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Appendix B—
National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet

The National Library of Medicine (NLM) announced a new, three-phase program in 1998 to develop innovative medical projects that demonstrate the use of the capabilities of the Next Generation Internet (NGI), such as improved quality of service, security, network management, and support for nomadic computing. Phase I awards were announced on October 14, 1998, and included 24 contracts totaling $2.3 million that were intended to improve understanding of ways the NGI can affect health care, health education, and health research systems in such areas as cost, quality, usability, efficacy, and security. Phase II awards were announced in late 1999 and consisted of 15 projects aimed at implementing capabilities in local testbed settings. Some of the Phase II awards build on projects begun under Phase I of the program, while others build on work originally conducted under other research programs. Summaries of each of the Phase I and Phase II projects announced to date are provided below. Additional information regarding these NGI awards and NLM's telemedicine evaluation program is available on the NLM home page at <http://www.nlm.nih.gov>.

Phase I Awards
1—
Pathology Image Database System

Yale University is planning a pathology image database system, Pathmaster, accessible via the World Wide Web. When a pathologist is con-soft



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Page 314 Appendix B— National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet The National Library of Medicine (NLM) announced a new, three-phase program in 1998 to develop innovative medical projects that demonstrate the use of the capabilities of the Next Generation Internet (NGI), such as improved quality of service, security, network management, and support for nomadic computing. Phase I awards were announced on October 14, 1998, and included 24 contracts totaling $2.3 million that were intended to improve understanding of ways the NGI can affect health care, health education, and health research systems in such areas as cost, quality, usability, efficacy, and security. Phase II awards were announced in late 1999 and consisted of 15 projects aimed at implementing capabilities in local testbed settings. Some of the Phase II awards build on projects begun under Phase I of the program, while others build on work originally conducted under other research programs. Summaries of each of the Phase I and Phase II projects announced to date are provided below. Additional information regarding these NGI awards and NLM's telemedicine evaluation program is available on the NLM home page at <http://www.nlm.nih.gov>. Phase I Awards 1— Pathology Image Database System Yale University is planning a pathology image database system, Pathmaster, accessible via the World Wide Web. When a pathologist is con-soft

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Page 315 fronted with a slide containing a cell whose nature is uncertain, a digital image of the cell can be submitted to Pathmaster, along with certain clinical information about the specimen. Pathmaster will automatically compute descriptors and pass back images to the user, along with their cell types and diagnoses. Contact: Perry L. Miller, M.D., Ph.D. Yale School of Medicine Center for Medical Informatics 333 Cedar Street P.O. Box 208009 New Haven, CT 06520-8009 203-785-6753 2— Networked 3D Virtual Human Anatomy The goal is to build a virtual human cadaver based on the Visible Human data set. An online virtual cadaver would be available to a wide range of students who could explore the virtual cadaver with a variety of tools. High-end applications will have a haptic interface. Contact: Victor M. Spitzer, Ph.D. University of Colorado Health Sciences Center 4200 East Ninth Avenue Denver, CO 80262 303-274-0501 3— Rural Health Science Education This project will develop a plan to evaluate the use of computer and interactive compressed video technologies to support rural health science education. It will enable delivery of interactive educational programming, such as grand rounds and continuing medical education, clinical information systems, library services, and consultation. Beneficiaries will be students, residents, and health care professionals. Contact: Dr. Leo Bairnsfather, Ph.D. Louisiana State University Medical Center 1501 Kings Highway Shreveport, LA 71130-3932 318-675-6536 318-675-7757 faxbreak

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Page 316 4— Biomedical Teleimmersion By combining teleconferencing, telepresence, and virtual reality, teleimmersion enables teachers and students to interact with three-dimensional models. Teleimmersion combines several virtual reality systems with advanced network capabilities for learning especially in surgical education. NGI guarantees data privacy and security and will allow teleimmersive environments derived from models of patient data. Contact: Jonathan C. Silverstein, M.D. University of Illinois at Chicago School of Biomedical and Health Information Services 1919 W. Taylor Chicago, IL 60612-7249 312-996-5112 312-996-8342 fax 5— National Emergency Medicine Information Extranet The National Emergency Information Infrastructure Consortium (EIIC) will create a plan for implementation of a secure National Emergency Medicine Information Extranet to improve emergency care across the nation. The primary application to be developed will enable interlinked standards-based emergency encounter registries, then feed back to providers just-in-time multimedia educational and treatment protocol services. The project will create an open architecture to enable other layered applications in the future. Contact: Edward Barthell, M.D. Infinity Healthcare, Inc. 1251 Glen Oaks Lane Mequon, WI 53092 414-290-6700 414-290-6781 fax 6— Personal Internetworked Notary and Guardian The Personal Internetworked Notary and Guardian (PING) project is designed to address the control of a personal record that can be integrated with more traditional sources of clinical information for patient use in the home, at work, and at school. In particular, PING is focused on (1) reconstitution of the patient longitudinal records from both provider-based information systems and portable, personal record systems, on thecontinue

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Page 317 Internet; (2) providing simple and secure authentication mechanisms; and (3) evaluation of the impact of PING upon the process of health care. Contact: Isaac S. Kohane, M.D., Ph.D. Director, Children's Hospital Informatics Program 300 Longwood Ave. Enders 150 Boston, MA 02115 617-355-7821 617-730-0456 fax 7— Implementation to Serve Visible Human Datasets This project plans to implement an NGI production system to interactively serve Visible Human data sets and anatomical data evaluation software. The image and knowledge data objects will be accessed by NGI-enabled World Wide Web users and evaluators. The system will provide to the user multi-resolution, anatomically labeled images within these Visible Human data sets as requested. Contact: Brian D. Athey, Ph.D. The University of Michigan Medical School 4771 Medical Science Building II Department of Anatomy and Cell Biology 1335 Catherine St. Ann Arbor, MI 48109-0616 734-763-6150 734-763-1166 fax 8— G-CPR and the NGI The Louisiana State University (LSU) Medical Center proposes to implement a system of longitudinal electronic health records over the NGI that will integrate its ten public hospitals. This project is based on the G-CPR, or Government Computer Based Patient Record, a collaborative effort between the Department of Defense, Department of Veterans Affairs, Indian Health Service, and the LSU Medical Center. The objective of this project is to enable secure access and sharing of clinical information. Contact: Richard Ferrans, M.D. Louisiana State University Medical Center Department of Public Health 1600 Canal Street, Suite 800break

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Page 318 New Orleans, LA 70112 504-588-3507 504-588-3938 fax 9— Secure Radiologic Collaboration on the Next Generation Internet The goal is to plan the implementation and deployment of a suite of collaborative medical applications to provide a secure, real-time, interactive environment for viewing, analyzing, and comparing radiological images in a clinical environment. This will provide clinicians and technologists the ability to share, in real time, diagnostic imagery and medical data. Contact: Douglas L. Long, Sr., Principal Scientist Odyssey Research Associates, Inc. Cornell Business & Technology Park 33 Thornwood Dr., Suite 500 Ithaca, NY 14850-1250 607-257-1975 607-257-1972 fax 10— Open Architecture Multispecialty Data and Telemedicine Integration on the Next Generation Internet The purpose of this project is to plan the implementation of a multispecialty telemedicine testbed using NGI. The plan will identify existing and new multispecialty applications in patient care, continuing medical education, and patient education to be integrated into this platform. The planning activity is to be conducted by a team of scientists and clinicians from all pertinent parts of the proposing organization. Contact: Joseph C. Kvedar, M.D. Corporate Director Partners Telemedicine 1 Longfellow Place, Suite 216 P.O. Box 8941 Boston, MA 02114 617-726-4447 617-726-7530 fax 11— Patient-centric Healthcare Management over NGI This project will demonstrate a patient-centric approach for health care management over the NGI. The demonstration will build upon the Elec-soft

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Page 319 tronic House Call system developed by Georgia Tech and the Medical College of Georgia to allow patients to videoconference with their health care providers and to monitor medical measurements over a secure network. A simple graphical user interface enables patients to control the system themselves. The system combines videoconferencing, vital signs measurements, patient education resources, and medical records, and enables patients to participate in their own health care. Contact: Mr. John W. Peifer Senior Research Scientist Biomedical Interactive Technology Center Georgia Institute of Technology 250 14th St., NW Atlanta, GA 30332-0200 404-894-7028 404-894-7025 fax 12— Adopting the NGI as a Tool for Healthcare and Information Access This project will assemble a team of medical informatics users and networking advisors to analyze biomedical and healthcare information processes and select those that best demonstrate the application of NGI technologies and tool sets, while simultaneously providing demonstrable benefit to healthcare practitioners and end users. Many information processes in health care clinical services, biomedical education, and research will be assessed. Once applications have been identified, the assessment team will select viable candidates, then formulate an implementation strategy for one application area. Contact: Brent K. Stewart, Ph.D. University of Washington Grant and Contract Services 3935 University Way NE Seattle, WA 98195 206-616-1314 206-543-3495 fax 13— The Empathy Network: Improved Healthcare Delivery for Survivors of Mild Traumatic Brain Injury The objective of the Empathy Network is to employ virtual reality (VR) technology, high performance computing centers, and NGI capabilities to dramatically improve the health care delivered to mild traumatic brain injury (MTBI) patients. VR technology will allow clinicians to construct acontinue

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Page 320 virtual world that simulates the cognitive and perceptual deficits experienced by an MTBI patient. VR and NGI technologies will then enable a patient's other health care providers, family, friends and co-workers to experience the MTBI patient's problems in coping with everyday life. This will engender empathic insight, support, and understanding that are crucial elements of an MTBI patient's recovery and adaptation. Contact: David L. Zeltzer Sarnoff Corporation 201 Washington Road Princeton, NJ 08540 609-734-2975 609-734-2662 fax 14— Remote, Real-Time Simulation for Teaching Human Anatomy and Surgery This project plans to demonstrate remote, real-time teaching of human anatomy and surgery, using the NGI. A simulator architecture will be developed to deliver real-time simulation and visualization technologies to a diverse audience. The client component is a desktop PC or workstation. The simulation server receives sensor and control input from the client and transmits response streams. The NGI network-based architecture will allow for a heterogeneous mix of client configurations ranging from simple mouse and color displays to multiple high-resolution stereographic displays and haptic devices. Contact: Parvati Dev, Ph.D. Stanford University School of Medicine SUMMIT 1215 Welch Road, Modular A Stanford, CA 94305-5401 650-723-8087 650-498-4082 fax 15— Interactive Medical Data on Demand: A High-Performance Image-Based Warehouse Across Heterogeneous Environments The goal of this project is to determine the requirements of a system for intuitive, real-time access to patient-specific data records based on multimodal images and multimedia. They will evaluate and select system architectures, software, and network configurations to provide access over different network bandwidths and platforms. This design will includecontinue

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Page 321 scalability of the system and extensibility to other health care applications. Contact: Donald L. Stredney Ohio State University Research Foundation Health Sciences Offices, B-030 Graves Hall 333 West Tenth Avenue Columbus, OH 43210 614-292-9248 614-292-7168 fax 16— NGI-Aware, Scalable, Secure, and Adaptive Technology for Rural Telemedicine The goal of this project is to develop a plan to demonstrate telemedicine applications that will utilize NGI infrastructure. Telemedicine scenarios include (1) nomadic clinics; (2) a public health station; and (3) a consulting health station in rural clinics and hospitals. These systems will be configured with a set of videoconferencing, diagnostic, and patient monitoring equipment. Contact: Y.V. Ramana Reddy, Ph.D. West Virginia University Research Corporation 886 Chestnut Ridge Road Morgantown, WV 26506 304-293-7226 304-293-7541 fax 17— Medical Nomadic Computing Applications for Patient Transport The goal of this project is to transmit multimedia diagnostic information in real time from ambulances to receiving physicians using NGI technologies, thus enabling diagnostic and treatment opportunities during transport. Contact: David M. Gagliano TRW, Inc. One Federal Systems Park Drive Fairfax, VA 22033 703-345-7497break

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Page 322 18— Distributed Revolutionary Medical Education Environment The objective of this project is to develop a plan to implement and evaluate a distributed, medical education environment on a network testbed that simulates the characteristics of the NGI. These applications will be delivered across the spectrum of medical instruction, from undergraduate to postgraduate to continuing education. Contact: Lael C. Gatewood, Ph.D. University of Minnesota Office of Research and Technology 1100 Washington Avenue So., Suite 201 Minneapolis, MN 55415 612-625-4909 612-625-7166 fax 19— Radiation Oncology Treatment Planning/Care Delivery Application The goal of this project is to develop, implement, and evaluate NGI capabilities for radiation oncology treatment planning and care delivery. The application will provide diagnostic support, treatment planning, and remote verification of proper operation of treatment equipment from the Comprehensive Cancer Center to a remote Johns Hopkins University treatment facility. The proposed project will have a strong evaluation component focused on quality of service, security, privacy, and data integrity. Contact: Joseph S. Lombardo Johns Hopkins University Applied Physics Laboratory 11100 Johns Hopkins Road Laurel, MD 20723-6099 240-228-6287 240-228-6834 fax 20— Applications Layer Security Solution for Stationary/Nomadic Environments This project will evaluate extant security techniques within the context of an open security architecture. The solution is based on security shared among collaborating parties, nomadic computing, and the privacy of medical information. The architecture includes user authentication, remote access to medical databases, nomadic computing, and confidentiality of data.break

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Page 323 Contact: Brenda Garman Motorola Space and Technology Group 1190 Winterson Road Airport Square #14, Suite 350 Linthicum, MD 21090 410-859-4761 410-859-0787 fax 21— Human Embryology Digital Library The goal of this study is to develop a research and education network for medical image acquisition and analysis. A high-performance optical network testbed will link government labs and universities with traditional medical research facilities. The focus of the project is on the analysis and delivery of digital histopathology image data. The proposal includes the definition of a set of demonstration projects that use a collaborative consultation system for research, surgical planning, and basic research. Contact: George S. Michaels, Ph.D. George Mason University Office of Sponsored Programs 4400 University Drive Fairfax, VA 22030 703-993-1998 703-993-1993 fax 22— Integration of Security Mechanisms for Internet Applications The goal of this project is to develop a plan to integrate the PCASSO (Patient Centered Access Secure Systems Online) with biomedical applications. It will be demonstrated through a testbed involving medical treatment facilities in Delaware, Pennsylvania, Maryland, and New Jersey and the Frederick (Md.) Biomedical Supercomputer Center in an information technology infrastructure. The NGI infrastructure for this region is being developed under the HUBS (hospitals, universities, business schools, and communities) Initiative. Contact: Raymond E. Cline, Jr. Science Applications International Corp. (SAIC) 1710 Goodridge Drive, M/S 2-3-1 McLean, VA 22102 703-749-8648 703-821-1134 faxbreak

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Page 324 23— Telemammography Using the NGI The goal of this project is to plan and implement a testbed to demonstrate the feasibility of a national breast imaging archive and network infrastructure to support telemammography using NGI technologies. The proposed infrastructure would support traditional breast screening; provide the opportunity to maintain and apply standard image processing and computer-aided diagnosis software; permit access to breast imaging experts for primary and secondary interpretations; and provide an opportunity to study and understand epidemiologic issues in breast cancer. Contact: Mitchell Schnall University of Pennsylvania Research Services 133 S. 36th Street, Suite 300 Philadelphia, PA 19104-3246 215-662-7238 215-662-3013 fax 24— Teletrauma and the NGI The goal of this project is to plan the implementation of an integrated system of trauma care for Southern Louisiana using an NGI telemedicine network. This network will provide instant access to the Trauma Team at the Medical Center of Louisiana at New Orleans, which will provide online assistance. Distance education training for emergency personnel, network management, and quality of service issues are all elements of the project. Contact: Richard Ferrans, M.D. Louisiana State University Medical Center Department of Public Health 1600 Canal Street, Suite 800 New Orleans, LA 70112 504-588-3507 504-588-3938 fax Phase II Awards 1— Personal Internetworked Notary and Guardian The Personal Internetworked Notary and Guardian (PING) proposal aims to provide a patient-controlled personal medical records system. Thecontinue

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Page 325 PING record is available to the patient from any Internet-connected device. It is encrypted and accessible only to authorized parties for health care and/or research or public health purposes. It will include integration of data from two birth hospitals, a tertiary care pediatric hospital, a pediatric practice network, public health authorities, and the patients and their families. The goals of the PING project include (1) providing access for highly mobile postpartum mothers at work, school, and home to their infants' records; (2) enabling patients and families to manage a fundamentally collaborative process of clinical documentation over the Internet; and (3) ensuring that all PING transactions provide the highest available confidentiality of the patient's data, under their control. Contact: Isaac S. Kohane, M.D., Ph.D. Director, Children's Hospital Informatics Program 300 Longwood Ave., Enders 150 Boston, MA 02115 617-355-7821 617-730-0456 fax 2— Biomedical Teleimmersion By combining teleconferencing, telepresence, and virtual reality, teleimmersion enables teachers and students to interact with three-dimensional models, point, gesture, converse, and see each other. Teleimmersion combines CAVE and ImmersaDesk virtual reality systems with advanced network capabilities to make learning environments so compelling that people will use them even when they are in the same room. They plan to demonstrate and assess teleimmersive environments for surgical education. Contact: Jonathan C. Silverstein, M.D. University of Illinois at Chicago School of Biomedical and Health Information Services 1919 W. Taylor Chicago, IL 60612-7249 312-996-5112 312-996-8342 fax 3— Patient-Centric Tools for Regional Collaborative Cancer Care Using NGI This project plans to investigate the application of collaborative tools in a distributed and differentiated medical enterprise, the Seattle area Cancercontinue

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Page 326 Care Alliance (CCA). The applications should (1) enhance the CCA partners' existing clinical care programs into new highly collaborative patient-centered interdisciplinary efforts; (2) allow for a fully integrated team approach to cancer, i.e., state-of-the-art diagnosis, treatment, and management of cancer patients through collaboration of distributed cancer care clinicians and researchers; and (3) accelerate the dissemination and application of new knowledge related to the diagnosis and the treatment of cancer, both inside the enterprise and throughout the region. They propose to examine the application of collaborative technologies to the three areas of physician interaction with patient information in the diagnosis, management, and treatment of cancer: consultations between referring physicians and CCA physician, including the patient; tumor board conferencing; and radiation oncology treatment planning. Contact: Brent K. Stewart, Ph.D. University of Washington Grant and Contract Services 3935 University Way NE Seattle, WA 98195 206-616-1314 206-543-3495 fax 4— Connectivity, Security, and Performance of an NGI Testbed for Medical Imaging Applications The objective of this project is to implement an NGI testbed in northern California's San Francisco Bay Area for medical imaging applications. The two regional sites are the University of California at San Francisco (UCSF) and Stanford University. This NGI testbed will be built on two existing high-performance networks. The goal is to provide insight into NGI capabilities with respect to performance in a regional environment, potential for extension to the national level, and improvements needed. The clinical applications to be evaluated include telemammography consultation service in a regional compared with a local environment and how real-time interactive teaching in breast imaging would improve the confidence level of general-practice radiologists. The two characteristics of NGI that will be utilized include file size capability and near-real-time transmission. Contact: H.K. Huang, D.Sc., FRCR (Hon.) Children's Hospital of Los Angeles/University of Southern California Department of Radiology, Mailstop #81 4650 Sunset Boulevardcontinue

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Page 327 Los Angeles, CA 90027 818-889-9411 (telphone and fax) 5— Indianapolis Testbed Network for NGI Applications to Telemedicine Indiana University Proposes to convert the Indianapolis Network for Patient Care (INPC) into a testbed of NGI technologies including IP Security (IPSec), quality of service (QOS) in televideo applications at a nursing home, and IP roaming capabilities with portable wireless workstations in clinical settings. The project plans to conduct randomized trials to test the effects of nursing home televideo and nomadic computing in the clinical environment. They plan to perform a trial to determine the effects of patient-physician videoconferencing and batch video applications (linked to Web-based electronic medical records) on health services utilization and physician/patient satisfaction at a 250-bed remote nursing home. The project will also perform a crossover trial of handheld personal computers, evaluating the effects on physician behavior by time-motion studies, physician satisfaction, and patient encounter data. These handheld computers will be equipped with capabilities for computerized order-entry, access to patient data, task-list management, and e-mail. Contact: Clement MacDonald, M.D. Regenstrief Institute for Health Care 101 West 10th Street, RG 6th Floor Indianapolis, IN 46202 317-630-7070 317-630-6962 fax 6— Internet Protocol Video Telemedicine and Patient Cardiology Education The purpose of this project is to address the technical issues impacting the delivery of telemedicine and sophisticated medical education using IP video over the Next Generation Internet (NGI). IP video over NGI has the potential to provide a common telecommunication infrastructure for real-time high bandwidth medical applications that cannot be supported by the commodity Internet. NGI solutions for real-time telemedicine with high-bandwidth video and audio requirements could eventually eliminate the need for expensive dedicated telemedicine networks and give broader access to these services. As part of the project, extensive evaluation, including impact on patient care, will be done. Technical and clinical protocols will be developed for all applications.break

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Page 328 Contact: Susan S. Gustke, M.D. East Carolina University School of Medicine Center for Health Science Communication Brody Medical Science Building, 1S-10 600 Moye Blvd. Greenville, NC 27854 252-816-5219 252-816-8596 fax 7— A Multicenter Clinical Trial Using NGI Technology NGI technology will be applied to provide the infrastructure of a multicenter clinical trial of new therapies for adrenoleukodystrophy (ALD), a fatal neurologic genetic disorder. This project involves the formation of a worldwide imaging network of clinical institutions to evaluate ALD therapies. This network is required to provide a sufficient number of patients for evaluating ALD therapies. This can serve as a model for many other disorders. Three centers will collaborate on this project. The Imaging Science and Information Systems (ISIS) Center at Georgetown University Medical Center, the Kennedy Krieger Institute, and the Department of Radiology at Johns Hopkins University. NGI technology will be used to speed the transmission and evaluation of high quality MRI images. Another important feature of this proposal is to gain insight into procedures that will ensure medical data privacy and security. Contact: Hugo W. Moser, M.D. Kennedy Krieger Research Institute, Inc. 707 North Broadway Baltimore, MD 21205 410-502-9405 410-502-9839 fax 8— PathMaster: A Web-Accessible Cell Image Database Indexed by Mathematical Descriptors and Supported by Parallel Computation The project will develop the PathMaster computer system as a testbed. PathMaster is designed to help the pathologist with the process of making a diagnosis in a cytologic specimen. Phase II focus will be on the analysis of lymphoma touch preparations and thyroid aspirates. To use PathMaster, the pathologist creates digitized images of a selected set of cells from a specimen and submits these to PathMaster over the Web. Each image is automatically subjected to a computational analysis tocontinue

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Page 329 determine more than 2,000 mathematically derived descriptors. Each image will then be compared to a database using network-based parallel computation. The analysis will produce ranked sets of images from specimens whose diagnosis is known. Images will be returned to the user to help in making a diagnosis. A variety of NGI testbed evaluations will be performed. Contact: Perry L. Miller, M.D., Ph.D. Yale University School of Medicine Center for Medical Informatics 333 Cedar Street, P.O. Box 208009 New Haven, CT 06520-8009 203-785-6753 203-785-6664 fax 9— Remote, Real-Time Simulation for Teaching Human Anatomy and Surgery Stanford University proposes to develop two teaching applications and a local NGI testbed network for evaluating their effectiveness. The first application will support instruction in human anatomy and the second the performance of surgical manipulations. Both applications will support synchronous collaboration through a shared virtual workspace and use haptic feedback to augment the visual sense. This technology will allow the definition of new curricular elements including the repeated dissection of anatomical structures, the visual segmentation of raw data sets, the creation of three-dimensional organ models, and the practice of fundamental surgical skills. The investigators anticipate that a wide community of teachers and users will, through a distributed client-server system, share online, image-rich data and professional experiences. Contact: Parvati Dev, Ph.D. Stanford University 1215 Welch Road, MOD B Stanford, CA 94035-5401 650-723-8087 650-498-4082 fax 10— Human Embryology Digital Library and Collaboratory Support Tools George Mason University proposes to develop and demonstrate technologies to enable collaboration between multiple, distributed research-soft

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Page 330 ers and to make progress toward advanced clinical and educational goals. The offeror plans to integrate existing data capture and analysis procedures at the National Museum of Health and Medicine (NMHM) into a high performance testbed network that will include a petabyte archive and analysis capability. The project will use an existing, government-funded gigabit network to connect the NMHM to key sites across the nation. The testbed requires a minimum data transport rate of 622 Mbps in the key regional networks and quality of service. Contact: J. Mark Pullen, Ph.D. George Mason University Computer Science MS 4A5 4400 University Drive Fairfax, VA 22030 Phone: 703-993-1538 703-993-1710 fax 11— Medical Nomadic Computing Applications for Patient Transport The objective of this project is the real-time transmission of multimedia patient data from an incident scene and during transport to a receiving center enabling diagnostic and treatment opportunities prior to arrival. The offeror will use the diagnosis and treatment of challenging clinical models—including acute ischemic stroke and trauma scene response—to define a range of quality of service (QOS) requirements for multiple critical care applications, evaluate the effectiveness of the system, and derive principles of nomadic computing applicable in other time sensitive emergency care models in which treatment options are constrained by the delay between onset/injury and definitive diagnosis. TRW and the University of Maryland, Baltimore had previously developed a mobile telemedicine system for remote, real-time diagnosis using narrow bandwidth wireless technologies, but suffered from QOS problems. Phase III will extend the trial in a larger regional setting. Contact: David M. Gagliano TRW, Inc. One Federal Systems Park Drive Fairfax, VA 22033 Phone: 703-345-7497break

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Page 331 12— Remote Treatment Planning System This proposal addresses the development, implementation, and evaluation of an application to support remote treatment planning for radiation therapy. This application, Remote Treatment Planning System (RTPS), relies on network infrastructure technology for collaboration; on high bandwidth and QOS to support interactive review sessions; and on data privacy and security to protect patient privacy, confidentiality, and data integrity. Review sessions provide a collaborative environment for dosimetrists at the planning site, the oncologists at the care delivery site, and peer reviewers. It utilizes video teleconferencing and a shared view of the images to support treatment planning. The evaluation will measure outcomes at the care delivery site, process improvements at the treatment-planning site, and estimate cost impact on the remote treatment planning process. Phase III is proposed to deploy the application and testbed features to Peninsula Regional Medical Center in Salisbury, Maryland. Connectivity will be provided by the Maryland State Asynchronous Transfer Mode (ATM) backbone, NetWork.Maryland. Contact: Joseph S. Lombardo Johns Hopkins University Applied Physics Laboratory 11100 Johns Hopkins Drive Laurel, MD 20723-6099 240-228-6287 240-228-5026 fax 13— Next Generation Internet Implementation to Serve Visible Human Datasets Phase II: Development of Testbeds The University of Michigan (UM) Visible Human (VH) project team will develop an NGI production system to serve visible human data sets. These include a comprehensive set of interactive 2D and 3D VH browsers with arbitrary 2D cutting and 3D visualizations. An interactive Web navigation engine will be deployed to create and visualize anatomic fly-through, under haptic control of the user, and to deliver fly-through developed by expert anatomists and clinicians. Anatomical labels will enhance these visualization sequences and enable real-time links with appropriate resources on the Web using XML. The UM NGI VH system will complement and extend currently deployed passive Web information systems with active computational services. This will allow for delivery of several simultaneous high-quality digital streams, creating structured medical knowledge using the VH datasets. An evaluation team will continuallycontinue

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Page 332 respecify and focus the testbed deployments and measure performance and educational effectiveness. Contact: Brian D. Athey, Ph.D. University of Michigan School of Medicine Ann Arbor, Michigan 48109-0616 734-763-6150 734-763-1166 fax 14— Networked 3D Virtual Human Anatomy, Phase II The University of Colorado Health Sciences Center proposes to demonstrate and assess the use of Web-based, 3D-explorable virtual humans to enhance traditional anatomic teaching. This will be accomplished with audio, graphic, and haptic interfaces. The application will be assessed in anatomy curricula developed for undergraduate to postgraduate levels of education. Modules teaching the anatomy, function, and pathology of the knee will be used for this demonstration. The investigators will also demonstrate an extension of the virtual environment to include surgical simulation applied to arthroscopy. Contact: Victor M. Spitzer, Ph.D. University of Colorado Health Sciences Center 13001 East 17th Place, PO Box 6508, Mail Stop F-435 Aurora, CO 80045-0508 303-724-0501 303-724-0911 fax 15— Mammography for the Next Generation Internet, Phase II The University of Pennsylvania proposes to develop a testbed to demonstrate the feasibility of a national breast imaging archive and network infrastructure to support digital mammography using NGI technologies. They plan to improve access and performance of breast cancer screening with an imaging archive that supports storage, retrieval, and distribution of breast images for clinical and research purposes and ensures privacy and confidentiality with multilevel security embedded throughout the system. The proposed infrastructure would (1) support traditional breast screening through the maintenance and distribution of a digital record of prior breast examinations and relevant medical history for primary interpretation and expert consultation; (2) provide the opportunity to maintain and apply computer-aided diagnosis (CAD) software at central, well-maintained computing resources to studies from all women; (3) providecontinue

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Page 333 unique tools for creating educational and training programs; and (4) create an unparalleled opportunity to study and understand many epidemiologic issues in breast cancer through searches of a national breast screening database. NGI technologies will be used to transfer large data files, execute real-time queries, and access information securely. The testbed will demonstrate that quality of service, medical data privacy and security, nomadic computing, network management research and development, and infrastructure technology for collaboration are NGI technologies that are integral to widespread deployment and optimal utilization of digital mammography. Contact: Mitchell Schnall, M.D. University of Pennsylvania Radiology Department 1 Silverstein 3400 Spruce Street Philadelphia, PA 19104 215-662-6470 215-662-3013 faxbreak