During FY16, 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 had long been the gold standard for patient status display in a 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 is expected to 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. Currently, manually generated data for three simulated patients is transmitted from the Data Gateway, via double encryption, to the iPads in the hands of CCMD staff. NIH single-factor authentication is integrated within the mICU CIS Application, in order to provide a pathway towards two-factor authentication. Specialized cases, with integrated PIV card readers, are attached to the iPads utilized in this project. For added security, these iPads will ultimately require two-factor authentication during login to the mICU CIS App. The mICU CIS Application currently provides a demonstration of the Clinical Data Viewer (CDV) Function, as seen on the CC MIS, and the Clinical Graphics Viewer (CGV) Function that provides novel Circle Diagram displays of physiologic parameters, respiratory parameters, clinical lab values, etc. In addition, an Electrocardiogram Waveform Display and Playback (ECG) Function is provided. 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. The development of ECG arrhythmia detection and display algorithms was initiated, with the ultimate goal of including these capabilities within the mICU CIS Application in the future. During FY16, the design and specification of a novel intravenous (IV) infusion Time Profile Diagram display methodology was finalized for pharmaceuticals that are administered via IV routes, and sample data was generated for inclusion into the simulated patients datasets. During FY17, the IV Time Profile Diagrams were integrated into the mICU CIS App as a separate data presentation selection within the Tab Bar at the top of the display screen. Also during FY17, development of a prototype of a derivative of the mICU CIS App was initiated, which is proposed to be utilized within the CC Operating Room complex to track patient progress during operative procedures. This mobile Operating Room (mOR) Clinical Information System (CIS) is designed to wirelessly connect to an OR Data Server, which in turn would interface via hard-wired connections to the multiple medical devices utilized within the operating room. This architecture would allow the automated collection of primary and derived physiologic data from the patient, and the subsequent relay and presentation of this data, in an easily interpretable format, to the OR Officer-of-the-Day. Future tasks related to the mICU CIS and the mOR CIS Apps include the next step towards the implementation of two-factor authentication during PIV card login, which is the selection of the appropriate PIV card Middleware. This Middleware will allow the mICU CIS and mOR CIS Apps to access the PIV cards Certificates for transmission to the two-factor authentication website. At the beginning of FY16, A new project was initiated with Kevin L. Briggman, Ph.D., Director, Circuit Dynamics and Connectivity Unit (CDCU), NINDS. This activity involves the development of an Image Stack Visualization Engine (ISVE) for an iPad environment, which allows 3D visualization and rotation of a stack of Serial Block-face scanning Electron Microscopy (SBEM) images of brain tissue from the zebrafish and mouse. The 3D ISVE is the main component of an iPad App under development, which will allow the elucidation of the neural interconnections (connectome), of the zebrafish or mouse brain though the use of crowdsourcing methodology. Crowdsourcing, whether by teams of neurobiologists or by undergraduate biology and physiology students, will greatly accelerate the process of adjudicating conflicts in the first guess at the connectome that was independently produced by NINDS staff utilizing a neural network to preprocess the SBEM imagery. In FY17, the ISVE was extended to allow for the overlay of the original SBEM images with preprocessed colorized Supervoxel image planes, which provide the first estimate of the connectome between and among the multiple layers of the image stack. During FY16 and FY17, 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), OIR, 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 will be controlled by hand-motion, and it is being developed to support brain imaging as the initial target application. Powered by a high-performance workstation containing dual quad-core processors, and a sophisticated 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. In FY17 the system was also re-configured, when it was co-located with the haptics glove subsystem.

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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