Lisa knew something was seriously wrong when the pain awakened her from sleep. She was no stranger to adversity, having lived her life in the Appalachian highlands where getting help with any sort of problem meant a long drive over winding mountain roads. But being a first-time mother-to-be brought special challenges, and this throbbing headache -- the worst she'd ever experienced -- made her sense of isolation as dark and deep as the nights sky over the Blue Ridge peaks. She picked up the phone and called the emergency number at the Valley Health Clinic. The nurse practitioner who answered the phone told her what she already knew: Dr. Clark, one of a few circuit-riding obstetricians who covered this sparsely populated part of the state, would be holding the coming days clinic hundreds of miles away. But the nurse added, "We'll be able to get his help as if he were right here," and directed Lisa's husband, Mike, to get her to the clinic promptly.
The couple arrived at the little clinic just as first light was outlining the nearby ridges. Lisa was worse, her vision becoming occasionally blurred. She knew the baby wasn't due for another four weeks, and she was scared that these symptoms might mean the baby was dying. The comforting words of the nurse, and her careful exam, helped to lessen the fear, but the findings were not good: Lisa's blood pressure was elevated and the fetal heart sounds were weak. The nurse said it might be a disease called "toxemia of pregnancy" and that she might need to go to the hospital. "Hospital! But that's a four-hour drive over the mountains, and if she could get better just by resting, we sure don't want to put her through that, Mike replied.
A few years before, the nurse and the family would have had to call Dr. Clark on the phone and get his opinion, an educated guess really, about whether to undertake the arduous journey. But high performance computing and communications had changed that. For the telemedicine workstation in this little two-room clinic now brought medical expertise from far away right to Lisa's side. Initiating a two-way video link, the nurse brought Lisa "face-to face" with the doctor, who had been reviewing the previous days X-rays at his own office workstation several hundred miles away. He greeted Lisa and observed from her expression that she was in much pain. He asked a few questions about the headache and vision problems, then asked the nurse to put the fetal ultrasound transducer on Lisa's abdomen. The image of the baby in the womb simultaneously appeared on the clinic workstation screen and on the distant physician's workstation. Dr. Clark guided the nurse to turn the sound beam right and left to obtain a better
"This certainly looks like toxemia," Dr. Clark said, "but something else is going on as well -- the baby's heart rate is intermittently slowing for some reason. Try moving the ultrasound probe over here." Using an on-screen marker, he pointed out the baby's head and neck, and the nurse tilted the pencil-like probe that rested lightly on Lisa's abdomen. "There it is!" the doctor exclaimed, as the outline revealed the umbilical cord wrapped several times around the baby's neck. As the child moved in the womb, the umbilical blood supply was occasionally pinched and the babys heart rate slowed down, a sign of fetal distress.
Lisa would need a Cesarean section to preserve the baby's health. What might have been an educated guess and an unexplained abnormality before high performance computing and communications was instead a certain diagnosis. And the hospital caring for her was well prepared for immediate action upon her arrival. The nurse used multimedia privacy-enhanced electronic mail to send the ultrasound images, electrocardiograms, and even Dr. Clark's video interaction with the patient to the receiving hospital staff. A simple point-and-click interaction on the workstation screen gathered the various signals and images. Together with copies of Lisa's prenatal care clinic notes, the nurse sent a comprehensive electronic patient record to the distant facility. When Lisa arrived later that day, the ward staff recognized her immediately and welcomed her as if she were an old friend.
The baby girl delivered by Cesarean section that afternoon started life a few weeks early, but grew and thrived. It would be many years before she could comprehend or even spell "National Information Infrastructure," but her mom would say, "We had to save your life when you were just a picture on the screen." The decisions made with speed and certainty that fateful morning depended on many information technologies: ubiquitous high speed digital communications techniques; medical computer workstations with advanced motion graphics and video; and secure methods to protect confidentiality and privacy of network communications. This young mother in rural Appalachia still doesn't know much about computers, but she knows she got speedy and effective health care. And she knows the bright eyes of a healthy child, brought safely into the world with the help of high performance computing and communications.