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MediLink -- A SmartCard-Assisted Wearable Data Acquisition
and
Communication System for Emergency and Mobile Medicine

 

3. MediLink Application

MediLink is the main application that runs on the TransPAC under Windows95 and Windows98, for medical applications. It is designed to be a common application useable by an emergency medical technician operating under adverse time demands and spatial constraints including physical and temperature constraints that may be faced at highway accident scenes, industrial locations, mines, at sea, or in the air. A MediLink system, for instance, can be equipped with a full Interactive Manual for standard cardio-vascular, childbirth, and other common emergency conditions and placed on every commercial passenger aircraft, for use by non-medical staff with a basic CPR level of training in emergency response techniques. MediLink’s main screen is shown in Figure 4 below. All functions operate in the background of a main window that is the "workspace" for both data input and ouput over the internet and locally. The application makes use of common browser technology to keep most interaction steps and sequences familiar to the manner of Internet Explorer and Netscape Navigator.

Writing Pad

The main application window is the Writing Pad that can be used to produce ordinary handwritten text and sketch graphics that are stored as a set of pages in a predefined folder on the PC as Windows BitMap (.BMP) images, or a collection of text and graphic objects that are stored with reference locations on the coordinate space of the Pad. Upon storage the bitmapped portions are also automatically compressed using Multi-Resolution Seamless Image Database (MrSID) wavelet compression and JAZZ-format (.JZZ) condensation compression to enable rapid transmission if so desired. The Writing Pad pages can be processed on a receiving server or desktop "base station" using software that extracts character-stream image data and performs optical character recognition on the text, converting it into a standard ascii text file, one per page or else one text file for all pages in a given session. The main .SID or .BMP files remain unaltered with graphics and character script, and a user can subsequently cut-and-paste graphic regions into other documents using any standard image editor such as Microsoft PhotoEditor or ImageComposer. Most of the elements in the Writing Pad space are, however, text boxes (bound or unbound) and pictures that have been dragged and dropped from elsewhere (e.g., online patient record, or data acquisition device.)

The main menu has several key functions that the user can activate at will, and all of these are intended to be voice-activated. Some selections are familiar to the typical PC user and this is intentionally so in the design, in order, once again, to minimize special training. TransPAC is more like the ordinary desktop PC than it is not, and in fact it can be used as a regular desktop for virtually any PC operation. With a keyboard, mouse, and standard CRT display, the main difference between the TransPAC and the typical desktop is that the former occupies only approximately 30% of the footprint and less than 8% of the volume of the typical mini-tower desktop.

Sessions

MediLink operates with patient sessions. A session is a collection of tasks that may involve several different applications and files, all tied together with one common denominator – a particular patient whose Patient-ID is the connecting link. The Patient-ID originates in a hospital or clinic database or it is assigned by the MediLink operator as a new ID which subsequently may be processed to match up with a standard ID such as a social security number. The Patient-ID, if supplied from a hospital database in the instance of a physician or nurse using MediLink to conduct home visits, nursing home rounds, etc., will be entered first into the Active Session Card, the 16-bit smart card that contains all start-up data about the patients, tasks, services, and other requirements that the user will want prior to starting a set of rounds and visits (cf. Section 4).

A dynamic HTML page is created and updated during the entire session process, so that when a provider is finished with a given patient session, this main page contains all the links to all other documents created or modified during the session. A new session instantiated by the user generates automatically the following:

Figure 4 : MediLink Main Screen showing Writing Pad(‡ - cf. Section 7)

The user fills out requisite patient information and during the course of the session generates new files either directly from the TransPAC and perhaps through data acquired from attached instrumentation (e.g., EKG, ultrasound), or through downloads from an internet or intranet server. All files that are saved during a session, unless specifically noted otherwise by the user, are automatically part of the new (current) session. When the session is saved on hard drive or via the internet on a server, the folder "newsession", now automatically renamed after the identified patient (e.g., "jgsmythe-243-67-9631") contains the session header "new_session.htm", now automatically renamed also after the patient (e.g., "jgsmythe-243-67-9631_session.htm") and a variety of forms, images, notes, URLs, etc. that have been compiled, created, modified, and downloaded by the medical practitioner as part of his or her duties in the session. Figure 5 below illustrates the data flow. The user is freed of about 90% of the headache tasks of managing and manipulating file and folder names.

The Writing Pad was described above and it constitutes the most generic and commonplace interface for the medical professional, the equivalent of the paper notepad for making any form of notes during a patient session. If it can be done with a pen, it can be saved and later processed – or simply printed in exact replica form. The advantages of the wavelet compression algorithms for Writing Pad page bitmap-portion storage are to enable not only fast transmission to a waiting server but to enable anyone to zoom and view the document at multiple scales. The wavelet methods enable image reconstruction that eliminates many of the problems with zooming that are difficulties for JPEG and other formats. Writing Pad was designed to provide some of the features found in applications like Microsoft Word as well as Adobe PhotoShop and even the archetypal Microsoft Paint, for the benefit of the user who wants to PUT things onto a blackboard and WRITE notes. Simple. Direct. Plain.

 

Figure 5 : Session Data Flow and Data Structure Buildup (‡)

Body Map

The Body Map is another application feature of MediLink. It operates as a browser that brings up a series of overlaid image maps each of which pertains to a system or layer of the human body. The user can set the parameters of the Body Map to be oriented to all generic anatomical and physiological systems or only to certain ones pertaining to the patient of the current session. In the former case, all possible links to different anatomical systems will be displayed or reachable through page navigation, by mouse/pen or voice command. Once at a terminal link level, the user can activate a search of the patient medical records for those records – in database form format or as images, notes, reports, etc. that are maintained as separate files – which exist for that patient. In the latter case, only those links for which there is data existing for the given patient of the current session will be displayed as active links. All of this activity is managed "behind the scenes" by the MediLink software and its gateway to different ODBC compliant databases (Microsoft Access and Oracle being the most common and for which MediLink is initially targeted).

A very early prototype of the Body Map is shown in the the Medilink screen of Figure 6, using an image map that originated in the web-based medical informatics system, CommonHealthNet. By either mouse/pen click or verbal command, the user can activate one of the particular links that are displayed. If the cardiac system is selected, then a dynamic web page will appear in the Body Map browser window showing a list, of text and icons, for all accessible records and files pertaining to the cardiac system for the specified patient (X). The requisite indexing operation is performed at the database server level when each new record is added for (X) and no special search procedure is required of the MediLink user when accessing records in this manner. Similarly, activating the link for neurology would produce a different page of dynamically generated text and icon links, although clearly some records and files could appear through both paths. This is not the only interface method that a user can employ to get patient information, but it is one of the most direct and visual, reducing entirely the need for the user to think and search about file names, folders, query expressions, and other computer terminology that detract from the process of performing medicine and healing, the true business at hand.

Figure 6 : MediLink Body Map (prototype)

The Data Table, Reference, and Internet services are other means that the medical professional can employ to obtain patient data, communicate with other professionals on a case, or enter new data into the system. The Data Table provides a standard form which can be customized to suit the needs of any given institutional patient database format. An example is provided in Figure 7 below. Using the form, the practitioner can rapidly browse through lists of files, records, or folders according to established set categories. The emphasis is upon minimizing the search, deliberation, and decision-making process steps wherever possible. Naturally this requires substantial coordination on the data server end of the channel connecting MediLink to the medical histories, images, and other data objects. However, the bulk of the task is accomplished through standard software gateways that exist on the MediLink side for connecting to Oracle, SQLServer, or Access databases through the web. It is a matter of configuration and demands less change on the part of hospital or clinic database administrators than may at first be imagined. What serves for data access also serves to allow the user to make new records, submit notes (including Write Pad not pages), and enter photos or biomedical instrumentation results into a patient database.

The Internet services within MediLink per se are to enable the practitioner to access more than just the resources of a given hospital intranet or database system. The intent is that in a dialogue with other health care providers connected by cell phone, radio link, or internet, the user can have at his or her disposal whatever may be needed that is a resource accessible through the web. This could include reference materials or live video feeds – for instance, to demonstrate a technique to be performed with a patient. Not everything may be in the manual and sometimes a demonstration of technique is in order. With wavelet compression of video it is possible to obtain relatively real-time full-motion video over a high-speed modem connection, or reduced 8-15 fps streaming over a fast wireless modem link. Without question this type of communications demands that there be a sufficient network in place for supporting and maximizing the bandwidth, but even over a standard telephone connection the performance for general non-video transfer is adequate for most conceivable applications, especially if the real-time voice dialogue is handled through a cell phone and not also loaded onto the requirements of the TransPAC and its modem.

The Reference feature of MediLink is a dynamic, self-indexing note system that the user can build on the TransPAC hard drive, with online links to intranet or internet resources, as a personal or group medical help system. It is designed to be a growing compendium of commonly accessed notes and documents, generated by the user as well as drawn in from outside sources, about techniques, pharmaceuticals, case histories, etc. It can be accessed in the usual manners – mouse, pen, keyboard, voice.

Figure 7 : MediLink Data Table (prototype)


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