A severed hand appears on the screen, fingers curled slightly inward, the tips wrinkled like miniature prunes. A slight movement of the mouse causes the hand to rotate, giving first a view of the back, then of the two sides. With the external examination complete, the professor clears his throat and instructs the students to locate and expose the scaphoid on the hand on each of their computer screens. One student clicks her mouse and the skin on her "specimen" falls away to expose muscles, fatty tissue and bone. Another click peels away a second layer to reveal tendons, more muscles and bone. As the students work the professor monitors their progress, giving them feedback as they go.

At first glance this scene, although hypothetical, could take place in any anatomy class across Canada, but there is one important difference. In the scene above the professor is standing in Montreal, the students are sitting at computers in Sudbury and Thunder Bay, and the anatomical data on the severed hand is streaming to them all from Sunnyvale, California. Even the software used to render and manipulate the 3D image is located elsewhere; some of it in Sunnyvale, some of it at the National Research Council in Ottawa.

Given the current state of networks and technology this hypothetical class could now be in session, but only with a dedicated network of fixed connections between all the participating institutions, a solution that is both too expensive and too inflexible for most organizations to consider. A unique collaboration, however, between several universities, government laboratories and private companies, is on the verge of changing all that.

HSVO partners at a planning retreat held at the NOSM campus in Sudbury in August. Back row, left to right: Michel Savoie, Bobby Ho, René Richard, Martin Brooks, Bruce Spencer, David Topps. Front row, left to right: Sandy Liu, Parvati Dev, Rachel Ellaway, Kevin Smith, Jeremy Cooperstock, John Spence.

On June 26, 2008 CANARIE Inc. announced funding for The Health Services Virtual Organization (HSVO) under its Network-Enabled Platforms program. Spearheaded by the Northern Ontario School of Medicine (NOSM) and McGill University, the project brings together NOSM and McGill with Stanford and Lakehead Universities; the Communications Research Centre and National Research Council; iDeal Consulting and Innovation in Learning, Inc. CANARIE Inc. is Canada's advanced network organization and is supported by membership fees, with major funding of its programs and activities provided by the federal government through Industry Canada.

When the HSVO team met in CRC’s BADLAB in October, some partners joined by video conference (lower right). Images of a specimen hand appear on the BADLAB screens to the left.

The goal of HSVO is to create a virtual network designed to link the most advanced medical resources - data, devices and healthcare experts - to students and healthcare professionals at widely dispersed locations. When completed, users will have access to a state-of-the-art virtual network for use in training, patient treatment and research collaboration. Because the network is "virtual" rather than being based on fixed connections, users can form and create the network connections they require to suit their immediate task, whether that be an anatomy class at dispersed locations or interaction with a "virtual patient" located at a server in a distant city.

"Our role at CRC," says Michel Savoie, Research Manager for CRC's Broadband Applications and Optical Networks group, "is to look after network infrastructure. We need to verify that the physical connections are in place to all the participating sites, then we have to virtualize the network elements. That's what creates this virtual private network." And the challenges, he explains, are considerable.

To begin with, the resources, whether databases, experts, or interactive surgical mannequins, may be located thousands of kilometers apart. To provide the speed and interactivity the users demand thus requires large amounts of dedicated bandwidth simultaneously linking multiple servers to the users' computers. To complicate things further, the users are experts in medicine, not computers. They require access to complex services and tools - HD videoconferencing, Canadian Medical Association guidelines, virtual patient simulation - but this access must be seamless and simple, the result of a few clicks of a mouse.

The HSVO virtual network, says Savoie, will rely on two critical software technologies. The user interacts with a program called SAVOIR - developed by the National Research Council - through a "dashboard" of icons on their desktop. The icons represent the services and devices available through the virtual network. Once icons are clicked to open a session, SAVOIR orchestrates and manages the session, ensuring that all the dispersed services arrive and function on the users' computers, and all the session-users can interact both with these "Edge Services" and with each other. This involves SAVOIR contacting multiple servers located across North America, but the important thing, says Savoie, is that beyond clicking on icons and choosing a common channel for interactive sessions, this flurry of activity is hidden from the user.

"If you're a doctor," says Savoie, "you don't want to know all the particulars of how the virtual network has been set up and what needs to be done to make it work. You also don't need to know where all the software and the databases are located. All you need are the icons that represent the tasks you want to do."

To achieve the speed and interactivity needed by HSVO users, however, requires more than just SAVOIR's excellent management. It also requires high bandwidth dedicated for the duration of the session. To accomplish this, the virtual network relies on another program, ARGIA, developed by CRC. ARGIA is designed to create and manage lightpaths - dedicated links - even across independently managed networks and domains, a critical necessity for any widely dispersed virtual network. At the behest of SAVOIR, ARGIA opens the necessary lightpaths on a schedule, and in a manner, determined by its instructions from SAVOIR. An analogy, says Savoie, would be getting dedicated access to a superhighway.

"ARGIA not only gives you your own on-ramp," he says, "it gives you your own lane. Since there's no one in front of you, you can go as fast as you want. More importantly, you can set this up whenever you need it - whenever you have somewhere to go - and when you're finished the resource is then freed up for others to use."

Bobby Ho (left), Research Engineer with CRC’s Broadband Applications and Optical Networks group, demonstrates three dimensional potential of HSVO applications to partners wearing 3D glasses.

Since SAVOIR sessions and configurations can be saved, pre-scheduled, and organized to stop and start at specific times, the technology has enormous potential for distance learning and collaborative research. By the project's end in June 2010, HSVO will link McGill's Medical Simulation Centre and Shared Reality Lab (Montreal), the Northern Ontario School of Medicine (Thunder Bay and Sudbury) and a suite of edge services and devices. These will include access to 3D anatomical visualization through the Bassett Collection and the Visible Human database; the ability to participate from a remote location in cadaver dissections in Montreal; and virtual patient simulations supported by simultaneous access to treatment guidelines and bibliographic information services.

Beyond that, says Savoie, the future goal is to deploy ARGIA and SAVOIR on a computing cloud, possibly even a commercial computing cloud such as Amazon's Elastic Computing Cloud (EC2), allowing not only for transparent scaling of HSVO, but for a more efficient use of computing resources with a resultant decrease in carbon footprint.

"Our project," says Savoie, "won't address all the issues, but it will set the stage, take care of the initial implementation, and ensure that the design can grow to accommodate what is needed when the full HSVO virtual network is developed."

For more information on CRC's role in HSVO contact Michel Savoie, Research Manager, Broadband Applications and Optical Networks, at 613-998-2489 or michel.savoie@crc.ca.