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As medical expert systems increase their use of on-line information systems, the need grows for Web-based infrastructures with which to make those on-line interactions more efficient, powerful, user friendly and intelligent. The Med Wide Web is a proposed cyberspatial infrastructure.
Here are presented some initial conditions for the installation and operation of a MWW system:
In its most basic sense, telemedicine is any instance of medical care occurring via the Internet and using real-time video-teleconferencing equipment as well as more specialized medical dignostic equipment (EEG, EKG, blood analysis, etc). For example, Dr. X is a dermatologist in Little Rock Ak. and is in clinical consultation with melanoma patient Y one hundred miles away in a rural clinic with minimal facilities. In addition to the live data from patient Y, the physician is also able to have a display of the patient record. The latter is stored in a data base maintained by the main communication hub of the system. In telemedicine lingo, the three sites of the patient, communication hub and expert medical system are known as Care Portal, Bridge and Docking Station, respectively. The diagram below gives a basic visual of the system with multiple Care Porals and Docking Stations.
Our dermatology example is one of the more simplistic applications of telemedicine. Yet, judging from the diagram the interactions may at times be very complicated requiring specialized mechanisms, beyond these basic sites and connections, to adequately maintain and execute the complex flow of real-time information traversing back and forth between participants. To further augment the primarily hardware based structure of this telemedicine scenario requires the introduction of the Ditributive and Collaborative Environment.
Taking telemedicine as a basic facility for doing medicine across the Web, Distributive and Collaborative Environments embed such systems into a networking mechanism for complex, time critical interactions across the Web between multiple users. TANGO is one such mechanism. Conceived, designed and implemented at NPAC, TANGO establishes a method and set of protocols for connecting multiple, geographically remote users into purpose and application specific environments for the sake of accomplishing some real world objective (s). A Web-based medical collaboratory is one wherein a specific group of expert medical personnel, their support staffs, clinical/hospital resources and all related databases comprise the collaborative. The collaborative, then, is a networked collection/aggregate of expert knowlegde and skill resources deployable as an entity, as needed.
Here we will outline the more general features of TANGO as they relate to
a discussion of MWW and then present a hypothetical example and diagrams
of a Med Wide Web-based collaboratroy in action. For a more thorough treatment
of TANGO click
here.
"TANGO is an integration platform which enables building Web-based collaborative environments. The system provides the means of fast integration of Web and non Web applications into one multi-user collaborative environment" (Walczak et al., 1996).
Terminology:
Given an already established networked aggregate of geographically remote participants and tools, the operation of a collaboratory may look like the following example wherein a hypothetical matrix is deployed at the site of a hypothetical emergency. Our fictitious patient is a farmer who went into cardiac arrest while plowing his fields.
The scenario picks up at a small rural clinic where emergency personnel have set up the care portal and have alerted the patient's primary care physician of the event. The patient has been connected to the necessary dignostic devices. From within her docking station the primary care physician immediately initiates the collaboratory session by launching the Cardiac Arrest Protocol (CAP: an application which gathers all critical post heart attack data) as well as the patient record data. The primary care physician is now the master of the session in progress. While emergency personnel are facilitating input of the data into CAP (e.g., renal fluid retention, potassium content, blood volume, etc) the primary care physician's session control has already brought the patient's cardiologist as well as a hematologist into the session. The specialists then each launch their own specialized applications with instances running only on the primary care physician system. Within the browser at the rural clinic, a Treatment Protocol Application launched by the primary care physicain giving very clear instructions to emergency personnel on what to do for the patient is ongoingly generated.
The telemedical event is in full swing with the central server mediating all exchanges in real time and logging all events. The cardiologist has done everything he can and leaves the session bound for the hospital where the patient will be transported once he has stabilized. The hematologist stays on and will now consult with a nutritional therapist on what to give the patient intravenously so as to stabilize him for the ambulence trip. The browser being used has made the entire event very fluid. Its powerful and accessible multisensory interface allowed the primary care physician to moderate the entire exchange through a system of simultaneous windows and other data rendering systems. In addition, this browser allowed ease of interaction between the various specialists all tailored to their optimal modality of data aquisition (e.g., visual, auditory, etc.). As an intelligent system, the user authentication/authorization process of joining a session tailors the system's outputs and performances to the requirements of the local expert's own set of critical parameters. The cardiologist then is presented with data in different configurations with different emphases and reductions than the hematologist, for example. What the system has learned from similar prior sessions also determines the content and nature of rendered data.
This example hopefully demonstrates the spontaneous, emergent, ubiquitous, and communicative nature of the Med Wide Web. In crisis, maintenance or other episodes of medical need a cyberspatial infrastructure is in place which facilitates necessary expert functioning. By integrating Web-based telemedicine technologies with the computational and system application requirements of TANGO, a powerful and realistic system of Distributed Medical Intelligence emerges: "Distributed Medical Intelligence promoties the development of an integrative medical communication system which addresses the process of providing expert medical knowledge to the point of need" (Warner et al.). As a spontaneous and emergent system it is a network gestalt dynamically changing its shapes with the changing needs of deployment.
Finally, the docking station is essentially the Grok Box scaled up or scaled down depending upon the needs of expert systems using MWW in a locally specific manner.