The telemedicine department is continually trying to improve the technology and applications we utilize to enhance the experience of providers and patients using our system.  We see telemedicine as having a solid foundation in the future of how medical care is provided.  To ensure we meet our expectations, as well as those we interact with, research is a prominent part of our work. 

Vermont Rural Telehealth Initiative

The Vermont Rural Telehealth Initiative began in 1998
through funding from the Office for the Advancement
of Telehealth (OAT Grant #H2A-TM00118) in order to evaluate the acceptance of telemedicine, satisfaction of use, apparent benefits, and strengths and weaknesses of the system for use by medical students and primary care physicians. 

University Classrooms were outfitted with telemedicine equipment so medical students doing rotations at remote hospitals could attend class by video and still interact with fellow peers and course directors.  The students then would complete a questionnaire assessing the videoconferencing system.  In-depth interviews and observational studies were also conducted among a sample of student users.

Physicians utilized the system to both conduct clinical consultations and view continuing medical education (CME) lectures.  Physicians using the system documented the type of consultation, satisfaction with both technical performance and quality of services provided, confidence in accuracy of the diagnosis or treatment, and costs potentially eliminated by using the system.  Patient responses to telemedicine
consultations were also collected through paper and
pencil questionnaires.

Image quality and viewer preferences, while using the telemedicine network, were assessed by tests designed specifically for areas of interest such as image quality and resolution.

Rural Trauma 

Trauma victims in rural communities are nearly twice as likely to die from their injuries as those injured in urban settings.(1) Delay in discovery times, longer transport times, and the rural practitioner's level of experience with major trauma are likely factors to contribute to this statistic.  In recent years, Fletcher Allen Health Care's trauma care has dominated much of our clinical care delivered over telemedicine.  Starting with a pilot project, funded by the Department of Commerce, Technology Opportunities Program (TOP Grant #USDOC50-60-990024), titled "Improving Rural Trauma Care, Education and Prevention Through Telemedicine", trauma surgeons provided full time, (7 x 24) coverage of several rural emergency rooms to assist in the care of injured patients.  In a few instances, this assistance was even judged to be potentially life-saving. (2,3) This program has proven to be a model example of the use of telemedicine in surgical disciplines.  When an injured patient arrives at a rural emergency room, a surgeon in Burlington immediately connects to that emergency room via video-conference.  A collaborative relationship with the rural surgeon or the emergency room doctor results in improved and more efficient care.  This program is ongoing and in fact expanded with a grant from the HRSA Office for the Advancement of Telehealth (OAT Grant #1DIB-TM-00081) in the Vermont Teletrauma Project. 

Currently we have 6 trauma doctors with home videoconferencing systems, and 7 emergency rooms in rural Vermont and upstate New York participating in our teletrauma program.

To learn more about our trauma program please click here to view a presentation.

FAST STAR
Fletcher Allen Specialized Telemedicine for Supporting Transport And Rescue

Since 2004 Fletcher Allen Health Care, the University of Vermont College of Medicine, and Texas A&M University, through funding from the National Highway Traffic Safety Administration, U.S. Department of Transportation, (USDOC Grant #DTNH22-04-H-01425) have collaborated on a project entitled: FAST STAR, Linking Telemedicine to the Moving Ambulance. The goal was to develop and field test one-way video and two-way audio in a moving ambulance.  The FAST STAR system utilizes current cellular telecommunications technology to multiplex and transmit high quality audio and video.  The objectives of this project were to evaluate the viability of the cellular system to handle multiplexed video calls, determine the optimal characteristics of a mobile video system for matching clinical needs and bandwidth requirements, develop software to maintain the video calls, and deploy the system into an existing ambulance for emergency simulation testing.

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