Virtually There?

Although her full-blown program is a long way off, Esserman has run a pilot project with 24 patients. She worked with both Oracle, the Silicon Valley database giant, and MAYA Viz, a Pittsburgh company that develops "decision community" software, to allow doctors across the country to collaborate virtually. Through Esserman's approach, when a patient arrives at the doctor's office to receive treatment instructions, instead of listening to a physician's monologue, she's handed a printout. On the top left side of the page is the diagnosis, followed by patient-specific data: the size and spread of the tumor, when it was discovered, and the name of the treating doctor. Below that is statistical information generated from clinical-research databases, such as the number of similar cases treated each year and details about survival rates.

A set of arrows point to treatment options. Next, the patient reads the risks and benefits associated with each treatment. She can follow along as the doctor explains the chances that the cancer will recur after each option and the likelihood that a particular treatment will require follow-up procedures, as well as a comparison of survival rates for each one.

At this point, the patient has an opportunity to voice concerns about treatment options, and the physician can explain her experiences with each one. "When you share this kind of information, patients and doctors can make decisions together according to the patient's values," Esserman says. This is where the network tools come into play. Drawing from stored databases of both clinical trials and patient-treatment histories local to the hospital, the physician can compare courses of action and results far beyond her own personal experience. "A medical opinion is really just one physician's synthesis of the information," notes Esserman. "So you need a way to calibrate yourself -- a way to continually ask, Are there variations among the group of doctors that I work with? Am I subjecting people to procedures that turn out not to be useful?"

With a real-time, shared-data network, these questions can be answered at the touch of a button instead of after hours, weeks, or months of research. But that's just the beginning. A real-time network also presents the possibility of seeking help from other specialists on puzzling cases, even if those specialists are on the other side of the world.

Ultimately, says Esserman, the questions that might be answered by this new way of practicing medicine are fundamental to the field. "Who's doing something different, and how do we learn? With tools like these, we have the opportunity to bring learning back in real time to the practice of medicine," she explains. And patients have the opportunity to get a second -- and even a third and a fourth -- opinion while their primary doctor stands by.

Developers: Even Better Than the Real Thing?

Most people who consider using virtual-collaboration tools assume that, even at their best, they are a second-best solution. If companies had unlimited travel budgets and if teams had endless amounts of time, then face-to-face meetings would be the best way to work, right? Not so fast. A team of product developers at Texas Instruments has discovered that virtual meetings work better than their face-to-face alternative.

A case in point: TI's efforts to develop the next generation of wireless communications devices. The company's Dallas-based mobility and collaboration team recently delivered a crucial strategy presentation to employees and business partners in Europe, Japan, and the United States. The format was pretty standard: 45 minutes of PowerPoint slides followed by an extended Q&A. Not so long ago, TI would have flown in participants from all over the globe. This time, managers conducted the meeting over WebEx, the Internet-based virtual-meeting platform. Participants followed the slides using their laptops and instant-messaged their questions and comments throughout the presentation.

The virtual meeting reduced travel costs and saved time. But over the course of the session, the team discovered that the virtual presentation was also more effective at soliciting feedback from attendees than any of the face-to-face meetings that they had conducted with international participants. "So many of our international partners are not comfortable with English," says Evan Miller, team manager. "On a conference call, or even in person, accents can be tricky -- especially when you gather a group from Europe, Japan, and the United States. With WebEx's chat feature, we found that many people could type English better than they could speak it. It made everything so much smoother."

Smoother, even, for meeting participants who were already in Dallas. During the same presentation, Miller's colleague Lisa Maestas was connected via WebEx from TI's South Campus, about five miles across the traffic-choked city. Says Maestas: "I got to stay at my desk, listen in, and participate, but I could still keep an eye on my other projects."