Collaboration Technology for Real-time Treatment of Patients

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Phase 2 Quarterly Report

July 1 - September 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:

The Meeting on the Network (MONET) system has been deployed in all of the sites in Huntington. The support environment for the radiologists' consultation scenario is currently being developed. This involves scanning and archiving X-ray images and supporting the retrieval and display of high-resolution X-ray images. The design and development of the referral system, and the customization of the image sharing facility, are also underway.

B. Work Accomplished During this Period:

During this phase, the major work included:

• release of the most recent version of MONET (v0.89003). This version is integrated with a high performance multithreaded audio server, which dramatically improves audio quality. Echo suppression is being currently implemented to improve echo behavior;
• delivery of the MONET package to Valley Health Systems (VHS) for use between VHS clinics. We have been continuously incorporating the physicians' feedback into MONET updates;
• implementation and testing of the HotJava-based transcript interface. The initial prototype will be enhanced to support operations that are useful in a medical application;
• initial work on porting MONET to PCs running the Windows95 operating system: the shared whiteboard design was completed and implementation was begun, the Conference Manager was ported, and the audio system was partially ported. The video system design was initiated; and
• continued work on the referral 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:

Last quarter was eventful. Dr. Sneiderman visited all of the sites to see first-hand the state of deployment of the CCN. In addition, we attempted to seed the system with a number of real patient charts. This turned out to be time-consuming and error-prone because we had to interpret providers' handwriting on the encounter notes and then digitize the information by both manually entering it through a transcriptionist's interface and by scanning it. Even the scanning of encounter notes and other information seems to be too time-consuming, with one patient chart taking as long as one to two working days, depending on how large it is. We have since then changed our immediate strategy. Instead of seeding the system with a large number of patient charts, we will start recording fresh information generated from new encounters into the patient chart. Also, we decided that we will reengineer the interface to support specific processes very well. The first such customization in this quarter was to support dictation. This work is now complete and is being tested and deployed in Huntington.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

• deployment, and initial tests on, the next version of the community care network;
• development of a new version of ARTEMIS' graphical user interface that supports a sneak-and-cache scheme (i.e., while the provider is doing other work, the system sneaks in and caches portions of the patient record);
• customization of ARTEMIS' graphical user interface to support dictation efficiently;
• change of the Oracle gateway to support the direct archival of files. This new gateway has reduced the maintenance requirements of the patient record database;
• customization of the transcriptionist's interface to allow key board binding of audio tools in PC environments, to support transcription; and
• completion of Orbix-based and Tcl/Tk-based interfaces to the scanner. This new version reduces the time taken to scan and store documents and eases the installation and maintenance of the scanner software.

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.

The basic elements of the system infrastructure -- workstations, local area networks, distributed file systems, wide area network, routers, firewall, etc. -- are now in place at all five sites.

B. Work Accomplished This Period:

The major work during this period included:

• initial clinical trials of the patient record system;
• installation of modems and PPP server software at VHS, allowing home dial-up access to patient records for VHS providers;
• installation and testing of new versions of CERC-developed software at both VHS clinics;
• additional configuration of Xyplex routers installed at each site to enhance network security (firewall);
• installation of network routers and Frame relay lines at St. Mary's Hospital and installation of Sparc 5 workstations at Cabell Huntington Hospital (CHH) and St. Mary's;
• preparation of the initial version of a questionnaire for the "after-deployment" scenario, currently undergoing review by the advisory board physicians and the ARTEMIS development team;
• design of forms for collecting "as-is" data on dictation/transcription turn-around time. Data collection will begin shortly; its purpose will be to show the significant reduction in turn-around time between the dictation and sign-off;
• collection of partial data on missing information and "after-hours" documentation time. These were recorded by the VHS providers themselves at the Wayne and Fort Gay clinics. The observer who did the work-sampling earlier was not able to track these activities;
• collection of patient satisfaction data for observer effect from one clinic. Data from the second clinic remains to be collected;
• submission (and subsequent acceptance) of papers describing the evaluation plans and the simulation work for presentation at the Symposium on Computer Applications in Medical Care (SCAMC) Spring Congress in New Orleans October 28- November 1. The papers will be published in the SCAMC proceedings;
• 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:

Workstations, frame relay lines, routers, and local-area networks are now installed at both St. Mary's Hospital and Cabell Huntington Hospital. The wide-area network between the hospitals and VHS clinics has been tested and is working. Initial work at St. Mary's Hospital demonstrated remote access to discharge summaries and other transcribed reports. The medical records department will install a new Windows NT file server in October. As soon as this task is complete, CERC personnel will be on-site to implement a robust integration with this system.

The Information Systems group at St. Mary is working on an initial project to link their laboratory system with their billing and demographics system. This is being accomplished with the HubLink integration platform using HL7 messages. This approach will offer increased opportunities for our project in the future.

B. Work Accomplished This Period:

The major work for this period included:

• design, development, and initial integration of discharge summary reports from the transcription system at St. Mary's Hospital. This work demonstrated access to hospital information from VHS clinics; and
• testing of working versions of components designed to extract demographics information from the VHS billing system.

http://www.cerc.wvu.edu/nlm/artemis/project_reports/p2q4.html
September 3, 1997, by Mary Carriger

Copyright © 1997 Concurrent Engineering Research Center