Collaboration Technology for Real-time Treatment of Patients

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Phase 1 Quarterly Report

April 1 - June 30, 1994

Task 1 Demonstration of Computer-assisted Collaboration in Specialty Areas

The objective of this task is to demonstrate the usefulness of computer-assisted collaboration technologies in patient care, where the general practitioner in charge of a patient's care is not physically collocated with an appropriate expert consultant. This task will demonstrate remote consultation in two specific instances: 1) between a primary care obstetrician and a tertiary care perinatologist and 2) between a primary care provider and a tertiary care radiologist.

A. Current Status:

This project leverages the work done under the ARPA DICE program. Under that program, a multimedia conference system and a MIME-compliant multimedia mail (ZEN) system were developed. We have augmented ZEN with privacy enhanced mail (PEM) as needed in this project.

As a result of our interactions with the physicians at Valley Health Systems (VHS) and Cabell Huntington Hospital (CHH), we have identified the requirements of the hardware and software systems needed for the proposed scenarios. We are in the process of building the hardware/software system that meets the needs of the health care professionals in the two specialty areas identified. This system will be integrated into the Patient Record Management System also being developed at CERC.

B. Work Accomplished During this Period:

During this phase, the major work included:

• augmentation of ZEN with privacy enhanced mail;
• identification of the equipment necessary for scanning X-ray film and storing it in the computer. We are in the process of procuring the equipment; and
• design of mock-up interfaces to be used by the primary care physician, the radiology assistant, the radiologist, and the perinatologist. We identified the interactions that take place and have designed the system to support the interactions. We are currently building the software prototype that meets these requirements.

Task 2 Collaboration Technology for Community Care Networks

Community health care primarily involves preventive and primary health care for community residents through the participation of individual practices, group practices, federally-funded clinics, community centers, and hospitals. Collaboration and cooperation among these multiple parties is essential for effective healthcare delivery. Limited resources and medical staff, coupled with the lack of proper health education and awareness among the population, make it difficult to provide healthcare in rural areas. The objective of this task is to develop a community care network that will allow a community of healthcare professionals to provide quality care to a rural population.

A. Current Status:

The overall system design and the technology to be used in each part of the Community Care Network (CCN) is completed. The overall view of the system was also mocked up and demonstrated to NLM and others on April 29 at CERC. The detailed design and implementation of all the components identified are progressing in parallel. The first version of the entire system will be demonstrated by the end of the next quarter.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

• completion and demonstration of the overall system design for the CCN;
• selection of equipment to purchase and refinement of the component design; and
• completion of prototype versions of several of the system components.

Task 3 Open Systems Architecture for Collaboration in Health Care

The objective of this task is to develop a domain-specific reference architecture for statewide collaboration in the health care domain that can serve as a model for promoting the use of such technology. Through direct experience with the experimental tasks, Tasks 1 and 2, we expect the architecture to evolve in its construction over the course of the project.

This task manages the planning and installation of infrastructure elements, networks, computers, etc., in the community care network. It also contributes to the overall effort to evaluate the effectiveness of the network and its individual elements.

A. Current Status:

This task is progressing as planned toward the definition of a reference architecture for collaboration in health care. We continue to refine our understanding of both the particular requirements of a community care network serving Valley Health Systems and the generic requirements which these specifics represent. A number of candidate approaches are under consideration for several architectural details. Plans for the initial infrastructure are complete. We have revised our original hardware and software purchase plans and are awaiting approval to purchase these items.

B. Work Accomplished This Period:

The major work during this period included:

• continued participation in site visits to Valley Health Systems and Cabell Huntington Hospital and contribution to the requirements definition and analysis efforts of Tasks 1 and 2;
• demonstration of a prototype user interface for a variety of providers at Cabell Huntington Hospital and at the Wayne and Fort Gay clinics;
• deployment of a mock-up of the community care network in the CERC testbed;
• selection of Orbix, an implementation of the CORBA framework, as one component of our initial implementation;
• development of software structures for efficient and accurate modeling of networks with stationary and mobile decision-making nodes. This will form the basis for the modeling and simulation of a realistic rural community health care network (CCN) that includes stationary medical clinics and hospitals, mobile medical vans, and physicians in transit. As the next step, we have started to develop the CCN model with appropriate parameters, etc.; and
• establishment of a health care advisory committee; the participating physicians will provide us regular input on the system as it evolves and also help in designing a study to evaluate the effectiveness of the CCN that will be deployed.

Task 4 Integration of Patient Care Information Legacy Systems

The objective of this task is to demonstrate open and easy access to patient information from legacy hospital information systems. This task is now focusing on integration at Cabell Huntington Hospital (CHH).

A. Current Status:

This task began during this reporting period. We have completed negotiations with Cabell Huntington Hospital (CHH) and have agreed upon a statement of work. We anticipate that the final details of the subcontract between CHH and West Virginia University will be completed within a few weeks. Larry Ball, Director of Medical Records at CHH, has been named as the primary facilitator of this project at CHH.

Lee Oxley was hired by Valley Health Systems (VHS) as the on-site person responsible for the integration work at CHH as well as integration with the billing system at VHS. Mr. Oxley has been introduced to the principals at CHH and is being trained by CERC personnel.

B. Work Accomplished This Period:

The major work for this period included:

• discussions (in person, via telephone, and via email) with persons from CHH representing medical records, radiology, information systems, and telecommunications, to determine the details of the statement of work for the CHH subcontract and to analyze the hardware and software requirements for this task;
• determination of the high-level requirements and resulting design elements for CHH integration; and
• orientation and training of the on-site representative, who is now working at the VHS administrative offices in Huntington, West Virginia. Pending the purchase of project equipment, CERC has loaned and installed a workstation for his use in the Huntington office. Connectivity is via the previously installed ISDN telephone line.

http://www.cerc.wvu.edu/nlm/artemis/project_reports/p1q3.html
September 3, 1997, by Mary Carriger

Copyright © 1997 Concurrent Engineering Research Center