconferencing enables neurology service to cover Northern Ireland
21 November 2006
Faced with a medical emergency at 1.30am in
Enniskillen, Northern Ireland, where would you expect a radiologist to
contact a consultant neurologist? In Belfast, perhaps? London, maybe? How
about Brisbane in Australia?
Impossible, you may think; but not with
videoconferencing. This is not a scenario invented to promote the benefits
of videoconferencing, but an actual event quoted by Dr. Victor
Patterson of the Northern Ireland Teleneurological Service. And he should
know for he was the neurologist in question. “It was 12.20pm over there,” he
explains, “so I could treat the case as part of my normal working day.”
The teleneurological service being pioneered by Dr Patterson from
Belfast’s Royal Victoria Hospital covers the whole of Northern Ireland which
is a largely rural area.
As a result patients and medical staff face extensive travelling time to
reach or provide specialist treatment and care. A round trip from Belfast to
Enniskillen, in the south-west of the province takes 3½ to 4 hours during
which time six or seven patients could be seen. Videoconferencing eliminates
much of this wasted time while still allowing patients to receive high
levels of diagnosis, monitoring and care. “The challenge,” Victor Patterson
explains, “has been to provide an expert service outside of Belfast; an
objective almost impossible to achieve without the application of
videoconferencing in a clinical environment.”
Linked by a 384Kb ISDN data connection, each of the
nine centres used by the Teleneurology Service is equipped with
predominantly Tandberg units supplied and installed by Questmark Limited.
The outlying systems are typically installed in District Hospitals such as
those at Enniskillen and Omagh, or in Community Centres. Most of the systems
have recently been updated to the latest Tandberg 880 set-top systems with a
commensurate improvement in performance. The first units used gave a very
pixellated picture, but the new systems, together with improvements in
bandwidth, now provide near-TV quality and high enough for a consultant to
recognise and interpret neurological symptoms in patients.
clinical videoconferencing it is important to find a reliable supplier as
this critical application is not about providing boxes,” says Victor
Patterson. “Integrating the systems into a usable installation that meets
the strict requirements of a clinical application is vital. Questmark have
achieved this as well as providing on-going support and ensuring all those
involved in the Service are properly trained.”
Starting in 1999 the systems were initially used for presentations to the
hospitals since when their applications have been extended to include new
patient referrals, and patients’ reviews.
Typical neurological conditions handled include headaches, meningitis,
epilepsy, multiple sclerosis symptoms, and strokes. Each centre has a
specialist teleneurological nurse to allow full and accurate examinations to
be undertaken at the far end watched by a consultant in Belfast who can
question the patient; ask them to describe their symptoms and any previous
history; and see them perform appropriate tasks. In addition relatives can
be interviewed for corrobative information. From this a diagnosis can be
made and a management programme for the patient devised.
To aid diagnosis a set of core signs in a patient has been established
which the high resolution of the videoconferencing systems show clearly.
These include eye movements, facial power and tongue movement which the
consultant neurologist can track via pre-set camera positions or by
remotely-controlling the camera. In the Brisbane example, the patient
complained of a severe headache: via videoconferencing Victor Patterson was
able to determine there was no neck stiffness; that eye movements, facial
power and tongue movements were entirely normal as were arm and leg power.
He could also see that there was no limb ataxia (unsteadiness) and that the
patient could walk without significant unsteadiness.
As the CT scan had
been emailed to him he had the necessary information from which to make a
diagnosis and a course of action could be recommended. His view that this
was not a serious problem was validated by further tests and examinations of
The Brisbane example may appear to be an extreme case of the
application of clinical videoconferencing, but, as Victor Patterson observes
“it shows the great potential it has for the future.” Nearer to home he
quotes the case of a 40-year old man whose back pains could not be diagnosed
as an orthopaedic complaint. The Teleneurology Assistant at the Tyrone
County Hospital in Omagh arranged for the patient to be seen remotely by a
consultant in Belfast who diagnosed a problem with the spinal cord. The
patient was admitted to hospital almost immediately to receive treatment;
without videoconferencing there may well have been a longer wait.
no doubt that clinical videoconferencing is making a major contribution to
delivering a neurology service throughout Northern Ireland,” says Victor
Patterson. “Since its introduction we have dealt with around 1500 acute
admissions, seen 1250 people with epilepsy, 750 outpatients, and 200 review
Over to IP
The next stage in the development of the
service is to migrate to IP transmission over the public internet. As Victor
Patterson explains: “The drawback of ISDN has been its call charges. With
free calls over the internet, IP will be ideal for expanding the reach of
the service provided it can match ISDN’s reliability and security.”
is being achieved by Questmark conditioning DSL broadband lines to take out
‘the enemies of video’ i.e. packet loss, latency and jitter to ensure the
transmission is genuinely in real-time and not subject calls dropping out.
The present speed is 192Kbits with the intention to increase this to
384Kbits later in the trial. The lines are connected to Questmark’s
management server as a managed service is crucial for this type of
application. The server captures and analyses performance data to ascertain
whether the IP calls are satisfactory.
Results, so far, have been
positive: of the thirty consultations that have taken place via IP only four
have failed and these have been due to incorrect operation rather than from
IP-related causes. Provided the trial is successful it is likely that the
Teleneurology Service will be expanded to include many more locations in
A further initiative is to introduce a home care service
whereby a ruggedised Sony unit will be taken to patients’ homes by a trained
teleneurology nurse who will be able to link with a consultant for a
diagnostic and monitoring session.