Electronic Prescriptions. Medication errors in the U.S. result in about 7,000 deaths per year [1]; a Massachusetts study found that 26% of prescription errors were due to illegible prescriptions, 29% due to similar-looking drug names, and 3% due to misinterpreting abbreviations [2]. Misreading a handwritten prescription is frighteningly easy given similar-sounding drug names such as Dynacin (antibiotic) vs. Dynacire (antihypertension), or Celebrex (arthritis) vs. Celebyx (seizures) vs. Celexa (antidepressant). The UVA Medical Center wants to capture prescription data electronically, allow the physician to verify it, validate it against a national database of drug interactions, then encrypt the prescription, digitally sign it, and provide it to the patient’s pharmacy electronically, thereby eliminating handwriting entirely.
Resulting projects: Configure commercial voice recognition software (e.g., Nuance™ [3]) to capture the spoken drug name, strength, frequency, and duration from a Pocket PC. Display resulting prescription and have the physician verify or correct it. Cross check this drug against the patient’s other prescriptions using a national drug interaction database. Select a preferred pharmacy from the patient’s profile, then encrypt, digitally sign, and transmit prescription data to the pharmacy. Use a notification web service to alert the patient via his/her choice of telephone, pager, email, etc. when the prescription is ready for pickup. A second project can replace the voice recognition with handwriting recognition on a Tablet PC. Dr. Kirk, Professor of Emergency Medicine, will be our medical consultant.
Prescription Drug Compliance. The UVA Medical Center’s Multi-Organ Transplant Team, operates on patients who are typically elderly and in poor health. It is not unusual to send a patient home with 16 prescriptions to manage organ rejection. While the physician knows what drugs were ordered, there is no reliable data available to document patient compliance. When patients exhibit an unexpected therapeutic response to a prescription drug regimen, physicians often have great difficulty discerning whether the response is due to non-response (the patient’s body is not reacting to the medication) or to non-compliance [4]. This complicates the physician's analysis of recurring symptoms and drug interactions. PDA technology can assist the patient’s drug management while at the same time providing compliance data for the doctor.
Resulting project: Download the patient’s prescriptions to a Pocket PC as he or she leaves the hospital. The PDA notifies the patient when it is time to take the next prescription by sounding an audible signal, showing a picture of the pill to be taken, and providing a textual reminder of the identity and number of pills to take. The patient signals compliance with a simple stylus tap. Upon the patient’s next visit to the Medical Center, the compliance data file is uploaded from the PDA, analyzed, and a compliance report generated for the physician. Dr. Pruett, Professor of Surgery and Director of the Multi-Organ Transplant team, will be our medical consultant.
Biometric and Digital Authentication. Physicians want to use wireless devices for convenient data access, but hospitals are reluctant to allow them for fear that an unauthorized electronic intruder will violate patient privacy and security. One way to address this security concern is to use biometric identification of the wireless device users. For example, the HP h5550 Pocket PC contains a built-in fingerprint scanner, fingerprint and iris scanners can be added to laptops for $100 or $200 respectively, and tablet PCs provide built-in support for signature recognition software. Create web services that capture biometric identification data from a device, compare it against a database of attributes of legitimately enrolled users, and issue an authentication token if the biometric/digital input matches the stored attributes.
Resulting projects: Write authentication web services for a variety of digital and biometric authentication technologies:
· Username and password
· Fingerprints using the Digital Persona U.are.U fingerprint scanner [5]
· Fingerprints using the HP h5550 iPAQ's thermal fingerprint scanner [6]
· Iris scans using the Panasonic/Iridian Authenticam iris scanner [7]
· Electronic security keys using the Aladdin Knowledge Systems eToken (an encrypted USB device) [8]
· Signature recognition using Communication Intelligence Corporation's iSign software on a Tablet PC [9]
· Voice recognition using Voice Security's software platform [10]
· Key fobs using the RSA SecurID unit (a two-factor identification technology requiring a PIN and a pseudo-random number that changes every minute) [11]
· Other combinations of who-you-are, what-you-have, and what-you-know technologies.
Given any attribute template for an authentication technology, write the web service to compare it to the database of enrollees and issue an authentication token with an appropriate authentication trust level. Dr. Dwyer, Professor of Radiology, will be our medical consultant.
Wireless Viewports. While modern medical imaging technologies such as CT and MRI are typically viewed on high-resolution (and high cost) monitors, medical centers such as Stanford are experimenting with using commercial display technologies such as Pocket PCs and Tablet PCs (with windowing to permit scrolling through an image) [12]. Providing the physician with the ability to see some diagnostic imagery on commercial-grade mobile devices is one route toward freeing the physician from geographic dependence upon the location of the high-resolution monitor.
Resulting project: Retrieve a diagnostic image (CT, MRI, ultrasound, x-ray) from a patient’s electronic record. Decrypt and display these images on Pocket PCs and Tablet PCs. Write the software needed for image navigation such as windowing, magnification, and contrast enhancement. Conduct a study to determine whether the resolution, contrast, and luminance of the PDA and laptop displays are suitable for making a reliable medical diagnosis. Dr. Gay, Professor of Radiology, will be our medical consultant.
Telesonography. Digital ultrasound is a superb diagnostic tool that can be used for noninvasive examination of internal organs. Current practice uses a trained technologist to operate the machine, scan the patient, and select images (either still images or “movie clips” or both) to present to a radiologist for interpretation. If the technologist produces an imprecise image, the procedure must be repeated, increasing cost, inconvenience, and delay. Alternatively, the live ultrasound imagery can be treated as streaming multimedia, a radiologist can provide real-time guidance (via teleconference or telephone) to the remotely located technologist to assure that the organ scan produces the images required for diagnosis.
Resulting project: Capture the digital image output of an ultrasound machine and transmit it over the Internet as streaming multimedia. Provide a teleconferencing facility between the radiologist and the technologist. For broadband connections, no compression is needed; for low bandwidth connections, experiment with image compression algorithms to determine how much compression can be tolerated without loss of diagnostic accuracy. Compute Receiver Operating Characteristic (ROC) curves for multiple readers to determine the correlation between compression technique and resulting diagnostic accuracy. Dr. Bassignani, Professor of Radiology, will be our medical consultant.
Security Architecture for Federated Trust. Once trust has been reliably established within one enterprise, the trust credentials should be exportable to another cooperating enterprise where they can be programmatically examined to determine if they meet the second enterprise’s trust requirements as specified in its WS-Policy document. If the first domain’s authentication credential is acceptable to the second domain, a token exchange server can issue a new local token that is valid in the second domain without requiring the user to undergo a second login procedure that would otherwise be needed to produce it.
Resulting project. In a suitable medical context (such as sending an electronic prescription from the hospital to the pharmacy or having the hospital file an electronic claim with an insurance company), define the content of a suitable trust credential (authentication token). Write the code for a token exchange server that will interface between the two domains, determine the validity of the credential within the issuing domain, determine the acceptability of the credential in the second domain by parsing its WS-Policy document, and issue a local authentication token if the source token is acceptable. Dr. Humphrey will be our web services consultant.
Wireless Telemedicine for Nursing Homes and Retirement Centers. The UVA Office of Telemedicine [13] has supported over 5,635 patient consultations from over 45 locations in Virginia, ranging from hospitals to clinics to private practitioners in rural areas. It has supported 26 medical specialties [14], including cardiology, dermatology, gynecology, psychiatry and pain management. Telemedicine has been extremely effective as a way to increase the quantity and quality of healthcare delivery to rural areas. Now we wish to bring the benefits of telemedicine to outlying (i.e., beyond the wired broadband infrastructure) retirement homes and nursing centers by developing a relatively inexpensive, portable, easy-to-use “telemedicine kit” that can be easily moved from place to place, installed and operated by a nurse, and yet still provide the two-way videoconferencing, electronic data capture, and clinical note-taking required for a successful telemedicine consultation.
Resulting project: Configure a Tablet PC to support simultaneous two-way audio/video conferencing, a webcam for videoconferencing, a high-resolution digital camera for close-ups, an electronic stethoscope, and an electronic sphygmomanometer (blood pressure). Write web forms that can gather data utilizing the user’s choice of handwriting or keystrokes. Interface the Tablet PC with a commercial Navini Ripwave modem to provide a bi-directional 256 kbps wireless connection through the local nTelos metropolitan wireless Internet network. Conduct acceptance tests with the populations of outlying nursing homes and retirement centers. Dr. Rheuban, Professor of Pediatric Surgery and Medical Director of the Office of Telemedicine, will be our medical consultant.
References
[1] "To Err is Human: Building a Better Health Care System," Institute of Medicine, National Academy of Science, 2001.
[2] "Medication Error Study," Board of Registration in Pharmacy, Commonwealth of Massachusetts, Dec. 2001.
[3] http://www.nuance.com
[4] Burnier M, Santschi V, Favrat B, Brunner HR. (2003). Monitoring compliance in resistant hypertension: an important step in patient management. Journal of Hypertension. Supplement, 2, 37-42.
[5] DigitalPersona U.are.U fingerprint scanner, http://www.digitalpersona.com/
[6] HP h5550 iPAQ PDA with fingerprint scanner, http://h10010.www1.hp.com /wwpc/us/en/en/WF05a/215348-64929-215381-314903-f44-322916.html
[7] Panasonic/Iridian Authenticam iris scanner, http://www.neutronexpress.com/prod.cfm/147876/PANASONIC/BMET100US/
[8] Aladdin Knowledge Systems eToken USB device, http://www.ealaddin.com/etoken/products.asp
[9] Communications Intelligence Corp. iSign software, http://www.cic.com/products/isign/
[10] Voice Security software, http://voicesecuritysystemsinc.goemerchant7.com /index.cgi?PageToView=catalog&Department=11591
[11] RSA Security SecurID two-factor authentication, http://www.rsasecurity.com/products/securid/tokens.html
[12] "Handheld Radiology Becomes a Reality," Stanford Medical Center Case Study, http://www.clarinetsys.com/site/downloads-page/Stanford_White_Paper.pdf
[13] http://www.healthsystem.virginia.edu/internet/telemedicine/
[14] http://www.healthsystem.virginia.edu/internet/telemedicine/services/specialties.cfm