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AV Systems
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Better health through technology
AV upgrades improve training, remote access
Dec 1, 2003
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by Jayne Scheckla
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 Management at the University of North Dakota's School of Medicine and Health Sciences understands the intrinsic value of effective communication. Over the past year, it has equipped its facilities with the necessary AV gear to deliver 21st century telemedicine solutions to its students, rural residents, and local community groups.
Thanks to recent upgrades, teleconferencing and digital video technology play a large part in training and evaluating future medical practitioners and extending reach of care into rural areas of the state.
Serious Introductions
Within the past two years, the School installed new digital technology in its Clinical Education Center (CEC), a self-contained, state-of-the-art educational facility for the assessment and realistic testing of clinical skills. The University's Medical Education program primarily uses the facility to instruct and evaluate 120 medical students in the "Introduction to Patient Care" course sequence and to conduct clinical skills assessments of up to 60 medical students at the end of their third year of curriculum.
Comprised of 9,000 square feet of uniquely designed learning space, the CEC opened in Fall 2001. It provides examination/interview rooms with one-way mirrors and observation areas, offers AV capabilities for remote viewing and video recording, and contains intercom and Internet connections throughout. The center also provides a 50-seat interactive meeting room with projection and multimedia capabilities, as well as three seminar rooms equipped with AV equipment.
The original technical facilities for media support included a fully digital control room for video, audio, voice, and data communications; equipment for multimedia storage, retrieval, and archiving; digital networks for multimedia distribution on the Internet; and a multimedia monitoring/playback room that accommodates up to 16 viewers at any given time. Recently, sophisticated digital video, voice, and data communication capabilities were installed by system integrator Cytek Media Systems, who also upgraded the facility to accommodate future distance learning requirements.
During class, instructors use video from videotape, DVDs, and video servers as an aid to instruction. All educational sessions can be, and typically are, videotaped for later viewing by students to determine their skill development progress -- and by the faculty to gain feedback on the effectiveness of their instruction. When off-site specialists are needed to join a group, teleconferencing technology brings their images and voices into the room.
Direct clinical instruction is provided in a 75-seat auditorium and a 64-seat divisible classroom, which can be turned into two classrooms by simply pulling a divider. Shure microphones at each station in the rooms allow questions and answers to be recorded and transmitted via the teleconferencing network, which uses a Polycom VS4000 phone system. Typical media used during instruction are PowerPoint presentations, webcasting, overhead projection, CD-ROM, and infrared stethoscope heart sounds provided by a Harvey cardiac simulator. A digital ophthalmoscope will soon be used to project retinal images to remote sites for evaluation and instruction.
A Closer Examination
One-on-one practice skills are held in one of 16 examination rooms, which also serve as skill evaluation rooms. There, students interview and examine patients, who are actually actors trained to realistically present with distinct illnesses, injuries, and/or disabilities. Each session is observed live through a one-way viewing window and is videotaped for future discussion. An AMX communication control system, using a combination of custom and AMX NetLinx software, automatically begins the video session, then powers the equipment down when not in use.
Panasonic WV-CP234 ceiling-mounted and wall-mounted color cameras, equipped with wide angle lenses, are mounted on the examination room's ceiling and wall. An observer can monitor the examination closely by switching between the two cameras using a laptop computer.
Video originating in the examination rooms and from four sources in the auditorium (from two front wall-mounted cameras and from a projection booth) is sent, along with the companion audio from Audio-Technica wall/ceiling microphones, via standard cabling to a Panasonic recording deck in the video control room. Each tape is digitized as MPEG-2 compressed video and placed on a four-channel video server for network retrieval.
Three channels on the video server are used for digital encoding of saved analog video or for transporting sessions to other locations over a TCP/IP network. The fourth channel is used for viewing or recording of stored video files. Video sources are routed through an AutoPatch 48x48 mono AV matrix switcher to one of 16 VBrick 4000 MPEG-2 encoders.
Three simultaneous streams of live or recorded video and digital multimedia files from Web servers can be transmitted over the Internet, the state's ATM network, or Internet2. CD-video, CD-ROM, and DVD video formats, as well as MPEG, AVI, QuickTime, Real Media, and Windows Media computer video formats can all be produced.
Video can be recorded from up to 17 sources at one time and can be viewed from any room in the facility. The system can playback up to 17 video signals to any of 17 locations at one time. Since all video and control is handled over standard Ethernet networking, an instructor can conceivably view and grade an exam anywhere the network is available.
The CEC has also been equipped with a ClearOne XAP 800 audio conferencing system -- unique audio gear that not only controls echo, but provides realistic sound clarity. This equipment processes audio for lectures and presentations, as well as enables audio conferencing, provides enhanced audio for videoconferencing, and ensures optimal sound distribution.
Dr. Robert Rubeck, chief information officer for the School of Medicine and Health Sciences, has been more than satisfied with the ClearOne's system performance."Each seat has microphone access, the speakers are zoned, and echo is controlled," he said."The result is that everyone can hear and be heard clearly, no matter how far away they are seated, and the sound quality on recordings and at the far-end site during videoconferences is very realistic."
Numerous external educational programs have made use of the CEC as a mini-conference facility, and community groups, such as Grand Fork's Medical School for the Public, routinely use the resources to present lectures and hold small group discussions related to biomedicine. Their agendas often include educational presentations, which can contain video and audio elements and can be teleconferenced to a larger audience over various communications networks.
Distant Diagnosis
Telemedicine is defined as the practice of health care delivery, diagnosis, consultation, treatment, and transfer of medical data by using interactive video, audio, and data telecommunications. It is routinely used at the University's School of Medicine to facilitate offsite patient diagnosis. However, any telemedicine solution is only as good as the technology supporting it.
Thanks to a recent $1 million federal grant, the university is transitioning its H.323 communication system to a more economical, flexible, and scalable solution. The new interactive communication network will support any number of potential participants, providing both videoconference and teleconference capabilities for one-to-one, two-way, or multi-point communication. It is being installed at the university's Health Information Technology Center.
Doctors at the university will use the network to communicate with doctors or nurse practitioners in rural areas and at Indian reservations. They use video from digital oroscopes and retinal scanners to see into ears and eyes of remote patients and audio from stethoscopes to listen to their hearts and lungs. Advanced telecommunication technology allows them to see and talk to patients who might otherwise have to travel long distances to receive expert care.
The communication network is based on Session Initiation Protocol, which is actively promoted by the Internet Engineering Task Force as the standard for multimedia applications. SIP is designed to provide flexible and scalable solutions for IP packet networks, taking advantage of endpoint processing power. The system is comprised of a Wave Three Conference Server and various seats of Wave Three Session communication software installed both at the university and at off-site locations being accessed.
Wave Three provides for point-to-point calls with both video and voice being transferred over IP networks. The Conference Server adds multi-point capability, where similarly some calls use both video and voice while others are voice only.
MORE INFO
AMX
(800) 222-0193
www.amx.com
Audio-Technica
(330) 686-2600
www.audiotechnica.com
AutoPatch
(800) 622-0246
www.autopatch.com
ClearOne
(800) 975-7200
www.clearone.com
Cytek Media Systems
www.cytekmedia.com
Panasonic
(800) 528-8601
www.panasonic.com/broadcast
Polycom
(800) 765-9266
www.polycom.com
Shure
(800) 25-SHURE
www.shure.com
UND School of Medicine and Health Sciences
(701) 777-3800
www.med.und.edu
VBrick
(203) 265-0044
www.vbrick.com
Wave Three
(888) 408-8422
www.wave3software.com
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