BR Med-Connect began as the dream of Dr. Cullen Hebert, a pulmonologist at Our Lady of the Lake (OLOL) Medical Center in Baton Rouge, who wanted to employ better ways to deliver health care services throughout the 471 square miles Parish, and, in particular, in the more rural areas. Among the special problems he needed to overcome was the demographic diversity of the region, going from the 75 sqaure mile urban area of the City of Baton Rouge, pop. 230,000, home to three universities, the largest oil refinery in the United States and a major hub for the Transcontinental Gas pipeline, to the rest of BR, with a population of over 180,000, largely poor and living in a highly rural setting. Spurred on by what he saw during Hurricane Katrina, Dr. Hebert’s thoughts went immediately to the Parish’s highly developed EMS System and the use of telemedicine technologies.
What is EMS telemedicine?
To understand what BR Med-Connect is all about, it is important to understand what EMS telemedicine really is. The best way to think about EMS Telemedicine is to think of it as simply the enhancement of EMS’s mission through the use of modern communications and information management technologies. EMS telemedicine is not the stereotypical “big brother camera looking over my shoulder,” or some return to “mother may I” permissions for treating patients. Quite simply, EMS telemedicine incorporates the concept of telemedicine in its fullest form -- the delivery of heath care at a distance.
When looked at that way, EMS Telemedicine refers to virtually ALL activities that relate to EMS:
Communicating voice, data and images
- Managing all forms of information (12-Lead reports, EPCRs, treatment protocols)
- Allowing distant participants to provide assistance in disaster response activities such as syndromic surveillance, treat and release, mobile clinics, and on and on.
This is a far broader concept than merely the use of cameras and images to help treat patients and this was the target that BR Med-Connect fixed its sights on.
Communications, ambulance and ED equipment
Making the concept of BR Med-Connect work required advanced forms of communications and specialized equipment in the ambulance and in the hospital. The following describes BR Med-Connect equipment infrastructure:
The communications infrastructure
East Baton Rouge Parish consists of pockets of moderate-to-high population density surround by a large area of very low population density, the former having a moderate-to-good communications infrastructure (mesh, 3G cellular, UHF/VHF radio) and the latter moderate-to-poor communications (2G cellular, UHF/VHF radio and some 3G cellular).
The bandwidth of a Tropos mesh system is fully capable of supporting all the video and data needs of an EMS telemedicine system whereas that of a 3G cellular broadband system can support most of the data transmission needs, with video images at slightly reduced performance. Because the telemedicine system uses a high-gain roof antenna to improve performance of 2G cellular, permitting it to support most of the data needs and some of the image transmission needs. Although voice can be sent by mesh and 3G cellular, it is often preferable to use existing UHF and VHF radio for this purpose.
Fortunately for BR Med-Connect, the City of Baton Rouge has a modern Tropos broadband wireless mesh system with 2-3 MB/sec capabilities already installed in nine square miles of its high call volume areas, exactly where advanced forms of prehospital trauma care are needed.
The ambulance side of BR Med-Connect is a General Devices’ Rosetta-VC (VC) Communications controller with mesh and cellular interfaces. A “roaming” feature automatically switches the connection between the two communications means and modifies the outgoing data stream to match the communications capabilities. The system automatically encrypts and “packages” the outgoing data to provide both secure and reliable communications. The ambulance has a headset as well as hands-free voice communication features and a remotely controlled ceiling mounted pan-tilt-zoom (PTZ) camera located above the patient’s midsection. A 15” touch-screen monitor located in the rear of the ambulance provides both display and control means for the system. This equipment allows the patient to both see and speak with the distant physician. In addition, a compact keyboard is provided in the forward section of the patient compartment for inputting text information. BR EMS has also gone as far as to work with their ambulance manufacturer in integrating the Rosetta-VC equipment into all new vehicles received from the company. This will allow for optimum placement of the camera, touch-screen monitor and other components so that they are delivering the best results for both the paramedic and the physician at the receiving hospital.
The hospital ED side of the system is a CAREpoint EMS workstation and is a fully integrated system for telemedicine as well as all other EMS functions that take place in the ED. At present the workstation is being used only for BR Med-Connect but will soon be used for day-to-day EMS radio communications. Combining these functions will greatly assist the ED staff in managing EMS calls and allow them to log all call activity (EMS, STEMI and telemedicine) for training, QA and other record keeping purposes. The workstation will also support the features BR Med-Connect is planning for the future.
The BR Med-Connect team
One of the more important aspects of BR Med-Connect is the team that was assembled to plan, implement and operate the system. Because the “stakeholder” concept was recognized from the onset, it was decided to involve all key participants in the project. A team was then formed of hospital-based physicians, EMS and ED staff, city communications and IT personnel, and city and hospital administrative personnel -- all of the major stakeholders in the system. The creation of this interdisciplinary team meant that the ultimate end users (the physicians), those who are using the system (EMS and ED), those that have to make it all work (communications and IT), and those that are responsible for managing and paying for the system were involved in its development and use.
(Part two will discuss planning, implementation and applications.)