Another day another story about a Cart with Video Conferencing equipment being used to remotely diagnose patients who have suffered a stroke (also see here). I suppose we should be grateful that more medics and care providers are waking up to the potential of video consulting to reduce the barriers of time and space to deliver more immediate expert care to their patients, but with Doctors using the iPhone 4 to consult with patients or consult with one another on a patients care aren’t these cart contraptions starting to look like relics?
Here are the major issues I have with the value offered by cart carried equipment in comparison to what can be achieved with a decent 3G Mobile:
+ It only works within a fixed location and requires trained professional staff to operate
In my opinion this creates several issues. First up – it will mean that the technology, education and experience continues to remain with the specialists who are working at the medical centre which hosts the cart. These professionals already have a fair amount of education on stroke diagnosis and the learning experience for both the specialists and the professionals are going to be limited after a while.
In contrast Mobile Video Calling can connect stroke specialists with GPs, ambulance teams, community health workers, home carers and lay people who will inevitably be calling 3G Video provisioned Emergency Services in the near future.
+ Technical Advantages
Of course quality Video Calling requires a decent camera, microphone and speaker like those featured on the RP7 Robot (pictured with me above) but is it really beyond us to build satisfactory capabilities into a mobile device? Will we really miss the benefits of the big screen? How much value do we get from having such a big video image of the Doctor’s face? Could we get the same with TV-Out functionality? Would a mobile videophone make the remote Doctor much less personable? Would clinics really miss having the trip hazard created by the power cables (that are always obscured in the media images) that drag behind these disguised computer carts?
With unprecedented convergence of electronic functionality to the mobile phone and 3G Mobile Phones now boasting features such as HD Video:
Surely there’s no point in resisting the advantages that mobiles have as a result of competitive market pressures, rapid replacement cycles and the economics of mass market manufacturing processes?
+ Familiarity, Access & Availability
The biggest problem with the cart carried equipment is that it can’t leverage the 8 unique attributes of mobile as a mass media. I feel the 1st, 2nd, 3rd and 5th of these are important in this use case and here’s why:
1st: Mobile is personal
Unlike mobiles, the use of video conferencing carts are unfamiliar because they don’t belong to anyone. Whilst I’d bet everyone in the Midwestern Hospital could tell you where their mobile is 24×7 and the approximate amount of remaining battery charge that it’s carrying, I’d be surprised if the actual whereabouts and status of their RoboDoctor is known to anymore than a small handful of resident clinicians.
From my experience cart based equipment differs greatly from mobile phones in terms of usability and a classic example of this issue is revealed by a quick look at the poor product design eg. in the picture at the top of this post you’ll notice a basket that has been fitted to carry the instruction guide booklets.
2nd: Mobile is permanently carried
The value of cart equipment is limited by not always being at hand and available. If it’s a bit of an upheaval to get it set up and ensure a qualified Specialist is going to available on the other end of the video call and it is inevitable that in the event of an emergency users will forget/fail/not bother to use it. The fact that a Mobile Video Call can be placed directly to the 3G phone on the bedside of a sleeping on-call consultant is a huge advance on equipment that requires specialist end points.
What’s more Mobile Video Calling has the potential to extend the skills and experience of the stroke specialist beyond the 4 walls and ramped floors of the hospital (where the cart can operate) and out into communities and remote locations as a tool for Paramedics, Carers and members of the public who play the most important role in early detection of and response to a stroke.
3rd & 5th: Mobile is always on and available at the point of creative impulse
A major advantage of the Mobile over Cart-based-equipment is that it’s always on and available. Obviously with the mobile you don’t need a power cord or to be within the clinic (where the cart is located), but you also don’t have all those mundane technical issues. We should never underestimate the need to hide technical complexities from the end users of medical equipment. Rather than having to think about “how to turn it all on”, “how to connect to NAMED specialist” etc etc, 3G mobile video calls are no more complex than making a phone call.
Although it may be a slightly obscure final comment from Dale Rodebaugh at the Durango Herald, I think it’s a great example of how these issues manifest themselves in underutilisation and lack of use of scientifically proven life saving technology:
“Country music great Charlie Daniels was treated at Mercy in January after suffering a stroke while snowmobiling in the backcountry. Daniels, whose left side became numb, recognized stroke symptoms and sought help. Mercy physicians administered t-PA to Daniels and consulted a neurosurgeon in Denver. But the teleconferencing was not used, Gibson said”
In my opinion this clearly demonstrates that when a similar solution can be achieved with a normal voice call, emergency medical personnel have the habit of going with that instead of spending extra time and effort dragging that cart out.
How long before Hospitals wake up and realise 3G Video Mobiles have killed the Video Conferencing Cart?
* UPDATE *
A twitter update drew a response that highlights a common misconception about diagnosis over mobile video calls:
First up I did say “in comparison to what can be achieved with a decent 3G Mobile”. Although it’s not yet (because Apple obviously had to sweeten up the operators in order to pull off their second Boca Raton moment) available on the iPhone 4 I think it’s reasonably fair to include video calling over 3G (and yes I know Apple iPhones CAN actually already do this) and TV-out (so that the images can be viewed on a larger screen). In my experience this feature is only required in one direction eg. so that the remote Doctor can view the patient on a larger screen (which is indeed a help when trying to diagnose over a Video connection).