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Telemedicine
At Makati Medical Center, our commitment to excellence shows. This commitment dictates that we exert all effort to keep up-to-date with the latest medical practices. Doing so involves making skillful use of advanced and evolving teleconferencing systems to consult with our colleagues in other parts of the world.
For some time, we have held teleconferences with our colleagues at the prestigious Stanford University Medical Center—known worldwide for advanced patient care and the treatment of rare disorders. More recently, we began holding teleconferences with the University of California San Francisco Medical Center. We call this practice telemedicine, and we use it to share medical knowledge across continents—and ultimately, to deliver exceptional care to you, our patients.
Our collaboration with Stanford has been going on for decades, allowing us to consult our colleagues there on medical cases, to gain second opinions and to attempt secondary diagnoses.
Optimizing Phone Lines
Initially, we communicated using overseas phone calls and fax messages. In November 1991, through the efforts of Ms. Dale Jensen, Director, and Dr. Walter Arons, Medical Director, of Stanford’s International Medical Services (IMS), Stanford loaned us an Optel Telemedicine conference system on an open-ended basis. Purna Prasad, the Stanford Medical Engineer, came over to install and set up the system.
At the heart of the Optel telemedicine system was a 1991 vintage PC 386 SX EL with 2 MB of RAM and 40 MB hard disk storage space. To obtain medical images, we used two video cameras and a Gordon light box to view x-ray, CT, MRI and Nuclear Medicine films. These images could be revised and annotated by writing on an electronic graphic tablet.
Live voice communication was accomplished through a second phone line provided with a speaker phone.
Using this system, we were able to conduct live consultations between our doctors and our colleagues in Stanford. This was practically the first trans-Pacific link between hospitals, and it used only ordinary phone lines!
To work around the time difference between the two countries, we held live consultations at 8-9am in Manila, which is 4-5pm in California.
Although not perfect, image quality of x-rays, CT, MRI, Nuclear Medicine and others at that time was good enough for the Stanford doctors to make a secondary diagnosis or give second opinions.
For all the Telemedicine consultations of 1992, the consultants, foreign and domestic, submitted no professional fees.
Upgrading Our System
On December 1996, we upgraded to a Pentium 100 PC with 16 MB of RAM, a 1 GB hard drive, a SGVA color monitor, a 28.8 kbps US Robotics Sportster modem and an Optel Telewriter 2000 ver. 2.33 software. The two video cameras and the Targa 16 video digitizing board were retained.
In September 1997, with the encouragement of Mr. James Bair, then director of the University of California in San Francisco (UCSF), we acquired a videoconference system that allowed conferees to see each other in real time.
Since ISDN was not available locally at that time, the Makati Med conferees were initially provided with two SDI (2×56/64 kbps) lines. The medical images produced left much to be desired, but this was still a great improvement over the still images seen in the past. Later, the system we acquired included a VTEL 232L C5000dM, provided with a Pentium 166 MHz CPU, 32 MB RAM, 8X CD-ROM, and a 1.2 GB hard drive.
Since 1997, we held monthly videoconferences, with the different medical departments of Makati Med able to suggest their preferred topics for discussion.
Makati Med Opens Videoconferences to All
Today, conferences started at 8am Manila time and generally last for an hour and a half. These are attended, not only by Makati Med doctors, but also be other doctors from the different Metro Manila hospitals. Conference participants usually number 80 to 100.
Today, our monthly videoconferences are organized largely through the efforts of Ms. Cara Towle, Manager of the U.S. Health Care at the UCSF campus who synchronizes topics and the speakers from the medical staff of the UCSF Medical Center and Stanford University Medical Center.
One distressing problem encountered initially was the difficulty of establishing a good SDI connection originating from Manila to California. Sometimes, it would take as long as 30-45 minutes before a call could go through. Video images obtained using the SDI lines were jerky. Even at best, a delay of few seconds noted.
But in June 1998, we upgraded and changed from the SDI lines to two ISDN lines (2×56/64 kbps with 4-channel capability up to 256 kbps). This considerably eliminated the video jerkiness and delayed audio. The image resolutions have also improved tremendously.
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