Services Description
The first service is
for antepartum patients who are confined to a hospital bed for extended
periods as a result of complications of their pregnancy. These patients,
particularly those who reside in distant rural communities, experience
significant isolation from their families as a result of their condition.
Lengths of stay for antepartum patients can last from one to several
months. Because spouses of expectant mothers have to continue to
work at their jobs, and children have to continue to attend school,
separation anxiety can be significant for the expectant mother,
and for the family members who remain at home. In this situation,
family members undoubtedly make regular telephone calls to the hospitalized
expectant mother. “Seeing Is Believing” allows expectant
mothers to see and talk to their distant family members using low
cost videoconferencing technology operating over a single regular
telephone line. The system also allows family members to see the
expectant mother. The value in this service is in allowing family
members to see each other while they talk to each other,
for the same cost as a regular telephone call. The impact of adding
a visual component to family communications under these circumstances
cannot be overstated or undervalued.
The second service is
for use in the Neonatal Intensive Care Unit (NICU). Parents of NICU
patients are encouraged to be present in the NICU with their infants
as much as possible. However, when the baby’s family resides in
a distant rural community, work and family responsibilities combined
with extended lengths of stay make it difficult for parents and
family members to be present continuously. In almost every case,
separation of family members results. While one parent may be able
to stay in Des Moines with the NICU patient, often the other must
return home to work and family responsibilities. Separation of one
or more parents and siblings from the NICU patient can have several
negative impacts on all family members. Separation of the parents
creates additional marital stresses during an already trying time
and bonding to the infant by one or the other of the parents can
be delayed. Additionally, this situation takes one parent out of
the household and creates stresses on siblings. Further, inability
of siblings to see and spend time with the infant delays their bonding.
Low cost easy to operate videoconferencing technology can be used
to enhance the level of communication between separated family members,
allow distant parents and siblings to monitor the status and wellbeing
of the NICU patient, and just see the patient. For separated
spouses and siblings the impact of being able to see a distant family
member while talking to them, or just see the new family addition
regularly, despite geographic separation, cannot be overstated or
undervalued.
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Technology Utilized
The two-way interactive
compressed videoconferencing technology utilized for these services
is both relatively new and highly revolutionary. The product used
is the ViaTV Phone, manufactured by 8x8, Inc.. (Note: The ViaTV phone remains in use, however, it is no longer manufactured by 8x8 Inc. Other similarly affordable replacement products are now available.) This technology is ideally suited for these services
for the following reasons:
- Uses a single regular
telephone line to send and receive both audio and video images.
Can be used with any existing telephone line already in a patient’s
home. Direct phone line connections do not require the complicated
security measures necessary with communications routed through
the Internet.
- Incurs no special
telecommunications costs. A two-way audio and video call costs
the same as a traditional local or long distance audio only call.
Users do not have to have and pay for Internet access.
- Very simple to install
and operate. Connects to the user’s regular telephone and TV set.
Set up time is five minutes or less. Does not use complicated
and expensive computers. A standard touch-tone telephone handset
controls all functions. Users need not be computer literate.
- Extremely affordable.
Assuming a standard telephone and TV set are already available,
the basic product costs approximately $499 to place in a patient’s
home. Patients and relatives may choose to purchase their own
systems and use them amongst themselves after the patient is discharged.
The ViaTV Phone does
not provide TV quality images. The video pictures are unquestionably
softer and slower to refresh than a standard TV image or than the
much more expensive and complicated compressed videoconferencing
systems used by the MRTC. However, the image and audio quality are
satisfactory for many social and medical applications. The ViaTV
Phone has been used extensively for telepsychiatry and telehome
health services delivery with resounding success. It represents
a very practical and affordable way to add significant value (the
ability to see the person on the other end) to a conventional telephone
conversation while not incurring the usual high costs of more traditional
videoconferencing systems.
The ViaTV Phone allows
the two parties to establish a regular voice telephone call first.
Then upon mutual consent, one party initiates a video call. After
approximately 30 seconds a video call is established and the parties
continue their conversation while simultaneously seeing the party
they are talking to at the other end. At the end of the call, both
parties just hang up the telephone to terminate the call.
The ViaTV phone has several
features that enhance its value. It allows the user to select settings
that maximize picture quality, or fluidity of motion. It has a remote
electronic pan, tilt, and zoom feature. And it has an auto-answer
feature that allows the calling party to enter a security code at
a prompt and automatically establish a video connection without
requiring the distant party to answer. After calling the NICU,
and being connected to the proper extension, this feature will be
used by the parents of a NICU baby to make regular visual status
checks on a baby without having to occupy the time of a staff nurse.
Of course the parents will want to talk to a nurse periodically
as well. But, just being able to call in and see the baby at any
time (anytime the baby is not sleeping in a hooded isolette) provides
reassurance for the distant parent and contributes to the parent’s
bonding to the child. Making it possible for the child to hear the
distant parent’s voice, even over the telephone, may contribute
to the child’s bonding to the parent as well.
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Policies and Procedures
"Seeing Is
Believing" is implemented in the antepartum and neonatal
intensive care units on a voluntary basis. Patients and families
are advised of its availability and asked if they would like to
participate in this service. There will be minimal cost to the patients
to use the service during the trial period – just the cost of the
telephone calls they make to establish a video connection. Patients
and NICU baby parents have to sign a consent form and a few specifics
regarding the use of the service are conveyed to the patient and/or
parents. A “loaner” unit is then be provided to the family and they
receive elementary training on how to install the ViaTV Phone in
their home. A roll-about unit is then placed at the patient’s bedside.
Distant family members are then able to call into the patient unit
and establish a video call at anytime it is not deemed to be inappropriate
by antepartum or NICU staff. The appropriate nursing personnel always
have control over whether or not a baby’s camera is turned on and
available to establish a video call. Similarly, both the nurse and
the expectant mother have the ability to determine the appropriate
time to receive and establish a video call. Other appropriate restrictions
on the use of the videophone are identified from time to time.
User satisfaction and
utilization statistics are solicited from patients and parents participating
using self-reporting tools. Use of the service and the ability to
receive a loaner system for installation in the patient’s/parent’s
home will be contingent upon participation in the evaluation program.
The
Midwest Rural Telemedicine Consortium provides technical support
for the program. MRTC staff provide training in the installation
and use of the technology to the nursing staff as well to the patient/parents
at Mercy Medical Center-Des Moines. Should assistance be needed
at the patient’s/parents’ home, a MRTC staff person is available
to assist telephonically. The need for on-site installation services
has never occured. MRTC staff are also available to troubleshoot
and resolve technical difficulties should they arise while using
the technology.
Because
the technology used for these services is both affordable and readily
available to the consumer users other than the immediate family
members of the patient may want to utilize these services. Responsibility
for distribution of the telephone number and security code for the
individual system at Mercy Medical Center-Des Moines will rest with
the patient, or parent(s) of the NICU baby. Anyone to whom they
distribute the number and code will be authorized by them to use
the service. This is explained in the consent form.
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Summary
These two initiatives
are primarily intended to add social value to the high quality services
Mercy Medical Center-Des Moines already delivers to its patients
in the Women’s and Children’s Health Services department. Patients’
and parents’ impressions on the value and success of these initiatives
has been universally high. These services represent psychosocial
considerations for, and support of the patients for whom we care.
The cost to provide these services is considered negligible compared
to the positive impact they have on our patients.
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