Search for: All records

Background: The implementation of telemedicine by healthcare providers was accelerated by the COVID‐19 pandemic and in most health systems has reached a lower but steady percentage of total visits. As health systems navigate the integration of telemedicine modalities into care delivery models, understanding the way each discipline can optimally utilize this technology has become increasingly important. The purpose of this study was to determine how specialists who perform surgical procedures as part of their practice want to implement telemedicine into their practice and when they believe it can be most effectively used within their work schedule. Methods: A survey regarding opinions about the use of telemedicine in the postoperative period was conducted in late 2019 prior to the onset of the COVID‐19 pandemic and re‐administered about one year later. The respondents were identified by department and division as physicians who perform at least some surgical procedures. All respondents practice as part of a single urban, academic, multispecialty group across the DC‐Maryland‐Virginia area. These healthcare professionals were asked about their experiences in telemedicine, willingness to incorporate telemedicine into their practice for post‐operative visits during their global surgical period, and their opinions on how accepting patients in general may be of telemedicine. The follow‐up survey provided an opportunity to examine how opinions evolved after having obligatory telehealth experience during the pandemic. Survey responses were analyzed and descriptive statistics are presented in this study. Results: A total of 77 unique respondents participated in the surveys, and we evaluated the responses of the 75 participants who had any telemedicine (TM) experience. Respondents were 74.7% male, 66.7% were aged 36‐55, and 46% had between 1‐10 years of practice experience while the rest reported >11 years of experience. Additionally, specialties included traditional surgical specialties, interventional radiology, ophthalmology, and dermatology. Of those who completed the second survey, 77.1% expressed that the COVID‐19 exposure to TM increased their interest in video TM follow‐ups for post‐operative visits. Respondents further believed that 93.6% of patients in general also express a similar sentiment. However, just 46.7% believe TM would increase their productivity even if the technological infrastructure was perfect. When asked about preferences for when they would perform TM visits, 40.0% said they would want to conduct them as a part of regular hours and 41.3% said they would want these visits during a dedicated time within working hours. If given the chance to offer TM outside regular hours or during the weekend, the majority of respondents was against it or unsure, 77.4% and 88.0%, respectively. Discussion: Although a majority of the respondents surveyed think patients are interested in telemedicine and are themselves interested in using telemedicine follow‐ups in the post‐surgical period, less than half believe that telemedicine would increase productivity. Also, there is great variability in preference for dedicated timeblocks for telemedicine versus integration into traditional clinic schedules. As health systems continue to iterate on optimal models to integrate telehealth into efficient care delivery, it is important to better understand how physicians performing surgical procedures consider the value proposition of telemedicine for post operative care. Further study is required to understand the barriers to utilizing telehealth and how its implementation could impact reimbursement, work hours, the future of work as well as patient access, patient convenience, and patient satisfaction. 

Augmented reality (AR) has great potential for use in healthcare applications, especially remote medical training and supervision. In this paper, we analyze the usage of an AR communication system to teach a medical procedure, the placement of a central venous catheter (CVC) under ultrasound guidance. We examine various AR communication and collaboration components, including gestural communication, volumetric information, annotations, augmented objects, and augmented screens. We compare how teaching in AR differs from teaching through videoconferencing-based communication. Our results include a detailed medical training steps analysis in which we compare how verbal and visual communication differs between video and AR training. We identify procedural steps in which medical experts give visual instructions utilizing AR components. We examine the change in AR usage and interaction over time and recognize patterns between users. Moreover, AR design recommendations are given based on post-training interviews. 

Background: Medical procedure training often requires constant feedback and different educational interventions. Analyzing gestures within the context of medical procedure training helps trainees better understand critical maneuvers that ensure the successful completion of a procedure. Most gesture feedback involves an instructor suggesting an alteration of the trainee's form or position. This type of feedback is often difficult to convey within telehealth procedure education. For example, remote training of medical procedures is difficult for trainees when they do not have the same type of in‐person interaction with the instructor. These challenges exist in various scenarios such as online physical exam education for medical students or medical procedure training for rural/disaster/wilderness scenarios. Since few tools exist to overcome this challenge, we developed a software program that uses data processing and OpenPose to quantify gestures to help remote trainees learn new procedural skills. Methods: Novice healthcare providers were recorded during an ultrasound‐guided central venous catheterization (US‐CVC) training session. Each trainee was paired with one physician instructor, who modeled and helped assist with completing the procedure. For this feasibility study, various gestures throughout the training were analyzed using video data to identify which gestures might be especially useful for completing the procedure. With our software, a single frame capturing the precise moment at which each of the individuals physically placed the central line needle into the mannequin was then processed. Keypoint data from both arms were further processed to identify critical angles for the insertion of the syringe. Both, left and right, arm angles of the trainees were then compared to the instructor's respective angles to assess whether trainees were mirroring the instructor's gestures, indicating successful procedure completion. Results: 7 trainees and 6 instructors were analyzed from the cohort consisting of 10 trainees and 10 instructors. A total of 13 frames were processed by the OpenPose algorithm and a total of 325 keypoints (25 keypoints per individual) were collected. The instructor's left arm angle was positioned at 163.1 degrees (SD = 9.7), while holding the ultrasound probe and their right arm angle was 109.9 degrees, while holding the syringe. The mean of the trainee's left arm angles was 160.9 degrees (SD = 12.7) and the mean of the trainee's right arm was 102.1 degrees (SD = 18.4). For the left arm, the mean difference between trainee and teacher was 2.24 ± 20.31 degrees, (95% CI ‐16.54 to 21.03 degrees), p = .78. For the right arm, mean difference was 7.84 ± 14.88 (95% CI ‐5.92 to 21.60), p = .21. Since each trainee was matched to a particular teacher as that trainee's gold standard, we used 2‐tailed paired t‐tests to examine differences between trainee and teacher angles for each arm. In this pilot data, the trainees' arm angles did not differ significantly from their teachers' angles. Discussion: This study's results suggest that trainees had similar arm angles to the instructor. The significance of these findings suggests that there is a way to quantitatively measure if a trainee successfully completes a procedure through a video. Assessing whether trainees effectively perform the procedure is challenging, especially from a 2‐D video. Yet, some of these limitations may be overcome with quantitative gestural analysis. Remote medical procedure training stands to benefit from this form of feedback as it is often difficult to convey to trainees how to alter their position over video conferencing alone. Instructors can suggest a change in the trainee's gestures with real‐time data, allowing the trainee to adjust and successfully complete the procedure. Our findings illuminate the utility of quantitative gesture analysis to overcome the challenges of communicating qualitative gestures and help trainees learn new procedures and maneuvers through telehealth‐related video platforms. 

We present our work in progress, a real-time mixed reality communication system for remote assistance in medical emergency situations. 3D cameras capture the emergency situa-tion and send volumetric data to a remote expert. The remote expert sees the volumetric scene through mixed reality glasses and guides an operator at the patient. The local operator receives audio and visual guidance augmented onto the mixed reality headset. We compare the mixed reality system against traditional video communication in a user study on a CPR emergency simulation. We evaluate task performance, cognitive load, and user interaction. The results will help to better understand the benefits of using augmented and volumetric information in medical emergency procedures.