Remote Conference for the benefit of residents rotating to satellite hospitals at almost no cost

1. Remote Conference for the benefit of residents rotating to satellite hospitals at almost no cost Arkansas Children’s Hospital University of Arkansas for Medical Sciences Dr Chetan Shah Dr Chandra Donepudi Dr Ralph Panek Dr Rohan Samant Presenter: Dr Sarah Klein

2. What is a Remote Conference? • Remote conference allows people to participate in the same conference at the same time even though they are physically not in the same place.

3. Conference at University of Arkansas Medical Sciences Hospital Residents and staff listening and watching from Arkansas Children’s Hospital

4. Let us sit on a time machine • Before we proceed, let us sit on a time machine and go to year 2091. • We are now in 2091 and entering a History 101 class

5. A slide from History 101 class of 2091 A.D. • There are two distinct eras in the history of human beings Pre-Internet Era - B.I. (Before Internet) & Internet Era - A.I. (After Internet) • Launch of modern internet in the form of www (world wide web) in 1991 A.D. was Year 1 A.I.

6. Pre-Internet Era • In the pre-internet era, remote conference meant Video conference that involved • High expense • Limited access • Poor quality

7. Internet Era • Internet era brought revolution in telecommunication technology. • Now, the remote conference is • Affordable • Accessible • High quality

8. Radiology Remote Conference • Radiology remote conference involves • Two way conversation between the speaker and residents located at different hospitals • Sharing the same image or text • Sharing the pointer to show a finding on an image

9. Pre-PACS Era • In pre-PACS era, Radiology Conference meant • Radiographs • Projector slides • Transparencies • Laser pointer • Even expensive video conference set-ups had unsatisfactory resolution of physical films or projector slides limiting visualization of subtle radiological findings. • High quality video conferences were even more expensive.

10. PACS Era • Today, in PACS era, Radiology conference require 5 ‘P’s • PACS images on the computer • Power point on the computer • Pointer of the computer mouse • Personal computer • Phone • Obviously, if we can share the same computer screen (desktop) at more than one location we can achieve a remote conference.

11. Flow Diagram of connection Internet connection Phone connection MAIN HOSPITAL CONFERENCE ROOM SATELLITE HOSPITAL

12. 4 Components of Remote Conference • Setting up a remote conference requires • 1) Broadband high speed internet • 2) Sharing the computer screen • 3) Good quality speaker phone • 4) Teamwork

13. Sharing the computer screen • Free software is available over the internet that allow us to share the computer screen. • It can be downloaded from http://www.tightvnc.com/vncviewer.1.html • When you go the next slide or image on one computer, the same screen is displayed on the remote computer. • When the mouse pointer is moved to point to a finding, residents at the remote location can see it moving.

14. How much computer knowledge is required? • Initial set-up will require the help of a computer savvy resident or someone from the computer department of the hospital to download and set up the software. • After initial set-up, only 2 mouse clicks and a password are required.

15. Can the residents take a case from the remote location? • Yes, because it is a two-way connection. In fact, conference call and the software allow multiple sites to participate at the same time. • Resident from remote location can also take a case and use mouse pointer from that computer to point to a radiological finding. • The speaker and the residents at other locations can see the same mouse pointer moving.

16. High quality speaker phone • Regular speaker phones at both the ends provide adequate quality of voice. • If you want better voice quality, you need to buy high quality speaker phones. • There are many high quality speaker phones available in the market.

17. Cost of high quality speaker phone • We used Polycom SoundStation2W. It Costs about $600 • For a larger room you can use Polycom SoundStation VTX 1000 model with 2 extra expanded speakers to cover entire room. It costs about $ 1100 • These are available at Best Buy or Staples or on various websites.

18. For remote connection where long distance call applies • www.skype.com allows unlimited calls within US and Canada for only $30 a year. • Skype talk from computer to computer is free. • Some paid software includes skype as a component.

19. TightVNC is currently in use at UAMS/ACH • TightVNC is free software that does not provide technical support. • We have been using this software daily without any problems. • If you want to share DVD or cine clips it might not work well and the transmission may be slow.

20. Those who want extra goodies for some cost Those who can spend more and want more luxurious features can use paid software that require monthly maintenance fee or one time fee. Generally, they allow a 2 to 4 week free trial. www.gotomeeting.com www.meetmenow.com www.teamviewer.com

21. Benefits of Remote Conferencing • Eliminates commuting between sites. At ACH/UAMS it saves 30 to 45 minutes per day per resident. • Post-call residents can connect to VPN and participate from home. • Multiple sites can participate at the same time. • Allows faculty and technologists at remote facility to participate in conferences. • Residency programs other than radiology can benefit from remote conferencing.

22. Post-call resident attending conference from home

23. Teamwork • Setting up this remote connection to connect our Arkansas Children’s Hospital (ACH) with University of Arkansas Medical Sciences (UAMS) required team work. • The team: • Chetan Shah (Fellow) • Chandra Donepudi (PGY 3) • Ralph Panek (PGY 5) • Rohan Samant (PGY 2)

24. Questions? If you have any technical questions about setting up the remote connection, feel free to contact us at: shahchetanc@uams.edu cdonepudi@uams.edu panekralphc@uams.edu rssamant@uams.edu