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NLM National Telemedicine Initiative Summaries of Awards AnnouncedOctober 1996

Telemedicine is the use of computers, the Internet, and other communication technologies to provide medical care to patients at a distance.

Web links included in the project summaries have been provided by the contractors, and the standard NLM disclaimer applies.

Awards Announced October 1996

Provide health care to underserved center-city elderly and offshore islanders in California. The University of Southern California's Medical faculty will treat multiple underserved communities ranging from North Hollywood's center-city elderly and minorities to the relatively isolated offshore island of Catalina via state-of-the-art telemedicine systems. Patients will be cared for in their own locale by means of PacBell network transmittal of USC Emergency medicine support instead of traveling to distant specialists (e.g., by helicopter or board from Catalina).

Contact: William D. Boswell, M.D.
University of Southern California
Advanced Biotechnical Consortium
1537 Norfolk Street, DEI-5103
Los Angeles, CA 90033

Period of Performance: September 30, 1996 - June 30, 2000.

Support rural primary care physicians consulting with remote specialists in West Virginia. A consortium of nine institutions led by the Concurrent Engineering Research Center (CERC) of the West Virginia University will demonstrate the viability of secure clinical telemedicine on public telecommunication networks and show that its adoption as an integral part of an overall health care plan can result in cost savings and improved access to quality health care for rural populations. Rural primary care physicians, physicians' assistants, and other authorized users will have secure access to electronic medical records and patient monitor data, and be able to confer with collaborating health care providers at a distance in the treatment of patients.

Contact: Ramana Reddy, Ph.D.
Concurrent Engineering Research Center
West Virginia University
886 Chestnut Ridge Road, P.O.Box 6506
Morgantown, WV 26506

Period of Performance: September 30, 1996 - December 1999.

Improve care to high risk newborns and their families in Massachusetts. Beth Israel Deaconess Medical Center will use telemedicine to provide educational and emotional support to families of high risk newborns both during their hospitalization and following discharge. This innovative use of technology should increase parental understanding of their baby's continuing medical needs, and provide a clear cost savings. Prior to their baby's discharge from the hospital, parents will be able to observe its care via a television monitor in their home. Upon discharge, patient homes will continue to be connected via television to Beth Israel. The trial will examine the potential of telemedicine to decrease the cost of care for very low-birth weight infants by increasing the efficiency of care.

Contact: Charles Safran, M.D.
Beth Israel Deaconess Medical Center
350 Longwood Avenue
Boston, MA 02115

Period of Performance: September 30, 1996 - September 30, 2000.

Test real time transmission of vital sign data from patients in ambulances to a hospital trauma center in Maryland. BDM Federal, Inc. and the University of Maryland at Baltimore will develop an advanced mobile telemedicine testbed which will investigate the feasibility and practicality of transmitting real time vital sign data and video images of patients from inside the ambulance to the hospital's trauma center and clinical information system via cellular communications and local area network technology. The purpose of the mobile testbed is to improve the quality and timeliness of care provided during the "golden hour" and to provide better information to the emergency room (ER) staff prior to the arrival of patients in the ER. Proven feasible, this mobile telemedicine application could be used in trauma centers throughout the United States.

Contact: David Gagliano
BDM Federal, Inc.
TRW Systems and Information Technology Group
12011 Sunset Hills Road
Reston, Virginia 20190

Period of Performance: September 30, 1996 - September 29, 1997.

Improve disease prevention and manage chronic illnesses in home settings in New York. Columbia University will use technology to provide information to patients that will improve disease prevention activities and effectively manage chronic illnesses in the home setting. Patients will receive alerts and reminders when standards of care (immunization, diabetes management, asthma control, etc.) are not being achieved. Patients will enter data (blood pressures, glucose levels, pulmonary function test results, etc.) into an electronic medical record using applications which run on home-based personal computers connected to the National Information Infrastructure (NII). These patients will also be able to communicate with health care providers, review their medical records, and receive desired information which will address their specific health care concerns. The project will demonstrate techniques to safeguard the confidentiality of personal health care records which are stored and transmitted electronically, and will evaluate the impact of patient use of information via the NII.

Contact: James J. Cimino, M.D.
Associate Professor
Columbia University
Department of Medical Informatics
161 Fort Washington Avenue
New York, New York 10032

Period of Performance: September 30, 1996 - September 29, 2000.

Prevent adverse drug interactions among the elderly in Missouri. Adverse drug interactions are often a problem, particularly among the elderly and others who take multiple medications. Sometimes the wrong dosage makes a medication more harmful than beneficial. But in St. Louis, and neighboring towns in Illinois, six hospitals are learning to prevent these problems, using the extensive telemedicine network that already links them. By year's end, they'll be able to ensure that patients are taking the correct dosage of their medications, and to prevent or quickly respond harmful drug events. Using pharmacy orders and patient data such as age, sex and weight, DoseChecker examines the prescriptions a patient is taking and issues dosage warnings when warranted. The other system, the Adverse Drug Event (ADE) Monitor, pulls together patient drug orders and lab test results, alerting hospital pharmacists when it detects signs of adverse reactions. Doctors and other health professionals will be notified immediately when a patient is at risk. This project was co-funded by the Agency for Health Care Policy and Research.

Contact: Thomas Bailey, M.D.
Washington University in St. Louis
School of Medicine
660 South Euclid Avenue
P.O. Box 8051
St. Louis, MO 63110

Period of Performance: September 30, 1996 - June 30, 2000.

Provide vital health information to health professionals in rural and urban settings across the Northwest. The University of Washington Academic Medical Center regional telemedicine network will connect health professionals and patients from big cities, small towns, and vast expanses of sparsely populated areas in Washington, Wyoming, Alaska, Montana, and Idaho to provide timely access to vital health information. The University of Washington links clinical and public health partners at selected sites in this five-state area via a regional telemedicine network that includes a World Wide Web interface to electronic medical records; secure clinical e-mail for clinician-to- clinician and clinician-to-patient interactions; electronic delivery and management of xrays and other clinical images; and access to medical library resources, such as MEDLINE and full-text journals. This innovative network will allow clinicians to consult with one another, health professionals and their patients to confer, and all to access medical information, despite the long distances that separate them.

Contact: Sherrilynne Fuller, Ph.D.
University of Washington
A-327 Health Sciences Center
Box 356340
Seattle, WA 98195-6340

Period of Performance: September 30, 1996 - September 29, 2000.

Provide patients with access to their own medical records while preserving confidentiality of that information in California. In a cooperative effort with the Science Applications International Corporation (SAIC), University of California, San Diego has launched PCASSO, a project designed to enable patients, health care providers and medical researchers to access clinical information over the Internet without any breaches of confidentiality. PCASSO will use everyday World Wide Web technology to support information search and retrieval, and state-of-the-art security technology to ensure patient privacy and the integrity of patient information. The project represents a new thrust within the health care industry: to provide patients more control over and access to their own medical records while preserving the confidentiality of that information.

Contact: Dixie Baker, Ph.D.
Science Applications International Corporation
1874 South Pacific Coast Highway, #901
Redondo Beach, CA 90277

Period of Performance: September 30, 1996 - May 31, 2001.

Transmit and manage brain and breast images and associated medical data in four California medical centers. This project, coordinated by the Department of Radiology at UCSF, is focused in scope but may prove to have far-reaching consequences for health care delivery. It links four San Francisco-area medical centers electronically, for the transmission and management of neuroradiology and mammography images. The hope is that a high performance tele-imaging information infrastructure will enhance health care in the Bay Area by improving telediagnosis, teleconsultation, telemanagement, teleresearch and tele education. Then, perhaps, this model can be extended for other types of medical images, and in other parts of the country.

Contact: Robert G. Gould, Sc.D.
University of California, San Francisco
Department of Radiology
School of Medicine
530 Parnassus Avenue
Box 0628, C 324
San Francisco, CA 94143-0628

Period of Performance: September 30, 1996 - December 31, 2000.

Measure the effectiveness of video consultations for patients with special needs, including children with disabilities or heart conditions and persons with mental illness in Iowa. The University of Iowa's National Laboratory for the Study of Rural Telemedicine was created in 1994. Now, with support from NLM, that group will expend its efforts in two directions: clinical consultations and the use of specialized databases in health care delivery. A series of projects will measure the effectiveness of video consultations for patients with special needs, including children with disabilities or heart conditions and persons with mental illness. Another project will give community hospital emergency rooms a shot of information and expertise by providing special database software and allowing teleconferencing with physicians at the University of Iowa Health Center. NLM funding will also support an innovative project to deliver health information into the homes of people with diabetes. They will receive an easy-to-use device that attaches to their TV and provides access to on-line health information. Researchers hope that this "electronic education" will help diabetes patients manage their disease more effectively.

Contact: Michael Kienzle, M.D.
University of Iowa
National Laboratory for the Study of Rural Telemedicine
Telemedicine Resource Center
1-208 Harden Library
Iowa City, IA 52242

Period of Performance: September 30, 1996 - December 31, 2000.

Analyze the benefits of rural telemedicine services by linking health professionals in three small Missouri communities. The University of Missouri-Columbia School of Medicine will implement and then analyze the benefits of rural telemedicine services, working with three small rural Missouri communities. In addition to creating links among the health professionals in each community, the project will connect rural providers to colleagues in other participating towns and to the University's Health Sciences Center, with its four hospitals, extensive medical library, hundreds of specialists, and other resources. Studies will involve tracking utilization of this new network, assessing rural providers' needs and noting any changes in health care utilization patterns and retention of health care personnel in rural communities after the network is in place. Costs of and savings from this venture will also be carefully reviewed.

Contact: Joyce A. Mitchell, Ph.D.
University of Missouri
Columbia School of Medicine
Medical Informatics Group
406 McHaney Hall Hall
Columbia, MO 65212

Period of Performance: September 30, 1996 - January 31, 2000.

Expand robust health care network that provides rapid access to patient record data in Indiana. With new funding from the NLM, Indiana University School of Medicine will broaden the scope of its existing Indianapolis Network for Health Care of hospital emergency rooms, clinics, HMOs, homeless care sites and pharmacies, so that more people can enjoy its benefits. Already this technically robust network provides instant access to patient records in emergency rooms, efficient access to medical library resources at numerous care sites, and permits collection of prescription information from a large chain of community pharmacies, to improve drug prescribing patterns in a range of health care facilities. New network linkages will include the Indiana State Public Health Department and a number of large clinical laboratories. Among other benefits, these additions to the network will provide clinicians on the network with better immunization data from health departments, and enable electronic reporting of communicable diseases from high-volume Marion County clinical labs to the relevant public health departments.

Contact: Clement J. McDonald, M.D.
Indiana University Regenstrief Institute
Department of Medicine
1001 W 10th Street, Fifth Floor
Indianapolis, IN 46202-2859

Period of Performance: September 30, 1996 - December 31, 2000.

Provide health care teams with computer systems to assist in outpatient care in Illinois. The goal of Northwestern Memorial Hospital's NetReach project is to provide health care teams with computer systems to assist in outpatient care, and to evaluate the impact of their use. The project performed observation studies of practicing clinicians at 7 diverse outpatient clinics (primary care, specialty care, faculty group practice, independent group practice, and urban care) to understand and specify the information needs of clinicians. Based on the requirements derived from the information needs study, they implemented information tools, including a computer-based patient record (CPR) at one site, to address the clinicians' needs. During the NLM-funded extension, the project will evaluate the impact of information technology on clinical and operational performance of physicians and on patient and provider satisfaction.

Contact: Paul Tang, M.D.
Northwestern Memorial Hospital
Information Services
259 East Erie, Suite 600
Chicago, IL 60611

Period of Performance: October 1, 1996 - June 30, 1998.

Increase the efficiency and improve the quality of emergency room and primary care in Indiana. The Indiana University School of Medicine will create the Indianapolis Network for Patient Care, a shared clinical data repository which will store encounter records, hospital abstracts, clinical laboratory data, prescription data and other data for use by emergency departments and primary care providers in the Indianapolis area. This repository will encompass 90% of Indianapolis' hospital emergency room care, and two managed-care systems, as well as a major share of the laboratory and hospital encounter data of the city. The purpose of this effort will be to increase the efficiency and improve the quality of emergency room and primary care by providing the responsible physicians with laboratory and other data important to emergency and primary care. The completion of this project should result in a workable model for access and confidentiality for large scale shared community clinical data.

Contact: Clement J. McDonald, M.D.
Indiana University Regenstrief Institute
1001 W 10th Street, Fifth Floor
Indianapolis, IN 46202-2859

Period of Performance: October 1, 1997 - March 31, 1999.

Provide telemedicine services to renal dialysis patients and information services for caregivers in the District of Columbia. Georgetown University Medical Center already has an extensive network consisting of radiological imaging nodes and hospital information systems that provide support to the nephrologists at the medical center and at home. The network links Georgetown University Medical Center, remote outpatient kidney dialysis clinics, and nephrologists' homes. The primary functions of the network are to provide telemedicine services to renal dialysis patients, to create, manage, transfer and use electronic health data and to provide decision support and information services for caregivers. This project will test the general hypothesis that by facilitating electronic interactive communication among physicians and patients, quality of patient care will be improved and lower costs to patients, physicians and the health care system will be incurred.

Contact: Seong Ki Mun, Ph.D.
Georgetown University Medical Center
2115 Wisconsin Avenue, Suite 603
Washington, D.C. 20007

Period of Performance: September 30, 1996 - June 30, 2000.

Establish a network for prevention and health care in Massachusetts. Increased access to information resources and technology allows consumers to take greater responsibility for health and wellness, as well as for their own health care. Boston College and the Partners HealthCare System will examine the impact of public education and access to information on matters of lifestyle and health; patient access to information about specific health problems; support for health care providers for facilitating optimal care practices; and clinical services provided by the health care system.

Contact: Robert A. Greenes, M.D.
Brigham and Women's Hospital
75 Francis Street
Boston, MA 02115

Period of Performance: September 30, 1996 - June 30, 2000.

Evaluate the impact of telemedicine technologies and applications on the health care system in rural Alaska. As federal health care contributions to health care systems decrease, and as the population of Alaska changes, telemedicine is seen as a strategy for cost containment and for increasing the quality of health care delivery that, in Alaska, has traditionally relied on the transportation of patients over long distances. The objective of this project is to replicate existing and developed Alaska telemedicine testbeds by modifying, interfacing, and expanding successfully deployed telemedicine technologies and to evaluate the impact of these technologies on the health care system in rural Alaska for cost, quality of care, and access to care by rural Native Alaskans where and when it is needed.

Contact: Frederick W. Pearce, Ph.D.
University of Alaska Anchorage
Applied Science Laboratory
3211 Providence Drive
Anchorage, AK 99508

Period of Performance: September 30, 1996 - September 30, 2000.

Use teledermatology to improve the ability of primary care physicians to recognize and treat skin cancers and other skin conditions in Oregon. This extension of an NLM contract at the Oregon Health Sciences University in Portland, Oregon will expand the range of technologies used to provide remote dermatologic diagnosis and collect and analyze the impact of teledermatology on the quality and cost of health care.

Contact: Douglas A. Perednia, M.D.
Oregon Health Sciences University
3181 SW Sam Jackson Park Road
Portland, OR 97201

Period of Performance: October 1, 1996 - July 1998.

Improve quality and efficiency of patient care by providing physicians with rapid access to important clinical information in a single, easy to use work station environment in Pennsylvania. An extension of an NLM contact at the University of Pittsburgh will evaluate the clinical utility of a multimedia clinical information system at the University of Pittsburgh Cancer Institute. Currently, the system can acquire, compress, store, retrieve, display and manipulate many kinds of clinical images, including radiographs, CT scans, nuclear medicine studies, gastrointestinal endoscopy images, EKGs and microscopic pathology. These images are linked, in real-time, with a wide range of clinical reports stored in the University of Pittsburgh Medical Center's electronic medical record system. The project will study the effect of integrated access to clinical images and textual patient data on the length of time required to diagnose cancer and on the management of cancer treatment.

Contact: Henry J. Lowe, M.D.
Section on Medical Informatics
University of Pittsburgh
B50A Lothrop Hall
Pittsburgh, PA 15261

Period of Performance: October 1, 1996 - September 1999; October 1999 - September 2001.

Awarded September 1997

Providing high quality dental care in a managed care environment. The University of Pennsylvania School of Dental Medicine is pursuing an innovative approach to dental care delivery through a network of practices that will be oriented toward providing high quality care in a managed care environment. The main objective of this project is to develop and test an internet-based prototype teledentistry clinical consultation system which includes radiographic and photographic images, patient chart information, consultation forms, and annotation capabilities.

Contact: Ray Fonseca, D.M.D.
School of Dental Medicine
University of Pennsylvania
4001 Spruce Street
Philadelphia, PA 19104-6003

Period of Performance: September 1997 - November 30, 2000.

Upgrading, expanding, and maintaining the Telemedicine Information Exchange (TIE). The Telemedicine Information Exchange is the single most comprehensive and heavily used source for information about the growing field of telemedicine. This working partnership between the Telemedicine Research Center and the National Library of Medicine will result in the continued maintenance and improvement of the TIE database.

Contact: Nancy Brown, M.L.S.
Telemedicine Research Center
2121 SW Broadway, #130
Portland, OR 97201

Period of Performance: September 1, 1997 - August 2002.