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More efficient videoconferencing moves toward the physician desktop.

It's called network videoconferencing. New standards are enabling physicians to make videoconferencing calls to each other and to patients using software on their desktop PCs instead of needing a dedicated telephony-based ISDN (integrated services digital network) connection.

The software setup lets doctors within a hospital, or doctors connecting from one hospital to remote hospitals, share video, documents and applications over a common network.

Sounds simple enough. But such high-tech telemedicine remains far from push-button. Videoconferencing over Internet protocol (IP), as the emerging desktop technology is called, runs into obstacles when network bandwidth is inadequate, resolution is poor or the equipment being used comes from different manufacturers.

Yet IP videoconferencing is making inroads into a market dominated by ISDN.

One reason is H.323, one of the videoconferencing standards adopted by the International Telecommunication Union. It applies to real-time multimedia communications over IP transport (http://www.intel.com/proshare/conferencing/h323/)

The standard's continued refinement is converging with telecommunications companies' move to IP telephony, an efficient way to transport data packets over bandwidth that's less expensive than dedicated links.

Will infrastructure matter?

Medical campuses are starting to divide into two camps: the few that have invested in multimedia networks with high bandwidth that will support IP, and those with 10 megabit per second Ethernet systems.

Those with 10 Mbps Ethernet systems are finding that their e-mail goes down regularly, and they are left with no choice but to use ISDN for videoconferencing.

The sites with 100 Mbps Ethernet are ahead of the curve, although that bandwidth will be eaten up quickly as more sophisticated technologies emerge.

One health care provider is taking no chances with a fast-switched Ethernet system that supports 622 Mbps speeds to the desktop. The Baylor Health Care System in Dallas is partnering with Southwestern Bell in creating a private, fiber optic telecommunications system that connects 100 sites across the Dallas/Fort Worth metroplex with either T-1 or ISDN links. Another 650 miles of copper cabling connects 9,000 desktop computers and clinical workstations to the network.

The project, which required a complete redesign of the cabling system and installation of centralized super-servers, ultimately will let physicians examine 3-D CT scans at clinical workstations while holding a telemedicine consultation and searching a clinical data repository.

The network is designed to eventually use ATM (asynchronous transfer mode), a digital transmission technology that simultaneously transmits broadcast video, data and voice. The ATM technology will allocate bandwidth on demand, which enables desktop videoconferencing as well as 3-D medical imaging or other bandwidth-intensive applications.

Unfortunately for many physicians, the philosophy behind the Baylor network design runs counter to today's managed care environment.

The project is an investment in Baylor's infrastructure and was a mandatory expense. "We didn't do this to show a positive return on investment," says Bob Pickton, senior vice president and CIO. The result is a scaleable network that supports high-end solutions, rather than a patchwork of separate systems.

Yet the Baylor strategy allows for an emerging hybrid solution that may prove more cost-effective for other health care systems. That hybrid will use IP in the campus environment and cross a gateway onto an ISDN connection to link to remote sites.

Three information technology heavyweights are collaborating to let videoconferencing work end-to-end, bridging the IP and ISDN worlds.

Intel Corp., Cisco Systems and VideoServer have started developing solutions that work together. Intel makes the video systems for desktops and conference rooms; Cisco manufactures routers and software that manages the video streams, and VideoServer makes the equipment that bridges the IP and ISDN networks.

Intel Corp. offers its TeamStation System 4.0 Update 2 for videoconferencing. The workgroup system, designed for the conference room, includes a PC, software, camera, microphone, keyboard, speakers and monitor. The company also makes an add-in card for the PC that works on both LAN and ISDN networks.

Other players are making their voices heard, too.

VTEL Corp.'s Digital Visual Communications system, called the HS2000, lets students in Jersey City, N.J., watch cardiac surgery and talk with operating room staff at Morristown Memorial Hospital in the same city.

The HS2000 is a roll-about system that connects to a range of video-based medical peripherals. Atlantic Health Systems hopes to expand the so-called cardiac classroom to other clinical areas, such as neuroscience and orthopedics.

VTEL (http://www.vtel.com/vtelgif/index.html) also is introducing a roll-about system with built-in videoconferencing capabilities designed for the emergency department. It operates over IP, eliminating the need for separate ISDN connections in each hospital room.

Sony Corp.'s flagship product, the TriniCom 5100Plus (http://bpgprod.sel.sony.com/medical/products/telemedicine.html), lets a doctor do videoconferencing among as many as four locations without bridging through the telephone system. It is to be used in an as-yet-unannounced cardiology application by enabling high-resolution video at 384 kbps speeds.

Regardless of the equipment or the transmission system, physicians need to get hands-on experience with videoconferencing technology and involve themselves in buying the best fit for their needs.

Tony DeFrancesco, health care marketing manager for PictureTel in Andover, Mass. (http://www.picturetel.com/) cautions his physician clients that it's an experience unlike their medical training. "There are no standards, requirements or books they can go to."

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Technically Speaking appears every other month with online insights for physicians. Send comments to sandra_guy@ama-assn.org