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The AFHCAN Office developed a hardware platform to support biomedical devices for telehealth applications, a software application to allow telehealth cases to be created and read by providers, and a statewide network to connect the 248 sites throughout Alaska that are involved in the AFHCAN Project. Every effort has been made to assure that the design of these deliverables is innovative and easy to use since many providers at the clinics are not technically literate, and a few do not speak English as a first language. A key innovative design was the adaptation of web-based technologies over satellite links to provide an easy-to-use interface at village clinics. For example, the software is designed to use simple but clear word choices and very specific color-coding for buttons. The use of a touch screen is a significant advance in going beyond the need for a keyboard and mouse, especially for technically challenged users. Examples of the design are shown below:
Step 1: This is the login page to start using the software.	Step 2: After logging in, the user has 4 choices. Selecting “Create a New Case” provides access to all the biomedical devices.
Step 3: The user may select any peripherals at this point. Selecting Video Otoscope starts the next screen.	Step 4: This is the view using the Video Otoscope. The live image is large enough to view and share with the patient. Controls are easily
It is difficult to maintain a simple user interface with a touch screen, and yet integrate sophisticated biomedical peripherals into this environment. The goal is to not require users to know anything about folders and drives, or file extensions, etc. A 12-lead ECG has been integrated in this manner, using a close collaboration with the manufacturer (Brentwood) to achieve a simple solution – users touch the [ECG] button and the Brentwood touch-compatible software is activated. When it completes, it returns a file to the AFHCAN software that is integrated into the case. The effect is that access to any biomedical peripheral, once the user logs in, is never more than 3 touches of the screen away. This is important. This means that users may walk up to a cart, login, then easily use the devices on the cart for a patient exam. This is in contrast to many other systems, which require a comprehensive form to be filled in before using any devices. On the AFHCAN system, users know they can easily discard the results without having to send the data, and are more likely to use the devices for a routine exam. The significant benefit is the equipment gets used more often because it is not just used when data has to be saved or sent, and it enables the provider to be more familiar with the device and more capable of capturing quality data. Involving the patient in this exam (as the images are clearly displayed for the patient to view) also improves health care. The AFHCAN office developed an innovative mobile cart that is robust, mobile, and scaleable. The cart is small enough to fit through doorways at most clinics, has large rubber wheels to negotiate uneven floor surfaces, has a low center of gravity to minimize instability, and is designed to meet the ergonomic needs of a wide variety of users. The cart is electrically isolated to minimize leakage current, is fully resistant to the wild power fluctuations seen in village clinics, and can run for up to 70 minutes on battery power. A cart even survived a power surge at a clinic that caused light bulbs to explode. To reduce support problems due to breakage of network wiring, all carts are connected through an encrypted wireless connection to an access point. This allows carts to roam up to 300 feet within any clinic, and still connect to the telehealth web server. Recognizing that a variety of digital cameras are used at sites, all carts are equipped with "trimedia" readers, allowing digital camera images to be read from floppy disks, CompactFlash cards, and SmartMedia. All items on the cart were carefully selected after a rigorous testing process and careful scrutiny. The scanner can detect the size and position of the document placed on the scanning surface - and then automatically set the scan area, color depth, and pixel density. The monitor has a backlight with a MTBF (mean time between failure) of 50,000 hours and provides the best diagnostic quality images of any monitor tested. The touch screen that is added to the monitor is specifically resistant to abrasion and vibration, and can be cleaned using standard glass cleaners (an important issue as other touch screens are readily damaged through cleaning).
The custom top shelf allows the video otoscope to sit high enough so that the cables do not drag on the floor, and the custom designed hook protects the hanging probe. The desktop surface has angled recesses that prevent the otoscope cables from being crushed when the cart is shoved against a wall. The surface of the desktop was specifically selected to provide a good optical surface for the optical mouse to work properly. The CPU was selected for minimal power and maximum performance, and has room to expand to more peripherals (3 spare video inputs, 3 spare PCI slots, and spare USB, Firewire, and parallel ports).
The entire cart has a very tight "cable management," with the result that virtually all cables are hidden from the user and immune to "pulling" or damage. Finally, every peripheral on the cart is firmly attached to the cart to minimize dislodging during movement. As an example of this, one cart was recently rescued from a burning village clinic and moved to a nearby classroom and continued to operate without a single item being dislodged during this process.