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The Baltimore Sun reports: Hospitals put medical skills on display with live webcasts


April 11, 2004

With a minute to airtime, producer-director Richard Furman peered at a bank of monitors in the control room.

"Sinus cam looks gorgeous," he advised his technicians. "Norm," he barked into his headset, "you're live."

Norm - Dr. Norman Sanders, medical director of a company that makes surgical devices - was in the operating room at Georgetown University Hospital in surgical scrubs, mask and headset. Laid out before him, however, were not surgical tools but lecture notes.

He was host of a live broadcast on the World Wide Web of a tonsillectomy operation using his company's device.

Lights. Camera. Cue the anesthesiologist.

Hospitals are increasingly producing live streaming video of their surgeries and posting them on the Internet, where they're available to anyone - sort of ER meets reality TV.

Such surgical webcasts are often a teaching tool. Doctors who watch them can generally take an exam for continuing education credit. But much of the impetus for the webcasts has come from hospital marketing departments, which believe this is a new way to build awareness of their services and attract patients.

"My goal is to gain market share, and I believe in doing it in a way that's educational," said David Brond, vice president of marketing and planning for the University of Maryland Medical System, which recently arranged a webcast of a heart valve repair.

Dozens of hospitals across the country - from renowned Massachusetts General to facilities as small as the Atlantic City Medical Center - have launched surgery webcasts. Three in the Baltimore-Washington area have started in recent months.

Medical equipment suppliers have also become involved. They sometimes underwrite productions that they feel will effectively demonstrate their product to doctors and others who might buy it. While some question whether the webcast could distract a surgeon, or at least pose such a threat, others praise the technique as an effective means to educate professionals and patients.

The payoff

While it costs about $35,000 to produce and promote a surgical webcast, "it doesn't take a whole lot of procedures to have a positive return on investment - and I anticipate we will have a positive return on investment," Brond said.

It's already paying off.

Brendan Kosowski, 37, a computer programmer from Melbourne, Australia, began to suffer shortness of breath last winter. Kosowski, a serious swimmer, learned he had a heart valve problem that would require surgery.

He typed "mitral valve repair" into Google, the Internet search engine, and discovered that the University of Maryland Medical Center Web site included footage of a heart valve repair procedure done in February.

Impressed by the surgical preview video, which included a patient describing a rapid recovery, Kosowski called the surgeon who had served as "host" of the webcast, Dr. James Gammie.

"It's a bit gory, to see the blood and all that," said Kosowski, who returned to the Web to watch the whole operation. But he was impressed that the broadcast said recovery would take a few weeks - a fraction of the time required to recover from the more invasive surgery typically used in Australia. He is considering flying to Maryland for his surgery.

After the webcast of the mitral valve repair, University of Maryland received nearly 200 e-mail messages, mostly from patients or their families interested in the procedure. Gammie, the heart surgeon who served as host of the heart valve webcast, estimated that about five patients have come through the hospital after watching webcast surgery.

Pleased with the results, the University of Maryland has scheduled another live webcast of a laproscopic surgery for gastic reflux - a type of severe heartburn - at 5:30 p.m. May 4.

Seeking 'wow factor'

The push to webcast surgeries isn't just at the large urban teaching hospitals, such as Johns Hopkins Hospital and the University of Maryland in Baltimore. Community hospitals are also using cyberspace to publicize their own cutting-edge procedures.

MedStar Health, a Columbia-based health services provider, recently initiated a webcast series. It runs seven hospitals in the Baltimore area and in Washington.

Corbin Riemer, vice president for marketing at MedStar Health, chooses surgeries for broadcast that have "a bit of the 'wow factor,'" he said. "For a community hospital, it's important to say, 'You're getting some world-class care there.'"

At its Harbor Hospital in South Baltimore, Riemer chose a procedure in which a cancerous part of a lung was removed using three small incisions rather than one large one. Hospital surgeons say the technique greatly reduces the mortality rate from the surgery - by 80 percent. MedStar also plans a webcast of a knee operation from Baltimore's Good Samaritan Hospital in June.

Although the world at large can watch a webcast, the public isn't always the coveted audience. Family doctors and referring specialists often are, because their recommendations strongly influence choices about surgery.

"Referring doctors are the prime target for hospitals in any given market, although we do have high consumer/patient viewership," said Alex Fraser, marketing director for a Connecticut video production house called slp3D. The company, which has developed a niche in health-related webcasts, expects to do about 100 at two dozen hospitals across the country this year, twice as many "events" as in 2002 and five times as many as 2001.

Although the audience is primarily doctors, patients or relatives of patients, anecdotes and e-mail to slp3D suggest that "there's a pretty decent audience of folks who are intrigued" and just like to watch surgeries, said Ross Joel, the production company's vice president for sales and marketing and a former Hartford television anchor.

The webcasts appeal to several audiences simultaneously, including potential buyers of the sophisticated tools used to perform the surgeries.

ArthroCare, a Sunnyvale, Calif., maker of surgical equipment, put up the $35,000 for the tonsillectomy production at Georgetown in the hope that potential buyers would be impressed by their surgical wand in action.

To build an audience, the company e-mailed 250 pediatric otolaryngologists across the country - the doctors who perform most of those operations - beforehand. It plans to send DVDs of the webcast to members of the American Academy of Otolaryngology, the professional society for head and neck surgeons. The marketing technique could be described as surgical: One mailing specifically targeted pediatricians with a history of referring patients for tonsil removal.

David Applegate, a division manager for ArthroCare, said it's too soon to translate the webcast two months ago into direct sales, but his company did receive 50 subsequent requests seeking a representative to demonstate the product. About 800 viewers watched at least some part of the tonsillectomy live, with about 3,500 more clicking on the video file in later weeks, he said.

While many of the webcast surgeries are posted live on the Internet, heart surgeries are often delayed several hours to satisfy ethical guidelines of the Society of Thoracic Surgeons, a professional association that includes heart surgeons.

"Live broadcasts of surgical procedures to the general public are to be avoided," according to society policy. "The society believes a possibility exists wherein participating surgeons might fail to follow proper medical procedures or might be distracted because of the media and, thereby, deprive the patient of the highest quality care."

'Mugging' not a concern

Dr. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said he's not aware of other medical associations that offer such admonitions.

"I think such guidelines are wrong," said Caplan, a supporter of surgeries on the Web. "It's a very interesting teaching technique.

"There may be issues about why not to do it, but mugging for the camera is not persuasive," he said. "Anybody who changed their behavior because of the cameras will be seen by his peers as unprofessional."

The production of a live webcast from the operating room may not be brain surgery, but it's not simple.

Tonsillectomy

Ryan Jakoby, 3, of Edgewater in Anne Arundel County, was the patient for the tonsillectomy filmed at Georgetown University Hospital. At 10 a.m. the day of his operation, he was scooting around the hospital corridor in a purple toy car. By noon, he was on the operating table.

His father, Garry Jakoby, had some reservations about the webcast. He didn't want it to extend the boy's time under anesthesia, especially if the doctor had to stop and explain the procedure to his audience. Nor did he want his son's face shown. Reassured on both counts, he gave his permission.

Surrounding the boy in the operating room was a clinical team of eight - anesthesiologist, nurses, residents and the surgeon, Dr. Earl Harley. Circling them was an equally large video production team from slp3D.

Harley did much of the talking during the webcast, even as he cut. He opened by introducing his operating room crew and showing the instruments he would use. ArthroCare offered to pay him an honorarium for webcasting the tonsillectomy, as they would a seminar speaker, but he declined.

In teaching mode during the webcast, Harley explained what he did as he went along - like a cooking or home-improvement show on cable, only for the less squeamish.

"We make our way to the interior lobe of the tonsil. Then, a sweeping motion," the surgeon explained. "So, I carefully dissect the tonsillar tissue away from the muscle."

Furman, the producer-director, said he and one or two cameramen typically visit a hospital a month or so before a shoot to check out the operating room and technical setup. They also film interviews with doctors and patients to assemble a short preview film that runs on their Internet site (www.or-live.com) and on the hospital's to promote the actual surgery.

"There's a lot of preplanning," said Fraser, the slp3D marketing director, "like a mini-sports event."

Copyright © 2004, The Baltimore Sun



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