High-Tech Collaboration Helps Taiwan Fight SARS

PRAGMA, an international collaboration consisting of fourteen founding institutions, was launched at a March 2002 workshop hosted by the San Diego Supercomputer Center (SDSC) at the University of California, San Diego (UCSD) and funded by the National Science Foundation (NSF). PRAGMA develops grid-enabled applications and deploys high-tech infrastructure throughout the Pacific Region, with the goal of sharing member institutions' data, computing power, and other resources. In this case, the resource to be shared was PRAGMA's expertise in network-based, high-performance teleconferencing.

PRAGMA Steering Committee member Fang-Pang Lin is director of the Grid Computing Division of Taiwan's National Center for High-Performance Computing (NCHC), which is responsible for the national grid project of Taiwan. On May 15, he sent an e-mail to Peter Arzberger, director of the Life Sciences Initiative at UCSD, and co-founder and chair of PRAGMA's Steering Committee. Lin described how the suddenness and severity of the outbreak were overwhelming the local health infrastructure. Doctors and staff are being quarantined inside their own hospitals with SARS patients, to prevent the spread of the disease. But the quarantines prevent attending physicians and specialists from consulting with physicians at other institutions. The intention of NCHC was to set up Access Grid teleconferencing stations inside and outside of quarantined areas, enabling physicians to communicate with one another and share high-resolution X-rays, diagnoses, and treatment methods.

A few hours later, the PRAGMA 4 Workshop Program Committee held a teleconference, to discuss the seriousness of the problem and the need for additional contributors to the fight against the outbreak of SARS. A request for assistance was e-mailed to PRAGMA members immediately following the teleconference.

The response was immediate. Within 12 hours, offers of assistance came from many PRAGMA partners and other institutions around the world, and offers of assistance have continued. These institutions included the Computer Network Information Center (CNIC) of the Chinese Academy of Sciences, the National Institute of Advanced Industrial Science and Technology (AIST), the Korea Institute for Science and Technology Information (KISTI), Indiana University and the NSF-funded TransPac project, SDSC, the National Center for Microscopy and Imaging Research, as well as the National Biomedical Computation Resource of UCSD, the National Center for Supercomputing Applications, Queensland University of Technology, AARnet, Argonne National Laboratory and inSORS, and the California Institute of Telecommunications and Information Technology.

"We truly thank the program manager of PRAGMA, Teri Simas, for sending out NCHC's call for Access Grid expertise in the international grid communities," said Grace Shau-Wei Hong, special assistant to the Grid Computing Division of NCHC. The Access Grid is used at over 150 institutions worldwide.

Arzberger independently sent the message to Rick Stevens, director of Mathematics and Computer Science at Argonne National Laboratory and professor at the University of Chicago, and Terry Disz, head of the collaborative tools effort at Argonne's Futures Lab. Stevens' response was immediate and direct: "We're on it!"

A second videoteleconference was organized by PRAGMA on May 17 involving the SARS Grid team at NCHC, Access Grid experts from Argonne and inSORS, and experts on grids and portals at SDSC and UCSD.

NCHC had received direct calls for assistance from the staff of the Chang-Gung Hospital system, who recognized NCHC's prior successes with the Asthma Grid, a grid-based remote diagnosis for asthma patients. Three hospitals -- San-Chung Hospital, Jen-Ai Hospital, and Chang-Gung Hospital at Linkou -- from north to south in the greater Taipei area, had immediate need of a system for remote diagnosis, quick access to specialized medical expertise, and a means of sharing X-ray images, numerical instrument readings, and white board and audio/video discussions. The system has to be scalable, since more hospitals will join the system once its feasibility has been demonstrated and funding and equipment become available. (See map at http://sarsgrid.nchc.gov.tw/index.cgi.)

Desktop-to-desktop teleconferencing targets individual communication, transmits low-quality images, and uses ordinary telephone lines. On the contrary, the Access Grid is based on grid computing technologies and high-speed data networks. The Access Grid supports group-to-group interactions across high-speed networks with large, high-resolution multimedia displays, advanced interactive environments, and interfaces to grid middleware and visualization environments. The Access Grid typically is used for virtual workshops, collaborative education sessions, seminars, and tutorials. Group conferences involving dozens of people at six or seven different sites are common. "All of these capabilities made the Access Grid the logical choice for hospitals in which entire teams of physicians need to consult," said Jer-Nan Juang, director of NCHC.

The Access Grid itself was used to organize the virtual support team, which includes participants from several PRAGMA member institutions. Their immediate tasks were to provide real-time consulting expertise with Access Grid setup and hands-on operations issues, and to expedite the response to an urgent situation. And several urgent issues did require resolution.

Initial plans to use an Access Grid communications server in the United States or Australia had to be revised when it was realized that quality-of-service issues on the data communications network made it necessary to set up and run a local server in Taiwan. A version 1.2 Access Grid server is being obtained from inSORS Integrated Communications, Inc. of Chicago, an Access Grid affiliate. But transportation disruptions stemming from the SARS outbreak have delayed the arrival of this system.

A less elaborate Access Grid version 2.0 "virtual venue server" (VVS) has been adopted as a substitute solution, and it has been installed and tested. But versions 2.0 and v1.2 are not compatible, and the VVS requires Access Grid v2.0 client nodes at the hospital sites. Unfortunately, the current user interface v2.0 is not suitable for a hospital environment. A new, high-level user interface now is being developed by NCHC to meet hospitals' requirements. The backup solution is to use support staff at the NCHC control center to perform real-time manual handling of all teleconferencing sessions.

But these issues were challenges, not barriers. By May 19, the components of the SARS Grid prototype had been assembled in record time. Three AG nodes were installed and tested, with a commercial (H.323) teleconferencing system available as a backup. The dedicated network for data communications between sites was operational. Terry Disz, Tom Uram. Ivan Judson, and Ti Leggett of Argonne National Laboratory provided real-time assistance on Access Grid issues. Access Grid technology development at Argonne has been supported by DOE, NSF and Microsoft.

By May 20, the Access Grid nodes had been delivered to San-Chung and Chang-Gung Hospitals, installed, and tested by the afternoon of May 21. The network connection between Jen-Ai Hospital and NCHC was successfully tested on May 22, and on May 29 the Access Grid nodes were established in Jen-Ai Hospital and in Taiwan's CDC. A second AG node for Jen-Ai Hospital is scheduled to be delivered on June 1. A dedicated backbone network with 1 Gbps bandwidth has been deployed for the SARS Grid by Chung-Hwa Telecom.

Nevertheless, much more remains to be done. Eventually, a dedicated backbone network with 1 Gbps bandwidth will be deployed for the SARS Grid by Chung-Hwa Telecom. The user interface issues will be overcome, permanent Access Grid nodes will be set up, and more hospitals will be integrated into the system.

Patients' diagnostic records of SARS need to be archived under a system that provides storage, retrieval, and viewing capabilities. A huge amount of data has to be stored and accessed. One X-ray image can be digitized as between one and 20 megabytes of data. If 3,000 patients have at least one X-ray image per day during 30 days of observation, then roughly two terabytes of storage will be needed. It may be feasible to use PRAGMA resources, such as the Storage Research Broker (SRB) environment at the San Diego Supercomputer Center to provide the necessary data storage.

PRAGMA members will meet in Melbourne, Australia, on June 5-6 to review technical issues. In addition, NCHC members are expected to recount their experiences with the SARS situation in Taiwan. Discussion topics will include procedures for expanding the Access Grid to other Pacific Rim institutions and the issue of how best to disseminate the lessons learned from dealing with the SARS outbreak.

"Advanced cyberinfrastructure can assist with critical disease control and emergency response needs," Dr. Lin said. "Thanks to PRAGMA, the alliance has been formed. NCHC has a responsibility to assist in handling this arduous task, and with assistance offered from the international grid community, we believe that we can adequately contribute to the nationwide call to assist in fighting the disease, relieving the epidemic, and ultimately save many lives."

At this point, SARS Grid nodes have been tested and are ready to assist the medical staff at the three hospitals. Having the SARS Grid VTC system in place will help researchers collaborate more fully with colleagues in the Pacific Rim region, and will encourage broader use of the Access Grid by policy makers and government officials in emergency response situations.