Digital Video for Medical Training and Telemedicine

With a total of16 hospitals, clinics, and universities in Pennsylvania, Allegheny Health Education Research Foundation (AHERF) needed a way to increase collaboration, share information, train medical students, and give the best possible care to their patients--in spite of the physical distances between AHERF's many locations. On a daily basis, AHERF's doctors, students, and professors share and exchange ideas and medical information through their computers and computer-expanded classrooms.

Sharing Expertise

"We have designed the system to allow us to share our lectures, surgery cases and other educational information with our medical students," says Dr. Julian Bailes M.D. "This is a tremendous benefit to our educational capabilities and ultimately our quality of patient care, while reducing medical costs." Dr. Bailes led the Neurolink program to implement telemedicine and save costs at Allegheny General Hospital.

Participants at AHERF use the new telemedicine system to share information every day. High quality video conferencing gives students the chance to observe an operation and ask questions, while avoiding travel time and expenses. Now several hundred students can observe an operation and learn new techniques without overcrowding the operating room.

Digital Video Expands Classrooms

AHERF's colleges, such as Medical College of Pennsylvania and Hahnemann University, use networked digital video to enhance learning and to offer classes to hundreds of additional students in satellite classrooms. The new system adds critical information to lectures, improves the learning environment, and uses live video and audio to connect classrooms at three campuses. AHERF's new system improves learning through enhanced teaching, offers a choice of learning environments, and provides a digital note-taking service.

In addition to improving the quality of education for students, AHERF's computer-based video system has made it possible to increase enrollment and sign up students at remote campuses while keeping the quality of instruction high.

Video Replaces the Chalkboard

With AHERF's computer-based video system, the instructor has a whole range of media and tools to improve communication, all accessible through the workstation. The instructor can show live video and audio coming over the network from a teaching hospital in Philadelphia or Pittsburgh, or video and audio stored on videotape or hard disk showing a surgical procedure, case history or medical animation. The instructor uses a digital whiteboard to write on and display images, so she never needs to turn her back to the class. She can display medical charts and graphs, and can use images such as X-rays, CAT scans and microscope photos to illustrate the lecture. The instructor watches video of the remote classrooms through a display to see if the students understand. And students see all the information projected onto large screens at the front of each classroom.

"This new technology takes account of different learning styles among students," says Dr. Arnold Smolen, AHERF's assistant dean of education resources. "Some students are comfortable learning in a large lecture room, and others prefer the small classroom setting. Now both can be involved in the same lectures, but can learn in ways that suit them best." When a class is offered on several campuses, students can choose the most convenient location. Students in every classroom receive all the information available, and use the digital audio/video between classrooms to participate fully in discussions.

Digital Note-Taking

So that students can focus on learning instead of speed-writing, AHERF's system captures information for class notes. Whiteboard notes, graphics, and video stills are captured and saved to provide reference material for the class.

Students See Better

Using computer-based video, AHERF has dramatically increased enrollment in medical classes and improved the flow of information to their students. A student at Medical College of Pennsylvania says, "I prefer the alternative classroom to the large auditorium. I can see and hear better than I can from the back of the auditorium. You forget that the professor is not actually there in the room with you."

Teaching with Live Surgery

AHERF uses its networked digital video system to show live medical procedures to students, so students can learn special techniques from the experts. In one demonstration, neurosurgeons showed their methods to a broad audience of medical students and other professionals up to 1,300 miles away (2,100 km). While medical students at two Universities in Pennsylvania and observers at a medical conference in Texas watched and asked questions, Dr. Takanori Fukushima, M.D., D.M.Sc., and Dr. Bailes performed three brain surgeries.

Doctor Fukushima is a world-renowned neurosurgeon who has made major breakthroughs in the art of neurosurgery. With a video microcamera inside the brain, a full-size video camera in the operating room, and a powerful telemedicine system, he was able to show others how to use some of his innovative techniques. The JPEG-compressed live video ran at full frame rate and full size (640 by 480 pixels), and was multicast over the network.


AHERF decided to use Asynchronous Transfer Mode (ATM) network technology for the telemedicine and distance learning network. AHERF's senior vice president Joe Dionisio says that with ATM, "AHERF will have universal access to experts and resources at all of our hospitals, clinics, and academic institutions, enabling us to provide our patients a superior level of service and treatment."

FORE Systems is providing AHERF's ATM network equipment, including ForeRunner ATM switches and adapter cards. AHERF is using AT&T's ACCUNET T45 (45 megabit per second) data communication service, with plans to move to SONET in the future. The video conferencing software is Paradise Software's Simplicity.


Director of technology management Dave Ruminski says, "We have just opened the door on the potential of this technology. Medical support of remote facilities, enhanced education and medical reference are in the future expansion plans for this project."

AHERF is a non-profit organization providing health care and medical training in Pennsylvania. With 2,622 hospital beds throughout the state, AHERF's goals are to heal the sick and keep patients healthy, and learn and teach good medical practices. AHERF employs 14,000 people, including 3,500 faculty members.

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