Betty A. Levine

Deployable teleradiology and telemedicine for the US military

The US military has been an effective proponent of digital imaging and teleradiology for the past 15 years. A digital imaging network that can eliminate the use of X-ray film can make the requirements simpler for military medicine. X-ray film requires the storage of new, unexposed films that have a fixed shelf life, and the storage and use of chemicals and water for processing. In some deployed situations, the chemical discharge has to be collected and shipped out of the deployed area. The technology of electronic imaging is therefore intrinsically important to military medicine. In December of 1995, the US government started to deploy 20000 US troops to Bosnia-Herzegovina as part of NATOs peace keeping operation (IFOR). A full complement of medical support facilities was to be established in the Bosnia region and Hungary where the deployment was staged. Primetime III was a project to deploy telemedicine and teleradiology capabilities linking these medical treatment facilities (MTF). The deployment of telemedicine was not the responsibility of our engineering team. This paper deals with the deployable teleradiology (DEPRAD) system that was installed by the ISIS Center at a number of facilities for filmless radiology and teleradiology services.

Diabetes home monitoring project

The objective is to study the feasibility of remotely monitoring people with diabetes using low-cost technology. Using a personal computer, randomly chosen people with type I diabetes transmit their diabetes related data to their physician at Georgetown University Medical Center on a weekly basis where he analyzes it and contacts the patient every week to make safe adjustments to diet, exercise plan and insulin dose to prevent different kinds of diseases. Based on the data received the physician at the Endocrinology Department was able to early correct blood glucose levels for many patients enrolled in the program and prevent many possible clinical complications. This preliminary study indicates that tight monitoring people with diabetes and frequent patient physician communication and feedback utilizing a low-cost technology can significantly lower the risk of getting diseases and avoid costly short and long term hospitalizations and ER visits thus increase the quality of life and life expectancy.

Media attitudes vs. use: the contribution of context to the communication environment in telemedicine.

Media attitudes and media use have been the focus of considerable academic research. This article uses this research to explore patient and health care practitioner attitudes toward telemedicine interactions via videoconferencing technology.

Potential impact of HITECH security regulations on medical imaging

Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act (ARRA) of 2009 [1] include a provision commonly referred to as the “Health Information Technology for Economic and Clinical Health Act” or “HITECH Act” that is intended to promote the electronic exchange of health information to improve the quality of health care. Subtitle D of the HITECH Act includes key amendments to strengthen the privacy and security regulations issued under the Health Insurance Portability and Accountability Act (HIPAA). The HITECH act also states that “the National Coordinator” must consult with the National Institute of Standards and Technology (NIST) in determining what standards are to be applied and enforced for compliance with HIPAA. This has led to speculation that NIST will recommend that the government impose the Federal Information Security Management Act (FISMA) [2], which was created by NIST for application within the federal government, as requirements to the public Electronic Health Records (EHR) community in the USA. In this paper we will describe potential impacts of FISMA on medical image sharing strategies such as teleradiology and outline how a strict application of FISMA or FISMA-based regulations could have significant negative impacts on information sharing between care providers.

Incentives to create and sustain healthy behaviors: technology solutions and research needs.

Health-related technology, its relevance, and its availability are rapidly evolving. Technology offers great potential to minimize and/or mitigate barriers associated with achieving optimal health, performance, and readiness. In support of the U.S. Army Surgeon Generals vision for a System for Health and its Performance Triad initiative, the U.S. Army Telemedicine and Advanced Technology Research Center hosted a workshop in April 2013 titled Incentives to Create and Sustain Change for Health. Members of government and academia participated to identify and define the opportunities, gain clarity in leading practices and research gaps, and articulate the characteristics of future technology solutions to create and sustain real change in the health of individuals, the Army, and the nation. The key factors discussed included (1) public health messaging, (2) changing health habits and the environmental influence on health, (3) goal setting and tracking, (4) the role of incentives in behavior change intervention, and (5) the role of peer and social networks in change. This report summarizes the recommendations on how technology solutions could be employed to leverage evidence-based best practices and identifies gaps in research where further investigation is needed.

Conversion to use of digital chest images for surveillance of coal workers' pneumoconiosis (black lung)

To protect the health of active U.S. underground coal miners, the National Institute for Occupational Safety and Health (NIOSH) has a mandate to carry out surveillance for coal workers pneumoconiosis, commonly known as Black Lung (PHS 2001). This is accomplished by reviewing chest x-ray films obtained from miners at approximately 5-year intervals in approved x-ray acquisition facilities around the country. Currently, digital chest images are not accepted. Because most chest x-rays are now obtained in digital format, NIOSH is redesigning the surveillance program to accept and manage digital x-rays. This paper highlights the functional and security requirements for a digital image management system for a surveillance program. It also identifies the operational differences between a digital imaging surveillance network and a clinical Picture Archiving Communication Systems (PACS) or teleradiology system.

The executive summary of the National Forum on the Future of Defense Health Information Systems.

The Department of Defense (DoD) has been engaged in the development and deployment of the longitudinal health record (LHR). It has achieved remarkable technological success by handling vast amounts of patient data coming from clinical sites around the globe. Interoperability between DoD and VA has improved and this information sharing capability is expected to continue to expand as the defense health information system becomes an integral part of the national network. On the other hand, significant challenges remain in terms of user acceptance, ability to incorporate innovations, software acquisition methodology, and overall systems architecture.

Development of a secure medical research environment

The confidentiality of medical information, including patient data security, is an increasingly important issue in todays health care environment. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the Department of Health and Human Services to create specific rules for managing the security and privacy of computer-based patient medical records. In November 1999, the Department of Health and Human Services implemented the privacy requirements of the HIPAA proposal to improve the effectiveness of public and private health programs by protecting individually identifiable health information. We give a brief description of some widely used security measures. We also address the steps that were taken at the Imaging Science and Information Systems (ISIS) Center at Georgetown University to secure our research environment and the patient medical information used within the network, and describe our efforts to become more HIPAA compliant. The paper concludes with some clinical applications.

Telemedicine and dialysis

More than 280,000 patients are treated by hemodialysis in the USA. The first-year annual adjusted mortality is very high and, in part, relates to the dose of the delivered dialysis (Kt/V). Using multimedia telemedicine, we have been following dialysis patients for over one year with a weekly telemedicine visit in addition to weekly physician visits, in an attempt to maintain compliance with the dialysis schedule, in addition to comprehensive medical consultation. Transmission is achieved with T1 lines from the clinic to the physicians office or home. The telemedicine session uses electronic patient folders containing relevant medical details, digitized X-rays, lab values, etc. We are able to achieve high-quality videoconferencing, capture still or video images, record remote stethoscope sounds, capture local or remote data and modify the medical record. Our goal is to increase the quantity of delivered dialysis and thereby improve quality of life and patient satisfaction, and reduce the costs of medical care, at the same time maintaining patient confidentiality. Appropriate measures to ensure data integrity and patient confidentiality have been integrated into the study. Questionnaires are also utilized to measure, on an ongoing basis, quality of life and patient satisfaction, while a weekly questionnaire captures any medical event taking place. The project is nearing completion, with subsequent data analysis to take place in the following six months. The system and procedures we have employed are accepted enthusiastically by patients and staff alike, and have aided in patient management.

Telemedicine: Future Promise for Dialysis Management

James F. Winchester, Betty Levine, Jeff Collmann, Kevin A. Schulman, Jeanine W. Turner, Saif Rathore, Nasib Khanafer, Adil Alaoui, Neela Pania, Arwa Al-Awaa, Lance Hoffman, Marisa Hofilena, and Seong K. Mun Department of Medicine (JFW, MH), Department of Radiology, Imaging Science and Information Systems Center (JWT, BL, SKM, JC, AA), Clinical Economics Research Unit (SR, NP, KAS), Georgetown University Medical Center, Washington, D.C., and School of Engineering and Applied Science, Institute on Computer and Telecommunications Systems Policy (AAA, LH, NK), George Washington University, Washington, D.C.