Author: Ara Felekian

With only a 48-hour window of opportunity, how do you keep a child from going blind when there is a lack of eye surgeons with proper training? That’s where telemedicine technology and eye specialists come together.

Children’s Hospital Los Angeles is the largest pediatric multispecialty medical group in the United States. Children from around the world can receive specialized care from 564 physicians in any of 32 specialties and 31 other areas of complex conditions.

Recently, one group within Children’s Hospital Los Angeles looked at the rate of infant blindness in Armenia – which was three times the rate of the U.S. and other Western countries – and asked, “How can we help?” How could the medical group eliminate preventable blindness in Armenia and neighboring rural areas? And how could the medical group educate doctors in third-world countries about complex blinding diseases in a cost-effective manner without compromising care?

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Thomas Lee, MD, joined the Armenia EyeCare Project at Children’s Hospital Los Angeles. He and a team of doctors traveled to Armenia to provide assessment, care and programming, and the need to train remote care teams became clear: There were not enough surgeons available with the specialized knowledge required to provide life-changing eye surgeries.

Another critical issue was that some of these sight-saving surgeries for premature infants with certain retinal conditions must take place within 48 hours of birth. The lack of trained surgeons meant many infants might miss their opportunity.

So SADA Systems, a Microsoft partner, built a telemedicine system using Microsoft technology especially for Lee to reach out from L.A. to Armenia to stop infants from going blind.

“Skype for Business along with a Polycom codec allowed us to be present virtually during the operation,” Lee said. “One of the primary obstacles to training surgeons in developing countries is the difficulty in getting the expertise to the trainee to properly supervise them during their actual operations. Historically this has required the expert to travel to the remote country and then assist the doctor directly.”

These medical missions are very time-consuming, and unfortunately often need to be arranged months in advance, a period of time many patients do not have, Lee said.

“By having a remote platform available, we were able to provide the supervision needed in a timely fashion for the patient without requiring the expert to disrupt their own practice,” he explained.

Various elements of the telemedicine technology enabled Lee and team members to succeed at this medical procedure.

“Historically, we have been limited in how the video signal is transmitted and brokered,” Lee said. “Encoding and compressing the signal has often relied on software compression performed in the OR before being placed on the wire. This results in compression and motion artifacts that cause signal degradation making it unusable from a medical standpoint.”

Some of the more affordable hardware systems resulted in latency of up to 60 seconds as the streaming system would buffer the video before broadcasting to the remote expert, Lee explained. A dedicated hardware codec at both ends would solve this issue but required the remote expert to be at the hospital where the codec is present, and since Armenia was 12 time zones away, this posed a specific challenge, he added.

“What was unique and novel about this solution was that SADA Systems reconfigured a Polycom codec to log directly on to Microsoft Skype for Business,” he explained. “The hardware compression resulted in a high-definition and high-frame-rate signal with none of the artifacts we had seen previously. Because this was being brokered by Skype for Business, the remote expert could simply log onto the video conference from home using a standard web browser.”

What was even more important was that the signal could be multicast to multiple experts around the world. This was a fundamental change.

“Where historically we could only have one expert training a surgeon, either in person or remotely, Skype for Business allowed us to crowdsource the surgical training to experts all over the world,” Lee said. “This changes the rules of the game. Experience that would normally take a trainee months to acquire through different experts can now be addressed in one operation. This really alters how we can approach a global problem through a disruptive platform to benefit children all over the world.”

So how important is telemedicine technology to the future of healthcare? Very, Lee said.

“In healthcare today, we are facing a crisis not just in cost but more importantly in access,” he said. “Telemedicine will allow us to address both of these issues by allowing subspecialists to partner with other providers in an efficient manner that can both increase access and reduce costs. The challenge is how to complete the proof of concept and then roll out the larger platform.”

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