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 the NCI Radiation Oncology Branch (ROB) environments on the NIH campus, during FY95 and FY97, 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 FY15, 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. A relatively new activity, initiated in FY13, involves the collaboration with Peter L. Choyke, MD, Senior Investigator and Director, Medical Imaging Program, Center for Cancer Research, NCI. Work continued with experimental and clinical studies directed toward the possibility of the use of MRI methodology for the early detection of prostate cancer, and the possibility of the development of a measure of its aggressiveness. In FY15, 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. The implementation of software stereo image generation will utilize a group of algorithms developed at Johns Hopkins University, which are organized as plug-ins to the MIPAV environment. 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, which was upgraded during FY15 to a Quadro 5000 Graphics Card. This development platform will ultimately be controlled by a 3D position-sensing haptics glove with internal tactile feedback, and will have speech recognition capability. 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 UDP Case Management 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 were NIH staff members, from other Institutes, and also outside subject matter experts. During 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. Later, system integration was completed with the addition of a 12-Terabyte Disc Array, and inclusion of the Galaxy Web-based Platform, which was developed by Penn State University and supports data-intensive biomedical research. At the end of FY15, the UDP Case Management Portal was taken off-line, due to staff departures, and the elimination of the international outreach effort using this methodology. During FY15, BIVS continued work on a collaborative project with Henry Masur, MDD, 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 ultimately 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. During FY14, Electrocardiogram (ECG) waveform display and playback capability was added to the mICU CIS Application. In addition, the development of ECG arrhythmia detection and display algorithms was initiated, with the ultimate goal of including these capabilities within the mICU CIS Application during FY16. During FY15, NIH single-factor authentication was integrated within the mICU CIS Application, in order to provide a pathway towards two-factor authentication. Specialized PIV card readers were purchased for use with the iPads utilized in this project, and the process of licensing mandatory PIV card middleware for the iOS environment was initiated.

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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