Secure Collaboration Technology for Rural Clinical Telemedicine

Secure Collaboration Technology for Rural Clinical Telemedicine

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Phase 1 Quarterly Report

September 30 - December 31, 1996

Task 1 Secure Collaborative Telemedicine Architecture

The primary focus of this effort is to develop a set of secure telemedicine services for use in customized telemedicine applications for healthcare providers in the treatment of their patients. . This task will support the three telemedicine applications providing secure access to healthcare information to authenticated healthcare providers, facilitating the authorized flow of healthcare information between healthcare providers and systems; and supporting secure teleconsultations by healthcare providers for the treatment of their patients.

A. Current Status:

This task began during this reporting period. The primary work thus far has included acquiring and evaluating software and hardware, and beginning a requirements analysis. We will continue to define the requirements, reflecting an improved understanding of the needs of the telemedicine applications in their targeted deployment sites.

B. Work Accomplished During this Period:

During this phase, the major work included:

evaluation and acquisition of computer peripherals and software development kits for smart card systems- and Medical Information Bus-compliant patient monitor integration devices;
evaluation of prototype software for role-based access control and for Java-based digital signoff of documents by healthcare providers;
analysis of the requirements for the three telemedicine scenarios; and
review of an interim report by the National Research Council's (NRC) Computer Science and Telecommunications Board's (CSTB), "Maintaining Privacy and Security in Health Care Applications of the National Information Infrastructure."

Task 2.1 Secure Telemedicine for Intensive Care Providers

The objective of this sub-task is to demonstrate the ability of secure, collaborative telemedicine applications to provide improved healthcare to patients at a hospital's Intensive Care Unit (ICU). By enabling specialists in intensive care medicine to have quick, yet secure, access to healthcare information, this application will allow the on-site ICU healthcare providers to consult with remote specialists and take timely steps in the treatment of patients.

A. Current Status:

This task began during this reporting period. We are currently gathering the requirements for analysis for the details of the scenario development.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

visiting St. Mary's Hospital and Valley Health Systems (VHS) to gather information from the two participating intensivists as well as on equipment needs for the transmission of data from the intensive care units to the intensivists. Based on this input, the development of the scenario and its scope began.

Task 2.2 Secure Telemedicine for Mid-level Providers

The objective of this subtask is to demonstrate the ability of secure, collaborative telemedicine applications to improve the delivery of healthcare through mid-level providers, such as Physician Assistants (PA) and Nurse Practitioners (NP). These applications will include teleconferencing, electronic patient record, and computer-aided diagnosis and treatment support systems, and will utilize an intuitive graphics/mouse interface.

A. Current Status:

This task began during this reporting period.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

determination of system-specific resources that Artemis should provide. These will include:
- a patient database (personal information, visits, labs, radiographs);
- orders (activities requested by a provider or MD);
- a database of EKG data (with animation);
- a database of sonogram data (with animation);
- history-taking tools (electronic forms); and
- physical exam tools (electronic forms to aid entry of physical data);
determination of electronic, medical reference resources to be integrated for the providers. These will include a medical dictionary, Harrison's Principles of Internal Medicine; the Physician's Desk Reference, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), a Laboratory Values Guide (including Reference Ranges), the Grateful Med or Medline database, the ILIAD Diagnostic Expert System Knowledge Server, the Drug Interaction Analysis System, Acid Maps (maps from blood chemistry to Dx, such as "metabolic acidosis"), and a "medical calculator" (drug doses, acid maps, etc.); and
development of a prototype client/server interface between Artemis and the Applied Medical Informatics' ILIAD Diagnostic Expert System Knowledge Server, using JAVA applets and RPC. The interface is called SAGE, and we are receiving much cooperation in its development from AMI staff.

Task 2.3 Secure Telemedicine for Home Care Patients

The objective of this subtask is to demonstrate the ability of secure, collaborative telemedicine applications to improve the delivery of healthcare for home care patients through patient counseling information resources and support for near-time monitoring of patients with chronic ailments. Homecare patients with ready access to such information will be able to responsibly participate in the healthcare delivery process and its outcome. By enabling the patients to provide information about their conditions, this application will allow healthcare providers to take timely intervention in the treatment of their patients.

A. Current Status:

This task began during this reporting period.

B. Work Accomplished This Period:

The following work was completed in this reporting period:

reading work performed at other universities and companies;
preliminary thinking on potential scenario of home health care in general; and
developing a checklist of base software technologies to be adopted.

Task 3.1 Evaluation/Assessment of the Impact of Collaborative Telemedicine Applications on Cost, Quality and Access to Care

The objective of this subtask is to assess the impact of telemedicine technology on cost, quality, and access to healthcare services in each of the three scenarios outlined in Task 2. We propose to develop three models that address different aspects of evaluation: 1) a multilayer model that provides an overall integrative framework for evaluation, 2) a presentation model for visualization of the impact of telemedicine on the healthcare enterprise at each layer of the proposed multilayer model, and 3) a cost model based on the selected scenarios.

A. Current Status:

This task began during this reporting period. Development of Multilevel evaluation based on the Evaluation Guidelines published by the Institute of Medicine (IOM).

B. Work Accomplished This Period:

The following work was completed in this reporting period:

initial development of an evaluation plan for three scenarios (intensive care, mid-level providers, and home health care) to be deployed for telemedicine applications. The plan is based on the recommendations made by the IOM study. These recommendations are being customized for each scenario; and
preliminary assessment of opportunities for cost modeling/savings in each of the three scenarios. This was done as a first step in the accumulation of current cost and activity data to provide a benchmark for changes in costs and activities for each scenario.

Task 3.1 Security and Integrity of Electronic Patient Records

The objective of this subtask is to evaluate the technical and organizational approaches at the telemedicine application test sites to ensure the confidentiality and integrity of personally identifiable electronic health data while permitting legitimate transactions. Through formal assessments we plan to determine the effect of secure collaborative telemedicine applications on the healthcare organization's electronic patient record security policies.

A. Current Status:

Work on this task will be initiated after the NLM guidelines are obtained.

B. Work Accomplished This Period:

None

Task 4 Technical and Management Support Services and Infrastructure

The objectives of this task are to provide a highly-reliable, state-of-the-art, networked computing environment for CERC's staff to use in their development and testing activities; to provide systems and networking support for computers installed at other sites as part of Tasks 1-3; and also to provide administrative, accounting, and clerical support for the project.

A. Current Status:

This task began during this reporting period.

B. Work Accomplished This Period:

The following work was accomplished during this reporting period:

completion of all paperwork to establish the new contract award in the university financial and contractual system;
preparation and processing of personnel action forms to begin charging labor to the new project;
establishment of internal project monitoring and tracking systems;
initiation of required paperwork (Statements of Work, proposal analyses) to establish proposed subcontracts with Valley Health Systems and Los Alamos National Laboratory;
initiation of dialogue and necessary paperwork with the university telecommunications department in order to install new frame relay lines for the project's communications network;
installation of Windows NT workstations;
normal maintenance of the existing computer hardware and software to support project activities; and
distribution of information about the project upon request.