Collaboration Technology for Real-time Treatment of Patients

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Phase 2 Quarterly Report

January 1 - March 31, 1995

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 (MONET) and a MIME-compliant multimedia mail (ZEN) system were developed. We are currently working on augmentations to these softwares as needed. 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, we identified the requirements of the hardware and software systems needed for the proposed scenarios. The initial prototypes have been implemented and will be deployed at VHS for use by the physicians. The feedback obtained will be incorporated into the next versions of the software prototypes.

B. Work Accomplished During this Period:

During this phase, the major work included:

• release of MONET Version 0.89. We implemented an initial prototype of its hypertext-based conference transcript and are continuing to enhance the audio quality of the audio server. We have completed the system's initial specifications for personal computers running OS/2 and Windows95;
• delivery of the MONET package to Valley Health Systems. We are currently working with VHS systems administrators to iron out the last wrinkles;
• continued work toward the implementation of the remote consultation system and its integration with the patient record system;
• acquisition and testing of a film digitizer; and
• development of an X Windows-based software for viewing and annotating X-ray images. The system allows various practitioners to add multiple layers of annotations to an X-ray image and will be enhanced to include other features, such as measurements along the X-ray.

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:

Testing of all of the components slated for initial deployment is underway. Initial installation efforts attempted last month at Valley Health Systems pointed to a number of packaging problems, which have since been fixed. Initial use of the system also revealed some performance problems, which are currently being addressed. The patient record environment is expected to be installed at the Fort Gay and Wayne Clinics by the end of April 1995.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

• completion of a four-panel World Wide Web browser to allow viewing of multiple pages simultaneously (Version 1);
• completion of a file archiver (Version 1);
• near completion of an interface between the network and a scanner;
• near completion of the integration of the network with a dictaphone; and
• major improvements in performance -- currently, the time required to retrieve a page is approximately 10 seconds.

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.

With the exception of a few workstations being used by the development team at CERC, all hardware components from the initial plan are now in place at VHS. Most Cabell Huntington Hospital (CHH) components will be installed after the finalization of the subcontract.

B. Work Accomplished This Period:

The major work during this period included:

• installation of networked file systems and information servers (NFS and NIS+) at VHS. Lee Oxley continues to gain valuable experience in managing these systems prior to full deployment;
• configuration of Xyplex routers installed at each site to implement network security policies (firewall);
• installation and configuration of an ISDN line at Dr. Bruce Merkin's home. This will be used in conjunction with the ISDN line at the VHS offices to evaluate the effectiveness of higher speed (128kbs) remote access and to contrast it with planned dial-up access for other providers;
• performance of initial experiments in our testbed on the new Vidar X-ray film scanner;
• continued participation in site visits to VHS and CHH and continued contribution to the requirements definition and analysis efforts of Tasks 1 and 2;
• collection of performance data related to the adequacy of the assumption that 1/2 T1 links interconnect the medical centers and hospitals. We found that the database and network pose no bottleneck to the performance of the system, regardless of the number of patients, doctors, or the number of queries generated corresponding to each patient-doctor interaction. We defined several key performance measures and collected data from the simulation runs. We are refining the simulation infrastructure to incorporate suggestions, namely, introducing on-line consultation for patients and measuring its impact on the performance of the system;
• continued regular meetings with the health care advisory committee. These physicians provide valuable feedback on the usability and generic applicability of our evolving implementation;
• study of the work process at VHS clinics to establish baseline data for comparison of the "as-is" and "to-be" processes. This work will be completed in the first part of April; and
• collection of completed questionnaires, from VHS providers, designed to document "as-is" processes at the VHS clinics.

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 received final approval from NLM and was submitted to CHH in late March for signature. The first step of the integration with the Valley Health System (VHS) billing system is completed.

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 the resulting design elements for CHH integration; and
• integration work on the VHS billing system, including the definition and implementation of a "report" that will be generated on a regular basis (nightly) by the billing system and will be processed by the CERC-developed systems to update demographic data in the clinical data base.

http://www.cerc.wvu.edu/nlm/artemis/project_reports/p2q2.html
September 3, 1997, by Mary Carriger

Copyright © 1997 Concurrent Engineering Research Center