Networked Computing for the 21st Century Telehealth

	Research in telehealth Computer-based patient records (CPR) Clinical decision support systems (CDSS) Research databases CPR in telehealth
Research in telehealth	A major goal of Federal CIC R&D investments in telehealth, or remotely-provided healthcare, is to close the gaps in healthcare expertise that exist between major urban medical centers and remote rural healthcare facilities. NLM, VA, and AHCPR support numerous telehealth projects. Cardiology, dermatology, ophthalmology, pathology, psychology, radiology, and surgery (endoscopic/laparoscopic) are some of the application areas where telehealth has been tested and evaluation has begun.
Computer-based patient records (CPR)	The primary function of the CPR is to support the delivery of medical care to patients by facilitating communication among healthcare providers and documenting the reasoning behind clinical decisions. CPRs can also be used to build information repositories about effective medical treatments that could improve population-based care.   CPR data can be entered from keyboards, by dictation and transcription, voice recognition and interpretation, light pens, touch screen terminals, and personal digital assistants. Data can also be input automatically via electronic patient monitors and bedside terminals, nursing stations, EKG systems, laboratory autoanalyzers, and clinical imaging digital systems.   Patient care data collected by a CPR system can be stored centrally or distributed, and can be retrieved by authorized users, who can then view the data as text, tables, graphs, sound, images, or full-motion video.
Clinical decision support systems (CDSS)	As a component of clinical decision support systems (CDSSs) -- software designed to aid clinical decision making -- CPRs can provide physicians with medical knowledge pertinent to patient care, such as diagnostic suggestions, testing prompts, therapeutic protocols, practice guidelines, alerts of potential drug-drug and drug-food reactions, and treatment suggestions. The link between the CPR and CDSS is the "knowledge server" that acquires the necessary information for the decision maker.   Knowledge sources range from the medical literature, which can be searched for review articles and specific subjects using NLM's Internet-based Grateful Med program to explore the Medline literature data base; to evidence-based practice reports sponsored by AHCPR; the Physicians Data Query program at NCI; other consensus panel guidelines sponsored by the NIH; guidelines developed by medical and specialty societies; and internal development and approval by a hospital's staff.   Software can provide rule-based alerts, reminders, and suggestions for the care provider when and where health service is delivered. This software can be developed as independent, portable modules. NLM's Unified Medical Language System (UMLS) provides a uniform medical nomenclature consistent with scientific literature, which is needed for widespread use of CDSSs.
Research databases	CPRs are useful in developing research data bases, medical knowledge, and quality assurance information. Outcomes research supported by AHCPR, such as evidence-based studies, can provide consumers, providers, administrators, and insurers with cost and medical effectiveness information. National repositories make systematic reviews such as statistical analyses possible. High performance computing and communications systems are needed to perform these population studies, retrieve data, produce information and knowledge, and send them to authorized users promptly and safely.
CPR in telehealth	Using CPR in telehealth permits the exchange of information between clinics and healthcare providers' offices in cities and rural areas, filling in the gaps where specialized expertise may not be available, thus allowing remote patients to receive proficient medical care. For example, digital images, such as MRI, should appear no different whether viewed at a patient's site of care or by a radiologist hundreds of miles away from the patient -- assuming compression and decompression algorithms that reduce transmission time and cost do not cause discernible loss of quality. Digital X-rays, on the other hand, are produced by scanning conventional film, making it necessary for radiologists to have training and specialized experience. In both examples, digital information can be assembled, shared, and discussed with appropriate specialists via telehealth communications links.