Developing and Using a Televideo Application in a Nursing Facility

Although video-based teleconferencing is becoming more widespread in the medical profession, especially for scheduled consultations, applications for rapid assessment of acute medical problems are rare. After regular business hours in the nursing home, physicians are often not immediately available at the bedside to evaluate patients with acute medical problems. Spontaneous videoconferencing between residents (patients) and off-site, on-call physicians offers additional opportunities for physicians to gather additional information directly from residents. We have designed, assembled, tested, and implemented a portable, wireless conferencing system that uses public Internet channels for secure, live videoconferencing. The system includes a rolling cart with videoconferencing hardware and software, a remotely controllable digital camera, lamps, wireless network, and battery. A semi-automated paging system informs physicians of residents’ study status and indications for conferencing. Data transmission occurs wirelessly in the nursing home and then through network cables to physicians’ homes. This provides sufficient bandwidth to support quality motion images. IPsec secures communications. Despite human and technical challenges, this system is affordable and functional. We conducted a clinical trial of the system. Although most calls for medical problems did not lead to videoconferencing, physicians and nursing-home residents were satisfied with videoconferencing when it did occur, and physicians reported that making medical decisions was easier with videoconferencing. Videoconferencing was most often conducted to assess residents with changes in mental status, abnormal laboratory values, or falls. Physicians often lacked immediate access to videoconferencing equipment when medical problems with residents occurred. This application could benefit from improved access and portability of equipment.