Webcasting pathology department conferences in a geographically distributed medical center.

Abstract

As academic pathology departments have become increasingly based in large, regional medical systems spread across hundreds of square miles, new methods are needed to tie these increasingly distributed departments together as integrated units. An important part of that integration is the ability to share academic and teaching conferences across long distances. In this article we present an effective, low-cost webcasting system that has evolved at the University of Pittsburgh Medical Center Department of Pathology over the past several years based on inexpensive, widely available software. To date, the system has broadcast and archived more than 400 conferences and currently serves approximately 80 to 100 requests each week. Important factors in the success of the program include the creation of a faculty steering committee to control resources and manage growth, the availability of informatics faculty and support for technical staff, and the decision to operate the service as part of the core information technology infrastructure of the department. Webcasting will likely become an even more important academic and operational tool in the future as more of the department's conferences, seminars, and even working meetings are communicated through the webcasting infrastructure.

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Webcasting Pathology Department
Conferences in a Geographically
Distributed Medical Center
YUKAKO YAGI, MD, ISHTIAQUE AHMED, WILLIAM GROSS, BS,
MICHAEL J. BECICH, MD, PHD, ANTHONY J. DEMETRIS, MD,
ALAN WELLS, MD, DMS, CLAYTON A. WILEY, MD, PHD,
GEORGE K. MICHALOPOULOS, MD, PHD, SAMUEL A. YOUSEM, MD,
BARBARA BARNES, MD, AND JOHN R. GILBERTSON, MD
As academic pathology departments have become increasingly
based in large, regional medical systems spread across hundreds of
square miles, new methods are needed to tie these increasingly
distributed departments together as integrated units. An important
part of that integration is the ability to share academic and teaching
conferences across long distances. In this article we present an effec-
tive, low-cost webcasting system that has evolved at the University of
Pittsburgh Medical Center Department of Pathology over the past
several years based on inexpensive, widely available software. To
date, the system has broadcast and archived more than 400 confer-
ences and currently serves approximately 80 to 100 requests each
week. Important factors in the success of the program include the
creation of a faculty steering committee to control resources and
manage growth, the availability of informatics faculty and support for
technical staff, and the decision to operate the service as part of the
core information technology infrastructure of the department. Web-
casting will likely become an even more important academic and
operational tool in the future as more of the department’s confer-
ences, seminars, and even working meetings are communicated
through the webcasting infrastructure. HUM PATHOL 35:790-797. ©
2004 Elsevier Inc. All rights reserved.
Key words: webcast conference, distance learning, continuous
medical education.
Abbreviations: CME, continuous medical education; PA, public
address; UPMC, University of Pittsburgh Medical Center.
Over the past 10 years, the University of Pittsburgh
Medical Center (UPMC) has grown from a handful of
continuous buildings in Pittsburgh’s Oakland section
to a major regional health system with 20 community,
specialty, and tertiary care hospitals serving 29 western
Pennsylvania counties. Figure 1 shows the distribution
of UPMC hospitals in western Pennsylvania. The De-
partment of Pathology has grown with the medical
center, and this rapid growth has brought major chal-
lenges as the department seeks to retain and expand its
tradition of education and academic discussion in a
growing geographic footprint.
Formanypathologists,animportantpartofthePathol-
ogy Department’s academic and educational mission is rep-
resented by a series of weekly conferences and “grand
rounds.” In these formal activities, pathologists, residents,
and researchers present didactic lectures on practice issues,
diagnostic skills, or ongoing research. In the major teach-
ing hospitals of UPMC, these meetings draw 30 to 100
attendees, are usually mandatory for residents, and often
provide continuous medical education (CME) credit.
As the medical center has expanded, however, the
concept of a series of central, physical meetings became
less and less tenable. As care became distributed across
the hospital network, the core academic and teaching
audience of the conferences became dispersed across
multiple physical locations. In some cases, a “centers of
excellence” model developed in which the manage-
ment of different disease types became centered at
different institutions. For example, genitourinary pa-
thology became centered in the Shadyside Campus;
breast pathology, at Magee Woman’s Hospital; and
transplant pathology, at Presbyterian University Hospi-
tal. These campuses are approximately 1 mile apart,
and traveling between them takes approximately 30
minutes. Attendance at a noon conference at another
hospital could mean an hour of travel or nonproduc-
tive time in the middle of the working day.
While the redistribution of service, academic, and
teaching facilities within the City of Pittsburgh was mak-
ing physical conferences problematic for their tradi-
tional audience of university-based pathologists, a new
audience was seeking access. Many previously indepen-
dent community hospitals had joined the UPMC net-
work, and their pathologists wanted access to the aca-
demic and educational resources of the traditional
teaching hospitals. However, a commute to downtown
Pittsburgh, often from a different county, for an hour-
long academic conference was never a serious option
for these pathologists. There had to be another way.
The UPMC had a history of pathology imaging,
distance learning, and telepathology. The center sup-
ports a wide range of telepathology and tele-educa-
tional initiatives from educational web pages (ie,
http://path.upmc.edu/cases.html,
edu), imaging-capable LIS (CoPath), traditional “cam-
http://tpis.upmc.
From the University of Pittsburgh Medical Center, Pittsburgh,
PA. Accepted for publication March 31, 2004.
Address correspondence and reprint requests to Yukako Yagi,
Director of Telepathology, University of Pittsburgh Medical Center,
UPMC Cancer Pavilion, 5230 Centre Avenue, Suite 338, Pittsburgh,
PA 15213.
0046-8177/$—see front matter
© 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.humpath.2004.03.013
790

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era on microscope” static systems, TV teleconferencing
based dynamic systems, static robotic systems (http://
telepathology.upmc.edu), and whole slide imaging
(http://virtualslide.upmc.edu).
been used to support tele-education, teleconsultation,
and telementoring across the UPMC health system,
including active support for UPMC hospitals overseas.1
This medley of campuses, systems, and requirements
had created a complex environment in which different
clinical groups would request different telemedicine
services, which had to be implemented within the con-
straints of limited budgets and preexisting image and
communication infrastructures.
To manage and prioritize the wide range of some-
times-competing telemedicine and distance-learning
initiatives, the UPMC Department of Pathology created
the telepathology steering committee in 2000. This
committee comprises the chairman, the anatomic pa-
thology and clinical pathology directors, and the direc-
tors of the clinical divisions most actively involved in
telepathology and tele-education. In late 2000, the
steering committee directed the telepathology imple-
mentation group to investigate the use of teleconfer-
encing for major academic and teaching conferences.
The telepathology steering committee developed
the following requirements for any system imple-
mented to broadcast the department’s academic or
educational meetings:
These systemshad
1. The system must be inexpensive and cost-effec-
tive (thousands of dollars, not hundreds of thou-
sands). The software must be widely available
with little installation and maintenance expense,
especially at the client (remote) sites. There
should be limited licensing fees, and the pur-
chase of additional client hardware should not
be required.
2. The system should operate as a “clinical” system
with high reliability.
3. The system should be easy to use with limited
(or no) user training. Use should be intuitive or
possible through limited on-line support.
4. The system should be portable and not be lim-
ited to a small number of conference rooms.
5. Access to the system should be limited to the
UPMC internet or DNS domain (http://www.
upmc.edu). (This requirement evolved as dis-
cussed below.)
6. The system should support conferences in real
time as well as in a searchable, archival mode.
7. There should be a mechanism to support CME.
Teleconferencing, or webcasting, is not a new con-
cept.Numerouscompanies
equipment, and others market web-based meeting ser-
vices. Some national meetings, including those of the
APIII (Advancing Practice, Instruction and Innovation
through Informatics) and ATA (American Telemedi-
cine Association), have been webcasting selected pro-
ceedings for years. However, there is relatively little in
the technical literature on the implementation of tele-
conferencing or webcasting services for academic con-
ferences in pathology departments, especially beyond
the support of medical school lectures. Most of the
literature focuses on using teleconferencing as a diag-
nostic tool2,3or on highly capable (and expensive)
systems, such as that developed by Japanese cancer
centers.4
In this article we report the implementation of a
web-based conferencing system with the capabilities dis-
cussed above and a total equipment cost of under
$10,000. After a 2-month trial period, the system began
operation in March 2001. Since that time, it has served
and archived more than 400 conferences. It currently
broadcasts an average of 1 new conference per day to
approximately 80 to 100 users per week.
sell teleconferencing
MATERIALS AND METHODS
The web-based teleconferencing system is best described
in 2 main areas: (1) hardware and software—including the
conference (video) server, conference (video) station, and
the webcast client—and (2) system operations and manage-
ment. Figure 2 shows a diagram of the system.
FIGURE 1.
tions of major UPMC hospitals. (Source:
UPMC website, www.upmc.edu.)
Map of Pennsylvania with loca-
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Hardware and Software
The system is relatively inexpensive; the total ocst of the
hardware was less than $10,000 in 2001. In 2003 we installed
a similar system for a non-UPMC, government client for
approximately $8,000 (with a much better camera and com-
puters). A free limited version of the server software is avail-
able, and client software is free and easily accessible.
Video Server
We use a Dell Power Edge 4400 with 4 GB of RAM and a
220-GB hard drive running Windows NT4 and IIS. The Power
Edge cost approximately $5000 in 2001 and is more than
adequate for this application. Windows NT4 is the standard
(approved) operating system for light-duty servers at UPMC.
The Media Server software is RealSystem Server 8 from Real-
Networks, Inc. (Seattle, WA). A free limited version is avail-
able from their website. This limited version allows a maxi-
mum of 25 concurrent users to access a live session, and
unlimited users to access an archived session.
Video Station
The video station is the package of equipment placed in
the conference room to webcast and record a conference.
Because there are multiple potential conference rooms, the
station is portable and configurable to different public ad-
dress (PA) systems and furniture layouts. This package con-
tains Multimedia Notebook PC (Dell Latitude C810, 512 MB
memory, 18 GB hard drive, Windows 2000), a USB video
capture card (Osprey-50; Osprey Video, Morrisville, NC), a
digital video camcorder (MiniDV HandyCam; Sony America,
New York, NY), and a tripod and a backup microphone. The
cost of this package was about $3000 in 2001.
To webcast a conference, the camcorder is fixed by the
tripod at a convenient location for capturing video, as shown
in Figure 3. The camcorder video is transferred to the note-
book PC as an s-video signal by the USB video card. Audio is
taken through the room’s PA system or through the backup
microphone on the digital video camcorder. The notebook
PC is equipped with Real Producer Plus, version 8.51 to both
capture (record) and broadcast the conference live through
the network. This has been recently upgraded to Helix Pro-
ducer Plus, version 9.01 (RealNetworks). Using Real Pro-
ducer, the technician on site creates a RAM file (also called a
metafile), with the file extension *.ram. The RAM file
launches RealOne Player (RealNetworks), gives it the URL to
a media clip, and can pass parameters to open an HTML
page. The RAM file production method is easy to use and is
well suited for simple presentations, such as a conference
documented by single video clip that displays an HTML page
as it plays. Note that if the conference room does not have
network access, the conference can still be recorded for later
display, as discussed below.
Webcast Client
To run the webcast, the client PC requires a sound card,
speakers, a browser, and a media player. Most pathologist’s
PCs had been previously equipped with a sound card and
FIGURE 2.
station) is portable to multiple conference rooms.
Network diagram of the conference webcasting system. The video camera and multimedia laptop setup (video
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speakers with volume control. Real Media Player (RealOne
Player) (RealNetworks) is part of the standard PC desktop at
UPMC and thus was chosen as our webcast client. The stan-
dard UPMC desktop also included Microsoft Internet Ex-
plorer, which was used as the web browser required to access
the system and use the utilities available at the webcast con-
ference website.
System Operations and Management
General Operations
It takes a trained technician approximately 20 hours per
week to manage the system and broadcast 5 to 7 conferences.
The great majority of this time is for setup and recording of
conferences. However, more than one technician is needed,
because conferences can occur simultaneously, early in the
morning and late in the afternoon (more than 8 hours apart),
or in different hospitals. Sick days and vacations must also be
accounted for. Therefore, whereas only 1/2 full-time equiva-
lent (FTE) is needed to run the system, multiple technicians
must be trained and available to support a consistent level of
service. An important aspect of maintaining service is provid-
ing ongoing training and ensuring the availability of on-line
materials, as discussed below.
Using the system entails going to the webcast web page
(off the department’s main home page, http://path.upmc.
edu) and clicking on the conference of interest. Future con-
ferences are announced on the webcast home page, includ-
ing the time, location, conference type, lecture title, and
speaker. When the conference begins, it is designated as a
“live” conference and can be accessed in the UPMC domain
by clicking on its hyperlinked title. (Access to some confer-
ences is more closely held, as discussed below.) After the
conference is over, the *.ram file is transferred from the
portable video station to the video server, where it can be
accessed in an archived form. In most cases, depending on
the preferences of the faculty running the conference, ar-
chived conferences can be accessed outside of the UPMC
domain or can ordered on DVD/CD. The conference archive
can be searched by date (range), speaker, title, or conference
type. Figures 4 and 5 show the operational workflows for users
and technicians, respectively.
User Support
Most pathologists at UPMC have highly capable PCs
(initially installed to support imaging) maintained by central
information services. The machines have speakers and sound
cards and are preinstalled with Real Player and Microsoft
Internet Explorer. Hardware/software user support has
therefore not been a major issue. That said, however, mini-
mum system requirements, installation, and operations
manuals are posted on the webcast home page (http://
teleconference.upmc.edu), and we have found these to be
extremely important. If necessary, users may send a message
from the webcast home page to the UPMC Help Desk, who
will triage any problems to telepathology and webcast staff.
Users can also make suggestions directly from the web page to
the technical staff and to the telepathology steering committee.
Communications
Information on scheduled and archived webcasts posted
on the website is kept current by department administrative
staff, who notify the webmaster of any changes in the time,
location, and nature of upcoming conferences. When a con-
ference is being broadcast live, it is occasionally necessary to
contact the technician in the conference room. The techni-
cian cannot use e-mail through the computer (and usually
cannot use the conference room phone) during broadcasts.
Therefore, text pagers with keyboards were requested for all
technical staff. These pagers can be used at the conference
locations to communicate between the technician and staff
about emergency matters that may arise during a conference
(eg, audio volume or frame alignment problems during the
webcast) that may not be obvious to the technician locally.
Only one pager was procured to be shared between staff,
however. This helped mitigate most, but not all, communica-
tion difficulties.
On-Line Help for Telepathology Staff
Because of the numerous potential locations for telecon-
ferences (and local differences, such as room size, lighting,
PA systems, etc), an on-line manual was prepared to docu-
ment this information. It contains details of each conference
room, including locations of active ports, port numbers, PA
configurations, contact information on administrative staff
responsible for the room, and so on. The manual also in-
cludes standard protocols for creating video files and manag-
ing them in the system (eg, how to move files from live
conference mode to the archived conference database). This
resource is extremely important to keeping webcasting oper-
ations functioning smoothly when technicians go on vacation
or when schedules become disrupted.
Management and Administration
Three groups define the course of the webcast confer-
encing initiative at UPMC. The first group is the technical
development leaders and support staff, who are responsible
for the development and operation of the system. The second
is the telepathology steering committee, which is responsible
for the overall direction of the system and its priorities. As
discussed earlier, the telepathology steering committee con-
sists of the department chairman, the anatomic pathology
and clinical pathology directors, the division directors actively
involved in telepathology and distance learning, and the sys-
tem developers. It was organized in the late 1990s to manage
implementation of teleconference-based telepathology sys-
tems in a growing number of UPMC hospitals and to manage
telepathology, tele-education, and network pathology issues
at UPMC.
The steering committee is very important to the devel-
opment group, because it provides legitimacy and support for
telepathology and distance-learning initiatives. The commit-
tee meets every 3 months, with additional meetings as
needed. Finally, and most important, there is the general user
communitee of pathologists, researchers, and physicians—
the ultimate judges and definers of the system. User feedback
is garnered through the web page, surveys, and direct inter-
action between users, developers, and the steering commit-
tee.
RESULTS
Overall Scope
The webcast conference system became opera-
tional in March 2001 with an initial schedule of 3
weekly conferences. Favorable responses resulted in
multiple requests to broadcast other conferences. The
main limitation to additional conferences was the staff-
ing required to produce a consistent, high-quality prod-
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uct. After consultation with the telepathology steering
committee, it was decided to broadcast 5 regular, hour-
long conferences per week, with 1 or 2 additional con-
ferences per week on request. Figure 6 shows screen-
shots from a typical conference.
The current regularly scheduled webcast pathol-
ogy conferences are as follows:
● Current topics in laboratory medicine. A “grand
rounds” environment in which faculty and resi-
dents present literature relevant to clinical pa-
thology practices.
● Pathology departmental seminar. The main “re-
search” seminar in the department, which often
includes invited speakers from other institutions.
● Clinical pathology didactic lecture. A weekly
teaching lecture in laboratory medicine.
● Anatomic diagnostic pathology conference. A
“grand rounds” environment in which faculty
present literature and case studies relevant to
anatomic pathology.
● Anatomic pathology didactic lecture series. A
weekly teaching lecture in anatomic pathology.
To date, more than 400 pathology lectures have
been webcast. All of these conferences have been ar-
chived and are available at the website.
Usage Statistics
In an average week, there are 80 to 100 completed
requests for a live or archived conference, with a live to
archived ratio of ?40/60. Over the past year, requests
have more than doubled, and the archived conferences
have become increasing popular. Saturday and Sunday
have the lowest number of visitors (?10%), followed by
Tuesday (?13%), which is the one weekday that does
not have a live conference. The most active day and
time is Thursday from 11:30 to 1:30, the time of the
anatomic pathology diagnostic conference. Impor-
tantly, physical attendance at these pathology confer-
ences has not decreased. Webcasting thus has signifi-
cantly increased the overall attendance (and, therefore,
the importance and impact) of the academic confer-
ences. Furthermore, other departments and institu-
tions have seen the effectiveness of webcasting and
begun to use the pathology webcasting service for their
own conferences.
DISCUSSION
Managing Growth
Webcasting of pathology conferences has been suc-
cessful in the UPMC environment. With this success
comes the challenge of managing increasing requests
for new conferences and services within the confines of
limited resources. It is becoming increasing easy to
purchase and set up video servers, and there is always a
temptation to capitalize more resources than can be
maintained over time. The result can often be under-
utilization of resources and poor, unreliable service. At
UPMC, the administrative body charged with directing
and managing networked technologies, including web-
casting, is the telepathology steering committee. As
discussed earlier, the steering committee includes the
chairman and division directors and has the ultimate
authority on what systems will be implemented in the
clinical department (the committee does not monitor
the research labs) and what departmental resources will
be expended. Although it requires time and effort of
the part of senior faculty, the telepathology steering
committee can be an effective mechanism for matching
departmental telepathology and distance learning
needs and resources.
Another important administrative aspect central to
the success of the system is that the system be treated
operationally as a clinical system, with dedicated tech-
nician effort and user support provided directly
through the UPMC help desk. From the very begin-
ning, the system was treated not as a “pilot” or a
“project,” but rather as an important, fully supported
information technology resource for pathologists.
FIGURE 3.
Portable video camera, tripod, and laptop PC (shown after a conference).
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