Remote Interactive Viewing System Provides Clinical Assistance, Education

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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.


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