Finding a videoconferencing platform for simulated telemedicine is not a trivial pursuit

Abstract

AIMS: Find a videoconferencing platform to implement a simulated learning environment (SLE) for supplementing clinical placements for physiotherapy students. BACKGROUND: Telerehabilitation is increasingly common in service provision and more recently in supervision of students and simulation. In the STEPS project, physiotherapy students remain in their clinical placements at remote locations and access an on-campus simulated learning environment, via a teleconferencing platform, for approximately 20% of their 5-week clinical placement. Students assess and manage standardised, simulated patients using scenarios based on what would occur in a telerehabilitation environment. The daily structure involves eight students transitioning between live interaction with each of two standardised patients, pre-recorded videos of some aspects of the assessment, peer review with other students, and discussion with each of two clinical facilitators. Finding a videoconferencing platform that is compatible with the sometimes conflicting needs of the university, health care facilities (such as public hospitals, private practices) and the STEPS project has proven to be one of the most challenging aspects the project. Universities and health care facilities require their systems to be secure and need to control the amount of data flow. Telerehabilitation requires secure encrypted transmission of information and can require a significant bandwidth. The STEPS project requires reasonable security and bandwidth, but also flexibility for multiple and rapid changes in connections between different combinations of up to ten people (and locations). METHODS/RESULTS: A dedicated stand-alone telemedicine system was secure but lacked flexibility for multiple connections and presented difficulties penetrating university or hospital firewalls. Publicly available videoconferencing systems were also blocked by some institutional firewalls and required a bandwidth that was not possible at remote locations using the alternative of wireless broadband. Videoconferencing facilities located in the hospitals were often not available for the eight hours per week needed for the project. Even when available, such systems struggle with multiple changes in connectivity, require higher level technical support on an ongoing basis, and could be inconsistent in their performance. CONCLUSIONS: Even though the technology for telerehabilitation is improving rapidly, finding and implementing a system for a specialised application may not be a trivial task.