During FY18, 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 it 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 could ultimately provide 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 IV Drug (IVD) Function provides a visual indication of the history of IV medications administered by IV Drip, IV Piggyback, and/or IV Push routes. Finally, an Electrocardiogram (ECG) Waveform Display and ECG Playback capability 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 FY2018, a final modification was made to the Clinical Data Viewer function that provides continuity with the ICU flow Sheet provided by the CCs electronic medical record system. In the mICU CISs ICU Flow Sheet implementation, a magnified viewing window slides up and down through the list of viewable parameters and/or left and right through the list of time periods. The Most Recent Time Columns position is user-selected so that it may be displayed in the rightmost position (common practice) or it may alternatively be displayed in the leftmost position, adjacent to the Variable Name Column (for ease in locating data). The Most Recent Time Column is always highlighted with a bright yellow tint for easy identification, and the selector is a clock face icon with a rightward or leftward facing arrow head. 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. In early FY2018, a working prototype of the mOR CIS App was completed, in which a single circle diagram with nine axes describes the current physiologic status of each patient in an operating room. Swiping progressively through all circle diagrams would provide a status review of all patients in the CCs active ORs. At the end of FY18, work on the mICU CIS Project was suspended, since all functionality planned for inclusion in the prototype version of the mICU CIS App was completed, and there appears to be little expectation that access to the CCs electronic medical record system will be forthcoming. In addition, the mOR CIS App will not be pursued at this time. In 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, by citizen scientists, can be expected to 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. During FY18, work on further extension of the 3D ISVE was suspended due to the departure of Kevin L. Briggman, Ph.D. from the NINDS, pending the arrival of a new CDCU Director. During FY18, development has ceased on a novel research-oriented Stereo Medical Image Display System, which was being developed in the JAVA Language, and was designed to be compatible with the Medical Image Processing Analysis and Visualization (MIPAV) Application designed by the Biomedical Imaging Research Services Section (BIRSS), OIR, CIT.

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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