Collaboration Technology for Real-time Treatment of Patients

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Phase 1 Quarterly Report

July 1 - September 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:

New versions of the conferencing system compatible with the Sun Solaris operating system and the Sun Video Board are currently being tested. The consultation scenario still needs to be customized.

B. Work Accomplished During this Period:

During this phase, the major work included:

• design and implementation of an object oriented conference manager to make the current version of MONET robust;
• design of a new, intuitive graphical user interface to simplify user interactions;
• porting of a version of the video manager to the Sun Video hardware;
• testing of the COMIX component of MONET for interoperability with Mosaic;
• enhancement of the Xpaint program to facilitate X-ray sharing and interactions between care providers;
• completion of the preliminary system design and the detailed design for the consultation systems;
• creation of mock-up screens that illustrate the user interfaces, using Mosaic;
• initial work towards the implementation of this system and its integration with the patient record system;
• completion and testing of an application programmer interface for reading and composing/sending MIME messages;
• completion and testing of a command line interface for composing/sending mail, as an alternative to the application programmer interface; and
• analysis of several film digitizers and submission of a request for the purchase of one of the digitizers.

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 (CCN) that will allow a community of healthcare professionals to provide quality care to a rural population.

A. Current Status:

A preliminary version of the Community Care Network (CCN), including the critical elements of the overall system, has been implemented and demonstrated. This version supports mechanisms that create and interpret layout pages for browsing the patient records in Mosaic. Sign-off mechanisms are in place. The current version of the CCN handles tabular information presentation using the Hypertext Markup Language (HTML). Mechanisms to create sessions in Orbix and to tie in the Oracle gateway are working. The preliminary version of the Mosaic-compatible interface is complete.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

• demonstration of Version 1 of the CCN system; 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 that these specifics represent. Initial approaches for most architectural details are in place or under implementation. Plans for the initial infrastructure are complete. The hardware and software ordered in during this quarter will be deployed in the second half of November (next quarter).

B. Work Accomplished This Period:

The major work during this period included:

• continued participation in site visits to Valley Health Systems (VHS) and Cabell Huntington Hospital (CHH) and contribution to the requirements definition and analysis efforts of Tasks 1 and 2;
• refinement of the community care network mockup in the CERC testbed;
• initial wiring required at the new addition at Wayne Health Services (part of VHS), to support our planned network. A wiring plan for the new Fort Gay clinic (also part of VHS), which is currently under construction, was approved by VHS. The wiring will be installed by the contractor responsible for telephone wiring;
• development of a simulation model of the community care network, including both mobile and static nodes. As part of this effort, a new scheme -- physical process migration -- was developed wherein the mobile nodes are modeled by autonomous and concurrent computing engines that dynamically initiate the creation and dissolution of software links. Preliminary data shows that physical process migration has a significant advantage over the conventional virtual process migration;
• regular meetings with the health care advisory committee;
• planning of several experiments to evaluate the impact of the community care network on rural health care. The study will focus on (1) availability of information, (2) duplication of tests, (3) degree of provider effort, (4) support for VHS Quality Assurance and clinical outcomes effort, and (5) use of new features provided by the informatics system. Studies will be conducted before and after the systems are deployed. Questionnaires for "as-is" scenarios were initiated, incorporating feedback from the VHS and West Virginia University physician advisory board. Since the study involves human subjects, the questionnaires must be submitted to the West Virginia University Institutional Review Board before actual experiments can be conducted. Necessary permission was obtained from VHS for this purpose; and
• design of time motion study forms for both providers and nurses.

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:

The statement of work for CHH has been finalized and a budget established. Final approval by CHH's legal staff for the second and third years of the project is expected soon. We have established the basic physical components of the system at CHH and an initial set of data items which will be "pushed" to the CERC-installed systems. An equipment purchase request for the Vidar x-ray scanner is pending. The subcontract between CHH and West Virginia University is nearly complete; however, technical and budget details are already established. CERC and CHH have been analyzing requirements.

Originally, we had planned to fund a computer programmer/analyst at fifty percent for two-and-one-half years at CHH. CHH was unable to procure internal funding for the remaining fifty percent or to free existing personnel from current duties, so we reallocated existing, unspent funds to allow for a full-time technical person at CHH for the remaining contract period.

We have established a network connection to the new billing and scheduling system at VHS and are working on the details of integration with this system. The plan is to extract demographic information that will reside in the system once it is placed online by VHS.

B. Work Accomplished This Period:

The major work for this period included:

• efforts to finalize the subcontract with CHH;
• continued discussions with CHH personnel representing medical records, radiology, information systems, and telecommunications, to reformulate the budget for the CHH subcontract and to analyze the hardware and software requirements for this task;
• refinement of the high-level requirements and resulting design elements for CHH integration; and
• continued training of the on-site representative, who is now an established member of the team at VHS.

http://www.cerc.wvu.edu/nlm/artemis/project_reports/p1q4.html
September 3, 1997, by Mary Carriger

Copyright © 1997 Concurrent Engineering Research Center