The Computerworld Honors Program
Honoring those who use Information Technology to benefit society
Final Copy of Case Study
Warsaw, PL




Technology Area:
Video Conferencing

Institute of Physiology and Pathology of Hearing


Cochlear Implant Innovation Project

Introductory Overview
The Institute of Physiology and Pathology of Hearing in Warsaw is a leading scientific research and development unit in Poland providing complex care for people with hearing, voice, speech and balance disorders. Professor Henryk Skarżyński is the the founder and the director of the Institute. Every year over 12,000 patients are hospitalized and more than 15,000 surgical procedures are carried out in the Institute. Particularly noteworthy is the fact that more than 2,500 patients have been provided with cochlear implants at the Institute. A cochlear implant is a surgically implanted electronic device that provides a sense of sound to a person who is profoundly deaf or severely hard of hearing. The cochlear implant is often referred to as a bionic ear. Unlike hearing aids, the cochlear implant does not amplify sound, but works by direct stimulation of any functioning auditory nerves inside the cochlea with an electric field.

The otolaryngologists, audiologists, phoneticians, speech therapists, psychologists, educators and bio-clinical engineers consult more than 200,000 patients in outpatients clinics located across Poland in Ciechocinek, Krakow, Łeba, Radom, Katowice, Olsztyn, Rzeszów, Szczecin and Gdansk. 

Professor Skarżyński and the Institute received long list of  awards and recognitions - to mention few of them like "Golden Scalpel 2008" for IT telecom solutions in medicine at the 1st edition Medicine Pulse Contest for the innovation of Polish health care, the project o Telefitting . Warsaw, Poland 2009. 
Gold Medal of the Jury of 108th International Innovation contest Concours-Lépine 2009"  in Paris for the Telerehabilitation of cochlear implant patients. Gold Medal for Gdansk Polytechnic, Young Digital Planet and the Institute for Multimodal Interface for Lips and Tongue Reading Computer Steering System and Silver Medal for Graphic Multimodal Interface.  Paris, France 2009
Diploma from Polish Ministry of Education for the System for Remote Fitting of Cochlear Implant Speech Processor. Warsaw, Poland 2009
Recognition from Romanian Ministry of Education and Scientific Research for the Institute of Physiology and Pathology of Hearing for the System for Remote Fitting of Cochlear Implant Speech Processor awarded at Brussels EXPO  57 International Fairs of Innovation and Scientific Research and New Techniques INNOVA 2008. Brussels, Belgium 2008
Medal  Labor Improdus Omnia Vincit for scientific achievements of the Institute at Brussels EXPO  57 International Fairs of Innovation and Scientific Research and New Techniques INNOVA 2008. Brussels, Belgium 2008

The Importance of Technology
How did the technology you used contribute to this project and why was it important?
Today there are 12 policlinics  equipped with Polycom HDX 8000, and 7 more Polycom solutions will soon be installed in outpatient clinics.  The National Program of Hearing Tele-rehabilitation will include 20 centers spread across the country, Poland is the 9th larges coutry in Europe, and is over 120000 square mile. The experienced specialists from the Institute of Physiology and Pathology of Hearing are able to perform necessary treatments of measurement and cochlear implant system fittings for 2,500 patients that have cochlear implants. The necessary element of the reahabilitation are fitting sessions - 3 to 12 in the first year after the operation. Trained support specialists provide basic technical tasks and help in communication process using the Polycom solutions.  Patients' follow-up treatments are insured remotely, near their homes, avoiding travel to the Institute which is very important especially for small children.  System of remote fitting is possible using an internet connection, making the rehabilitation process cost effective, and time efficient both for patients and for medical staff. Emergency and critical procedures have also proven to be successful using the videoconference solutions. For instance when implant processors are damaged or the parameters are changed, an immediate intervention of clinical engineer is required. Such intervention often takes no more than few minutes, and no longer requires the patient to travel to the Institute.  Using the Polycom solutions, patients can go to the nearest satellite center, reach directly the specialized clinical engineers, and receive the care required.  
The video technology is the backbone of this program, which is making a difficult situation easier. By being able to trea the patience using the solution, the institute is able to releave the pain immidiately. 

The Polycom solutions were chosen for the unique features that made this project possible.  It is the only available system where transmitted voice in frequency higher than a human ear. The voice over the microphones is naturally clear which is necessary for patient in the first stage after surgery, as patients do not always understand and hear human voice properly. Polycom terminals are transmitting sound on 22 kHz frequency and the picture in Full HD (1080p). Post-implantation rehabilitative therapy is critical to ensure successful outcomes.  Being able to provide the therapy using the Polycom technology has made a significant increase in patients well being.
According to head of IT at the Center - Paweł Kochanowicz, the very important function "Lost Packet Recovery" allows good quality of the picture even with the low quality internet connection. Without this function the picture is blurred.

The Institute of Physiology and Pathology of Hearing purchased  23  Polycom HDX 8006 XL, with  LCD 32 inches monitors, video-conference server Polycom RMX2000, routing server  Polycom CMA4000. This equipment enables connection between several people in several centers at the same time. This function is used either for rehabilitation purposes as well as for staff training and online counseling for patient's parents and teachers. Server CMA4000 allows remote management and monitoring the condition of the equipment within the country.
The Polycom Technology is the only solution on the market today, that provides the requirements needed to accomplish the project, and make it happen.  once intalled, it is easy to use, and the patiens, the doctors and therapist have quickly adapted to it, and are pleased with the numerous advantages.

Has your project helped those it was designed to help?  

Has your project fundamentally changed how tasks are performed?  

What new advantage or opportunity does your project provide to people?
New method of using Internet connection to provide service for patients near their home area was developed and introduced into clinical practice. Experienced specialists from the Institute of Physiology and Pathology of Hearing are now able to perform necessary measurement and cochlear implant system fittings for patients in policlinics across the country. Trained support specialists help in communication process via audio-video connection.
Remote fitting of cochlear implant speech processor is applied for versatile care for patients with cochlear implant according to program of complex postoperative hearing rehabilitation matched to individual needs of every patient; coordination of hearing rehabilitation process that is necessary for development of sound perception. Systematic training makes  speech communication possible; social, educational and professional development programs are based on knowledge and experience of multidisciplinary team of specialist from the Institute of Physiology and Pathology of Hearing; spread of knowledge about cochlear implants and rehabilitation process of implanted patients.
Patients are now treated right away, and do not have to go to the Institute for treatment. They simply go to the nearest policlinic. 
The project provides better care for patients. They are treated faster. The patients are able to have regular speech therapy sessions, which will increase their progressand they heal faster. 
The video solutions also provide a teaching application. The institude being a teaching hospital records the lectures and the surgeries, enabling students to listen to a lecture when not abble to attend.  As well as viewing complicate surgeries and learning from the professors performing it.
The students are also able to watch live surgical procedure.  
The Polycom project allows doctors to spend more time with patients and less time on the roads driving from one clinic to the next.  

If possible, include an example of how the project has benefited a specific individual, enterprise or organization. Please include personal quotes from individuals who have directly benefited from your work.
Results of the studies performed at the Institute and the feedback from patients during clinical 
practice with usage of the new method and Polycom solutions, proved 
that remote fitting was accepted by more than 94% of patients as a very good alternative for standard fitting sessions. The quality of video and audio connections was evaluated as very good and adequate  for daily use. 
Time effectiveness and quality of remote fitting were appraised as comparable to standard, local fitting. Analysis of fitting results obtained during remote fitting showed no significant differences compared to maps obtained in standard fittings. Remote fitting system proved to be easy to use for both fitting and support specialists. For patients  it made a significant change in terms of time and effort saving. Additionally, this new method increased the sense of security and comfort of patients, offering them easier access to professional care closer to their homes. 
"One day our daughter's kindergarten teacher pointed out that Victoria was not responding as well as earlier and I have noticed the same behavior at home. Our standard visit at the Institute was scheduled in 4 weeks. We live 200 km away from Warsaw and I wasn't able to take two days off to travel for an additional visit. When I called the Institute they told me about remote fitting and scheduled the visit in the nearby policlinic in Olsztyn  12 km from our home. The next day I took Victoria over there, the clinical audiologist adjusted the implant and everything worked fine. It saved us a lot of time and gave us a peace of mind. " - quote from mother of 5 years old Victoria
Cases of this time have happenned numerous time, and it gives the project its purpose when a young patient is able to get the proper treatment she needs right away.

Is it the first, the only, the best or the most effective application of its kind?   All of the above

What are the exceptional aspects of your project?
Studies on remote fitting with different equipment were conducted at several clinics across the world. The solution of the instutue of Physiology and pathology in Warsaw was first of its kind and most developed in clinical practice using highly advanced technology and methodology that allows full postoperative care of implanted patients.
Exceptional aspect of proposed system provides professional care of implanted patients by multidisciplinary team of experienced specialists without traveling long distances. The 
methodology and equipment used in the system allows individual fitting and rehabilitation of cochlear implant speech processor for each patient; Optimal fitting of cochlear implant system;
 Psychoacoustic rehabilitation; Speech therapy;  Psychological and pedagogical consultations;
 Constant cooperation of team of specialists in hearing rehabilitation of cochlear implant recipients;	Instant exchange of information regarding patient's hearing progress based on individual predispositions; Optimization of cochlear implant system fitting;  Continuous monitoring of hearing benefits in terms of speech improvement and use of multimedia tools appropriate for different age groups;  Support for parents, caregivers and spouses to fulfill rehabilitation tasks; 
 Cooperation with local rehabilitation policlinics;  Cooperation with school and workplace.
While the project is complexe and the result revolutionary in treating the hearing impaired, the implamentation and usage are simple. 
The project in itself is exceptional.

What were the most important obstacles that had to be overcome in order for your work to be successful? Technical problems? Resources? Expertise? Organizational problems?
From the start of the remote fitting project, risk factor was constantly monitored. Number of adverse situations was simulated during first stage of the study. No additional risk related to connection breakdown, power supply shortage, computers or videoconferencing software breakdown was found. In the most pessimistic scenario the fitting process was not possible.  
During next stages of the study when patients were measured and fitted with the new method, no unsecure situations occurred in all cases when inclusion criteria were kept. There was one case with severe facial nerve when stimulation remote fitting had to be interrupted due to the risk of possible problems related to the adverse effect. This decision was made before any unpleasant or unsecure situation took place. 
However, the specialists have to be aware that remote fitting can introduce additional lag between giving a command in fitting system and observing feedback on computer's screen. The extent of the lag depends on quality of internet. An uncontrolled lag could lead to the risk of patient's overstimulation. Therefore knowledge of this factor, proper training, experience in clinical work and complying with remote fitting protocols can reduce the risk of overstimulation to minimum. In clinical practice during recent years of using remote fitting no case of overstimulation was observed.

Often the most innovative projects encounter the greatest resistance when they are originally proposed. If you had to fight for approval or funding, please provide a summary of the objections you faced and how you overcame them.
The most serious obstacle that occurred was the quality of internet network. In Poland outside of large cities it is difficult to have an access to wide band line. Since there is no competition on a telecommunication market the dominant operator does not provide high quality telecom infrastructure and the prices are very high. It takes weeks or even months to set up an internet access. Once the connection is ready there is no guarantee that the quality will be sufficient. this is one other advantage of the Polycom solution that have the lost packet recovery technology which helps in achieving high quality video even on public broadband networks susceptibe to packet los and congestion.

Has your project achieved or exceeded its goals?  

Is it fully operational?   Yes

How do you see your project's innovation benefiting other applications, organizations, or global communities?
Teaching application
The Polycom video conference capabilities of the Institute were deployed to serve as an education tool. Element of the Polycom equipment is central server RSS2000 used for registration and archiving of video conference sessions.  The solution is also used in the institute as a teaching tool.  Lectures of the Institute professors are recorded and can be seen from the students' personal computers.  Students can also assist to training sessions, and to live surgical procedures using the video solutions.  These recorded sessions are available to students through streaming or as archive materials.  
Another application would be for other medical organizations to use a similar model for their treatments. we know that video can assist in various other domains, and this program can be seen as a positive example of what is pobbible. 
Other countries do ear surgery using video conferencing. and we hope the model in Poland can be replicated in other countries.

How quickly has your targeted audience of users embraced your innovation? Or, how rapidly do you predict they will?
First project of Remote Fitting of the cochlear implant system was started at the end of 2005. By the end of June 2006 trials of system requirements concerning software, hardware and IT infrastructure were conducted but without patients. Good results of the first stage of the projects led to clinical trials with patients, starting in July 2006. The trials were performed within one building, but using Internet connection between two subsidiaries of the Institute in different cities. In 2007 new international, multicenter study of Remote Fitting was started. Using new, improved protocol detailed information about risk, patients' and specialists' opinion, time and effort effectiveness were collected. In 2007 the new method was introduced into clinical practice between the International Center of Hearing and Speech in Warsaw and International Center of Hearing Rehabilitation in Łeba. Very good results of clinical introduction, patients and specialists' appreciation lead to further development of newly created System. Four more centers were included in the System during 2008. Thanks to the co financing and, new state-of-the-art software and hardware (Polycom HDX 8006 XL) will replace quite simple systems used till now, consisting of basic cameras and PC computers. In 2009 the teleconference systems were replaced with the newest Polycom equipment in order to extend functionality of the System. Most of the 19 satellite centers are now functioning on a daily basis and by the end of the 1st quarter of 2010 the System will reach its full operating capability.

Digital/Visual Materials
The Program welcomes nominees to submit digital and visual images with their Case Study. We are currently only accepting .gif, .jpg and .xls files that are 1MB or smaller. The submission of these materials is not required; however, please note that a maximum of three files will be accepted per nominee. These files will be added to the end of your Case Study and will be labeled as "Appendix 1", "Appendix 2" or "Appendix 3." Finally, feel free to reference these images in the text of your Case Study by specifically referring to them as "Appendix 1", "Appendix 2" or "Appendix 3."

Currently Uploaded Appendices: