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

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Project Summary

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:

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 versions.


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:

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:

Other services that we will plug into this backplane to provide custom support features to specific providers include:

Application Scenarios

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 sites.

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:

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.


Telemedicine Team

Project Team | Advisory Board

Telemedicine Project Team

Telemedicine Advisory Board

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

Viewfoil Presentations

Progress Reports

Other CERC Documents




Health Care Advisory Board

Valley Health Systems, Inc.

CEO: Steve Shattls

Health Care Providers (users of ARTEMIS)

VHS System Personnel

Cabell Huntington Hospital

CEO: Don Smith

Health Care Providers (users of ARTEMIS)

CHH System Personnel

St. Mary's Hospital


Health Care Providers (users of ARTEMIS)

SMH System Personnel

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