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Teleconferencing May Be (Micro)Wave of Future

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Teleconferencing May Be (Micro)Wave of Future Teleconferencing may be (micro)wave of future BY DAVID J. BALTZER, MARK GRAY, AND JACK FFITZER TELECOMMUNICATIONS Microwave communications system between two VA hos- pitals and a school of medicine provides teleconferencing activities for educational programs and staff meetings he Greeks had a word for it— Veterans Administration Medical located in mid-town St. Louis, 18 tele for far off—but even those Center (SLVAMC), was accompanied miles by vehicle or 11.2 miles by air Twise wordsmiths of old could by numerous communications prob- from Jefferson Barracks in the not have envisioned how modern lems. John J. Cochran Hospital is southern suburbs. Shuttle buses leave man would combine their four-letter root word with camera, lens, film, and a host of other inventions that Figure 1—Growth under umbrellas* would make far off appear nearby, • IN HOSPITALS IN BEDS almost like being in the same room. Telecommunication is the catch-all term. How it applies to the delivery 1797 341,382 of health care in multihospital sys- Contract tems is a timely subject. 1400 247,800 1315 Excluding government-operated hos- pitals in 1979, there were 267 multi- Owned institutional health care systems in the United States, consisting of 1,400 owned and 397 contract managed hospitals with 341,382 beds. Figures 1 and 2, at right, show the extent of 1975 1979 1975 1979 the growth of these systems in the past few years. The trend to merge 'American Hospital Association. Directory of Multi-Hospital Systems. Chicago: AHA, 1980. is likely to continue as organizations seek to economize by sharing ser- vices and professional expertise. The 1971 merger of the John J. Figure 2—Comparison of facilities under umbrellas to facilities Cochran VA Hospital (JC) and the not under umbrellas* Jefferson Barracks VA Hospital (JB) into two divisions under one adminis- U.S. HOSPITALS U.S. BEDS tration, now called the St. Louis David Baltzer was a Washington University, St. Louis, graduate student on escternship with the St. Louis Veterans Administration Medical Center at the time this article was written. He now is administrative resident with the Evangelical Hospital Association, Oak Brook, IL. Mark Gray was chief, Learning Resources Service , St. Louis Veterans Administration Medical Center. He now is with Telstronix, Inc., Santa Clara, CA. Jack Pfitzer is chief, Medical Media Production Service, St. Louis Veterans Administration Medical Center. 'American Hospital Association. Hospital Statistics. Chicago: AHA, 1979. HOSPITALS/JULY 16, 1981 185 each division four times daily carry- ing interoffice mail, laboratory speci- mens, patients, and employees. The Figure 3—Microwave teleconferencing system at St. Louis Veterans ride is notoriously rough, and, Administration Medical Center regardless of the purpose of the mis- sion, the round trip invariably John Cochran Division consumes half a day. The telephone VA Medical Center requires only the prefix "1" for direct dialing between divisions, and conference calls are frequently used 1 mile by administrators. 11.2 miles "Interactive media" is the broad term for communications exchange linkups between two or more locations. Passive "Telehealth" refers to communica- Metal Reflector St. Louis University tions support systems. An informal School of Medicine application of a telehealth system is physician consultation via telephone. Jefferson Barracks Division SLVAMC uses formal applications VA Medical Center including telephone-to-computer re- production of scans from seven VA hospitals as far away as Syracuse, NY, and Grand Junction, CO, for have a technician in the control room rounds, and departmental staff diagnosis by the SLVAMC Nuclear at JC, monitoring can be adjunct to meetings. Medicine Department; telephone-to- other duties. Educational sessions usually require a cameraman at the New nurses are given a feeling for computer color graphic reproduction the larger purpose of the VA in of teaching slides; and teleconferenc- place of origin to obtain close-ups of demonstrations and written work. house education sessions. Policies are ing. Communication signals can be presented in consistent fashion, and transmitted by telephone, cable, Training sessions in which competen- cy must be proved may require the teleconference gives a cohesive direct microwave, and relayed micro- approach to standardized procedures. wave. Microwaves, because of short camera operators at both ends of the transmission. Grand rounds, which originate at any wavelength and high frequency, one of the three locations, are educa- transmit only along line of sight. JC is the switching point for trans- tional experiences in which formal When a ground object or the curva- mission to the St. Louis University papers, clinical cases, and lectures ture of the earth obstructs the line of Medical School, which is by line of using visual aids are presented. De- sight, the waves may be relayed by sight, and to JB, which requires one partment heads are also beginning to satellite or by repeating surface relay from a reflector on a water realize the value of teleconferencing. stations. tower at JB (see figure 3, above). Weekly meetings are scheduled Teleconferencing operations at Distribution is through the hospital's through MMPS. Library service, SLVAMC come under the Learning closed-circuit television system, which medicine service, nursing service, Resources Service and Medical Media has control room videocassette re- and now pharmacy service are regu- Production Service (MMPS). In cording capability. Participants view lar participants. Learning Resources addition to teleconferencing, func- themselves as they are seen at the Service has weekly staff meetings via tions include medical illustration, other division on one screen and view microwave as a matter of routine. photography, and production of com- the distant party on another screen. Television studios at JB and JC are In April of this year, the director's plete instructional packages for dis- staff meeting was held via micro- tribution throughout the VA system. acceptable for small informal meet- ings but not for large conferences. wave for the first time instead of Because of SLVAMC's systemwide There are approximately 50 locations having half the participants travel VA role, staffing consists of television at each division, including the via shuttle bus. Administrative assis- production specialists, graphic artists, director's office, the chief of staffs tants were also invited to attend. writers, designers, photographers, conference room, and auditoriums, The agenda was short. Because of and engineers. Because MMPS had that can receive and transmit simul- the newness of the situation, reports already been designated a regional taneously. were given efficiently and much time production center, no additional em- was saved. Some original stiffness ployees were required to staff the SLVAMC has established patient dissolved into a more relaxed atmo- microwave system. During a typical care, medical education, general sphere after the first 10 minutes. teleconference, cameras at each site education, and administrative uses as Oral and written responses were all are fixed and do not require move- priorities for the teleconferencing favorable, although one participant ment. Although it is advantageous to system. Current regular uses of tele- did suggest that the meetings should conferencing include nursing educa- be held in person at quarterly inter- tion orientation programs, grand 186 HOSPITALS/JULY 16, 1981 vals in order for people to mingle of the privacy of their transmissions, computed. It may be possible to before and after the meeting. because regular television receivers quantify benefits gained from in- lack necessary converter components. creased control for a corporate execu- Teleconferencing is especially useful tive. But how does an executive eval- when there is more than one person To be sure, there are problem areas uate the safety and convenience of at one of the locations, because par- in telecommunications. Technology decreased travel during inclement ticipants are forced to be responsive provides the hardware, but what weather? How does an administrator to the issues under discussion. Meet- about the people involved? Telehealth assign a dollar value to the sense of ings held via microwave are viewed deals in an area in which human identification with the mission of the by participants as being more struc- beings need to catch up with tech- organization gained by a nurse tured, so agenda adherence and orga- nology. Problems in the microwave during orientation? Values formed nization are enhanced. Leaders pre- system may mean that a meeting has during this crucial experience could pare their topics well, because the to be rescheduled. The very notion of greatly affect future performance. camera accentuates their roles. Meet- technological answers to communica- ings are easier to control, because tion problems requires difficult cost Past applications of telehealth sys- side conversations can be picked up justification to cautious administra- tems have been limited to remote by the microphone. One study shows tors. regions—Indian reservations, geo- that teleconferences were from 15 to graphically isolated regions, and 40 percent shorter than meetings in The cost of a basic microwave tele- rural areas. Advancing more readily person.* Teleconference can supple- conferencing system will vary de- available technology will make tele- ment or totally replace travel. pending upon distances, number of
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