Recent trends in healthcare informatics and telemedicine indicate that systems are being developed with a primary focus on technology and business, not on the process of medicine itself. Distributed Medical Intelligence promotes the development of an integrative medical communication system which addresses the process of providing expert medical knowledge to the point of need.

Many current efforts in developing medical informatics and telemedicine systems are primarily focused on the technological and business aspects of the problem. The issues of network security, interoperability, and database standards for archiving patient information are on the forefront of most technological development agendas. The majority of telemedical systems are primarily of two main types; they are designed for remote diagnosis of some still image (radiological, dermatologic or pathologic) or they are simply video teleconferencing systems (talking heads) with minimal data exchange. The business issues of medical information systems such as Community Health Information Networks, Managed Care Information Systems and Hospital Information Systems mandate an infrastructure which is primarily to ensure the secured transfer of financial, administrative and clinical information throughout the corporate enterprise. The use of the communication network for remote knowledge access and/or patient care is not designed into the system.

While the considerations in developing healthcare information systems mentioned above are important they seem to be incomplete. Their focus is on data transmission and the network technology not on the patient or the process of providing support to the care provider. There appears to be little effort to embed intelligent features into these systems. Systems should be designed to take advantage of developments of modern interface design, high speed communication systems, decision support technologies and computer facilitated communication techniques.

Distributed Medical Intelligence requires a systematic approach for developing a networked medical communication system which can effectively deliver medically relevant knowledge efficiently to a remote site. Such a system intelligently optimizes the flow of medical information between the persons seeking care and/or medical advice over the medical care network and the expert knowledge provider rendering the care and/or advice over that network. Distributed Medical Intelligence focuses on the process of communicating medical knowledge not the just the development a medical informatic infrastructure.

The Distributed Medical Intelligence system is divided into three main components. The Care Portal, The Docking Station and The Bridge. These components are described below in an operational way. These operational descriptions help elucidate the discrete areas where improved technologies, as they become available, and methods of decision support, as they are refined, can be implemented. An intelligent medical communication system must be able to be refined at the component level without redesigning the entire system. That is to say that it must be designed to be scaleable, extensible, interoperable and modular at a fundamental level.

The Care Portal

The Care Portal is defined as any port of entry to the medical communication network which is utilized to seek care for a patient and/or knowledge for a remote care provider. The Care Portals will have the most variability in their design. The common feature of all Care Portals is that they are tele-linked to a medical communication infrastructure. A Care Portal may be a remote rural clinic, a mobile clinic in the inner city, a patient’s bedside monitor in the intensive care unit, a remote monitor in the home of an elderly patient, a health info kiosk in the mall.....i.e. anywhere a person can seek medical information or service from a source on the medical network. The Care Portals will have the most variety in the infrastructure of their communication systems. The Care Portals communication infrastructure will range from the "plain old telephone" through multiple megabit transmission systems like ATM. The Care Portals will also have a wide variety if input devices to aid in the acquisition of relevant information/data from the patient. Along with the patient’s history and physical data the Care Portals will include data from a host of diverse sensors such as cameras, microphones, bioelectric monitors, x-ray, and ultrasound machines. There may be a host of vital signs indicators and bio-chemical lab instruments to determine blood, urine and other body fluid compositions. Care Portals may also be utilized to educate patients and medical personnel at remote sites.

The Docking Station

The Docking Station is the site where the medical expert provides consulting services, education and collaborative input over the medical network. The Docking Stations will have a wide range of complexity in their interface options depending upon what kind of expertise is to be rendered. Most Docking Stations will have multiple viewing options where the expert can view and interact with a wide variety of information simultaneously. The Docking Stations will support a wide variety of data display devices including both visual and auditory. In their optimal design the Docking Station’s will support a spatialized array of data displays, both audio and visual, thus optimizing the interaction with multiple data sets simultaneously. The Docking Stations are designed to allow optimal interaction between the Care Portals, relevant databases, other experts in the healthcare team and the primary knowledge providers themselves.

The Bridge

The Bridge is an intelligent medical communication hub which optimizes the flow of information between the Care Portals and the Docking Stations. The bridge’s functions include facilitating connectivity, data tracking, accessing medical data bases and intelligently enriching the Care Portal’s information through proactive query so as to optimize the interaction between the Care Portal and the Docking Station. The Bridge is the intelligent electronic triage system which determines which Docking Station is appropriate to service a given Care Portal The Bridge is an intelligent consult manager. In the optimal configuration the Bridge will function to ensure that all the relevant information from the Care Portal is gathered, organized, filtered and presented to the Docking Station expert in a way which facilitates an efficient interaction. Along with optimizing the relevant information from the Care Portal, the Bridge will automatically also link the Docking Station to the most relevant medical databases and other medical experts which may be required during the consultative interaction.

When designing the communication infrastructure for Distributed Medical Intelligence there are several considerations to take into account. One of the most important considerations is the design of the interface. There are different classes of interfaces, human-computer, computer-computer, and computer-human. The interface is a key component and there are many opportunities to enhance the interface for Distributed Medical Intelligence both in the instrumentation and the design. Each class of interface presents an opportunity to embed more functionality into the system. For example, when designing the interface for a Care Portal, considerations should include some knowledge about the specific needs and knowledge level of the users which are most likely to use it. Thus, a Care Portal designed for a home health nurse in a mobile clinic will differ greatly from the Care Portals in a cardiac intensive care unit. The purpose of this communication infrastructure is ultimately for the purpose of communicating expert medical knowledge and it is that fact should which influence the overall design.

Other considerations include ensuring a flexible configuration, allowing for far-end-control of diagnostic devices and ensuring that there is an open architecture that allows for the adaptation of new devices without the redesign of the whole system.

One final point to be made for this paradigm of Distributed Medical Intelligence is that it is scaleable and extensible, therefore it can meet the custom medical knowledge access needs of a wide variety of users.