BRAVO/TeleTrend: a comprehensive WWW-based neuromonitoring system for the neurosurgery ICU

This paper describes BRAVO/TeleTrend--a comprehensive client/server-based system for remote access, review and analyses of continuously acquired multiparametric physiological data from Intensive Care unit (ICU) patients. The system is designed as a distributed three tier model and implemented in Java (Sun Microsystems). TeleTrend is a data review package, which interfaces to existing physiological bedside monitors such as the BRAVO suite of products (Nicolet Biomedical, Madison, WI) and the vital signs monitors compatible with the Unity Network (Marquette Electronics, Milwaukee, WI). It does not transfer over the web the entire patient record, which can be hundreds of megabytes. Instead, it provides tools to view a compressed representation of the raw data in a trend display and to zoom into the raw data if needed. Thus, it eliminates the need for a high-bandwidth Internet connection and makes possible the use of a slower modem access to the vast amount of physiological data acquired per patient. In addition, TeleTrend features a rule-based module capable of generating clinical alerts, which is a potentially useful tool for neurointensivists and other critical care personnel. Finally, TeleTrend is intended as a multi-user, semi real-time telemedical application, which features built-in white-board and chat components. These components allow several physicians at different locations around the world to simultaneously view and brainstorm over critical chunks of continuously recorded raw and trend data. By allowing the end-user user to switch on-the-fly from monitoring patients in one ICU to those in another, and by integrating an HL7 interface TeleTrend steps over the boundaries of a single ICU. Thus, it can be provide a medical enterprise-wide solution to the remote access of an important component of the electronic patient medical record. Currently in house validation, verification and alpha testing of the system are underway.