Collaboration Technology for Real-time Treatment of Patients

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Phase 2 Quarterly Report

October 1 - December 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:

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 (v0.89006). Several bugs were fixed, including occasional hang-ups of the graphical user interface, improper closure of the audio device, and dying of processes when a user dials in the wrong address format. Audio was also improved, and some echo suppression features were incorporated into the current release;
• release of the HotJava-based Transcription System, and its incorporation into the MONET system;
• removal of several bugs in COMIX, such as the "sequence lost error" and "mouse event error" messages in the pull-down menu;
• near completion of the graphical user interface, conference manager, and audio portions of the PC-based version of MONET. The video portion is in the design and initial implementation phase;
• completion of the first version of the white board, with basic features, written using the Java programming language; 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:

The major event in the last quarter was our participation in the American Medical Informatics Association's Nineteenth Annual Symposium on Computer Applications in Medical Care (SCAMC). Our participation included the presentation of three papers on project research and a demonstration of the ARTEMIS system. During the demonstration, Dr. Bruce Merkin fielded questions from the audience from his clinic in Wayne, West Virginia. Our participation in the conference increased visibility for the project.

The scheduled deployment of the Dictation and Transcription systems was delayed because of multiple snow storms.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

• testing of the dictation and transcriptionist interfaces in Huntington;
• near completion of support for specific processes, such as Nurse's intake and front desk entry;
• completion of the support for referrals. We expect to have a version deployed by end of the next quarter;
• near completion of a white paper on how to address security and how security can be improved. As part of this effort, we are investigating the deployment of a system that supports single logon to multiple environments;
• completion of an initial prototype of a CORBA-based public key server for encrypting mail messages;
• preliminary design of matching patient identifiers across clinics and hospitals; and
• demonstration of ARTEMIS at the 19th Annual Symposium on Computer Applications in Medical Care (SCAMC) n New Orleans on October 28- November 1, 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:

We are actively writing a number of white papers that define elements of the architecture. We are also actively participating in a group called "CORBAMed," sponsored by the Object Management Group and the Medical Records Institute, that is in the process of defining CORBA-based architectures, such as the one we have developed.

B. Work Accomplished This Period:

The major work during this period included:

• collection of final data on missing information and "after-hours" documentation time;
• completed design of experiments for evaluating the use of the dictation and transcription interfaces;
• collection of partial data on dictation/transcription turn-around time;
• development of white papers on security issues and the evaluation of medical informatics systems;
• presentation of papers at the 19th Annual Symposium on Computer Applications in Medical Care (SCAMC) in New Orleans October 28- November 1. These papers were published in the SCAMC proceedings:
• "Evaluation of Community Care Network (CCN) System in a Rural Health Care Setting," pp. 698-702;
• "A Distributed, Scalable Community Care Network Architecture for Wide-Area Electronic Patient Records: Modeling and Simulation," pp. 352-356;
• "An Overview of the CERC ARTEMIS Project," pp. 12-16; and
• "ARTEMIS Collaboration in a Rural Community Care Network" (poster session), pp. 1027;
• 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 installed a new Windows NT file server in October, and CERC personnel will now be able to implement a robust integration with this system.

The Information Systems group at St. Mary's 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:

• evaluation of alternatives for integrating St. Mary's dictated reports to the ARTEMIS network. One technical staff member spent two months at St. Mary's to determine the final option.

http://www.cerc.wvu.edu/nlm/artemis/project_reports/p2q5.html
September 3, 1997, by Mary Carriger

Copyright © 1997 Concurrent Engineering Research Center