Tumor Conferencing Tools for Regional Collaborative Cancer Care Using the

Next Generation Internet

Brent K. Stewart, PhD, DABMPBrent K. Stewart, PhD, DABMP

Professor of Radiology, Bioengineering and Medical EducationProfessor of Radiology, Bioengineering and Medical EducationDirector of Imaging Informatics and Diagnostic PhysicsDirector of Imaging Informatics and Diagnostic Physics

University of Washington School of MedicineUniversity of Washington School of MedicineDepartment of Radiology, 357115Department of Radiology, 357115

Seattle, WA 98195Seattle, WA 98195bstewart@u.washington.edubstewart@u.washington.edu

What Have We Done?What Have We Done?

• Design, construction and evaluation of collaborative Design, construction and evaluation of collaborative Internet tools providing effective, distributed tumor board Internet tools providing effective, distributed tumor board conferencing among multiple sites of practice conferencing among multiple sites of practice

• Web accessible info. system that can upload (case Web accessible info. system that can upload (case preparation), store, and display (case presentation) clinical preparation), store, and display (case presentation) clinical images, video, graphics, documents, URLs, and protocolsimages, video, graphics, documents, URLs, and protocols

• Web browser visuals and interactions trans. to all sitesWeb browser visuals and interactions trans. to all sites• The Web browser in parallel with IP videoconferencingThe Web browser in parallel with IP videoconferencing• Both channels use high-bright/contrast LCD projectorsBoth channels use high-bright/contrast LCD projectors• Special attention to sound quality requiredSpecial attention to sound quality required• Retrospective reference or clinical mgmt purposesRetrospective reference or clinical mgmt purposes

Preparation Before a Preparation Before a ConferenceConference

Enter patient information in the database through the web and schedule them to the conference.

Upload patient studies that are to be shown and sequence.

Schedule a new conference.

Presentation Presentation During a During a

ConferenceConference

Information Objects Information Objects Typically Presented at a Typically Presented at a

ConferenceConference

Why Have We Done It?Why Have We Done It?

• Seattle Cancer Care AllianceSeattle Cancer Care Alliance• University of Washington Medical CenterUniversity of Washington Medical Center• Childrens Hospital and Regional Medical CenterChildrens Hospital and Regional Medical Center• Fred Hutchinson Cancer Research CenterFred Hutchinson Cancer Research Center• Southeast Lake Union (SELU) Outpatient CenterSoutheast Lake Union (SELU) Outpatient Center

• January 29, 2001: all outpatient adult oncology services January 29, 2001: all outpatient adult oncology services move to SELU – inpatient/outpatient oncologists splitmove to SELU – inpatient/outpatient oncologists split

• Tumor conferences important in oncology patient mgmt.Tumor conferences important in oncology patient mgmt.• Requires a gathering of multidisciplinary expertsRequires a gathering of multidisciplinary experts• Relative advantages/disadvantages of treatment alternativesRelative advantages/disadvantages of treatment alternatives• Collegial atmosphere – a place for networking and learningCollegial atmosphere – a place for networking and learning

• Hypothesis: more frequent expert participationHypothesis: more frequent expert participation

CCA - Geographical DistributionCCA - Geographical Distribution

UWMCUWMC

CHRMCCHRMC

FHCRCFHCRCSELUSELU

GigapopGigapop

How Have We Done It?How Have We Done It?

• NLM Phase 2 award: Biomedical Applications of the NGINLM Phase 2 award: Biomedical Applications of the NGI• Univ. of Washington participant in Internet2 and NGIUniv. of Washington participant in Internet2 and NGI• UW created the Pacific Northwest GigapopUW created the Pacific Northwest Gigapop• PNWGP connects the SCCA partners with 2.5 or 10 GbpsPNWGP connects the SCCA partners with 2.5 or 10 Gbps• Three investigational groups formedThree investigational groups formed• Apache w/128-bit SSL encryption, Debian Linux, MySQLApache w/128-bit SSL encryption, Debian Linux, MySQL• Programming: server – PHP4; client - HTML/JavaScript Programming: server – PHP4; client - HTML/JavaScript • Digital connectivity to path. slide and radiology imagesDigital connectivity to path. slide and radiology images• eSQL query connectivity with the UWAMC EMReSQL query connectivity with the UWAMC EMR• Three tiered security infrastructure (authentic./authoriz.)Three tiered security infrastructure (authentic./authoriz.)

Seattle Cancer Care Alliance NetworkSeattle Cancer Care Alliance Network

Fred HutchinsonCancer Research Center

University of Washington

Internet

ExternalPartner

Childrens Hospital andRegional Medical Center

PNW Gigapop

OC-192, 10 Gbps

OC-48, 2.4 GbpsSeattle Cancer Care Alliance

(SCCA/SELU)

Three TeamsThree Teams

• Contextual Inquiry/Contextual Design TeamContextual Inquiry/Contextual Design Team• Cultural anthropology (observations, interviews, coding)Cultural anthropology (observations, interviews, coding)• Design requirements, simulation scenarios and usability testingDesign requirements, simulation scenarios and usability testing• EvaluationEvaluation

• Technical Infrastructure TeamTechnical Infrastructure Team• Collaborative tool developmentCollaborative tool development• Synthesis of existing on-line clinical information resources (e.g., Synthesis of existing on-line clinical information resources (e.g.,

MIND/MINDscape and PACS images) into developed toolsMIND/MINDscape and PACS images) into developed tools• Medical data privacy and security, network QoSMedical data privacy and security, network QoS

• Telepresence (Folie Telepresence (Folie áá Deux) Team Deux) Team• Our advanced R&D team (augmented reality, immersion, etc. )Our advanced R&D team (augmented reality, immersion, etc. )• Technologies for human interfaces and collaborationTechnologies for human interfaces and collaboration

Conference AttendanceConference Attendance

FerndaleBellinghamAnacortes

Sedro WooleyArlingtonMarysville

Darrington

EverettForks PortAngeles Port

Townsend

Shelton

BremertonEastGraysHarbor

Aberdeen

ShoalwaterBay

CathlametWahkiakum

County

MasonCounty

VancouverWhiteSalmon Goldendale

ToppenishEast LewisCounty

AuburnSnoqualmie Wenatchee

EphrataQuincy

OthelloOdessaCle Elum

EllensburgYakimaWapato

Grandview Dayton

OrovilleTonasket

Omak

GrandCoulee

RepublicNorthPendOreilleCountyChewelah

Newport

Colville

Orcas IslandFriday Harbor

Island CountyOak Harbor

OlympiaMadiganUS Army

Tacoma

Spokane

RitzvilleColfax

Pullman

Carnation

SouthBeach FamFam

FamFam

FamFam

FamFam

FamFam

Ob/GOb/G

FamFam

IntMdIntMd

XFamFam

IntMdIntMdOb/GOb/GPedsPeds

FamFamIntMdIntMdPsychPsych

FamFamOb/GOb/GPedsPeds

2 xFamFamOb/GOb/GPedsPeds

XA

A

FaFam m

FaFam m

FaFam m

FaFam m

7 xSeattle

FaFam m

Bozeman

Great Falls

Lolo

Superior

RonanLibby

WhitefishColumbia

Falls

Browning

Cut Bank

Shelby

Conrad

Choteau

Chester Havre Harlem

St. Ignatius

Helena

PhillipsburgHamilton

DeerLodge

Dillon

Sheridan

Ennis

ThreeForks

Livingston

Red Lodge

Big Timber

Harlowton

Columbus

Roundup

Lewiston

Glasgow

Plentywood

Culbertson

Sidney

Wolf Point

Glendive

BakerMiles City

FamFam

PedsPedsFamFam

FamFam

IntMdIntMdMissoula

XBillings

IntMdIntMdFamFam

FamFam

A

SandPoint

PinehurstSaint

Maries

Moscow

Troy

Grangeville

McCall

Salmon

RigbyRexburg

DriggsHailey

Mountain Home

Twin Falls

JeromeWendell

ShoshoneRupert

Malad CityPreston

Montpelier

Blackfoot PocatelloAmerican

Falls

Council

Emmett

Caldwell

Nampa

BoiseFamFam

IntMdIntMdOb/GOb/GPsychPsychSurgSurg

IntMdIntMdFamFam

Orofino

FamFamXFamFamPedsPeds

AFairbanks

Juneau

Ketchikan

Kodiak Island

Kotzebue

Metlakatla

PetersburgWrangell

Sitka

HainesCordova

Glenallen

Seward

ValdezPalmer

Wasilla

KenaiSoldotnaHomer

FamFam

AnchorageFamFamOb/GOb/GPsychPsych

FamFam(planned)

A

Note: Alaska not to scale

U N I V E R S I T Y O F W A S H I N G T O N S C H O O L O F M E D I C I N E

WAMI Program Site Maps

Residency SitesResidency Sites

IntMdIntMd

PsychPsych

FamFam Family PracticeInternal MedicinePsychiatry

Clerkship SitesClerkship Sites

PedsPeds

Family MedicineInternal MedicineOb/GynecologyPediatricsPsychiatrySurgery

PsychPsych

SurgSurg

FamFam

IntMdIntMd

Ob/GOb/G

FaFa m m indicates presence ofboth Family MedicineClerkship and FamilyPractice Residency

WAMI FirstYear Sites

CommunityHealth ServicesDevelopmentSites (CHSD)Rural / UnderservedOpportunitiesProgram PreceptorSites (R/UOP)

Area HealthEducation CenterSites (AHEC)

A

indicates presenceof both CHSD and RUOP

LEGEND

Laramie

Cheyenne

Casper

FamFam

FamFamA

A

Rawlins

Newcastle

Greybull/ Basin Sheridan

Torrington

Green River

Thermopolis

Biomedical Applications of the NGI - Phase 3Biomedical Applications of the NGI - Phase 3

• Vision: extend infrastructure/tools from Phase 2 to demon. Vision: extend infrastructure/tools from Phase 2 to demon. with SCCA affiliates throughout broader multi-state regionwith SCCA affiliates throughout broader multi-state region

• Treat the resultant ‘product’ of Phase 2 as a clinical trial in Treat the resultant ‘product’ of Phase 2 as a clinical trial in Phase 3 (IOM global telemedicine evaluation framework)Phase 3 (IOM global telemedicine evaluation framework)

• Use of multicast capabilities for conferencing “n” sitesUse of multicast capabilities for conferencing “n” sites

• Multi-resolution and multi-rate solutionsMulti-resolution and multi-rate solutions

• Tx info. from referring instit. for conference/patient mgmtTx info. from referring instit. for conference/patient mgmt

• How effective at providing a collaborative environment?How effective at providing a collaborative environment?