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Wednesday, November 24, 2010

HPCC Program Management


  HPCC Program Management
The HPCC Program reports to the Director of the Office of Science and Technology Policy. At his direction, overall Program budget oversight is provided by the National Science and Technology Council through its Committee on Information and Communication. In September 1993, the National Coordination Office for High Performance Computing and Communications (NCO) completed its first year of coordinating the HPCC Program and serving as a liaison to the U.S. Congress, state and local governments, foreign governments, industry, universities, and the public.
The High Performance Computing, Communications, and Information Technology (HPCCIT) Subcommittee and its Executive Committee coordinate Program planning, budgeting, implementation, and review; meet with other Federal organizations with mutual interests; and communicate with other Federal agencies and the U.S. Congress. In FY 1994, the Subcommittee met with technology experts from leading hardware, telecommunications, and software companies. The representatives were asked to comment on the Program and provide advice on technical and programmatic issues in high performance computing and communications. Similar meetings are planned with other constituencies.
HPCCIT working groups coordinate the efforts in the various Program components. The newest one, the Information Infrastructure Technology and Applications Task Group, established in 1993, has developed coordinated agency plans for R&D in NII technology and National Challenge applications. The networking working group coordinates its activities with the Federal Networking Council (FNC) whose membership extends beyond HPCC. The FNC establishes strategy and policy direction, provides further coordination, and addresses technical, operational, and management issues of the Interagency Internet. Its Federal Networking Council Advisory Committee represents a broad spectrum of network users and providers. Both individual agencies and these working groups sponsor meetings with industry and academia, including biennial meetings with hardware vendors to discuss plans, and periodic Grand Challenge workshops.


The early success of the HPCC Program is now providing it with one of its greatest management challenges, as more programs use its technologies, as new sectors of the economy are relying on scalable parallel systems, and as more people are becoming aware of its value to the Nation. The Program itself is highly leveraged across many other governmental and private sector programs, and the synergy between the emerging technologies and pilot applications of this R&D program is revealed in numerous other application areas. Practically every Federal agency has activities that are not part of the HPCC Program but that use the technologies and results from the Program. Some of those associated with agencies that participate in the Program are described in this document. Other education, health care, design for manufacturing, and related scientific research programs are not part of the HPCC Program but depend on HPCC technologies. The explosive growth of computing and networking will result in the pervasiveness of high performance computing and communications that are the foundation of the NII.

10. Information about the HPCC Program

In FY 1993, the NCO held some 50 meetings with representatives from the Federal and other governments, industry, and academia. The HPCC Program actively seeks input and advice from all interested parties.
The NCO has provided electronic, print, and video materials to hundreds of media representatives in the U.S. and abroad, and responded to thousands of information requests from Congressional offices, industry, academia, and the public. The NCO distributed over 20,000 copies of its FY 1994 Annual Report entitled "High Performance Computing and Communications: Toward a National Information Infrastructure." That 186-page book details Program goals, activities, accomplishments, and plans, and complements this shorter document. Some 300 copies of the six-minute minute video of the same name have been distributed. The video has been used in a number of television reports.

"Home Page" for the Mosaic interface to the HPCC WWW (World-Wide Web) server. Established in October 1993, this server was accessed by 900 users in February 1994. Its URL (uniform resource locator) is: http://www.hpcc.gov/
Mosaic was developed at the National Center for Supercomputer Applications (NCSA), an NSF Supercomputer Center. Mosaic may be the first "killer ap," that is, an extremely successful application in the National Information Infrastructure. Thousands of servers around the world can be accessed using Mosaic, which is available for Unix, DOS Windows, and Macintoshes.

In FY 1994, the NCO established World Wide Web and Gopher servers as well as anonymous FTP (file transfer protocol) capabilities for electronic dissemination of information about the HPCC Program over the Internet. The servers allow users to view and download information about the HPCC Program including the FY 1994 Annual Report, this FY 1995 Annual Report, information about sources of funding for HPCC R&D, and related materials. These servers also provide links to other servers, including those managed by HPCC agencies and the Information Infrastructure Task Force. At Supercomputing '93, held in November in Portland, OR, the NCO demonstrated these technologies and distributed materials to thousands of visitors.


High Performance Living Today and Tomorrow

High performance computing and communications have already had a profound impact on the lives of all Americans. Among the benefits: better prediction of natural disasters such as hurricanes; more rapid deployment of needed services in times of crisis; the use of more and more powerful computers to solve complex problems never dreamed of a decade ago.
In the past year, the concept of the "Information Superhighway" has captured the imagination of persons from all walks of life and around the country. Millions of Americans have discovered its precursor, the Internet. Millions more have read about it. Even more are vaguely aware that computers can somehow help them obtain information rapidly and communicate instantaneously with others around the world.
Americans are also discovering that computing and communications help to save lives, direct scarce resources, and locate survivors. When an earthquake struck Southern California this winter, a record number of persons logged onto commercial and nonprofit networks to learn about the safety of loved ones.
A typical example is that of a 62-year-old woman in Arizona who was concerned that she could not reach her son in the Los Angeles area following the quake. She called her brother near Indianapolis who called his son in Dallas, who in turn used his home computer to inquire about the whereabouts of his cousin. Several hours later, a total stranger in California called the mother to report that her son was unhurt.
A record cold spell and snowfall paralyzed much of the East Coast this winter. Tens of thousands of businesses were closed. What happened? Hundreds of thousands of workers stayed home, but many of these continued working. As snow and ice blanketed the East Coast, they communicated electronically and telecommuted while avoiding the icy roads. Similarly in California after the quake, where demolished freeways and unstable buildings made a normal business routine nearly impossible, a record number of workers and businesses turned to telecommuting as the region began to rebuild.
Imagine the possibilities with a ubiquitous information infrastructure, one accessible by all Americans, which allows users to use two-way video as easily as they use the telephone or fax today.
The Federal government and the HPCC Program firmly believe that the NII should and will be built primarily by the private sector. One role of government in this monumental undertaking will be to conduct government information intensive activities in ways that support the testing, development, and deployment of new technologies to meet the nation's networking and computing needs in the coming century.
The following scenarios illustrate how high performance computing and communications and the NII can benefit all Americans in the coming years. Many of these activities are already or will soon be taking place in research and educational settings. Much of the future described is already here, but only for a relatively small number of users. The challenge faced by the government is to ensure that these benefits are accessible by all Americans from all walks of life. And that we spur the development of the best possible technologies for a truly National Information Infrastructure to be shared equally by all our citizens.



CRISIS MANAGEMENT: EARTHQUAKE RELIEF IN THE YEAR 2000

A series of minor tremors along a major California fault line over the past two months has fueled more than premonitions that "the big one" might soon come. Real-time assessments of the probability and potential location of a severe earthquake have been continuously relayed to state and local emergency managers via the National Information Infrastructure. In turn, these managers use their real-time logistics and management control system to determine the state of readiness in each community within the region.
These last minute preparations are just in time. Within seconds of the massive earthquake, real-time computer analysis of seismic monitoring data from a broad array of sensors placed across the region and nation pinpoint the location and magnitude of the quake. Before the initial jolt is over, an automated regional resources management system combines the new data with a large data base that describes in detail the geological structure of the area. A map appears showing the areas most likely affected, and the kind and degree of earth motion expected in each area.
This geographically referenced information is consistent with a standard geographic encoding of the area, which enables other emergency response systems to spring immediately into action.
Within the first 30 seconds of the onset of "the big one," this information is fed into still another interconnected computer system that contains a detailed data base of buildings, highways, and other structures in the affected area. The system shows the expected ability of these structures to hold up after the kind of earth motion just experienced and that to be expected as a result of aftershocks from a quake of this magnitude.
Another database predicts the expected distribution of people in those areas, taking into account the time of day, special events that are underway, and real-time data for hotel and theater occupancy rates, traffic distribution, and the location of hazardous materials in every building, truck, and train throughout the area.
Still within a minute of the initial jolt, a master database combines all this and other data, such as the prevailing and forecasted weather conditions, to create an instant picture of the likely nature and extent of this major emergency.
Alarms are quickly activated in emergency control centers, fire and police stations, hospitals and other medical care centers, and in the offices and homes of local, state, and federal emergency officials. By the end of this first minute, "informed" emergency bulletins immediately interrupt the routine in all schools, offices and homes in the area, providing a concise message of what has happened and what to do.
As a result, emergency resource teams are deployed within a few minutes of the quake, knowing where they are most needed and what types of injuries to expect. Hazardous materials response teams are dispatched to the needed sites, armed with current information about the location and nature of the hazardous materials and the latest weather data. Appropriate warnings are issued, allowing the general public to take immediate action to protect their safety.
In the hours following the quake, this information is updated continuously and is relayed to emergency support teams, hospitals, government officials, and private sector managers. Wireless interfaces and satellite links ensure the rapid transmission of critical information to teams working in areas where phone and electrical lines are disrupted. Community centers and others register millions of local residents for quick location by loved ones and a first step in emergency assistance programs.
The result? Thousands of lives saved through fast, appropriate emergency response, and billions of dollars of property protected from unnecessary danger, such as hazardous materials or other threats.


EDUCATION AND LIFELONG LEARNING

Advanced computing and communications technologies have revolutionized the way many students learn. Elementary school students correspond with electronic pen pals around the world, learning more about faraway lands, cultures and current events than from mere lectures; students from three geographically distant high schools collaborate to simultaneously measure the distance from the earth to the sun, learning invaluable lessons in math, science, and communications; other students visit distant art museums and other educational sites via "electronic field trips." Interactive multimedia encyclopedias and other learning tools allow students to select a myriad of information -- sound, video, maps, charts, and text -- on virtually any subject.
Because of high performance computing and communications, academic research will continue to change at an increasingly rapid pace. The many collaborations of scientists in the 1990s, such as remotely sharing scientific instruments and simultaneously working on scientific problems from distant sites, will, within a few years, likely result in even more and increasingly sophisticated collaborations involving geographically diverse researchers and institutions.
For example, a National Virtual Laboratory will allow geographically distributed researchers to share experimental results, collaborate on team research projects, and share coursework for their students who are also geographically distributed. Likely collaborations will include projects that are too expensive for one institution to perform, such as research on robotic vehicles.
Simulation-based education and training will increasingly be used for on-the-job training. For example, the aircraft industry has long used flight simulators for pilot training, especially in handling emergency situations. Today, simulation is also being used in training across the field -- while aircraft are still under construction, mechanics are learning maintenance and repair via computer simulation. By the time the planes are built, these mechanics will be able to confidently and efficiently maintain and repair the craft within weeks rather than the year it used to take.
Fifteen blocks from Yankee Stadium in the South Bronx, it is the elective period for several sixth grade students in P.S. 91. They are sitting in front of computers and are wearing headphones with attached microphones.
Renaldo is studying Chinese with two dozen other students scattered around the city led by a teacher in Queens. On the screen two children say, in Chinese, "It's nine oclock." The teacher asks Renaldo to repeat the phrase. "Very good, Renaldo," she says.
At the next desk, Laverne is working on a solid waste project with Cindy, her "key pal" in Schoharie County in upstate New York. Laverne and Cindy met when Laverne posted a question on a bulletin board about recycling. Cindy lives on a farm and organized a plastic recycling program when the local dump was in danger of exceeding its capacity.
Eric is in the music section of the library assembling material for his research "paper" about Duke Ellington. He attaches pieces of a 1942 audio recording and the 1959 video clip of "A Train" to illustrate the changes in orchestration styles between those times.
Mrs. Esformes, the classroom teacher, is "attending" a seminar on teaching visually impaired children. She has a blind student this term and she is comparing her experiences and techniques with 14 other teachers from around the city who are also working with severely visually impaired students for the first time. The leader of the seminar is a professor in Madison, WI.
The NII will also aid in lifelong learning, making it more accessible to millions of Americans. Jennifer, a secretary at a small marketing firm, wants to complete her college education and receive a degree in geology. Although the small business for which she works has no formal educational assistance program, they offer to let her use their computers and network connection on her off hours. During her lunch break, for example, Jennifer is enrolled in an interactive class on soil conservation. She is able not only to listen to and see the lecture, but can ask questions via a microphone at her workstation. If other classes, however, are not offered at a time she can attend, the computer can store the transmission of the class for later viewing. Questions can be mailed electronically to the professor, who can send answers back the next day. And when it is time to write a term paper on the effects of heavy rains in the Rocky Mountains, Jennifer can electronically access databases and academic and specialized libraries around the world. She retrieves, electronically, a topographical map of the Western Slope of the Rocky Mountains. Using a mouse, she moves an icon to a certain point on the ridge, and releases a drop of water to see which way it flows downhill. Using existing databases, she is able to create a scenario for the soil effects of heavy rain in the area, including the projected loss of specific minerals in the land.


ELECTRONIC COMMERCE

Imagine 20 years ago, being told that you could go to a city virtually anywhere in the world and receive instant cash with a wallet sized card. Not so many years ago, emergency cash on a weekend was something obtained from friends or relatives with ready money or through the graces of a check-cashing card at the local grocery store. Today, automated teller machines can provide cash across the country and around the world.
Automated teller machines have revolutionized the way we bank. Americans no longer try to fit their hours around the narrow "bankers hours" of yesteryear. And banking institutions have actually expanded their operations in response -- offering satellite banks in grocery stores, and evening and even Saturday hours. Commercial electronic shopping networks already exist; tax returns can be filed electronically. Why not online applications for loans or other financial needs that can be completed at home at one's leisure?
These are but a few examples of the many benefits electronic commerce can bring to American society. But, unless developed carefully and wisely, these benefits could carry enormous risks. To date, electronic commerce has taken place in protected networks maintained by banks or other businesses. Ensuring privacy, security, and authenticity is essential for a National Information Infrastructure.
Today's Internet is a fabulous example of what a little federal investment can stimulate. But it was designed as, and remains, a tool for research and education, an opportunity to explore what is possible and what works best. HPCC-funded gigabit testbed sites explore not only higher speed transmission of data, but how such data can best be used and shared in the real world, and how best to protect the privacy of its users. Applications such as electronic banking can benefit from these efforts.
Electronic brokering services are already demonstrating significant savings in time and money. The ARPA-funded Fast Brokering system for small purchases, for example, has proven in several pilot studies that it can operate five times faster than standard procurement procedures. When an item is needed, a data base search considers not only the lowest price, but the projected delivery date, and past performance by the suppliers, to determine the most suitable provider or providers for the item. Potential vendors are then notified electronically, or via fax or phone, and asked for price quotes and delivery dates. Currently in pilot use at some 20 military bases across the country, the system has reduced the number of days from the request for quotations to completed procurement from 96 to 20 days.
Under this system, intragovernment lines of funding are established with the broker, who then transfers the funds to the supplier upon acceptance of the delivery. New payment mechanisms, such as credit card or debit payments, will need to be integrated into the system to support the more spontaneous transactions demanded by consumers.
Consumers could receive price quotes on specific products as well as related reports on performance and customer satisfaction, and information on suppliers (such as store hours, delivery terms, warranties, length of time in business, and reports from consumer protection agencies such as the Better Business Bureau).
Electronic commerce will enable consumers to make more educated choices about their purchases, and at the same time, enable businesses and manufacturers to provide the kinds of information and products most needed by Americans.


BUYING A CAR IN THE YEAR 2000

Jim and Rhonda grudgingly agree it is time to buy a new car. They have held on to their old vehicle in part because of how much they hated their last car buying experience -- the hours spent at the library evaluating specific cars; the seemingly endless trips to car dealers where they were provided with little information other than glossy brochures; the hassles of getting a loan and new insurance; and the disappointment upon later learning that one of their neighbors bought the same car for much less.
This time, they think, maybe their computer can help. They know they need a larger vehicle for their growing family, but which is best -- a minivan or station wagon? A quick literature search pulls up independent reviews that outline the advantages and disadvantages of each model.
Still not sure which they would prefer, Jim and Rhonda review safety and performance reports on two minivans and two station wagons chosen from their initial search. The computer provides independently produced reports on consumer satisfaction, as well as the estimated maintenance and operating costs of each model.
The couple now decides to take a look at the candidate cars -- the automobile manufacturer's computer server allows them to see a video of the car, as well as make selections to view different colors, interiors, upholstery, and other options. The interactive display allows them to select options such as engine size, sound system, rear passenger air bags, and customized climate controls, while at the same time showing the estimated cost for these options and the impact on fuel consumption. This computer service actually allows the couple to custom design their car, choosing power brakes, for example, while bypassing power windows if they prefer. The availability of a car with the chosen options is shown at the bottom of the screen, along with an estimated delivery time for special orders. Reviewing the various packages available, the couple narrows their choice to two models.
While Jim and Rhonda could order their car directly from the manufacturer, like most drivers they want to experience for themselves how the car feels and handles, and find a reputable dealer near their home who can perform routine maintenance and handle repairs.
Using electronic "yellow pages," they request information on dealers carrying the two cars located within a 10-mile radius of their home, who also have service hours on Saturdays and until at least 8 p.m. on weeknights, and offer shuttle service to and from public transportation or work. These are displayed on a computer-generated map. Using the computer mouse to click on a specific dealer, information is displayed on the length of time the dealer has been in business, and other considerations, such as whether loaner cars are offered, and customer satisfaction rates.
Jim and Rhonda electronically notify two dealerships that they would like to make appointments for test drives on Saturday morning.
Using an electronic brokering service, the couple now checks information on the best advertised price for the cars, and whether it is best to lease or buy. The service also checks for the best loan terms available for a new car purchase, and offers electronic loan application forms that can be filled out, then electronically sent to the chosen lender. Another click and the couple compares insurance rates for the two cars -- is one more likely to be stolen and therefore more expensive to insure? How much can they save on insurance rates by investing in an alarm system? What company offers the best rates for their particular driving history and needs? Which has the greatest level of customer satisfaction in processing claims?
On Saturday morning, the couple test drives the two cars. That afternoon, they issue an electronic bid, which is answered by an electronic commerce service. They then pick the best offer and, upon acceptance, activate a process that orders their new car from the factory. Electronically generated loan and insurance procedures are carried out as well, so that a week later, when the dealer's shuttle comes to pick them up at their home, the couple signs the papers and drives home in their new car. "That wasn't so bad now, was it?" asks Jim. "No," responds Rhonda. "I can't imagine why I dreaded it so much. It was really quite fun."
Much of the technology described in this example of electronic commerce is available today, but on a far more limited basis. These innovative services will primarily be developed by private industry and public consumer organizations. The Federal government's role in these efforts will be to help develop the most effective technologies, ensure standards for interoperability of different multimedia systems, and spur the development of security measures to ensure privacy and protect against consumer fraud.
Advanced security protections such as encryption technology and authentication measures are crucial to the widespread use of electronic commerce, and the ability for Americans to conduct their business over the NII.
Services to support the publication, dissemination, and access of multimedia information will make electronic commerce readily available to the American public as well. Intelligent services will make it easy and convenient for first-time users to easily browse information spaces with a combination of speech and graphics and to delegate tasks associated with brokering to automated agents.
These services extend far beyond consumer convenience -- when Jim and Rhonda access the car manufacturer's computer, for example, it tracks the combination of features and options most sought by browsers, alerting the manufacturer to those that consumers are most and least interested in. A special option that is viewed frequently, but then rejected because of the price, could be popular enough to make in larger quantities for a lower price. These data, as well as those on what customers actually buy, can help auto manufacturers respond quickly to customer needs, and at the same time, increase their competitiveness in the global economy.

INCREASED PRODUCTIVITY THROUGH IMPROVED ENVIRONMENTAL DATA

The use of the latest information technology, coupled with more timely and complete environmental information provided by the government, is essential for U.S. industry to succeed in the highly competitive global marketplace.
American industry already makes substantial use of real-time and historical weather and other environmental information from NOAA to optimally route airplanes, trucks, and ships, thereby minimizing transit time and fuel consumption and assuring safer travel.
More timely access to more comprehensive environmental information will support both day-to-day and long-term business decisions by thousands of large and small companies. Marketing and distribution decisions, key ingredients in economic growth, are driven by readily available information. Companies are already using high performance computing technology pioneered by the HPCC Program to sort through extremely large volumes of data, seeking patterns for potential sales of products and services that will both minimize resource consumption and maximize bottom lines. Increased availability of the Nations vast amounts of environmental data on the NII will allow companies to improve the ways their inventory and distribution operations respond to changing weather conditions across the nation. This increases productivity and serves customers better. Weather sensitive indicators can be better factored into product development and marketing activities to achieve additional increases in productivity.

ENVIRONMENTAL MONITORING IN THE YEAR 2000

Michele, a biological oceanographer and fishing industry analyst, sits at her workstation at the Western Regional Environmental Center analyzing predictions for a record pollock catch off Kodiak Island. The source? Observations from an on-going cruise in Alaskas Shelikof Strait that suggest the recent El Nino-Southern Oscillation (ENSO) event is influencing the fish harvest in the area.
The analyst, whose job it is to guide the U.S. fishing fleet, has her doubts, however. She is accessing data from satellite-linked moored subsurface ocean sensors, polar-orbiting satellites, numerical forecasting models, and coastal sampling stations from the past three months. All these data indicate that warm tropical water has been progressively moving northward along the U.S. and Canadian Pacific coast. Real-time data from satellite-linked drifting buoys and current meter arrays, as well as ship surveys of fish egg and larvae, suggest a major circulation anomaly is occurring in the spawning region off the coast. In fact, what looked like a high catch year seems to be turning into an economic bust!
Observations from an on-going cruise in the area, as well as the beginning of disturbing reports from fishing boats also hint that something may be wrong.
Using a mouse, Michele clicks a satellite icon that downloads the most recent 24-hour set of visible and infrared imagery from NOAA and NASA ocean-observing satellites. After clicking another icon, a new window opens that allows her to extract and compile a time series of the last 30 days of infrared imagery from the NASA satellite database in Pasadena, CA, and the NOAA satellite database in Suitland, MD. Using tools available on the NII, she is able to quickly integrate these disparate data sets spread across the country and to create an animation that clearly shows the progression of warm tropical waters toward the Alaskan coastal region that serves as a safe nursery for pollock larvae.
In order to put this environmental event into perspective, Michele next queries the National Oceanographic Data Center ship observations data base in Washington, DC, for the past 50 years of sea surface temperature data. Using a graphical user interface available on the NII that lets scientists intuitively explore and visualize a variety of multi-dimensional data products, she zooms in on the North Pacific and quickly creates a 50-year animation loop of sea surface temperature. In another window of her workstation, she accesses the ENSO and Equatorial Undercurrent oceanographic database at the University of Washington. Next she creates a new graphical overlay of her data that suggests a long-term, phased relationship between equatorial processes and sea surface temperature in the northern Pacific. This visual observation is confirmed by running correlation and coherence analyses using a point-and-click time series package, available on the NII from the Scripps Institution of Oceanography in La Jolla, CA.
Based on these data, she is able to project nearby regions where the fish are likely to go. With another icon selection, she overlays several tracks of drifting buoy data and subsurface moored current meter data onto the satellite imagery. These data suggest that the planned track of an observation cruise underway will have to be modified to properly sample the new circulation feature and the whereabouts of the fish. To plan for the new cruise track, she checks the online National Weather Service's five-day weather forecast and the Navy's Pacific Ocean Circulation Model forecast for the study region.
The ship's captain is fully informed through the ship's onboard workstation, which is networked by satellite link to the shore-based support systems, of the relevant observational and environmental forecast information. He instantly accesses electronic maps and charts to plan a changed course. Several hours later comes the news -- yes, the fish have moved. Michele notifies the Northwest Pacific Fishery Council, which in turn issues a recommendation to relocate the commercial fishing activities.


DELIVERING HEALTH CARE TO REMOTE AREAS

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.


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