When we review the positive impact that the integration of ostensibly independent patient-care services have on the efficient management of quality care, education, and collaborative research, it is not surprising that telehealth deployment is on the rise. The forces that drive this phenomenon include: the need to manage the entire disease episode; the desire for wider geographically-distributed quality health care; the escalation of customer expectations; globalization of healthcare and its support services; an increase in patient and provider convenience; and the acceptance of the present technological community. At the Telehealth Center at the Texas Children's Hospital, current classifications of clinical applications are listed: (1) initial urgent evaluation of patients, (2) triage decisions and pretransfer arrangements, (3) medical and surgical follow-up and medication review, (4) consultation for primary care encounters, (5) real-time subspecialty care consultation and planning, (6) management of chronic diseases and conditions, (7) extended diagnostic work-ups, (8) review of diagnostic images, and (9) preventive medicine and patient education. The delivery of such services is associated with challenges and opportunities. As we move forward from limited data processing to an integrated communication system, from centralized main frame functions to personalized and location-independent workstations, and from hospitals to clinics and homecare, an increase in the minimum features provided by the equipment and the communication systems must accompany the widening variety of clinical applications. Future expansion of telehealth systems stands to revolutionize the delivery of services to the benefits of providers' networks, our economy, and patients through integration.

Acute patients require immediate intervention of physicians, that are not always able to be present at the point of care. This can be detrimental to the patient's outcome. A new system, VIGIATRIX^TM (VX^TM), accommodates remote decision support in real time. It facilitates the rapid status assessment mandatory to avoid further deterioration of patient's condition. VX continuously analyzes the status of all vital signs and presents a single status indicator--The Vital Function Status (VFS). The VFS focuses the attention of the immediate care provider and the remote physician to vital signs changes and their correlation to causative events or actions. VX can be used in telemedicine to improve patient outcome.

Abstract not available.

We describe a PACS system being developed for the radiation oncology department of Harper Hospital. The system is compatible with the DICOM 3 standard. The system consists of two broad parts: the database and communication system, and the viewing station(s). The system can be used to view patient images, import images from and export images to, other DICOM compatible systems, and check port films.

My name is Luis Kun and I am chairing this conference. Today we are going to discuss issues dealing with telemedicine, health information networks and computer based patient records. We have people here representing very different aspects or views perhaps of the same problems. Some coming from the academic side like Dr. Warren Grundfest, who is a medical doctor. In other instances we have some people like Dr. David who represents a series of hospitals, Dr. Michael Fitzmaurice representing government, Jeff Blair representing industry, IBM, in terms of health systems. And we have Louis Lorton from Host, which represents a solution as I see it, combining government, industry and academia. It's a new way of perhaps solving problems in health care. He's part of the AlP program of NEST [Department of Commerce sponsored program]. What I would like to do now, is give a few minutes to each of the participants in the panel to introduce themselves so the audience will have an idea of who they are and how they are involved in this field and what institutions they represent. After that we will go into a round table format with the audience. I would like, if possible, for all of you, when making a comment or question, to introduce yourselves, stating your name and the institution that you represent. I'm going to be acting as a moderator. So, Dr. David, if you could start by introducing yourself.

During the first Health Care Technology Policy [HCTPI conference last year, during Health Care Reform, four major issues were brought up in regards to the underway efforts to develop a Computer Based Patient Record (CBPR)I the National Information Infrastructure (NIl) as part of the High Performance Computers & Communications (HPCC), and the so-called "Patient Card" . More specifically it was explained how a national information system will greatly affect the way health care delivery is provided to the United States public and reduce its costs. These four issues were: Constructing a National Information Infrastructure (NIl); Building a Computer Based Patient Record System; Bringing the collective resources of our National Laboratories to bear in developing and implementing the NIl and CBPR, as well as a security system with which to safeguard the privacy rights of patients and the physician-patient privilege; Utilizing Government (e.g. DOD, DOE) capabilities (technology and human resources) to maximize resource utilization, create new jobs and accelerate technology transfer to address health care issues. During the second HCTP conference, in mid 1 995, a section of this meeting entitled: "Health Care Technology Assets of the Federal Government" addressed benefits of the technology transfer which should occur for maximizing already developed resources. Also a section entitled:"Transfer and Utilization of Government Technology Assets to the Private Sector", looked at both Health Care and non-Health Care related technologies since many areas such as Information Technologies (i.e. imaging, communications, archival I retrieval, systems integration, information display, multimedia, heterogeneous data bases, etc.) already exist and are part of our National Labs and/or other federal agencies, i.e. ARPA. These technologies although they are not labeled under "Health Care" programs they could provide enormous value to address technical needs. An additional issue deals with both the technical (hardware, software) and human expertise that resides within these labs and their possible role in creating cost effective solutions.

The introduction of modern information technology into the US health care system has tremendous potential to reduce health care costs. The DOE National Laboratories and the DoD contractor base have substantial technology that may be useful in realizing cost reduction. This paper gives examples of some of the information technology that is available, show potential applications to the medical community and describes mechanisms for working with the National Labs.

The intricacies and the size of the healthcare enterprise in the United States means that extraordinary measures are needed to encourage the industry to move forward in some coherent manner. The Department of Commerce, through its Advanced Technology Program, has formed cooperative partnerships with industry to develop infrastructure, implementation efforts and applications. This paper will discuss the largest of the current programs in the infrastructure layer, the Healthcare Information Infrastructure Technology program--a joint venture organized by HOST involving 5 major companies and many healthcare providers.

The National Network/Libraries of Medicine is a program of the National Library of Medicine designed to promote accessibility to biomedical databases for U.S. health care providers.

To provide quality health care, clinicians need to be well informed. For health care to be cost effective and efficient, redundant services must be eliminated. Urban centers and rural areas need regional health information networks to ensure that primary health care is delivered with good continuity and coordination among providers. This paper describes the development of a city-wide computer-based pediatric health care network to improve decision-making and follow-through, and to provide aggregate data for public health purposes. The design criteria and process for this regional system are presented, addressing issues of network architecture, establishment of a uniform data base, and confidentiality.

In today's world, medical information on patients is usually recorded by a variety of health care providers who write their thoughts either on paper or in a word processing program. Telemedicine and other high technology initiatives add to the existing information database. However, most stored data are not easily linked. This makes it difficult to do process evaluations and nearly impossible to determine treatment effectiveness. Any aggregate data analysis must rely on the very few standardized patient data points that may include some demographic information, diagnosis and codable procedures. This paper demonstrates the utility of business process reengineering techniques using Integrated Computer Assisted Manufacturing Definition modeling to create a data model in which patient information is used to build an analyzable database. This provides the infrastructure in which to store all patient data.

Challenges in implementing a computer-based patient record (CPR)--such as absolute data integrity, high availability, permanent on-line storage of very large complex records, rapid search times, ease of use, commercial viability, and portability to other hospitals and doctor's offices--are given along with their significance, the solutions, and their successes. The THERESA CPR has been used sine 1983 in direct patient care by a public hospital that is the primary care provider to 350,000 people. It has 1000 beds with 45,000 admissions and 750,000 outpatient visits annually. The system supports direct provider entry, including by physicians, of complete medical `documents'. Its demonstration site currently contains 1.1 billion data items on 1 million patients. It is also a clinical decision-aiding tool used for quality assurance and cost containment, for teaching as faculty and students can easily find and `thumb through' all cases similar to a particular study, and for research with over a billion medical items that can be searched and analyzed on-line within context and with continuity. The same software can also run in a desktop microcomputer managing a private practice physician's office.

The Provider Workstation prototype integrates current computer technologies into an innovative, image-based tool which improves health care. Storage of both structured patient encounter information and a paper medical record image provides a rich data base supporting managed care and creates a unique living laboratory for developing the computer-based patient record.

At the Georgetown University Medical Center Department of Radiology we are currently involved in integrating three diverse networks into a coherent whole. We are installing a new Radiology Information System (RIS) and a new Picture Archiving and Communication System (PACS) as well as upgrading our existing research network, which provides Internet access, to add office automation tools. To accomplish this, many issues have to be resolved. Users of the different systems have different requirements and must have different levels of access to data on the various systems. For example, researchers need access to Internet resources and e-mail while data from the clinical systems must be protected from the outside world. Physicians and some other users on the non-clinical network also require fast and convenient access to the RIS and PACS for clinical uses. Parts of the network should be shielded from the heavy image traffic created by the PACS. On the other hand, because clinical data is also used for research, a connection between the networks is necessary. Our solution for providing adequate access for all users, assuring confidentiality for patient data, and managing network traffic will be described.

This paper discusses the CARE (Cancer Attitude Risk Education) system, an interactive user friendly hypermedia information system that will allow users to learn more about various aspects of cancer such as risk factors, diagnosis and available treatment options. The CARE system provides information to the user through various means like text, video, graphics, photographs, animation and sound. A defining feature of the CARE system is that it collects information from the user as well as disseminating information. The CARE system collects items such as name, age, gender and answers to risk assessment questions as the user browses through the system. The data collected through the CARE system is valuable to cancer researchers and support groups.

This paper describes work in progress to develop an Information Technology (IT) model and supporting information system for the evaluation of clinical teaching in the Emergency Medicine (EM) Department of North Shore University Hospital. In the academic hospital setting student physicians, i.e. residents, and faculty function daily in their dual roles as teachers and students respectively, and as health care providers. Databases exist that are used to evaluate both groups in either academic or clinical performance, but rarely has this information been integrated to analyze the relationship between academic performance and the ability to care for patients. The goal of the IT model is to improve the quality of teaching of EM physicians by enabling the development of integrable metrics for faculty and resident evaluation. The IT model will include (1) methods for tracking residents in order to develop experimental databases; (2) methods to integrate lecture evaluation, clinical performance, resident evaluation, and quality assurance databases; and (3) a patient flow system to monitor patient rooms and the waiting area in the Emergency Medicine Department, to record and display status of medical orders, and to collect data for analyses.