Secure Collaboration Technology for Rural Clinical Telemedicine
Funded by the National Library of Medicine
Principal Investigator: Dr. Ramana
Reddy, Director, CERC
Co-Principal Investigator: Dr. V. "Juggy" Jagannathan, CERC
Technical Point of Contact: Ravi Raman
| Summary |
Team | Technical
Reports | NLM's 8
Oct. 1996 Press Release
Artemis Home Page
Telemedicine has captured the interest of the medical community, the government, and
the public as a cost-effective means of improving access to quality healthcare. In rural
areas, where specialized medical care may be unavailable, telemedicine can have an
especially large impact on the quality and speed of patient care. But, while many people
acknowledge the practical advantages of telemedicine, not everyone is at ease with the
transmission of confidential patient data over electronic networks.
Addressing this concern, our team of computer system developers, medical practitioners
and products companies, and other experts will utilize the cutting edge in data security
to show that secure telemedicine is viable over public networks. In addition, we will show
that its adoption as an integral part of an overall healthcare plan can result in cost
savings and improved access to quality healthcare for rural populations.
Through a competitively-won contract from the National Library of Medicine (NLM), we
will achieve our objectives through three primary tasks:
- developing open, standards-based, secure, collaborative telemedicine services for use in
customized telemedicine applications,
- field testing these services in three representative, rural healthcare scenarios in
which telemedicine shows great potential for reducing cost and improving access to quality
- evaluating the effect of the services in a set of rural West Virginia healthcare
Additionally, we will develop the software components to be reusable and will make them
widely available so vendors and healthcare organizations can create their own customized
Working prototypes of numerous telemedicine systems already exist. While some of these
systems show considerable promise, all are far from realizing their full potential until
several fundamental barriers are overcome. In developing the next generation of
telemedicine applications, we will address these barriers by:
- assuring the security, privacy, and integrity of medical information stored in computers
and during communication over public networks,
- ensuring usability by seamlessly integrating telemedicine applications into the
"workflow" of healthcare providers and into the enterprise's overall support
- ensuring interoperability by providing a standards-based, open architecture to enable
the creation of plug-and-play component-based solutions that can access information from
legacy systems, and
- demonstrating cost-effectiveness measures by ensuring scalability and migrating research
prototypes into real-world operational environments.
Characteristics of the System's Architecture
For this project, we will develop a set of secure telemedicine services for use in
customized applications for healthcare providers. Our goal is to develop mechanisms that
can support a wide range of security policies and procedures and provide for a secure
telemedicine healthcare framework.
Using the open systems approach and emphasizing the reuse of technologies already
developed under previous projects as well as those available commercially, we are
developing a Secure Collaborative Telemedicine Architecture (SCTA). The overall philosophy
is best described as "plug-and-play."
To accomplish this, we will develop a telemedicine system "backplane" (a
software system) into which a variety of modules can be "plugged," by embracing
the object-oriented approach and using the industry standard protocol known as CORBA
(Common Object Request Broker Architecture), which is presently supported by over 600
vendors world-wide. Our architecture will be flexible to accommodate other standards, such
as Object Linking and Embedding (OLE) by Microsoft.
The backplane will provide as its core capabilities:
- a security infrastructure that supports authentication and the secure transmission of
private and confidential patient information, utilizing high-bandwidth communications and
secure communications technologies (encryption, authentication, non-repudiation,
certification authorities, and smart cards,
- transparent and easy access to distributed patient information through a distributed
virtual master patient index,
- a secure workflow in the context of patient treatment, using common patient record
- a secure consultation service with voice, video, and shared applications for patient
information and treatment.
Other services that we will plug into this backplane to provide custom support features
to specific providers include:
- real-time or near real-time access to information gathered by instruments monitoring a
- seamless access to clinical decision support systems and on-line knowledge repositories,
such as MedLine.
In order to successfully assess and evaluate the results of employing telemedicine, it
is necessary that we demonstrate its utility in real-world scenarios. We therefore chose
three application areas particularly suitable for the practice of clinical telemedicine.
For each scenario, the clinical telemedicine tools and applications will be integrated and
customized to meet the specific needs of the roles of healthcare providers at the pilot
Remote access to Intensive Care Unit electronic patient data
We will demonstrate secure, collaborative telemedicine applications that will provide
improved healthcare to patients at a hospital's Intensive Care Unit (ICU). Intensivists at
a clinic will be able to confer with healthcare providers at a remote hospital's ICU in
the treatment of their patients, as well as to remotely and securely review ICU patient
information and monitor data from selected bedside devices.
Secure telemedicine for mid-level providers
We will demonstrate secure, collaborative telemedicine applications to improve the
delivery of healthcare through mid-level providers, such as Physician Assistants (Pass)
and Nurse Practitioners (NPs). These applications will include teleconferencing,
electronic patient record, and computer-aided diagnosis and treatment support systems; and
will utilize an intuitive graphics/mouse interface. Physicians will be able to supervise
mid-level providers in remote rural clinics, review patient information, and approve
diagnosis and treatment decisions. Mid-level providers will be able to employ a
computer-aided diagnosis support facility to assist them in the diagnosis and treatment of
their patients. The on-demand integration of selected portions of the patient's medical
data with an up-to-date medical information knowledge base will reduce healthcare provider
data entry without compromising patient confidentiality.
Secure telemedicine for home care patients
This telemedicine application will enable home care patients to access patient
counseling information sources and will also allow near-time monitoring for patients with
chronic ailments. For example, diabetic patients could provide periodic updates of their
daily medical logs (blood sugar, weight, medication, well-being) and benefit from early
intervention, such as changes in drug dosage, diet, or further check-ups. Home care
patients with ready access to such information will be able to responsibly participate in
the healthcare delivery process and its outcome.
Studies of the healthcare organizations, healthcare providers, and patients for each
telemedicine scenario will provide insight into the effect of these secure telemedicine
applications. Our evaluation effort consists of two components:
- assessing the impact of secure collaborative telemedicine applications on cost, quality,
and access to care. We will incorporate the recommendations from the National Research
Council's Computer Science and Telecommunications Board into our risk assessment process,
- assessing the security, confidentiality, and integrity of electronic patient records. We
will determine the "before and after" effects of the telemedicine applications.
Previous Technical Experience
Several of the team members previously collaborated to develop a multimedia patient
record system, known as ARTEMIS, through separate funding by NLM and the Defense Advanced
Research Projects Agency. ARTEMIS was the first application that enabled healthcare
providers to access distributed clinical patient records over an intranet utilizing the
World Wide Web. The system is currently undergoing field trials and evaluations at a set
of VHS clinics and at Cabell Huntington and St. Mary's Hospitals. We will reuse the
technologies developed for ARTEMIS during this project.
Project Team | Advisory Board
- The Concurrent Engineering Research Center is an interdisciplinary
research unit of West Virginia University. CERC's primary business is the research,
development, and demonstration of computer and communication technologies to enable
collaboration in different domains. Over the last eight years, CERC developed software
technology for the Defense Advanced Research Projects Agency (DARPA) and has been applying
collaboration technology in the medical informatics arena in the last three years under
both DARPA and the National Library of Medicine's (NLM's) High Performance Computing and
Communications (HPCC) Initiative. CERC developed the ARTEMIS multimedia patient record
Its director, Professor Ramana Reddy, is the Principal Investigator
of this project and has managed over $50M in sponsored research from both the Federal
Government and industry.
Associate Professor V. ("Juggy") Jagannathan, Co-Principal
Investigator, is renowned for his work on object-oriented programming, and distributed
artificial intelligence and, more recently, for his contribution to starting the CORBAMed
special interest group to bring a standards based approach to healthcare information
- Valley Health Systems, Inc., is a private, non-profit corporation based in
Huntington, West Virginia, that operates an integrated network of 15 community health
centers and public health programs in southern West Virginia. It serves mainly rural or
physician-short areas in seven counties in West Virginia as well as some counties in Ohio
Three VHS clinics are connected via a frame-relay communications network, and are
similarly connected to CERC and St. Mary's Hospital. VHS recently received a grant of $50K
from the Bell Atlantic Corporation to improve its computing and counications
infrastructure based on the success of the separately-funded ARTEMIS project, for which
VHS is a field site. VHS is also a field site for this project.
One of the Co-Principal Investigators of this proposal, Bruce Merkin, M.D., is the former
Medical Director of VHS and is now a rural, general, internal medicine specialist.
Another Co-Principal Investigator, Dr. Michael Kilkenny, M.D. is the Medical Director of
- Cabell Huntington Hospital is a 300-bed tertiary care medical center with
teaching and research affiliation with the Marshall University School of Medicine. Serving
29 counties in the tri-state area of southern West Virginia, Ohio, and Kentucky, CHH
provides emergency and trauma services. Its health care providers are participating in the
telemedicine application for intensive care providers.
- St. Mary's Hospital is a not-for-profit, teaching hospital serving
southern West Virginia, southeastern Ohio, and Kentucky. Health care providers at St.
Mary's are participating in the telemedicine application for intensive care providers.
- The Huntington Internal Medicine Group is a group practice of physicians
associated with St. Mary's Hospital. An intensivist from this group will work with CERC in
the development and testing of the intensivist scenario experiment.
- The Marshall University School of Medicine, at one of the two major
universities in West Virginia, emphasizes primary care and the training of medical
students in rural areas of West Virginia. An intensivist from the school will work with
CERC in the development and testing of the intensivist scenario application.
- Alderson-Broaddus College is a four-year college with a nationally
recognized program for training mid-level healthcare providers, and has targeted
telemedicine as an important new area for emphasis. The Claude Worthington Benedum
Foundation of Pittsburgh (a major regional charitable foundation) recently awarded
Alderson-Broaddus $250K for five projects in the Physician's Assistant program, including
telemedicine and distance learning. Alderson-Broadus will provide consultation in the
design and testing of telemedicine applications for mid-level providers.
- West Virginia Primary Care Association, Inc., represents the more than 70
non-profit community health centers in West Virginia. Their mission is to strengthen
access to primary care through a network of health services, providing community awareness
and identifying areas of unmet need. Home care providers will work with CERC researchers
and VHS physicians to define and deploy the home care scenario application.
- Wayne County Community Service Organization, Inc., operates and finances
social and public welfare programs for the benefit of disadvantaged populations of Wayne
County. Home care providers will work with CERC researchers and VHS physicians to define
and deploy the home care scenario application.
- Los Alamos National Laboratory is a US Department of Energy laboratory
that is actively pursuing telemedicine. The goal of LANL's Telemed project is to
develop an open standards-based radiology repository. LANL is assisting CERC in the
development, customization and integration of diagnostic support services for the
telemedicine application for mid-level providers.
- Applied Medical Informatics, Inc., is a company specializing in customized
expert systems and diagnosis and treatment decision support tools, such as Iliad,
which is in use in many medical schools; and Medical HouseCall and Pediatric
HouseCall, which provide information about disease symptoms, medical procedures, and
drug interactions to healthcare consumers. AMI is the recipient of a $2 million grant from
the National Institute of Standards and Technology to provide a medical knowledge server
based on Iliad's expert system capabilities enabling real-time diagnosis, treatment, and
alerts. AMI will donate software that will be integrated into the ARTEMIS system.
- Protocol Systems, Inc., is a manufacturer of patient monitoring
instruments and systems. Protocol's portable Propaq monitors and Acuity
central monitoring systems provide cost-effective care for monitoring patients in a
continuous manner. Protocol will donate hardware that will be integrated into the ARTEMIS
- Senator John D. Rockefeller, West Virginia (Chair)
- Dr. Thomas Bender, M.D., Executive Director of the International Union for Circumpolar
Health, Anchorage, Alaska
- Mr. Denis Bone, President, Bell Atlantic West Virginia
- Dr. Neil Bucklew, Ph.D., former President of West Virginia University; Professor of
Management and Chairman of Informatics Taskforce at WVU's College of Business and
- Dr. Michael DeBakey, M.D., Chancellor Emeritus, Baylor College of Medicine and Director,
DeBakey Heart Center
- Mr. J. Thomas Jones, Executive Director/CEO, St. Mary's Hospital, Huntington, West
- Dr. Michael Kilkenny, M.D., Medical Director, Valley Health Systems, Inc.
- Dr. Raman Mitra, M.D., Ph.D., Rush-Presbyterian-St. Luke's Medical Center, Chicago,
- Judge Dan O'Hanlon, Judge of the West Virginia Sixth Judicial Circuit
- Mr. A. Michael Perry, President/CEO Bank One, Huntington, West Virginia
- Dr. Niels Rossing, Professor of Medicine, National University of Denmark, Copenhagen,
Denmark; former head of the European Health Telematics program
- Dr. Jay Sanders, M.D., Eminent Scholar Chair of Telemedicine, Medical College of Georgia
Mr. Steve Shattls, CEO of Valley Health Systems, Inc., and Dr. Ramana Reddy, Director
of CERC and Professor of Computer Science at West Virginia University, will serve as
ex-officio members of the panel.
This initial group will be augmented with members of other healthcare professions.
Related Technical Reports
Other CERC Documents
Valley Health Systems, Inc.
CEO: Steve Shattls
Health Care Providers (users of ARTEMIS)
- Dr. M. Kilkenny, M.D., Family Practice, Medical Director for Valley
- Dr. Bruce Merkin, M.D., Internal Medicine
- Dr. Herb Myers, D. O., Ob/Gyn
- Dr. DeRosa, D.O., Ob/Gyn
- Dr. Richards, M.D., Family Practice
- Colleen Rager, Nurse Practitioner
VHS System Personnel
- Anita Anderson
- Casey Jones
Cabell Huntington Hospital
CEO: Don Smith
Health Care Providers (users of ARTEMIS)
- Dr. Howard Gordon, M.D., Perinatologist
- Dr.R. McWhorter , M.D., Radiologist
CHH System Personnel
- Larry Ball, Director of Medical Records
- Virgil Kelly, Asst. Director of Information Systems
- Jim Smith, Director of Information Systems
Health Care Providers (users of ARTEMIS)
SMH System Personnel