Background

The attached paper describes a major Information Technology (IT) telemedicine project in which Cecil Thornhill participated as a system and application architect and project manager. The paper describes the development of an asynchronous web-based telemedicine system developed for the Department of Defense (DoD) to serve the highly mobile patient population spread across the Pacific Theater of Operations.  The Theatre Telemedicine Prototype Project (T2P2) required research, design, development and integration of many components from several related IT, Computer Science (CS) and Health-Care Informatics (HCI) disciplines. Graphic user interfaces and interactive web multi-media applications, database development, networking and security and inter-process communications were all key IT and CS components of this project. The preliminary analysis involved a large requirements development effort, and attention to a variety of specialized HCI issues such as health record privacy and biometric data gathering. Implementation efforts demanded substantial integration efforts with many field personnel and multiple component systems vendors.

Approach to the Project

To meet the challenge of delivering specialist health care to a population often far from the location of the nearest appropriate practitioner or facility, the T2P2 team identified a number of specialist disciplines that offered the potential to codify diagnostic or care related steps into discrete protocols that could be transferred into small web applications. In conjunction with interfaces to existing Health Care Information Systems (HIS) and a number of capture modalities, such as scanners and cameras, these protocols would allow a non-specialist at a remote site to extend the diagnostic and treatment reach of selected specialists. As a starting point, the T2P2 team selected the fields of Orthopedics and Dermatology.

A number of protocols for each discipline were developed. These interactive web applications were implemented using Java Script, XML and other browser technologies. Server-side code was developed to support the transfer of all data and multi-media elements, as well as to connect to existing modalities such as X-Ray and HIS systems.

Many back-end systems were required to support the capture, transmission and storage of the data for the T2P2 system. These included elements such as SQL databases, Microsoft DCOM distributed objects for inter-process communications, Microsoft Queue Server transport layers and Network IPSec routing configurations. In addition to the development of new code, many existing applications were integrated into the T2P2 system. All of these efforts were coordinated in dedicated development and test environments and then deployed for an extended period of field testing under controlled conditions.

Issues Conclusions/Results/Lessons Learned

The T2P2 project revealed a number of technical limitations in web applications, as well as important networking, security and privacy issues for delivering healthcare using web-based systems. The overall approach was successful and the protocols appeared to allow the specialists to leverage their skills across distance and to improve care and reduce the need for emergency transport of patients. Subsequent DoD telemedicine projects have built on the results of T2P2, making it a successful prototype.  The experience gained by each participant in this project has also been very useful when addressing new challenges in their careers.