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Networking Health: Prescriptions for the Internet (2000)

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

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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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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

Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
×
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
×
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Suggested Citation:"Appendix B: National Library of Medicine Awards to Demonstrate Health Applications of the Next Generation Internet." National Research Council. 2000. Networking Health: Prescriptions for the Internet. Washington, DC: The National Academies Press. doi: 10.17226/9750.
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Consumer health websites have garnered considerable media attention, but only begin to scratch the surface of the more pervasive transformations the Internet could bring to health and health care. Networking Health examines ways in which the Internet may become a routine part of health care delivery and payment, public health, health education, and biomedical research. Building upon a series of site visits, this book:

  • Weighs the role of the Internet versus private networks in uses ranging from the transfer of medical images to providing video-based medical consultations at a distance.
  • Reviews technical challenges in the areas of quality of service, security, reliability, and access, and looks at the potential utility of the next generation of online technologies.
  • Discusses ways health care organizations can use the Internet to support their strategic interests and explores barriers to a broader deployment of the Internet.
  • Recommends steps that private and public sector entities can take to enhance the capabilities of the Internet for health purposes and to prepare health care organizations to adopt new Internet-based applications.
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