Dr Nick Palmer
Dr Nick Palmer
Consultant Cardiologist at Liverpool Heart and Chest Hospital
Revolutionizing Live Medical Broadcasting in Cath Labs with Medinbox
Since 2021, Liverpool Heart and Chest Hospital (LHCH) has leveraged its expertise in live case transmission by relying on Medinbox to deliver world-class medical broadcasting and education directly to its Cath labs, achieving full autonomy with an in-house audiovisual system.
Why Liverpool Heart and Chest Hospital Chose Medinbox
Since 2021, Liverpool Heart and Chest Hospital (LHCH), one of the leading cardiothoracic centers in the UK, has leveraged Medinbox to elevate its medical broadcasting capabilities. By adopting an audiovisual system that provides full autonomy, LHCH has successfully integrated live case transmissions directly into its Cath Labs, enhancing both education and procedural collaboration. Dr. Nick Palmer, Consultant Cardiologist at LHCH, shares his experience with Medinbox and why it was selected over other options.
Enhancing Reputation and Efficiency at Liverpool Heart and Chest Hospital
The integration of Medinbox into LHCH’s daily operations has not only enhanced its reputation but also improved the efficiency of its procedures. The system’s high-quality live broadcasting capabilities have allowed LHCH to deliver world-class medical education through real-time transmission, enabling collaboration across multiple institutions and improving the experience for staff and patients alike.
Key Features of Medinbox
Medinbox stands out in the field of live medical broadcasting due to its advanced technology and seamless integration with Cath Labs. The following features make it the preferred choice for leading medical institutions worldwide:
High-Quality Hardware and Software Solutions
Medinbox combines cutting-edge hardware with intuitive software to deliver a top-tier broadcasting experience. The system is designed to be user-friendly, allowing for easy customization and real-time adjustments during live transmissions.
Key features include:
- High-definition video and crystal-clear audio for uninterrupted communication
- Customizable layouts that enable real-time adjustments for optimal viewing
- Intuitive fingertip controls that allow operators to manage broadcasts seamlessly
Comprehensive 24/7 Support
Medinbox provides 24/7 remote technical support to ensure uninterrupted service. In addition, the technical team can be dispatched on-site when necessary, ensuring that the system remains operational without delays.
Proven Outcomes with Medinbox
Since adopting Medinbox, Liverpool Heart and Chest Hospital has seen measurable improvements in medical education and collaboration. The system has contributed significantly to:
- Enhancing medical staff expertise through live, real-time educational transmissions
- Improving operational efficiency during procedures
- Enabling seamless proctoring and knowledge-sharing across international borders
Improving Staff Experience and Expertise
The feedback from LHCH staff highlights the positive impact Medinbox has had on both their daily operations and long-term educational goals. Medinbox’s easy-to-use interface and high-quality technical capabilities have made live case transmissions a core part of their educational strategy.
Looking Ahead : Medinbox’s Role in Future Medical Education
Looking toward the future, Liverpool Heart and Chest Hospital plans to expand its use of Medinbox, with more live case transmissions and educational initiatives aimed at global medical communities.
LHCH has already successfully carried out live case transmissions to national and international conferences. The hospital continues to lead the way in interventional cardiology education, with Medinbox playing a key role in its future initiatives.
Are you ready to revolutionize your medical broadcasting and enhance your educational programs ?
Discover how Medinbox can transform your Cath Lab experience and bring your medical education and live broadcasting to a global audience.
Case Study - Digital support for catheter ablation from the home office
Case Studies
Prof. Dr. Christian-Hendrik Heeger, Dr. Julia Vogler and Prof. Dr. Roland Richard Tilz, Lübeck
Background
Catheter ablation of cardiac arrhythmias in the electrophysiological examination laboratory (EPU laboratory) is supported by electroanatomical 3D mapping procedures. This requires a good knowledge of the software to be used in order to achieve the best possible results. This 3D mapping process is usually carried out by technical support who operates the software on site.
Due to the global COVID-19 pandemic, there were changes in electrophysiology: the number of cases decreased and restrictions on freedom of travel meant that technical support was repeatedly not available on site. This not only frequently delayed the procedure’s initiation but also had implications for the overall procedural planning. In addition, ecological aspects resulting from climate change are currently in focus. Long travel times for technical support do not make sense both ecologically and economically. In addition, unplanned traffic disruptions can lead to further delays. The need for technical support will continue to increase in the future due to the progressive number of procedures. In addition, there is an increasing shortage of skilled workers, making the use of “remote” support an ideal option.
A trained employee can provide remote support in various EPU laboratories from a workstation via WLAN in the shortest possible time. A high level of procedural efficiency and flexibility is required to meet future requirements. (1)
Thanks to new hardware and software solutions, it is now possible to receive more than just advice from technical support. Rather, they can directly control the software for creating a 3D map (“remote access”) and communicate audiovisually with the treating team on site. This remote access is made possible using a combination of Medinbox (Abbott) and Ensite TM Connect Remote Support (Abbott).
Goal
The aim of the remote study is to test the feasibility, effectiveness and security of remote support using remote access through Medinbox and Ensite TM Connect Remote Support and to compare it with standard on-site support.
Methods
As part of the remote study, patients who received an electrophysiological procedure supported by the EnsiteX system (Abbott) between September 2022 and February 2023 were included in the analysis (n=50). All procedures were accompanied externally by an FTE (Field Technical Engineer ) as remote access support. The collective was compared with a matched control group of 50 consecutive previous procedures using EnsiteX on-site FTE support.
Remote Support/Access
The procedure was accompanied by remote support to create an electroanatomical map on defined days of the week. Audiovisual communication was facilitated using Medinbox (Abbott) was used and the FTE was invited to the procedure via a video conferencing system (Zoom) and screen shared. This enabled a complete audiovisual representation of the procedurally important information (ECG, electronic signals from the recording system, visualization of the electroanatomical mapping, X-ray fluoroscopy, ultrasound recordings, remote control of the visual controls (camera)). Remote support was able to communicate with the on-site team via Bluetooth headsets.
The EnsiteX TM mapping software (2) was controlled via the Ensite TM Remote Support software solution, so that the FTE could operate the EnsiteX system in real time from the home office. The employee was able to control and set all relevant aspects himself. It was not possible for the FTE to operate the recording system; it was carried out on site.
Results
A total of 50 consecutive patients who were treated with remote support and an electrophysiological procedure were included. The procedures involved 20 pulmonary vein isolations, four CTI blocks, 13 ablations of atrial tachycardia, one ablation of ventricular premature beats, three ablations of ventricular tachycardia and nine procedures for the treatment of supraventricular tachycardia. The cohort was matched with a control group regarding the procedures performed. There were no demographic differences between groups.
Remote support was possible in all 50 cases without any relevant technical problems. The audiovisual transmission via the Medinbox is consistently available in good quality. The 3D mapping via EnsiteX was stable during the mapping and the maps were edited without delays, map shifts or software crashes. The internet-based connection was continuously available throughout all procedures. In no case was it necessary to switch to on-site support. This meant that the usual travel time could be reduced by a cumulative 8,340 minutes (= 139 hours; 166.8 min./case).
The median procedure time was:
Remote: 100 min [IQR 76, 120] vs. Onsite: 86 min [IQR 60, 110], p=0.051.
The median fluoroscopy time was Remote: 9.1 min [IQR 6, 13] vs, onsite: 8.7 min [IQR 5, 12], p = 0.109.
The procedure data were comparable to the control and showed no significant differences. Acute procedural success was observed in all studies. With regard to periprocedural complications, apart from one AV-III in the remote group, no other serious complications and no differences between the groups were observed.
Conclusion/Conclusion
This study showed that support for electrophysiological procedures can be carried out safely and stably using a remote FTE in everyday clinical practice. A trained person on site is not absolutely necessary. In addition, by using an audiovisual communication unit, it is possible to easily process various impressions from the EP laboratory in real time and incorporate them into the procedure. The only requirement for this is a stable internet connection.
Credentials
- Müssigbrodt, Andreas et al. (2021) Feasibility of remote technical support for electrophysiological ablation procedures during the current COVID-19 pandemic, in: European Heart Journal of Digital Health. 25;3(1):77-80. doi: 10.1093/ehjdh/ztab107.
- Heeger, Christian et al (2023) Treatment of frequent premature ventricular contractions via a single very high-power short-duration application, in: Europace. 2023 Apr 15;25(4):1515. doi: 10.1093/europace/euac226.
Characteristics | Remotely | Onsite | P |
| Number of patients, n | 50 | 50 | |
| Procedure time, min. | 100 (76, 120) | 86 (60, 110) | 0.051 |
| Fluoroscopy time, min. | 9.1 (6, 13) | 8.7 (5, 12) | 0.109 |
| Treated arrhythmia | |||
| CTI | 4 (8) | 4 (8) | 0.999 |
| PVI | 20 (40) | 20 (40) | 0.999 |
| AT | 13 (26) | 13 (26) | 0.999 |
| VES | 1 (2) | 1 (2) | 0.999 |
| VT | 3 (6) | 3 (6) | 0.999 |
| AVNRT | 7 (14) | 7 (14) | 0.999 |
| AVRT | 2 (4) | 2 (4) | 0.999 |
| Complications | |||
| Pericardial tamponade | 0 | 0 | 0.999 |
| Severe bleeding | 0 | 0 | 0.999 |
| Apoplexy/TIA | 0 | 0 | 0.999 |
| AV block III° | 1 (2) | 0 | 0.553 |
Table 1: Periprocedural data (C. Heeger)
Figure 1: Screen view of the Medinbox: Remote support from the home office during catheter ablation of atrial tachycardia at the University Heart Center Lübeck (C. Heeger)
Read the original article on herzmedizin.de
Dr Dale Yoo
Case Studies
Electrophysiologist, Heart Rhythm Specialist at McKinney, Texas
I don’t think I have to state, or overstate, or even understate why remote support matters. With the Covid world we live in, I thought there would be an end to it but it’s just the new normal, we have been able to continue to do what we do day to day with the safety measures that we needed and the continuity of safety into healthcare; and still being productive and being everything that we want to do with new technologies is an important part of this.
We want to make sure that cases can be done, add-on cases occur, but your favorite mappers, clinicals, reps, they don’t always exist, they can’t be everywhere at the same time. So, it’s been fantastic to be able to utilize some of the support that we get (…) and then of course pulling in something new: that’s the Medinbox component. You can basically do this entire support remotely safely without taking longer. It’s basically the same time you normally do it with the best of the best anywhere in the world potentially supporting you. And I think that’s really great. Also, it enhances the education piece (…).
A lot of the new mappers, and a lot of the new support staff can kind of learn how to do what they need to do back home they can now do this live with us, like they’re part of the case, from where they are in the comfort of their own homes and labs, and I think that’s a really important part of that as well. So, of course we’ve kind of talked about a case support getting input from other sites, other leaders that have been a little bit more advanced in this field. Maybe they have experienced more cases than you and your team. I think that’s very important. We’ve talked about how this is going to really revolutionize our ability to do high-level mapping, high-level technology delivery to all parts of the globe, maybe to Mars if we get some help with Musk and other people! But at the end of the day, we’re able to help every nook and cranny of this planet because there is patients on every nook and cranny of this planet and they all deserve equal care, if you will.
Technical support has always been there, but this really highlights the opportunity to really use that 24/7 support from a team leader, somebody that you may know or somebody that you want to know, and they can help you again remotely. I think in terms of the world we live in; we’ve seen a lot of the movies that have already shown you what you can do but what’s great is, I think, this is the first time we’re actually bringing the future to today. We actually have the technology that allows us to meld all these things as of a couple of days ago, when we did our first live case with every integration as I know it, the first case in the world where we took the best of the best, we were able to do the support with the Medinbox that allowed the mapper, the support staff to actually control items in our lab live from a remote site, with minimal use of bandwidth; which has been a limitation for a lot of different companies and delivery technologies in the past.
Everything is done remotely with the two strains, as you saw there, they have the ability to see all that you can see on here, including anesthesia if you want that as well, that’s another input that we had. And again, up to eight inputs of any kind. And even though we have more and more technology going into this, eight is fairly a lot that encompasses pretty much everything you need and then some. I think we had six going in, but if you wanted something additional, that gives you the extra capacity of that as well. In terms of mapping, there was no delay when I was asking them to rotate the map as my mappers hate and love me, for I love orthogonality; I like to have two separate views. I want them to follow me. I asked them to do it. They did it immediately, just like they’re in the lab. So, except I can’t throw things at them, so, I think they love the experience probably even more! So being there and being able to see it live and for our first case, we initially thought that maybe we’d do a simple Flutter, an Avian RT, let’s just, let’s tread lightly and figure out how we use this. It didn’t turn out that way, the real world doesn’t. This was an Afib ablation. We went in there, we identified, and we did everything like it was in the lab.
I think the bounds are endless and so I’m very proud and very lucky and humbled to be a part of this experience. Hopefully more going forward and hopefully some of you out there will have this opportunity too going forward. (…) I think the utility is huge in developing and emerging markets. Of course, the education pieces need to be there more, but these are the types of technologies that allow us to do that in a safe manner, expand that knowledge to everyone around the world.
Case Study - Ordensklinikum Linz Elisabethinen
Client: Ordensklinikum Linz Elisabethinen, Linz, Austria
Need/Issue:
- To guarantee a continuous training and medical education for young doctors despite social distancing and the Covid-19 pandemic.
- To have a live medical collaboration solution to share knowledge
Medinbox installed a system.
“This is the future which we started right now.”
Helmut Pürerfellner, Cardiologist, Ordensklinikum Linz Elisabethinen
Target:
- To be the first digital transmission system permanently installed in Austria, which means that heart experts from all over the world can join the procedures as if they were standing in the OR themselves
- To watch and work in real time
- Live medical collaboration at operating procedures
- Availability of the procedures at the cardiac catheter laboratory worldwide on a digital platform
- All the data used in the Heart Rhythm Laboratory is accessible worldwide with visuals and audio
- Strict compliance with data protection
- Better patient care and patient's benefits improved
- Clinical networking for enriching knowledge exchanges
- Better medical education
"I think this is the technique which we need in the next years, not only in times of a pandemic."
Helmut Pürerfellner, Cardiologist, Ordensklinikum Linz Elisabethinen
Dr Helmut Pürerfellner
Because of the pandemic, contacts have been limited for future doctor’s trainings. In Austria, at the Ordensklinikum Linz Elisabethinen, medical education has been maintained live from the operating rooms.
The first digital transmission system has been permanently installed in Austria, meaning that heart experts from all over the would can now join in on the procedures as if they were physically attending.
Being able to attend an operating procedure is the basement of a solid education and training in the medical field. Procedures that take place at the cardiac catheter laboratory are now available all over the world on a digital platform, allowing experts to watch and work in real time.
In the heart rhythm laboratory are cameras and monitors that can be remotely controlled. All the data gathered can be manipulated individually; and thanks to a control room you can access the information worldwide, simply using the internet.
With a perfect transmission of every single detail, the Medinbox system gives doctors a real viewing and an insight as if they were standing in the operating room themselves – with a strict compliance of data protection.
The experienced professionals can thus train their younger colleagues, and in this case, in interventional treatment of cardiac arrhythmia, allowing attendees to follow and participate interactively in the procedures. There are also significant advantages for the patients.
Networking with other centers who possess digital platforms has become a prerequisite and can significantly enrich the exchange of knowledge in the medical field.
Case Study - Montreal & Atlanta
Case Studies
The McGill Hospital in Montreal and the Emory University Hospital in Atlanta needed a stress-free device for their broadcasts and a support team on location.
Client: Stéphane Rinfret, McGill Hospital (Montreal) and Emory University Hospital (Atlanta)
Need/Issue: To install in the CUSM a stress-free device for MLCTO lives and to have a support team on location.
Medinbox has installed 2 Medinbox Systems in Montreal, One Hub USA for MLCTO with a tailored 3D studio and provided audiovisual production services for EPIC-SEC.
Case Study - St. Louis (MO)
The Barnes-Jewish Hospital in St. Louis, Missouri, was in need of an OR-integrated AV-system and Medinbox met with their demand.
Client: Barnes-Jewish Hospital St. Louis, MO
Need/Issue: Barnes-Jewish Hospital needed an integrated AV solution to organize onsite and online medical workshops as well as broadcasting live HD images from their cathlabs via the internet to the ARCH Symposium (annual international conference organized by the cardiology department).
After studying the context and the cathlabs on location, Medinbox was able to provide the most appropriate response.
Jasvindar Singh MD, Barnes-Jewish Hospital St. Louis, Missouri
Medinbox has installed many devices in the past years and has been providing broadcasting and audiovisuel production services for the ARCH congress.
Will migrate to Medinbox Link 2nd semester of 2021.
