Collaboration Technology for Real-time Treatment of Patients

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Phase 2 Quarterly Report

April 1 - June 30, 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 the most recent version of MONET (v0.896);
• delivery of the MONET package to Valley Health Systems for use between VHS clinics. We are currently working with VHS systems administrators to incorporate the physicians' feedback. We have already implemented the bandwidth control and color map management features as requested by the physicians. The system is also being used for weekly meetings between VHS and CERC personnel. The use of headphone sets has improved the audio quality; several people at CERC can use the system for internal communication;
• continued work with an initial prototype system for MONET, based on HotJava from Sun Microsystems, for transcribing meeting minutes;
• initial implementation of MONET's audio system with silence control, echo suppression, and other features to improve the audio quality;
• implementation of a shared white-board feature by which the physicians can freely discuss ideas;
• commencement of the PC implementation of MONET. A user interface was designed in Visual Basic and is running in Windows;
• completion of a system, based on Xpaint software, for sharing X-rays during a MONET consultation; and
• implementation of the asynchronous consultation system. We have completed a screen mock-up of the system.

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:

The current system at Valley Health Systems' (VHS) Wayne Clinic now has two real patient records, and the clinic is employing the first experimental, usable subsystem of our project, which currently includes a patient record database, a file archiver, a scanner interface, Web*, layout pages, and the ARTEMIS graphical user interface (a multi-panel Web browser).

B. Work Accomplished This Period:

The following work was completed in this reporting period:

• deployment, and initial tests on, the first version of the community care network;
• support for prefetching to improve perceived performance;
• installation of the patient record environment at the Fort Gay and Wayne Clinics. Orbix was installed successfully, and the Oracle Gateway is functioning flawlessly. A new version of the patient record database is being developed and will be phased in as the model-level layer and corrections to layout pages are implemented. The first version of the layout pages is in place, and some bugs that surfaced when the first two patient charts were seeded are being fixed;
• extension of Web* to support other file types. We have found a way to take FrameMaker-generated PostScript files and embed Tcl-Orbix commands in them to generate Postscript files. The Popras form (one of the most difficult ones) was completely duplicated in FrameMaker. We need to check the copyright issue here;
• completion of an initial version of the Document Scanner Interface that uses Mosaic as its front end. We are investigating the use of Orbix-based and Motif-based interfaces to the scanner; and
• development of a first version of the Dictaphone, which is in place at VHS.

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.

With the infrastructure largely complete, team members are now using the MONET desktop conferencing software on a regular basis for long-distance project meetings.

B. Work Accomplished This Period:

The major work during this period included:

• establishment of user accounts for a growing number of users at VHS;
• installation of new computer systems at both VHS clinics;
• installation of a variety of new software at both VHS clinics;
• additional configuration of Xyplex routers installed at each site to enhance network security (firewall);
• ordering of network routers by St. Mary's Hospital. Sparc 5 workstations for Cabell Huntington Hospital (CHH) and St. Mary's were delivered to Valley Health Systems (VHS). CHH is almost on the network;
• completed the study of the work process at VHS clinics to establish baseline data for comparison of the "as-is" and "to-be" processes. Questionnaires were collected, and work sampling and time motion studies were completed. The current status of the evaluation process and methodology is available through ARTEMIS' World-Wide Web site. The analysis pointed out that additional information needs to be collected related to 1) documentation time for providers , 2) instances of missing information , and 3) the notice of an observer effect with respect to patient surveys. The additional patient survey information will be collected;
• completion of the data collection for Phase I of the Community Care Network simulation, which executes for the equivalent of 30 minutes. The Phase I simulation was refined to include mobile medical vans, and the Phase II simulation was started. This is a less accurate, high-level simulation that will be executed for the equivalent of 12 months or more. Professor Ghosh is moving from Brown University to Arizona State University, and his simulation work is temporarily stalled by this move. He will resume work with the beginning of the fall semester;
• meeting of team members with technical representatives of the Children's Health Fund (CHF) to discuss requirements for computing and communications systems for the mobile clinic operated by VHS. We will coordinate with CHF in their efforts to modernize their systems and our efforts to include the mobile clinic in our network;
• attendance by team members at a training class for the Andrew File System (AFS), which is being considered as a distributed system for the community care network;
• continued participation in site visits to VHS and CHH, and continued contribution to the requirements definition and analysis efforts of Tasks 1 and 2; and
• continued regular meetings with the health care advisory committee. The physicians provide valuable feedback on the usability and generic applicability of our evolving implementation.

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.

A primary development in this task during this quarter was the addition of St. Mary's Hospital in Huntington, West Virginia, to the Community Care Network (CCN). This addition was necessitated by the changing business relationships between VHS and the two hospitals in Huntington -- Cabell Huntington Hospital and St. Mary's. The VHS referral patterns will now include St. Mary's in addition to CHH, so it became necessary to include St. Mary's in the project. St. Mary's eagerly agreed to join our team and has agreed to share the cost. They have already purchased the required communications equipment (router and CSU/DSU) to become part of the project. CERC has placed an order for the additional Frame Relay service at St. Mary's, and it is scheduled for installation in July. CERC has executed a memorandum of agreement with St. Mary's outlining the agreed-upon responsibilities of both parties. These changes will have no impact on the total project budget.

In related developments, CHH had difficulty in hiring a programmer to accomplish the hospital systems integration tasks. To solve this problem and to better accommodate the second hospital, a decision was made to amend the CHH statement of work to eliminate the direct programmer support at CHH. The integration work will be performed by CERC staff who will begin full-time, temporary work in Huntington in July.

The actual changes to the CHH/West Virginia University contract are in progress. All parties are moving forward with the agreed-upon changes.

B. Work Accomplished This Period:

The major work for this period included:

• negotiations with all parties regarding the addition of St. Mary's Hospital;
• discussions with CHH personnel to analyze the changes in hardware and software requirements for this task; and
• development of detailed requirements and the resulting design elements for hospital systems integration.

http://www.cerc.wvu.edu/nlm/artemis/project_reports/p2q3.html
September 3, 1997, by Mary Carriger

Copyright © 1997 Concurrent Engineering Research Center