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Medical AV – healthy prospects

To the uninitiated, healthcare as a market for AV solutions may seem rather too specialist. But, as Ian McMurray finds out, it’s a vibrant market with plenty of opportunities for most integrators.

The cry of “The screens, nurse! Quick, the screens!” isn’t as often repeated as it once was. Given that The Goon Show was broadcast on BBC radio in the 1950s, few today would associate the catchphrase with Peter Sellers’ cowardly character Major Denis Bloodnok, or realise that he wasn’t asking for large LCD displays. Healthcare has come a long way in 60 years. “AV is playing a great role in assisting with the ever-changing way healthcare is delivered,” notes Duffy Wilbert, senior vice president, membership services of InfoComm International. “It plays a role with diagnosing illness even in remote locations, creating simulations and teaching complex techniques to doctors around the world – and provides a host of other benefits as well.” “It’s an expanding and exciting market for us,” notes Ian Wallington, regional director at UK integrator proAV. “We’ve received a number of contract awards recently for projects including videowalls, digital signage and videoconferencing technologies within immersive learning facilities, MDT [multidisciplinary team] rooms and operating theatres.”
 “Healthcare is a challenging vertical in which we have many years’ experience; we find that repeat business, referrals and demonstrable experience within the sector are the best way to develop further opportunities,” he continues. “We have successfully been awarded a place on the NHS Shared Business Services framework which is generating further opportunities.”
 “For us, medical AV is growing and has tremendous potential,” echoes Jim Hatcher, chief technology officer at Human Circuit, a US integrator of Atlona AV connectivity solutions. Worldwide opportunityIt’s not just in the UK and the US where opportunity lies. “I don’t have any hard evidence but, anecdotally, it seems that North America is more progressive in terms of applications,” says Tom Pfeuffer, global vice president of medical markets at video networking, digital signage and IP video distribution company Haivision. “In fact, some say that this region could be considered the trendsetter for the rest of the world. In Europe, there are many similarities with video collaboration, but my sense is that the European market is not pushing the envelope in applications where AV is making big strides, such as in telemedicine. In Asia, telemedicine is, it seems, even less common; Asia is just getting up to speed on teaching applications that are otherwise hot across the globe, and looks as if it will be Asia’s first step into medical AV. The biggest growth opportunities, from what I’m hearing, are definitely in North America and Europe.”
At the heart of any investment in AV systems in healthcare is, unsurprisingly, the desire to improve patient care. It is something of a mantra in the industry that happy patients are likely to recover more quickly – and hospitals are responding.
 “One trend that we are seeing is a strong interest in enhanced patient entertainment systems that can incorporate new HD video services and meet the more demanding expectations of the iPad generation,” says Colin Farquhar, CEO of IPTV communications specialist Exterity.
 “In today’s connected world,” he continues, “patients are accustomed to highly evolved media solutions at home, at work and in hotels, creating much higher expectations for AV in healthcare than ever before. By utilising a hospital’s existing IP network, healthcare providers can deliver all of the services that patients are increasingly coming to expect throughout their stay in hospital while also driving revenue through additional services. That’s only one of the reasons why IPTV technology is being increasingly adopted throughout the healthcare industry.” Multipurpose terminalsSeeing that same opportunity, Barco acquired UK-based JAOtech – a manufacturer of patient entertainment and point-of-care terminals for hospitals – earlier this year. 
 “The UK is an established market for bedside terminals compared to other European countries,” points out Warren Kressinger-Dunn, a VP of strategic marketing at Barco. “France can also be seen as a well-established market. The US market is a young one, gradually switching on to the benefits of replacing traditional TV and PC solutions with terminals and very much focusing on the clinical and administrative applications as well as entertainment. Asia and Pacific is a new market, but it is growing in countries like Singapore and Hong Kong, where medical tourism is popular. The growth in the Middle East is partly a result of many new hospitals being built with sizable budgets for healthcare IT infrastructure. In South America we see a lot of potential, especially in Chile and Brazil because of the developing IT infrastructure.”
 The JAO bedside terminals combine both patient care functionality and entertainment facilities. Via third-party software solutions, prescribing can be done at the point-of-care and information sent directly to the pharmacy. Meals can be ordered through the terminal to the hospital kitchen, saving nurses valuable time from physically taking orders on a ward. Concurrently, each screen provides movies on demand, music, internet access and so on. By improving efficiency and reducing the possibility of errors on the one hand while generating potential income streams on the other, the terminals pay for themselves, Kressinger-Dunn estimates, in less than three years. 
 Return on investment is no less of a requirement in AV systems for healthcare than it is in other markets, and it’s driving increasingly widespread adoption of videoconferencing. 
 “Cost and ROI are important,” says Andrew Graley, healthcare director at Polycom EMEA. “Costs in the healthcare sector are carefully scrutinised, so the value of the technology needs to be clear and measurable.” Telemedicine Polycom’s telepresence solutions are used for delivering, for example, medical lectures – but the company has also developed solutions specifically for the healthcare market. Polycom RealPresence Mobile allows patients to receive healthcare remotely – with applications including physiotherapy – while the Polycom Practitioner Cart (which conforms with the EN60601 standard) connects patients in hospital with, for example, remote stroke experts elsewhere. As well as improving patient care, videoconferencing can enable scarce medical specialists to make better use of their time. ‘Telemedicine’ is a recurring theme. 
 His point about ROI is echoed by Hatcher. “The right integrator can bring immediate value to the medical AV market,” he says, “if they understand customers’ problems as they relate to improving performance, lowering costs and raising revenues.” 
 Projection systems are also widely used in healthcare applications. “Teaching, virtual reality and simulation and training are the primary applications,” notes Anders Løkke, marketing director at projectiondesign. “We have a medical imaging range of projectors that are PACS-compatible [see boxout below] and that meet stringent requirements not only in image quality, predictability and operational reliability, but also electrical and operational safety, and ease of use for a variety of personnel. Thousands of projectiondesign projectors are installed in medical applications worldwide.”
 “For medical training, high image quality is essential,” echoes Graeme Davidson, business manager for visual imaging at Epson UK. “A DICOM simulation mode is required for display products in order to accurately represent medical images. Epson’s EB-1700, 1900, G5000 and Z series projectors all support DICOM simulation.” He also notes the requirement for high contrast ratios and very high resolutions that preserve image detail, such as WUXGA. Product adaptationIn some cases, standard AV products can be used in the healthcare environment. In others, however, some degree of adaptation is required. 
 “A hospital is a unique environment,” notes Kressinger-Dunn. “Bedside terminals have multiple users such as doctors, nurses and patients in an environment where the danger of transferring germs or contagious diseases is huge. It’s important that the terminals can be easily cleaned, that they are waterproof and dustproof and that there are no gaps or crevices where germs and bacteria can collect.”
 “Another challenge is noise,” he continues. “A ward has to be very quiet because patients need to rest and recover. So, instead of the noisy cooling fans used in the general all-in-one consumer PCs, the JAO terminal dissipates heat via an internal heat sink and a cooling plate connected to the arm or medical cart. This allows the system to run virtually silently.” consistent serviceReliability is, of course, another vital requirement. “You can’t have a system which goes to the infamous blue screen of death part way through your heart valve repair, can you?” smiles Tim Brooksbank, chairman of electronics display equipment company Calibre UK. 
 “We develop products specifically for the medical market,” he continues, “but they tend to be spinouts from technology we originally developed for pro AV. Sometimes, the reverse is true too; a medical product might spin out a pro-AV product. For example, our HQView400-series product started life as a medical AV scaler for telepresence and training AV racks. The very low latency demanded by the medical market was also ideal for live-event pro-AV use.”Polycom has also developed its product line specifically for the healthcare market, and Graley sees a real opportunity for integrators.
 “Existing installations are being continuously updated across Europe, and there are plenty of new-build clinical sites in progress or in planning,” he says. “Although many countries have a requirement for framework agreements to cover the commercial supply of equipment to hospitals, medical AV is still a specialist area where the tender process can help highlight the expertise of the integrator. Customers are very keen to work with the supplier who can understand their requirements and provide a quality solution, on time and on budget.”
 “Integrators are especially successful in certain ‘hot’ areas such as telemedicine, but there are other opportunities for them as well,” adds Haivision’s Pfeuffer. “Healthcare has similar requirements to the enterprise market. Integrators can get involved in other use cases by leveraging simple solutions into expanded ones; for instance, by setting up a conference room and linking it to other clinical departments, an integrator can propose as a next step a digital signage installation – another hot area in healthcare. Then, as a medical AV integrator, the integrator can use the fact that it is already ‘on site’ to sell additional products. This is appealing to hospitals that prefer to use a single partner for as many of their technology needs as possible. AV integrators can certainly differentiate themselves this way, but it requires them to have deep knowledge of the healthcare market and focus on the big picture.”
 “Because of their knowledge of the human factors of communication, integrators can create excellent experiences for those who work in healthcare facilities,” notes InfoComm’s Duffy Wilbert, “as well as those who are receiving medical treatment.”
 In many ways, the healthcare market for AV solutions is a microcosm of the wider AV market. It makes extensive use of videoconferencing, digital signage, enterprise communications, meeting room technologies, IPTV, entertainment systems and so on. But it is also a specialist market in terms of applications and standards – not to mention often challenging procurement processes. It is also true that AV solutions that can have a critical impact on patients – such as in an operating theatre, for example – will remain the province of specialist medical integrators. Where the market is certainly no different, however, is in its preference to deal with a single supplier who is prepared to understand the problem and propose an appropriate solution delivering an acceptable ROI – skills which the best integrators unquestionably have that transcend market boundaries.