While video over IP isn’t new, the University Health Network is using it in a new way: to digitally record, replay and critique simulated patient exams.The UHN’s Paul B. Helliwell Centre for Medical Education is expanding traditional learning methods with VBrick’s EtherneTV Media Distribution System, which delivers video over IP networks. A Web-based management portal centrally secures and controls the video, while video-on-demand servers store recorded video across the network.
This is the first deployment of its kind in Canada, though the technology is already being used south of the border at the Ohio State University Medical Center and George Washington University Medical Center.
The UHN was looking for a digital solution where clips would be stored on a secure server in one central location — and would be easy for students to learn how to use.
“With 90 new students each year, we can’t have staff running around showing them everything, so it has to be user-friendly,” said Dr. John Bradley, director of the Wightman-Berris Academy at the UHN and Mount Sinai Hospital. Nor did staff want to deal with VHS tapes, which would require cataloguing, storage and retrieval — and could be lost.
The UHN rolled out the system in early 2005 with VBrick reseller Videoconference Solutions Inc. Pilots were run in March and April with three groups of primary users, including students and faculty, along with a mix of professional actors and real patients. The system went live in September.
Students can access stored video from any of the centre’s 18 computers, and even create a library of their work. And there’s no need to file tapes. “They can dump it after they view it or save it onto a server that they and they alone can retrieve,” said Bradley. “They can show it to fellow students or their teacher.” Professors can also stream real-time video from an exam room to any of the centre’s seminar rooms.
The centre has eight clinical skills rooms, each with a touch-screen monitor that operates two cameras offering 20 to 30 viewing angles. MPEG-2 encoders record the exams and save the digital files to the EtherneTV Media Control Server, a central library available on demand to authorized users.
“For now we decided to keep it on our own Helliwell network,” said Bohdan Sadovy, manager of audio-visual services with the UHN. Currently, digital files are recorded in MPEG-2 format. If the UHN were to open up the system to the Internet, however, digital files would have to be converted on-the-fly to MPEG-4 to conserve bandwidth.
With video over IP, you’re going to see a delay in the order of 20 to 30 seconds with a typical Windows Media or RealNetworks solution, said Andy Howard, senior product manager with VBrick Systems Inc. “We can get the delay down to the 200 millisecond range — things are in real time as they’re viewing them.”
For live video, he recommends using multicast over an Ethernet network. “You send one video stream out onto the network, and the network replicates that for you,” he said. While it may sound like a lot of bandwidth, it’s only being sent out onto the network once, so it doesn’t impact the network much, he said. “On a Gigabit Ethernet network, that’s half a per cent of the network utilization.”
There are also Quality of Service (QoS) mechanisms, both on the network and in the products themselves. “It’s just a matter of how many people are going to be using the video and how much video you want to be sending out at any one time,” he said. Generally, network upgrades are not required when using 10/100/Gigabit Ethernet.
But will it make a difference in the classroom? “You can’t ask teaching universities to put in hundreds of thousands of dollars worth of equipment, hire and train the staff, if it’s just something neat,” said Bradley. “The truth is that it is still an experiment, a very expensive experiment.”
It works extremely well, he said, although they certainly had their “bugaboos” while installing it.
“This is not like buying an air conditioning system and putting it in your car or house,” he said. “There is an enormous amount of personal energy way and above any job description to get this in.”

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