March 1, 2010

By James A. Martin

To help speed her recovery from a fall, Dr. Kate Burke turned to a Flip video camera.

Burke, who had injured a knee while skiing, struggled at times to recall exactly how to do her physical therapy exercises at home. Then she had an idea: On the next visit to her therapist, she took her Flip video camera, planning to ask him to record her correctly performing her exercises in his office, so she could remember exactly how to do each movement at home.

To her surprise, Burke's therapist, Mike Roberts, pulled a Flip video camera out of his pocket, too.

"It was a real 'a-ha' moment for us both," says Burke, who is chair of the Milford Regional Medical Center emergency medicine department in Milford, Mass. She and the therapist had each recognized the potential of inexpensive, portable, easy-to-use video recorders to help patients follow instructions for their own care.

"Video is a game changer," Burke adds. "It will become the standard for ongoing physical care and in other areas of healthcare, too."

Recalling Less Than Half of the Information

From consumer cameras to state-of-the-art telepresence systems, video is playing an increased role in helping to improve patient care.

Consider the common problem of correctly recalling healthcare instructions. According to a report by the Center for Information Therapy, patients often remember only half the information conveyed to them just five minutes after a healthcare consultation.

"In typical healthcare encounters today, information transfer involves considerable information being 'dumped' on a patient during a clinical visit, and patients understand and retain little of what clinicians convey to them," according to a report by the Center for Information Therapy. (The report, "The Ix Evidence Base: Using Information Therapy to Cross the Quality Chasm," is available as a free downloadable PDF.)

Using video clips to help her remember how to do her exercises has been an "incredible" aid to her own recovery, Burke says. "I live 25 minutes away from my therapist's office. Because I have such clear instructions on video I can watch anytime, I don't have to make as many trips to his office. And I get more value out of the visits I do make," she explains.

Video Helps Caregivers, Too

Video can also help a patient's family members and friends provide consistent care that adheres more closely to the healthcare practitioner's original instructions, says Lynne A. Dunbrack, program director of IDC Health Insights.

Many patients today leave the hospital or other treatment facility much sooner than in years past. "So it's incumbent upon family members and friends to fill the gap," she explains. By providing a visual record, video can give everyone—physician, patient, and caregivers—a greater level of comfort.

"Video can also play a role in training and improving healthcare procedures. For example, video captured in an intensive care unit might be used for teaching and for reducing variations in healthcare practices," says Dr. Kaveh Safavi, a physician who is vice president and global lead for the Cisco Internet Business Solutions Group Healthcare Practice. "You can review how nurses and doctors are caring for patients so you can make adjustments," he explains.

"Video recordings of physicians visiting patients in clinical settings could be added to patient medical records, providing a valuable visual documentation of the patient's recovery at various stages," Safavi adds.

Extending the Physician's Reach with Video

Though still in its infancy, the use of video and other visual information in healthcare—from consumer devices such as Flip Video to web conferencing technologies such as WebEx to state-of-the-art conferencing such as Cisco HealthPresence—will continue to grow over the next few years, says Safavi. (See related press release, "Cisco Launches HealthPresence Telemedicine Solution.")

One reason is that younger generations are accustomed to YouTube, webcams, and inexpensive, easy-to-use Flip Video camcorders. They know it's not unusual today for parents to monitor their kids in daycare remotely over webcams and the Internet. And so, when they enter healthcare as patients or practitioners, "Gen Xers and Millennials bring certain expectations about the use of video as a form of communication," Safavi says.

The expectations of a younger generation are beginning to break down barriers to deploying video in healthcare.

Also, in the current economy, "everyone's trying to figure out how to do more with less," Safavi explains. "Technologies (such as video) that allow organizations to extend their reach without extending their physical infrastructure will help eliminate inefficiencies in communication and many other areas."

"For example, a home care nurse could record video of a patient at home with a Flip camera and share it later with the patient's physician. The physician could see how the patient is progressing between office visits," says Safavi.

Or a patient in a rural area could visit a Cisco HealthPresence mobile clinic for a virtual face-to-face consultation with a specialist in a distant city. The remote doctor, with the help of a physician's assistant in the mobile clinic, could see inside the patient's ears or mouth using video camera-equipped diagnostic devices connected to the telemedicine system.

"When you allow physicians and patients to see things that they typically don't have access to, suddenly you have a variety of solutions to healthcare problems that weren't available before," Safavi says.

The Challenges of Video in Healthcare

"While video has strong potential for improving the quality and results of healthcare, there are some obstacles to overcome before it will be more widely adopted," Dunbrack points out.

"Not all patients will be comfortable using a video camera or having one focused on them during a doctor visit," Dunbrack says. "Patients concerned about privacy may also resist having a video of them added to their electronic medical record."

Healthcare practitioners who are already overburdened with more than they can handle, may see new technologies as risky or disruptive to long-established procedures. Therefore, they may be hesitant to try new technologies, which is one of the main barriers to adoption. Also, doctors and patients who are concerned with privacy and medical liability issues may be reluctant to communicate with patients online, Dunbrack adds. So the thought of attaching a video clip containing care instructions to an e-mail is worrisome for them.  

"Uncertainties about the business model for using video to extend healthcare beyond traditional medical facilities is another potential roadblock," says Safavi. While insurance usually pays for services provided in traditional healthcare facilities, it's unclear what the reimbursement model for online patient care delivered to the home will be, he explains.

Overcoming the Obstacles

Within the next few years, the benefits to incorporating video throughout healthcare will be compelling enough to overcome many of the obstacles, says Dunbrack.

Meanwhile, advocates such as Burke and therapist Roberts are doing their part to spread the word. Burke continues to perform the exercises Roberts prescribed and has even resumed skiing. In addition, Burke says at her recommendation, Milford Regional Medical Center (where she's chief of ER) has purchased four Flip Video camcorders to test in training and education.

Roberts says Flip video recordings are making a difference for his other physical therapy patients, too. Not everyone wants a video record of his or her rehabilitation exercises, he admits. "But almost always, the patients I video will be exercising correctly the next time I see them," Roberts says. "With the other patients, it's a toss-up."

James A. Martin is a writer based in San Francisco.