Collaboration Technology for Real-time Treatment of Patients

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Phase 2 Quarterly Report

October 1 - December 31, 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:

We are currently working on augmentations to the MONET multimedia conference system and the ZEN multimedia mail system as needed, such as to enable privacy enhanced mail (PEM). In addition, we are integrating these softwares with public-domain modules, such as Mosaic. 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 and have completed the preliminary system design and the detailed design phase for the consultation systems.

B. Work Accomplished During this Period:

During this phase, the major work included:

• internal release of an alpha version of MONET (Version 0.8) with a new graphical user interface -- a virtual machine based conference manager -- to be used with SunVideo as well as Parallax hardware. Some of the audio problems inherent to Sparc 5 systems were fixed. We are continuing to work on the graphical user interface and the multimedia parts of the MONET system to improve its user-friendliness;
• completion of the preliminary system design and the detailed design phase for the consultation systems and creation of mock-up screens that illustrate the user interfaces using Mosaic. We also have been working on the implementation of this system and its integration with the patient record system;
• analysis of several film digitizers and submission of a request to purchase one; and
• implementation of an interface that allows primary care physicians to send referral requests and receive referral responses, and the design and implementation of an interface that allows a specialist (radiologist or perinatologist) to do the same. Both interfaces will not only enable the composition, sending, and receiving of referrals but will also facilitate the archival and retrieval of referral information from the patient record database.

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 robust version of the CCN layer which generates and presents patient information on the World Wide Web has been released into the public domain as "Web*" (Web Star) software. Most of the components slated for initial deployment in April 1995 are now ready. A clear picture of how the system will be used is slowly emerging. A detailed document on the process issues of how the system will be used by each provider was completed this quarter (CERC Technical Report number CERC-TR-RN-94-007).

B. Work Accomplished This Period:

The following work was completed in this reporting period:

• completion of a careful analysis of the process by which the new system will be deployed and used;
• increase in the robustness of the electronic patient record access through Mosaic; and
• specification of a phased deployment strategy for the short term. We intend to have the network infrastructure in place by end of January, priming it with sample patient records and dry run using select physicians in mid-February, inputting of patient records for the experiment in March and field trials to start sometime in April 1995.

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 continues to make progress 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 (VHS) and the generic requirements that these specifics represent. We have delayed translating this understanding into a formal reference architecture document. Instead, we have concentrated on defining a system-level Concept of Operations document and the generic architectural elements, such as Web* (cf. Task 2). We have decided that we need on-line experience with our initial architectural elements before we publish a formal document.

We have identified additional equipment requirements and have prepared a new hardware request for submission to NLM in January 1995.

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;
• installation of workstations and a document scanner in the CERC Testbed that match those being deployed in the community care network;
• completion of wiring at the new Fort Gay clinic and the installation of a project workstation at that site. Two workstations were installed at the VHS offices and were networked with the Motorola workstation which runs the VHS billing and scheduling system;
• receipt of all hardware included in the initial hardware request. Workstations were configured and tested at CERC, and a copy of the Oracle data base was installed to support development and testing;
• installation of three workstations and a printer at VHS. Lee Oxley received training in systems administration and configuration issues at CERC and is gaining valuable experience in managing these systems prior to full deployment;
• completed installation of frame relay lines at three of the four sites by Bell Atlantic of West Virginia. Installation at the Wayne Clinic is delayed until late January 1995 due to Public Service Commission paperwork necessary for the coordination with Citizens Telephone, the small company which provides local service in Wayne County;
• completion of most of the components of the simulation infrastructure. We are currently developing the representation and integration of, hopefully, the last remaining component -- the mobile medical vans. We have already developed stochastic representative input data, i.e., the initial location of patient records, the distribution of patient visits, the length of the visits, and the migration of patients and the corresponding medical reports that are created. We are currently focusing on executing the simulation for the equivalent of 12 months, using the synthesized input data;
• continued regular meetings with the health care advisory committee. These physicians provide valuable feedback on the usability and generic applicability of our evolving implementation;
• conducting of a pilot study of the time motion experiment at VHS clinics, using both time motion and work sampling forms, and establishment of initial baseline data for comparison of "as-is" with "to-be" processes. Given the constraints of the physical layout of the clinics and the difficulty of minimizing observer affects, work sampling techniques appear to be the most promising at this time;
• receipt of the West Virginia University Institutional Review Board's approval to conduct the studies. The questionnaire has been sent to VHS; and
• development of a prototype version of software to support data collection and interpretation.

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:

A subcontract and budget with CHH is now in place. This budget includes funding for a full-time UNIX programmer who will be primarily responsible for the programming necessary for existing systems belonging to CHH. The Vidar X-ray scanner has been ordered and is expected to be delivered soon. Integration with the Valley Health System (VHS) billing system is underway.

B. Work Accomplished This Period:

The major work for this period included:

• efforts to finalize the subcontract and budget with CHH;
• continued discussions with CHH personnel to analyze the hardware and software requirements for this task;
• refinement of the high-level requirements and resulting design elements for CHH integration; and
• participation in a training session with the vendor of the VHS billing system, and initial integration work on this system.

http://www.cerc.wvu.edu/nlm/artemis/project_reports/p2q1.html
September 3, 1997, by Mary Carriger

Copyright © 1997 Concurrent Engineering Research Center