The National Library of Medicine (NLM) announces 24 contract awards totaling $2.3 million to medical institutions and companies to develop innovative medical projects that demonstrate the use of the capabilities of the Next Generation Internet (NGI). The NGI program, announced in the fall of 1996, combines the resources of such government entities as the National Science Foundation, the Department of Defense, NASA, and NLM.

According to NLM director Donald A. B. Lindberg, M.D., "If we are to benefit from the fruits of modern medical science we must be able to transfer massive amounts of data-instantaneously, accurately, and securely. These projects are an important step in that direction." Among the NGI capabilities widely expected to be available are virtually error-free service, security and medical data privacy, "nomadic" computing, network management, and infrastructure technology for "collaboratories."

Michael J. Ackerman, Ph.D., NLM Assistant Director for High Performance Computing and Communications, and coordinator of the projects, said that "The availability of the NGI will lead to a whole new set of applications that are based on the ability to control, feel, and manipulate devices at a distance. To get an idea of what we foresee, one need only read the terms used in the descriptions of the projects: telepresence, tele-immersion, teletrauma, telemammography, internetworking, and nomadic computing." The word "haptic," used in several of the descriptions, refers to the sense of touch and motion.

The NLM is funding these demonstration projects with the goal of improving our understanding of how the Next Generation Internet can affect health care, health education, and health research systems in such areas as cost, quality, usability, efficacy, and security. There is a link to more information about the NGI and telemedicine on the NLM home page at http://www.nlm.nih.gov/.

A list of the projects follows.

Pathology Image Database System.
Yale University is planning a pathology image database system, Pathmaster, accessible via the World-Wide-Web. When a pathologist is confronted with a slide containing a cell whose nature is uncertain, a digital image of the cell can be submitted to Pathmaster, along with certain clinical information about the specimen. Pathmaster will automatically compute descriptors and pass back images to the user along with their cell types and diagnoses.
Contact: Perry L. Miller, M.D., Ph.D. Yale School of Medicine
Center for Medical Informatics
333 Cedar Street, P. O. Box 208009
New Haven, CT 06520-8009
Phone: 203-785-6753; Fax: 203-785-6664

Networked 3D Virtual Human Anatomy.
The goal is to build a virtual human cadaver based on the Visible Human dataset. An online virtual cadaver would be available to a wide range of students who can explore the virtual cadaver with a variety of tools. High-end applications will have a haptic interface.
Contact: Victor M. Spitzer, Ph.D.
University of Colorado Health Sciences Center
4200 East Ninth Avenue
Denver, CO 80262
Phone: 303-274-0501; Fax: 303-315-4729

Rural Health Science Education.
This project will develop a plan to evaluate the use of computer and interactive compressed video technologies to support rural health science education. It will enable delivery of interactive educational programming, such as grand rounds and continuing medical education, clinical information systems, library services, and consultation. Beneficiaries will be students, residents, and health care professionals.
Contact: Dr. Leo Bairnsfather, Ph.D.
Louisiana State University Medical Center
1501 Kings Highway
Shreveport, LA 71130-3932
Phone: 318-675-6536; Fax: 318-675-7757

Biomedical Tele-immersion.
By combining teleconferencing, telepresence, and virtual reality, tele-immersion enables teachers and students to interact with three-dimensional models. Tele-immersion combines several virtual reality systems with advanced network capabilities for learning especially in surgical education. NGI guarantees data privacy and security, and will allow tele-immersive environments derived from models of patient data.
Contact: Jonathan C. Silverstein, MD
University of Illinois at Chicago
School of Biomedical and Health Information Services
1919 W. Taylor
Chicago, IL 60612-7249
Phone 312-996-5112; Fax: 312-996-8342

National Emergency Medicine Information Extranet.
The National Emergency Information Infrastructure Consortium (EIIC) will create a plan for implementation of a secure National Emergency Medicine Information Extranet to improve emergency care across the nation. The primary application to be developed will enable interlinked standards-based emergency encounter registries, then feedback to providers 'just in time' multimedia educational and treatment protocol services. The project will create an open architecture to enable other layered applications in the future.
Contact: Edward Barthell, M.D.
Infinity Healthcare, Inc.
1251 Glen Oaks Lane
Mequon, WI 53092
Phone: 414-290-6700; Fax: 414-290-6781

Personal Internetworked Notary and Guardian. The Personal Internetworked Notary and Guardian (PING) project is designed to address the control of a personal record that can be integrated with more traditional sources of clinical information for patient use in the home, at work, and at school. In particular, PING is focused on: 1)reconstitution of the patient longitudinal records from both provider-based information systems and portable, personal record systems, on the Internet; 2) providing simple and secure authentication mechanisms; and 3) evaluation of the impact of PING upon the process of healthcare.
Contact: Isaac S. Kohane, M.D., Ph.D.
Director, Children's Hospital Informatics Program
300 Longwood Ave., Enders 150
Boston, MA 02115
Phone: 617-355-7821; Fax: 617-730-0456

Implementation to Serve Visible Human Datasets. This project plans to implement an NGI production system to interactively serve Visible Human datasets and anatomical data evaluation software. The image and knowledge data objects will be accessed by NGI-enabled World Wide Web users and evaluators. The system will provide to the user multi-resolution, anatomically labeled images within these Visible Human datasets as requested.
Contact: Brian D. Athey, Ph.D.
The University of Michigan Medical School
4771 Medical Science Building II
Department of Anatomy and Cell Biology
1335 Catherine St.
Ann Arbor, MI 48109-0616
Phone: 734-763-6150; Fax: 734-763-1166

G-CPR and the NGI.
The Louisiana State University Medical Center proposes to implement a system of longitudinal electronic health records over the NGI that will integrate its ten public hospitals. This project is based on the G- CPR, or Government Computer Based Patient Record, a collaborative effort between the Department of Defense, Department of Veterans Affairs, Indian Health Service, and the LSU Medical Center. The objective of this project is to enable secure access and sharing of clinical information.
Contact: Richard Ferrans, M.D.
Louisiana State University Medical Center
Department of Public Health
1600 Canal Street, Suite 800
New Orleans, LA 70112
Phone: 504-588-3507; Fax: 504-588-3938

Secure Radiologic Collaboration on the Next Generation Internet.
The goal is to plan the implementation and deployment of a suite of collaborative medical applications to provide a secure, real- time, interactive environment for viewing, analyzing, and comparing radiological images in a clinical environment. This will provide clinicians and technologists the ability to share, in real-time, diagnostic imagery and medical data.
Contact: Douglas L. Long, Sr.
Principal Scientist
Odyssey Research Associates, Inc.
Cornell Business & Technology Park
33 Thornwood Dr., Suite 500
Ithaca, NY 14850-1250
Tel: 607-257-1975; Fax: 607-257-1972

Open Architecture Multispecialty Data and Telemedicine Integration on the Next Generation Internet.
The purpose of this project is to plan the implementation of a multispecialty telemedicine testbed using NGI. The plan will identify existing and new multispecialty applications in patient care, continuing medical education, and patient education to be integrated into this platform. The planning activity is to be conducted by a team of scientists and clinicians from all pertinent parts of the proposing organization.
Contact: Joseph C. Kvedar, M.D.
Corporate Director
Partners Telemedicine
1 Longfellow Place, Suite 216
P.O. Box 8941
Boston, MA 02114
Phone: 617-726-4447; Fax: 617-726-7530

Patient-centric Healthcare Management over NGI.
This project will demonstrate a patient-centric approach for healthcare management over the NGI. The demonstration will build upon the Electronic House Call system developed by Georgia Tech and the Medical College of Georgia to allow patients to videoconference with their healthcare providers and to monitor medical measurements over a secure network. A simple graphical user interface enables patients to control the system themselves. The system combines videoconferencing, vital signs measurements, patient education resources, and medical records, and enables patients to participate in their own healthcare.
Contact: Mr. John W. Peifer
Senior Research Scientist
Biomedical Interactive Technology Center
Georgia Institute of Technology
250 14th St., NW
Atlanta, GA 30332-0200
Phone: 404-894-7028; Fax: 404-894-7025

Adopting the NGI as a Tool for Healthcare and Information Access.
This project will assemble a team of medical informatics users and networking advisors to analyze biomedical and healthcare information processes and select those which best demonstrate the application of NGI technologies and tool sets, while simultaneously providing demonstrable benefit to healthcare practitioners and end users. Many information processes in healthcare clinical services, biomedical education, and research will be assessed. Once applications have been identified, the assessment team will select viable candidates, then formulate an implementation strategy for one application area.
Contact: Brent K. Stewart, Ph.D.
University of Washington
Grant and Contract Services
3935 University Way NE
Seattle, WA 98195
Phone: 206-616-1314; Fax: 206-543-3495

The Empathy Network: Improved Healthcare Delivery for Survivors of Mild Traumatic Brain Injury (MTBI).
The objective of the Empathy Network is to employ virtual reality technology, high performance computing centers, and NGI capabilities to dramatically improve the healthcare delivered to MTBI patients. VR technology will allow clinicians to construct a virtual world that simulates the cognitive and perceptual deficits experienced by an MTBI patient. VR and NGI technologies will then enable a patient's other healthcare providers, family, friends and co-workers to experience the MTBI patient's problems in coping with everyday life. This will engender empathic insight, support, and understanding that are crucial elements of an MTBI patient's recovery and adaptation.
Contact: David L. Zeltzer
Sarnoff Corporation
201 Washington Road
Princeton, NJ 08540
Tel: 609-734-2975; Fax: 609-734-2662

Remote, Real-time Simulation for Teaching Human Anatomy and Surgery.
This project plans to demonstrate remote, real-time teaching of human anatomy and surgery, using the NGI. A simulator architecture will be developed to deliver real-time simulation and visualization technologies to a diverse audience. The client component is a desktop PC or workstation. The simulation server receives sensor and control input from the client and transmits response streams. The NGI network-based architecture will allow for a heterogeneous mix of client configurations ranging from simple mouse and color displays to multiple high- resolution stereographic displays and haptic devices.
Contact: Parvati Dev, Ph.D.
Stanford University School of Medicine
SUMMIT
1215 Welch Road, Modular A
Stanford, CA 94305-5401
Phone: 650-723-8087; Fax: 650-498-4082

Interactive Medical Data on Demand: A High-Performance Image-Based Warehouse Across Heterogeneous Environments.
The goal of this project is to determine the requirements of a system for intuitive, real-time access to patient-specific data records based on multimodal images and multimedia. They will evaluate and select system architectures, software, and network configurations to provide access over different network bandwidths and platforms. This design will include scalability of the system and extensibility to other healthcare applications.
Contact: Donald L. Stredney
Ohio State University Research Foundation
Health Sciences Offices, B-030 Graves Hall
333 West Tenth Avenue
Columbus, OH 43210
Phone: 614-292-9248; Fax: 614-292-7168

NGI-Aware, Scalable, Secure, and Adaptive Technology for Rural Telemedicine.
The goal of this project is to develop a plan to demonstrate telemedicine applications that will utilize NGI infrastructure. Telemedicine scenarios include: 1) nomadic clinics; 2) public health station; and 3) a consulting health station in rural clinics and hospitals. These systems will be configured with a set of videoconferencing, diagnostic, and patient monitoring equipment.
Contact: Y. V. Ramana Reddy, Ph.D.
West Virginia University Research Corporation
886 Chestnut Ridge Road
Morgantown, WV 26506
Tel: 304-293-7226; Fax: 304-293-7541

Medical Nomadic Computing Applications for Patient Transport.
The goal of this project is to transmit multimedia diagnostic information in real time from ambulances to receiving physicians using NGI technologies, thus enabling diagnostic and treatment opportunities during transport.
Contact: David M. Gagliano
BDM International, Inc.
1500 BDM Way
McLean, VA 22102
Phone: 703-848-6134; Fax: 703-848-6741

Distributed Revolutionary Medical Education Environment.
The objective of this project is to develop a plan to implement and evaluate a distributed, medical education environment on a network testbed that simulates the characteristics of the NGI. These applications will be delivered across the spectrum of medical instruction, from undergraduate to postgraduate to continuing education.
Contact: Lael C. Gatewood, Ph.D.
University of Minnesota
Office of Research and Technology
1100 Washington Avenue So., Suite 201
Minneapolis, MN 55415
Phone: 612-625-4909; Fax: 612-625-7166

Radiation Oncology Treatment Planning/Care Delivery Application.
The goal of this project is to develop, implement, and evaluate NGI capabilities for radiation oncology treatment planning and care delivery. The application will provide diagnostic support, treatment planning, and remote verification of proper operation of treatment equipment from the Comprehensive Cancer Center to a remote JHU treatment facility. The proposed project will have a strong evaluation component focused on quality of service, security, privacy, and data integrity.
Contact: Joseph S. Lombardo
Johns Hopkins University Applied Physics Laboratory
11100 Johns Hopkins Road
Laurel, MD 20723-6099
Phone: 240-228-6287; Fax: 240-228-6834

Applications Layer Security Solution for Stationary/Nomadic Environments.
This project will evaluate extant security techniques within the context of an open security architecture. The solution is based on security shared among collaborating parties, nomadic computing, and the privacy of medical information. The architecture includes user authentication, remote access to medical databases, nomadic computing, and confidentiality of data.
Contact: Brenda Garman
Motorola Space and Technology Group
1190 Winterson Road
Airport Square #14, Suite 350
Linthicum, MD 21090
Phone: 410-859-4761; Fax: 410-859-0787

Human Embryology Digital Library.
The goal of this study is to develop a research and education network for medical image acquisition and analysis. A high performance optical network testbed will link government labs and universities with traditional medical research facilities. The focus of the project is on the analysis and delivery of digital histopathology image data. The proposal includes the definition of a set of demonstration projects that use a collaborative consultation system for research, surgical planning, and basic research.
Contact: George S. Michaels, Ph.D.
George Mason University
Office of Sponsored Programs
4400 University Drive
Fairfax, VA 22030
Phone: 703-993-1998; Fax: 703-993-1993

Integration of Security Mechanisms for Internet Applications.
The goal of this project is to develop a plan to integrate the PCASSO (Patient Centered Access Secure Systems Online) with biomedical applications. It will be demonstrated through a testbed involving medical treatment facilities in Delaware, Pennsylvania, Maryland, and New Jersey and the Frederick (Md.) Biomedical Supercomputer Center in an information technology infrastructure. The NGI infrastructure for this region is being developed under the HUBS (Hospitals, Universities, Business Schools and Communities) Initiative.
Contact: Raymond E. Cline, Jr.
Security Applications International Corp.
(SAIC)
1710 Goodridge Drive, M/S 2-3-1
McLean, VA 22102
Phone: 703-749-8648; Fax: 703-821-1134

Telemammography Using the NGI.
The goal of this project is to plan and implement a testbed to demonstrate the feasibility of a national breast imaging archive and network infrastructure to support telemammography using NGI technologies. The proposed infrastructure would: support traditional breast screening; provide the opportunity to maintain and apply standard image processing and computer-aided diagnosis software; permit access to breast imaging experts for primary and secondary interpretations; and provide an opportunity to study and understand epidemiologic issues in breast cancer.
Contact: Mitchell Schnall
University of Pennsylvania
Research Services
133 S. 36th Street, Suite 300
Philadelphia, PA 19104-3246
Phone: 215-662-7238; Fax: 215-662-3013

Teletrauma and the NGI.
The goal of this project is to plan the implementation of an integrated system of trauma care for Southern Louisiana using an NGI telemedicine network. This network will provide instant access to the Trauma Team at the Medical Center of Louisiana at New Orleans which will provide online assistance. Distance education training for emergency personnel, network management, and quality of service issues are all elements of the project.
Contact: Richard Ferrans, M.D.
Louisiana State University Medical Center
Department of Public Health
1600 Canal Street, Suite 800
New Orleans, LA 70112
Phone: 504-588-3507; Fax: 504-588-3938