Report on Memorial University of Newfoundland's Experimental Use of the Communications Satellite Hermes in Telemedicine |
VOL. 8, No. 1, 34-42
One of the experiments mentioned in the articles by Doris Jelly and Terry Kerr1 was the telemedicine project at Memorial University. This article, excerpted from a 1977 report, records one project team's experience in the Hermes program and describes the origins of what is now one of Canada's more extensive telemedicine and distance education networks.
Les articles de Doris Jelly et de Terry Kerr signalent entre autres le projet en télémédecine effectué à l'université Memorial. Le présent article, extrait du rapport présenté au Ministère des Communications en 1977, fait état d'un groupe de projets qui ont participé au programme Hermès, un des réseaux de télémédecine et d'enseignement à distance les plus importants au Canada
Editor's Note:
This article is the third in a trilogy on the applications of Canada's communications satellites for distance education.
In June 1972, officials from the federal Department of Communications (DOC) visited St. John's. At a meeting organized by the provincial Department of Transportation and Communications, they outlined their plans for the Communications Technology Satellite (CTS), which was named Hermes after its launch in January, 1976. Representatives of the various educational agencies present formed a 15 member Newfoundland Communications Technology Committee (NCTC), chaired by Dr. C. Peter Benedict, Faculty of Engineering, Memorial University. Membership was drawn from several departments within the University, various provincial government departments, and agencies such as the School for the Deaf, the CNIB, the Colleges of Fisheries and of Trades and Technology, and the Women's Institute.
In October, 1972, the Committee submitted to DOC a document entitled "Preliminary Presentation to the Department of Communications for Experiments with the Communications Technology Satellite Program." Thirteen user agencies signed the report, and ten of them included specific proposals for use of CTS by their institution. Two features of the document were: one, a commitment by the University's Educational Television Centre (ETV)2 through its Assistant Director, Mr. W. C. McNamara, to allocate 50% of its resources to the planning and production of the proposed programs; and two, a series of medical education programs suggested by the Continuing Medical Education (CME) Office of the Faculty of Medicine, represented by its Assistant Dean, Dr. A. M. House.
In July 1973, the NCTC applied to DOC for a grant of $29,860 to engage a Project Director and an assistant. A contract of $7,000 was approved for the period October 1–December 31, 1973, for a project entitled "Study and Evaluation of the Possible Sociological Benefits and Design Criteria of Operational Orbiting Satellites for Communications with Remote Communities in Newfoundland and Labrador."
The resulting report describing the NCTC's revised plans was submitted in January 1974 to the CTS Evaluation Committee in Ottawa, chaired by Dr. H. Duckworth. The submission was entitled "Newfoundland Experiments with the Technology Satellite (NETS): A Project of the Newfoundland Technology Committee." It focused on two of the original ten proposed experiments, both of which were University projects based on the same ETV production commitment.3 The Telemedicine component was to consist of 31 hours of continuing medical education, medical consultation service, transmission of medical data, and community health education. Terminals were to be located at nine communities (St. John's, St. Anthony, Happy Valley, Burin/Marystown, Stephenville, Labrador City, North West River, Black Tickle, and Nain) for an eight week period in the fall of 1976. There was no budget, no technical plan, and no evaluation proposal in the document.
The NCTC was awarded an additional $21,999 for the 1974 calendar year, under a contract entitled "Socio-economic Studies Relating to the Newfoundland Experiments with the Technology Satellite (NETS)." In addition to the main NCTC, a Telemedicine Committee was struck by the Medical School, with representatives from telemedicine committees in the hospitals in Stephenville, St. Anthony, Labrador City, and Happy Valley.
The NETS Project was officially approved by the DOC Evaluation Committee in July 1974. In August, a new Project Coordinator (J. Roberts) was hired, and in October, Mr. N. Harris (Department of Education, Government of Newfoundland and Labrador) replaced Dr. Benedict as Chair of the NCTC.
In January 1975, the NCTC received renewed funding support from DOC. Since DOC policy did not envisage long term support for any of the projects, NCTC applied for $471,634 in April 1975 to the Canadian Urban Demonstration Program (CUPD), federal Department of Urban Affairs. In May, an application was submitted to Health and Welfare Canada (HWC) for the community health and consultation service components of the Telemedicine Project.
In July of 1975, the CUPD was cancelled and the NCTC application returned. This development precipitated a crisis in the NETS Project and resulted in substantial reorganization.
As a result of the funding crisis, the Extension Service decided to withdraw from the Project, leaving ETV and the Faculty of Medicine to make a final effort to fund a three-part Telemedicine Project consisting of: one, continuing medical education (CME); two, consultation services and the transmission of medical data; and three, community health education. Only the four communities with hospital-based Telemedicine Committees were to participate, not the nine originally hoped for. The NCTC was disbanded and Telemedicine became a University research project, with Dr. A. M. House and Mr. W. C. McNamara as co-principal investigators, and Ms. J. M. Roberts as Project Coordinator working out of the CME Office. Obtaining the HWC grant was considered the Project's last chance for viability.
Technical, production, and evaluation issues had to be addressed:
In December 1975, it was learned that without a greatly expanded research design, Health and Welfare Canada would not fund the project. Although the Department provided formulation funding to support such design activities, its application deadlines were incompatible with the DOC schedule, which was constantly undergoing revision because of the experimental nature of the technology and the social applications. DOC had postponed the Newfoundland broadcast dates from the fall of 1976 to March–June 1977, with the result that funding had to be assured by June 1976 if the project were to proceed.
DOC again provided Project Office funding for the 1976 calendar year, tangible evidence of its growing belief in the importance of such an office for innovations of this type.6 In contrast to previous contracts, however, approximately 60% of the total was allocated for hardware and software.
Preparations accelerated in all task areas, but not without the usual setbacks. The microwave system, planned for early 1976, was not installed until November of that year and was not available for program simulations until January 1977. The School of Nursing agreed to develop 10–12 hours of continuing education for the nursing staffs in the four participating hospitals outside St. John's. ETV was deeply involved in designing the interface between the DOC terminals and its own equipment and in advising on terminal installations. There was some discussion of organizing audio-conferencing activities, as ETV had learned of the University of Wisconsin's ETN in researching the type of microphones to be used in the satellite interaction. It was decided that any efforts in that direction were impossible, given the Project's uncertain future.
A Research Assistant (E. Keough) was engaged in June 1976 with the Health and Welfare Canada formulation funds. She and a multidisciplinary team, with different membership from the other telemedicine activities, planned, implemented, and evaluated a two-year project entitled "The Home Centered Videotape Counselling Program for Parents with Deaf Children (0– 5 years of age) in Rural Newfoundland." The program started in the spring of 1977.7
The Telemedicine Project finally became a reality when DOC made an exception to its stated policy of not supporting project implementation costs and provided a grant of $124,408 for the period July 1976 to December 1977. This decision permitted all efforts to be concentrated on the final planning, preparation, and implementation of the Project.8
ETV and the University Computer Services developed a computer program that could handle all content, technical, and production details, but very little of its capacity was used, for a variety of reasons. ETV was small enough that all technical and production details were settled by personal contact. The Medical School/ETV management links were also based on close personal contact as the Project was constantly evolving. Updating the computer information consumed a disproportionate amount of time. Using the satellite itself for programming announcements was more functional as participants consistently mislaid computer-generated information.
Contingency plans were developed for every possible human and technical communication during the immediate pre- and post-broadcast months. Paging units, redundant telephone lines, preproduced videotapes: all these and more were felt to be essential given the first-time nature of this particular satellite technology.
Many course instructors did not feel that simulations were necessary and/or had no time to prepare them because the installation of the micro-wave link was so delayed. Another problem was that it proved difficult to find audiences for the simulations. Furthermore, many simulations took place on days immediately preceding the satellite broadcasts because the instructors only realized the need for simulations when confronted with the broadcast deadline. The workload for ETV staff increased dramatically as a result.
The Project Coordinator and Research Assistant assumed many unexpected roles in response to demand: moderating programs, acting as simulation "audiences," attending to endless details, and ensuring that they were communicated. The logistics of a project involving high stress and multiple stakeholders required constant flexibility from everyone and a "someone" in the middle to fill in the gaps.
In the end, 136 hours of education, consultations, and special programs took place on alternate days between March 14 and June 18 1977. Some programs were drawn from the pre-planned "stock." Other programs were organized at the last minute in response to audience request, or to accommodate satellite and technical difficulties and illness, or to demonstrate special features of the satellite. Archival tapes were made of all the programs.
Once overall Project funding was secured, DOC's Social Policy and Programs Branch9 decided to fund the project-specific evaluation. A Memorial researcher 10 not previously involved in the Project agreed to evaluate the Project. He first examined the ways in which telecommunications equipment could be combined with other project components (for instance, subject matter or instructors) to produce effective teaching and learning environments at the sites. Evaluating learning outcomes, however, was not possible given the diverse and shifting population. His second task was to examine project implementation factors as perceived by physicians, nurses, nursing assistants, and administrators. 11 In summary, not withstanding important qualifications contained in his full report, Mr. Pomfret reported that the users gave the technological components of the Project consistently high ratings. Moreover, most users were very satisfied with the content and presentation of the courses. The interactive component was a qualified success, although learners appeared much more satisfied with this aspect of the Project than did project plan-ners. Approximately one-quarter of those attending one or more of the broadcasts used the microphones (269 of the potential audience of 452 in the four hospitals attended at least one session). Finally, the comparison of satellite with conventional classes indicated that, in the minds of many users, the satellite classes were actually superior to conventional classes as a way of learning.
In addition to introducing the University's Faculty of Medicine and ETV to the latest, most sophisticated satellite technology then available, the Hermes project generated a number of spin-off projects:
Evaluation of the Project led to the following conclusions:
The Telemedicine Centre operates a 190 site audiographic teleconferencing system in 100 communities in Newfoundland and Labrador. Sites include all provincial hospitals, community colleges, university campuses, 50 small rural high schools, a number of nursing clinics on the coast of Labrador, and a variety of government offices. The user consortium, consisting of health, education, government, and community groups, participates in approximately 5,500 hours of programs per year.
The Centre continues its close collaboration with ETV, now the Division of Educational Technology, through a joint venture called TETRA (The Telemedicine and Educational Technology Resources Agency). Its goal is to make the distance education resources of the University available to the private sector. TETRA also facilitates application trials of new technologies: for example, compressed video (fractional T1) applications in distance education and high speed diagnostic medical data transmissions.
At present, the basic approach to distance education is a multi-media combination of print, videotape, audiotape, and audioconferencing using telewriters as necessary. On the health side, a variety of single purpose remote testing units are used in patient care. The "original" format of oneway video and two-way audio is now rarely used, if the standard of "number of hours of activity" is applied. However, it is used by TETRA when it serves a large audience in an informal learning situation; satellite conferences on women in business and alternatives to the fishery are two recent examples. The pioneering format is not lost. It continues to be an important component of a constellation of technology and applications that hardly seemed feasible in 1972 through 1977.
1. See articles by D. Jelly and T. Kerr in this issue.
2. Now known as Educational Technology (ET).
3. The Extension Service's community interaction proposal, the second project remaining from the 10, envisaged that a fieldworker would be hired and programs would be developed in accordance with the expressed wishes of the people in the participating communities.
4. The link eventually cost double that amount; the extra cost was absorbed by the University.
5. Then at the Télé-université, Université du Québec; now Vice-Chancellor of the U.K. Open University. His colleague was Murray Richmond (Director, Instructional Development, Athabasca University at the time; now Acting Director, Training & Education Department, Addiction Research Foundation of Ontario).
6. See T. Kerr in this issue.
7. After participating in this initial phase, the Newfoundland School for the Deaf assumed responsibility for the program, which still continues with the same teacher hired in 1977.
8. DOC's plan to have experimenters sign a legal agreement regarding project implementation was amended because of considerable pressure exerted by all project sponsors. A Preliminary Experiment Plan, intended as an attachment to the agreement, was completed as an information document. Had it been available from the beginning as a planning aid, it would have greatly facilitated planning activities in all experiments.
9. Its Policy Analyst, Anna Stahmer, is now an independent consultant in Toronto specializing in distance learning, training, and international education.
10. Alan Pomfret, Co-ordinator, Unit for Program Evaluation, Institute for Re-search in Human Abilities, now at University of Western Ontario.
11. For a more complete description of that effort, see Stahmer, 1977.
House, A. M. (M.D.), & McNamara, W. C. (1977, December). Report on Memorial University of Newfoundland's experimental use of the communications satellite Hermes in telemedicine. Unpublished report submitted to DOC.
House, A. M. (M.D.), Robbins, C. (M.D.), & Roberts, J. (M.A.). (1977). Trial use of slow scan equipment to transmit x-rays via the satellite Hermes. Unpublished report submitted to DOC.
Pomfret, A. (1978, March). Final evaluation report on Memorial University of Newfoundland's telemedicine project: Focus on implementation and the user. Unpublished report submitted to DOC.
Stahmer, A. C. (1977). A guide to the evaluation of the Canadian public service experiments. In I. Paghis (Ed.), Hermes (The communications technology satellite) its performance and applications (Vol. 3, pp. 145– 152). Ottawa: The Royal Society of Canada.
At the time of writing the report from which this excerpt is adapted, the four authors were, respectively, the Project Coordinator, Co-Principal Investigators and Research Assistant of the Telemedicine Project. At this time, Judy Roberts is an independent consultant in telemedicine and distance education in Toronto. She is also a former CADE Board member. Dr. House is Chairman of Telemedicine at Memorial University. Mr. McNamara is Director of the University's Division of Educational Technology. Erin Keough is Director of Telemedicine and is a past President of CADE.