DRAFT 11/17/1999

BALCH-WARNER-------- DRAFT 01/04/2000

INTELLI-MED-COM-MATRIX

Knowledge on demand services infrastructure

“ Strong Angel”-- Distributed Medical Intelligence

“Strong Angel” an experiment in Civil-Military Operations for Humanitarian Assistance

Project Strong Angel is a humanitarian focused extension to the RIMPAC 2000

Naval exercise conducted jointly by the Pacific Rim countries.

The Strong Angel project is bringing focus, energy and resources to the development of new knowledge for refining advanced applications of emerging technologies to meet the requirements of developing a globally deployable, intelligently configurable medical communication

matrix

“METHODS AND METRICS FOR MAPPING THE MEDICAL MATRIX”

This is a world class adventure/learning experience in Interventional Informatics and Distributed Medical Intelligence

We are planning to establish a telecommunications link that will facilitate multiple T-1 bandwidth channels for the first 20 days of June, 2000. The two sites we need linked are the northwest corner of the Big Island of Hawaii on a region called Puu Paa ( 019.59.11.6 North 155.42.15.2 West, 3400’ altitude) to the Bridge at ECU (035.48.69 North 078.13.66 West 20’ altitude) in Greenville, North Carolina.

Testing of an intelligent medical communication matrix

A medical communication matrix, comprised by a heterogeneous array of networked and “roaming” communication assets, biosensors and distributed knowledge resources with intermittent connectivity and various bandwidths and protocols will be configured and systematically tested.

Applications such as provision of health care in a humanitarian crisis, transmitting reliable biomedical sensor data, public health monitoring, health education and medical knowledge on demand services will be tested in an environment designed to provide a realistic measure for determining the actual usability, reliability and operational functionality needed to support such a variety of biomedical communications

applications which will be needed to effectively respond to real world needs.

Some of the intended outcomes-

Study the impact of new infrastructure, services and applications in the design and implementation of an operational global emergency response capability.

Promote experimentation with the next generation of medical communications technologies, in ways that will allow us to examine the demands for technical characteristics such as bandwidth, quality of service, security, and access; and recommend an appropriate strategy for implementing these capabilities in future instantiations

We plan to do general telemedicine consults in 10 different specialties with the simulated refugees in the makeshift camp. We also plan to test a variety of CODECS (compression/decompression) technologies for the transmission of real-time video, diagnostic imaging, vital-signs monitoring, and anthrontronic controls. The goal is to build partnerships with international experts in providing on-demand bandwidth, clinical expertise, and next generation internet tools for medicine.

ECU will provide a functional Telemedicine Practice Suite at the remote site, and a Bridge capable of multi-site ISDN, T1, and ATM connectivity. The Telemedicine Practice Suite will consist of clinical tools, IP and conventional CODECS, and support software.

The following support technology is still needed for Strong Angel:

T1 wireless connectivity from Hawaii to North Carolina

2 Portable ground stations (full duplex 1.5 mb/s minimum)

2 T1 Multiplexors

768kbps Bandwidth to the internet

Power source (generator or solar) for remote operations

Wireless 100mbps network with 5 mile range

Ethernet router, hub, and network cards

This setup will be configured to support real-time IP video, NGI, biosensors through telemetry, and store/forward clinical telemedicine applications. In essence, we are building a nomadic computing network matrix with links to the 7 countries participating in the Strong Angel exercise through the ECU Bridge. The long-term goal is to build a global infrastructure which is NGI compliant and can support clinical needs as part of disaster response in a global environment.

We will evaluate frame-rate loss, video degradation, audio drop-outs, audio/video synchronization, and data retransmissions. The telemedicine application will provide the inputs to the IP CODEC. The codec will connect to the Ethernet router and hub. The network management protocol will be TCP/IP.

We will need this network link in place June 1 through June 20. We will need confirmation on available bandwidth by the end of this month. We would like to have at least 2 T1’s in place to test different network architectures.

Disaster recovery efforts from around the world have become a special focus of the Telemedicine Center at East Carolina University (ECU) http://www.telemed.med.ecu.edu and the Institute for Interventional Informatics (I3) (www.pulsar.org). Over the past 10 years ECU has been providing clinical consultations to rural North Carolina in over 30 different medical specialties. Recently funded by the National Library of Medicine (NLM) and the National Institutes of Health (NIH), we are currently building a knowledge base for the practice of Telemedicine over Next Generation Internet (NGI). We have built a diverse team of clinicians and technicians with extensive resources and expertise. We are now able to rapidly assess technology requirements at disaster sites, identify providers and other resources available from anywhere in the world, deploy scaleable telemedicine systems, and provide training to laypersons and medical professionals.

Most recently, The Telemedicine Center at ECU demonstrated its real-world experience and practical methods to provide relief efforts for the short term and long term health problems affecting the citizens in our region in the aftermath of Hurricane Floyd. Ten’s of thousands of people were affected, many needing medical care that ranged from acute injuries to chronic, long term care. The Telemedicine Center at ECU set up emergency telemedicine systems in area shelters isolated by floodwaters and hurricane damage. In rapid response time, telemedicine equipment was airlifted into these areas and military vehicles were used to move personnel between sites. Inside make-shift clinics our telemedicine team established inexpensive videolinks, set up portable videophone systems, and provided crash course training sessions for volunteer clinic staff. Currently, the critical use of the telemedicine in disaster relief seems to be communication between medical staff, triage of acute illnesses, management of chronically ill patients, and mental health care counseling.

A global exercise like the one described below (Strong Angel) will help us further refine the applications for Telemedicine in disaster relief. As part of ECU’s NLM/NIH contract to develop next generation Telemedicine tools, technical and clinical protocols, the Telemedicine Center plans to participate in the RIMPAC2000 (code name Strong Angel) exercise scheduled for June 11-16, 2000. The RIMPAC project is a civilian-military humanitarian exercise organized by the United States Navy Third Fleet. Contributors to the demonstration project include various branches of the United States military, United Nations relief organizations, and members of academia and the private sector. The project is designed to build extensive knowledge and experience in developing a response plan for the delivery of human aid, medical support, supplies and medical information. For this exercise, we plan to establish an interactive Telemedicine link between a remote area in Puu Paa, located off the northwest corner of the Big Island of Hawaii and a Bridge at East Carolina University (ECU). The Bridge at ECU willl facilitate global connectivity to medical facilities on the U.S. mainland and the seven countries participating in this exercise. Through this connection, the Center will demonstrate how to implement a telemedicine rapid response model, in which hybrid communication technologies will be deployed to create a referral matrix for medical assistance in disaster situations. Specialized Telemedicine toolkits will be deployed that can be adapted to the information architecture of any location or type of disaster on the planet. The knowledge base built from this exercise will facilitate a real-world plan for Telemedicine in global disaster response.

We intend to refine our ability to test experimental protocols which can facilitate development, adoption, deployment, and operation of an affordable communications infrastructure, capable of supporting differentiated Quality of Service (QoS) based on applications requirements of effectively responding to an emerging humanitarian crisis in a wide variety of regionally specific constraints.

Coordinate adoption of agreed working standards and common practices among participating institutions to ensure end-to-end quality of service and interoperability Refine experiments to test enhanced delivery of services (e.g., health care, environmental monitoring) by taking advantage of "virtual proximity" created by an advanced communications infrastructure.