Collaboration Technology for Real-time Treatment of Patients

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Phase 2 Quarterly Report

April 1- June 30, 1996

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 is being tested on PCs with the Windows95 operating system. The audio system works well and is being fine-tuned to work on a variety of bandwidths, such as LANs, telephone lines, and the Internet. The video works with digital cameras (and hence requires no hardware support), such as Connectix black and white cameras as well as color quickcams. The setup and installation procedures are smooth, and the bandwidth manager manages the effective bandwidth intelligently between the audio and video streams. A person locator (which locates the machine on which the person is logged) has also been implemented to make conferencing easier. The whiteboard currently supports image capture and image display.

B. Work Accomplished During this Period:

During this phase, the major work included:

• continued testing and implementation of features for MONET in the Windows95 PC environment.

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:

We released a new version of the dictation and transcription system which is based on GSM compression. This new version reduces the time to save and load dictation by a factor of five (the efficiency of the compressed audio size over uncompressed audio file). The major holdup during this phase was the unexpected resignation of the system administrator at Valley Health Systems (VHS). Deployment has stalled while we seek his replacement.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

• performance tuning of the dictation and transcription interfaces at Huntington;
• completion of an initial JAVA-based version of a referral module;
• replacement of the original four-panel ARTEMIS GUI with a standard Netscape front-end for signing off on transcribed notes and for viewing related information; and
• placement of a secure remote link (secure Telnet with triple DES encryption) between CERC and VHS's main office to support remote system support of VHS. This link is now also being used to re-seed demographic information from VHS's billing system to the ARTEMIS system.

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 involved in a number of activities related to the overall architectural frameworks for healthcare. One such activity is the CORBAMed effort jointly sponsored by OMG and MRI. We helped organize and attended the first in a planned series of workshops in the Master Patient Index area to define a common framework for developing such indices. We will cosponsor the second workshop, which will be held in Washington, DC, in September.

VHS has hired a transcriptionist, and our evaluation work is proceeding.

The goal of the simulation work at Arizona State University for the current research period has been to model and study the issues of referrals and "continuity" in a representative community care network. To achieve this goal, we need access to a wide body of patient records, preferably in electronic form, relative to patient visits and referrals. Despite our best efforts, this has been a very difficult search since, as we now know, there are only five facilities in the country that have collected patient records in electronic form over a reasonable period of time. We have been most fortunate to get in touch with the CIGNA health care facility at Chandler, Arizona, and, following a few months of negotiation, we were given access to a reasonable portion of the 90,000 patient electronic records corresponding to a total of 30,000 patients over a three-year period.

VHS was awarded a "Health Connect" grant from Bell Atlantic which will enable them to purchase computers and communications hardware necessary to add three additional clinics to the network. We are working with VHS to implement these network additions.

B. Work Accomplished This Period:

The major work during this period included:

• reimplementation of the firewall between our intranet and the Internet;
• presentations on ARTEMIS at the first Master Patient Index Workshop in Santa Fe, New Mexico, and at the Conference on Circumpolar Health in Anchorage, Alaska;
• update of work-sampling results based on data collected so far on "after-hours" documentation time;
• analysis of missing information and dictation turn-around time data collected to date;
• drafting of the first of the series of "after-deployment" questionnaires;
• collection and analysis of the data from CIGNA, and development of stochastic models for patient-doctor episodes including the distribution of patients by age, interaction durations, distribution of interactions involving primary and non-primary physicians, referrals, follow-ups, etc. The model also reflects US census data and actuarial data; and
• performance of extensive simulations corresponding to a single experimental medical facility.

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:

Lee Oxley resigned from his position as system administrator at VHS during this period. We have initiated a search for his replacement and have several strong candidates. We expect to fill the position in August.

After spending time onsite at St. Mary's Hospital, CERC personnel are implementing and testing final elements required for integration with their new dictation system.

B. Work Accomplished This Period:

The major work for this period included:

• implementation of elements required for integrating St. Mary's dictated reports to the ARTEMIS network; and
• initial planning and design for integrating Cabell Huntington Hospital's dictated reports to the ARTEMIS network.

http://www.cerc.wvu.edu/nlm/artemis/project_reports/p2q7.html
September 3, 1997, by Mary Carriger

Copyright © 1997 Concurrent Engineering Research Center