Development of the TELESYNERGY(R) Medical Consultation WorkStation System (MCWS) was initiated in the mid 1990s, and it was first deployed in the Center for Information Technology (CIT) and NCI Radiation Oncology Branch (ROB) environments on the NIH campus in 1995 and 1997, respectively. The MCWS allows real-time multimedia teleconferencing between distributed sites, and the systems include high-resolution electronic view boxes for the display of CT, MRI or chest films. The TELESYNERGY(R) System quickly became a major IT component of several national and international National Cancer Institute (NCI) programs, through NCI/CIT collaborations. A portable, ruggedized version of the TELESYNERGY(R) environment was also developed, which includes a Very Small Aperture Terminal (VSAT) Satellite Antenna System. During FY13, five full TELESYNERGY(R) Systems were operational worldwide, and were partially supported by CIT staff. During FY13, BIVS continued to support the small Telenephrology System that provides Andrew Narva, MD, Director, National Kidney Disease Education Program, NIDDK, with the ability to conduct regularly scheduled clinics with his previous renal patients at the Zuni PHS Hospital in Zuni, AZ. In FY13, efforts continued on the development of signal processing algorithms in support of our long-term MRI Diffusion Tensor Imaging (DTI) Research collaboration with Peter J. Basser, PhD, NIH Senior Investigator and Chief, Section on Tissue Biophysics and Biomimetics (STBB), NICHD. Activity has continued on development of novel techniques for reduction of image distortion and motion artifacts during image acquisition in MRI studies. Efforts included the development of new techniques for the estimation of axon diameter distribution (ADD) within white matter of the brain, which is a crucial neurophysiological parameter that correlates with conduction velocity. A new activity involves the joint collaboration between NICHD/STBB and Peter L. Choyke, MD, Senior Investigator and Director, Medical Imaging Program, Center for Cancer Research, NCI. Preliminary work has begun on studies related to the possibility of the use of MRI to detect prostate cancer, and the possibility of the development of a measure of its aggressiveness. In FY13, development has slowly continued on a novel research-oriented Stereo Medical Image Display System, which is being developed in the JAVA Language, and will be compatible with the Medical Image Processing Analysis and Visualization (MIPAV) Application designed by the Biomedical Imaging Research Services Section (BIRSS), DCB, CIT. This Stereo Medical Image Display System, which will be controlled by hand-motion, is being developed to support brain imaging as the initial target application area. Powered by a high-performance workstation containing dual quad-core processors and an integrated high performance graphics processing system, this development platform will be controlled by a 3D position-sensing haptics glove with internal tactile feedback, and will have a speech recognition capability. The implementation of software stereo image generation was demonstrated, utilizing a group of algorithms developed at Johns Hopkins University, which are organized as plug-ins to the MIPAV image processing environment. Computational latency, during stereo brain image generation, will be greatly improved during FY 2014 by the incorporation of the new high-speed graphics-rendering engine that will be added to the system. During FY10, BIVS was asked by William A. Gahl, MD, PhD, Chief of the NHGRI Undiagnosed Diseases Program (UDP), and Murat Sincan, MD, Research Fellow, NHGRI, to create a secure portal whereby the UDP could provide outside consultants remote secure login to NIH to help as outside experts in the diagnosis of undiagnosed diseases. Consultants are NIH staff members, from other Institutes, and also outside subject matter experts. In FY11, BIVS demonstrated the operational version of the UDP Portal website, which indicated how a sample case might appear to an internal NIH case manager or an outside reviewer, using sample de-identified patient data that was provided by NHGRI. Ultimately, this system will provide an on-line repository of de-identified case studies for UDP patients. The UDP is able to grant secure, authenticated access to outside consultants through the NIH Federated Login Service. During FY12 integration was completed for a 12-Terabyte Disc Array, and for the Galaxy Web-based Platform that was developed by Penn State University and supports data-intensive biomedical research. These two new components allow the UDP Portal to easily incorporate genomic data into the patient case presentation. During FY13, BIVS continued work on a collaborative project with Henry Masur, MD, Chief, Critical Care Medicine Department (CCMD), CC, and Naomi P. O'Grady, MD, Staff Clinician, CCMD, CC, aimed at the development of novel methods for the graphical presentation of the status of patients within a critical care environment. The prototype system, departs from the electronic spreadsheet display format that is the goal standard for patient status display in the modern critical care unit, and is being implemented on the iPad platform to capitalize upon multi-touch display technology and swipe screen control capability. Software development for the mobile Intensive Care Unit (mICU) Clinical Information System (CIS) Project began in January 2012. The associated Data Gateway became operational in FY13, which may eventually allow patient data from the Clinical Center (CC) Medical Information System (MIS) to be channeled to the iPad, via the buildings wireless network, in an encrypted format. For added security, the mICU CIS iPads will eventually utilize two-factor authentication during login. Prototype iPad tablets were released to the CCMD staff in May 2013. The mICU CIS Application provides a demonstration of the Clinical Data Viewer Function, as seen on the CC MIS, and the Clinical Graphics Viewer Function that provides novel Circle Diagram displays of physiologic parameters, respiratory parameters, clinical lab values, etc. In addition, the mICU CIS Application provides a direct connection to the NIH Library's Journal Download website and NLM's PubMed website;Bookcase Function for downloaded .pdf files;Medical Camera Function;Medical Photo Album Function;Direct access to the UpToDate(R) website;and Direct Access to the Micromedex (R) website. Eventually, the mICU iPad Tablets will also have a Signoff Function that is geared towards patient handoff during CCU staff shift changes.

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Narva, Andrew S; Romancito, Gayle; Faber, Thomas et al. (2017) Managing CKD by Telemedicine: The Zuni Telenephrology Clinic. Adv Chronic Kidney Dis 24:6-11