In addition to traditional security and monitoring functions, Milestone Systems’ open platform video management software at Nemours Children's Hospital delivers unique services to radiology and cardiology units, behavioral health clinics, perinatal care and more.
The Nemours Children’s Health System is a national resource focused on providing pediatric medical care, research, education, prevention, and advocacy. As one of the largest integrated children’s health systems in the U.S., Nemours is committed to keeping the highest quality care close to home for the convenience of patients and their families.
Nemours owns and operates two free-standing children’s hospitals: the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, and the Nemours Children's Hospital in Orlando, Florida, along with outpatient facilities in five states. The Orlando facility is a full-service, 100-bed hospital with emergency care.
Nemours also offers CareConnect, a 24/7/365 on-demand video-based, pediatric telehealth program, which provides family access to pediatricians through a smartphone, tablet or computer. At Nemours, technology plays a large part in their health system services.
Joe Summanen has been the Technical Architect for Nemours in Florida for over eight years and has seen the hospital and its systems nearly triple in size. Now with more than 1,800 network cameras, the hospital uses video for surveillance, security and situational awareness throughout the interior and exterior of the facilities.
Centralized Control with a Flexible Foundation
The hospital has two command centers with traditional operators acknowledging alarms, monitoring in real-time, performing investigations and other forensic work. Over the course of the video system's growth in size and sophistication, the technical team at Nemours has built on the scalable Milestone XProtect Corporate open platform Video Management Software (VMS).
The Nemours Tactical Logistics Center (TLC) serves as mission control for the hospital video system. With 16 large monitors, every child patient can be seen on-screen along with the patient data, local news, weather, and communications from surrounding hospitals. If there's a mass casualty drill or an actual emergency, officials can make real-time decisions on routing traffic or patients to or from other hospitals. Also, if needed, the Logistics Center uses XProtect Screen Recorder to capture video from the displays and rebroadcast the data to hospital leadership for additional direction.
"Nemours has utilized the Milestone platform for several years. Once the initial federated topology was implemented, we were able to migrate all of our IP and existing legacy analog cameras into our system. One key feature that drove that decision was the ability to update or change camera settings on the backend without our end users ever experiencing any downtime or interruption of service," said Summanen. "Milestone’s open platform gives us the ability to quickly and securely integrate new capabilities and services. Having that flexibility truly gives us the opportunity to provide innovative solutions to our associates and is proving to be an invaluable resource for Nemours."
At Nemours, the video system sits on a federated topology with a parent server and three child servers (two in Florida, one in Delaware). At each hospital, all recorders run on virtual servers utilizing SAN or block storage, providing a highly reliable architecture. The remote clinics use localized Lenovo recording servers, in order to mitigate pushing video over the WAN. Summanen said that they’ve standardize on Lenovo hardware for their smaller locations and HP servers within their data centers.
"If we experience a significant issue with a remote recorder, we’re able to redeploy a new recorder with our standard Windows image. This lets us take advantage of the PC hardware we currently stock on our shelves and allows us to quickly restore functionality with minimal impact to operations," said Summanen. "We're all about the process, and Milestone’s open platform VMS is very flexible with off-the-shelf hardware."
Beyond the Traditional for Better Patient Care
Summanen explained that Nemours uses their video surveillance system in many non-traditional ways, including a range of integrations that help the hospital improve facility efficiency, lower operational costs, and deliver a safe, pleasant and healthful patient experience.
With child safety foremost in mind, Nemours has deployed a camera in every patient room. Summanen explained this allows for a level of monitoring that a patient wouldn’t normally have in place. Not only are there nurses and clinical staff in the room and at the nursing station, but the TLC is able to announce themselves via audio, then see into a room with video, giving them the ability to assist remotely and call other rapid response teams if needed.
"We have an AXIS P33 Series fixed network camera in every room, to provide a third level of patient monitoring and situational awareness within the patient envelope. None of the cameras are recorded, but when an alarm trigger is activated, it allows highly trained paramedics to monitor every child in each bed at Nemours 24/7,” said Summanen. “This capability has greatly extended our patient coverage and allowed us to provide more effective and cost-efficient care."
Summanen added that each patient room camera is equipped with a privacy LED light indicator. The hospital uses a range of LED notification solutions, some triggered by the Milestone VMS and some by the AXIS camera itself. When anyone is accessing the video, the LED will flash, letting those in the room know that the camera is in use. Only authorized personnel are allowed access to the video.
Along with the cameras, Nemours uses a mix of video/data integrations and analytic tools to extend the effectiveness of human operators by quickly flagging potential issues. The open platform VMS enables other systems to share video and data.
"Several clinical groups within Nemours use our Milestone system regularly, including Cardiology and in our ORs. We also share real-time ultrasound video across the system for physician 'wet reads' for fetal care and other diagnostics," said Summanen. "Our Behavioral Health and Autism clinics use video in patient care and in tracking patient development over the course of several visits.”
As a data foundation for the system, the hospital keeps tabs on patients through video integrated with Epic Monitor. Epic is the hospital’s Electronic Medical Records (EMR) system. An EMR is a digital version of the patient's medical chart. By tying the information to the Logistics Center, operators can keep a vigilant watch on patients with their medical information data also presented on screen. This detail allows operators to stay informed and keep a close eye on the most critical patients.
Remote Wet Reads for Fetal Care
The Perinatal department uses the Milestone platform to share video of ultrasound scans with others located throughout the region, for real-time ’wet reads’ of the imaging. A wet read is a reference to reading an x-ray immediately following the processing of the film (i.e., while it is still wet from hand processing).
"When a technician is performing an ultrasound scan, they can share the scan video with others remotely if needed," said Summanen. "This can be done live, giving the provider immediate feedback. A diagnostic-level reading is still forthcoming, but the immediate sharing allows us to provide a more thorough service, and perhaps save the patient from additional ultrasound scans."
Today, for example, a technician may notice an abnormality in a scan and want to share the live video with a perinatal specialist in real-time, who may be at a remote location.
"Remote video offers a great level of efficiency for our care providers because they don't have to leave the hospital and go to another location, they have the ability to provide guidance to the ultrasound technician remotely," said Summanen. "It's another tool that we can provide to our associates and to our clinical staff to help them connect with families and provide better care more quickly."
Cardiac Unit Benefits from Video
Another use of video is with the cardiac unit, which encodes every physiological monitor in the cardiac unit with the information integrated on the VMS displays, allowing cardiac intensivists to monitor patients around the clock. Also, with remote connectivity through the Milestone XProtect Smart Client, if the cardiologists are home or traveling, they can quickly check in on patients through their smartphones or mobile devices.
When connecting with the XProtect client remotely, a care provider can look at all the physiological monitors within his or her unit, keeping their patients top of mind. The video system has had a very positive impact and has helped reshape how they are providing care.
“Something that has always resonated with me was feedback I received from several providers about how they are now able to monitor and check on their kids’ physiological monitors when they are at their desk or even at home,” said Summanen. “By always being present in their day-to-day life, they’re now thinking about the care of those children all the time. It’s really changing the model of care here at Nemours.”
Managing Behavioral Care
With the Orlando Behavioral Health unit, video is used primarily as a clinician tool to allow multiple people — often including the parents — to observe a patient session without causing the child additional stress or distraction. Also common is for the clinician to have a set of tasks for the parents to work through with their child in the room, and video records the family as they work through the tasks together.
The Nemours Applied Behavior Analysis team was looking for a way to help teach skills to patients with behavior deficits or issues of inappropriate behavior, such as tantrums or self-injurious actions, and to help the patient adapt more appropriate conduct. The skill development and training is a valuable tool for staff, parents and other family members as well.
“The use of cameras and recorded video is a critical tool: problem behavior is often difficult for parents to see,” said Ansley Hodges, Lead Behavior Analyst, Nemours Hospital. "The cameras make it easy because parents can sit with me in my office as we watch the therapist at work with the patient. I explain what the therapist is doing and why, and the parents can start to see that. Then they think OK; this might look bad but the patient is responding and making improvement."
Hodges added that the same concept applies for new skills when instructing patients on how to communicate more effectively. Here, cameras and recorded video are an efficient way to illustrate and reinforce desired behaviors. The capability has been a huge game changer for the hospital’s Autism clinic.
“We've received such great feedback from parents and our staff about how helpful the video is," said Hodges. “Parents feel more confident in leaving their child in our care because they know that we're monitoring everything very closely. Some patients are here for 30 hours a week, and at any point in time, we can review specific events or simply observe their progress.”
Summanen added that upon parental approval, live session video is also used for staff and student observation and training purposes. Each room features an LED indicator, so the parents or clinician know when they are or are not being observed.
Flexible, Open Integrations
The Milestone XProtect open platform VMS currently supports more than 8,000 different security devices from more than 150 manufacturers. Technology Partners include providers of network video cameras, encoders, DVRs and NVRs, storage equipment, access control, alarm and detection systems, video analytics, GPS technology, laser scanners, emergency call boxes and much more.
With the Milestone VMS, systems integration is easy via Application Program Interfaces (APIs) to share data between systems, devices and components for an efficient, unified solution.
"The Milestone open platform allows me the flexibility to source and integrate third-party products and capabilities," said Summanen. "This enables us to greatly expand and customize the tools and services that we provide to the organization and our patients."
For example, Summanen found the UK-based company, Antrica, a manufacturer and supplier of H.264 and H.265 hardware, who offered a video encoder solution that the Nemours team was interested in working with. Summanen contacted their lead engineer and explained that he wanted to integrate their system with the Milestone VMS, and it was no problem.
"The engineer contacted Milestone, and within a few weeks, they were able to write a new codec into the Milestone driver pack — and now it's part of the driver pack that's released with every Milestone product," said Summanen. "The entire process was just so simple. At the end of the day, when you have a great partner, it’s easy to be innovative and successful."
Milestone Systems is a leading provider of open platform video management software; technology that helps the world see how to ensure safety, protect assets, and increase business efficiency. Milestone enables an open platform community that drives collaboration and innovation in the development and use of network video technology, with reliable and scalable solutions that are proven in more than 150,000 sites worldwide. Founded in 1998, Milestone is a stand-alone company in the Canon Group.
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