LANS, WANS and VANS--networking made simple.
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Computer Communication Networks↗
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Hospital information systems applications and potential: a literature review revisited, 1982-1992.
Although this article has addressed the many advancements in administrative and clinical applications of hospital information systems, there are many other issues that have affected and will continue to affect the development and transition of hospital information systems that are beyond its scope. A few of the more critical of these issues are the emergence of local area networks and wide area networks, more widespread use of graphical user interfaces (such as Windows), the powerful technology afforded by workstations and personal computers built with the 486 microchip, legal issues, and the always present obligation of ensuring data confidentiality and system security.
Clinical Medicine↗
Open your laboratory to the Internet.
The Internet can open many opportunities for laboratories. A wide variety of information resources are available via the Web, which can be researched more quickly and efficiently with a search engine. A laboratory can pursue marketing and advertising of its services on the Web as well. Consultation and collaboration can be accomplished via e-mail, listservs, and newsgroups. An Intranet can be created on a local area network to share electronic data within an organization. In addition, the rapid technological advances make the possibilities for tomorrow's communications limitless.
Communications Media↗
Changes in business communications: innovative uses of new media and technologies.
An overview of communication technologies and concepts for intra- and inter-business communication, including local area networks, electronic mail and tele-conferencing, illustrates the wide spectrum of methods which challenge traditional forms of business communication such as correspondence and telephone. It is shown how the application of these technologies, in concert with the computer and new storage media, allows integration of communication, data management and recordkeeping functions. The systematic application of electronic technologies and recognition of the advantages of graphics for effective communication lead to the stimulation of graphic forms of communication. Technologies and methods of graphic communication are discussed, and the impact of these new approaches on the work environment in the office is explained.
Data Display↗
Office management: increasing productivity in the workplace.
Healthcare managers are seeking new ways to increase productivity in the workplace. New technologies, such as word processing, electronic mail, electronic conferencing, calendar management, data base management systems, artificial intelligence, decision support systems, and local area networks, are being developed to help the healthcare manager make the workplace more productive. The challenge therefore is to implement these systems smoothly and address the organizational issues associated with implementation.
Decision Making↗
Intelligent buildings.
The maturing of technologies in computer capabilities, particularly direct digital signals, has provided an exciting variety of new communication and facility control opportunities. These include telecommunications, energy management systems, security systems, office automation systems, local area networks, and video conferencing. New applications are developing continuously. The so-called "intelligent" or "smart" building concept evolves from the development of this advanced technology in building environments. Automation has had a dramatic effect on facility planning. For decades, communications were limited to the telephone, the typewritten message, and copy machines. The office itself and its functions had been essentially unchanged for decades. Office automation systems began to surface during the energy crisis and, although their newer technology was timely, they were, for the most part, designed separately from other new building systems. For example, most mainframe computer systems were originally stand-alone, as were word processing installations. In the last five years, the advances in distributive systems, networking, and personal computer capabilities have provided opportunities to make such dramatic improvements in productivity that the Selectric typewriter has gone from being the most advanced piece of office equipment to nearly total obsolescence.
Efficiency↗
A multimedia database for dermatology.
The World Health Organisation (WHO) Radiation Emergency Medical Preparedness (REMPAN) centres have built up the International Computer Database for Radiation Accident Case Histories (ICDREC) to document the treatment of acute radiation syndrome (ARS) patients. Radiation induced skin lesions may cause severe late effects in radiation accident patients. Dermatological multimedia documentation is included into the ICDREC. In particular, retrieval and display of digitised skin photographs and medical reports serves to improve patient care, medical education, and scientific analysis concerning the cutaneous radiation syndrome (CRS). The database has been built up as a client/server system. A particular focus has been set on using commercial off-the-shelf software components. The medical data including the multimedia data are stored in a relational database system. The database can be accessed by inexpensive personal computers in the dermatologist's workplace. Authorised institutions can access the database via the Internet. Retrieval of one skin photograph via local area network (LAN) requires approximately 3 seconds. The current state of the application is illustrated with the skin lesion treatment of a Chernobyl patient. An example is given on how to access the ICDREC from a dermatologist's desktop personal computer. The discussion focuses on the advantages of storing the textual and pictorial data in one central database to be accessed from different care centres and how the results can be generalised for medical multimedia information systems.
Dermatology↗
An intelligent, interactive platform for ophthalmic teaching, telemedicine, and telecollaboration: design considerations and prototype construction.
The development of technologies permitting processing, compression, and transmission of digital images and image sequences enables powerful methodologies for local and remote medical teleconsultation. We are developing a slit-lamp-based ophthalmic augmented reality (image overlay) environment incorporating features to permit real-time, interactive teaching, telemedicine, and telecollaboration. A binocular slit-lamp biomicroscope interfaced to a CCD camera, framegrabber board, and PC permits acquisition and rendering of anterior segment and retinal images. Computer-vision algorithms facilitate robust tracking, registration, and near-video-rate image overlay of previously stored retinal photographic and angiographic images onto the real-time fundus image. Our algorithms facilitate shared control of pointing, drawing, and measuring functions registered with the retinal image video stream and direct audio communication between an examiner (student, generalist) and remote observer (instructor, specialist). Bandwidth and video compression considerations limit the frame rate and latency for video stream transmission. Excellent and acceptable performance are demonstrated in model eyes over a local area network and through a modem connection, respectively. These studies represent the first investigations towards the design and implementation of an intelligent platform for ophthalmic telemedicine and telecollaboration.
Algorithms↗
Using IP-videoconferencing systems in a surgery consulting.
In this paper we describe how to use IP-videoconferencing systems in medical surgery consulting. We started to think about how we could use special doctor's services without patients having to travel a long way. The answer to this question is that the information goes from one place to another, not the patient. First we had a pilot project, where we used the 3xISDN transmission rate and now we are using ATM. We have here in Satakunta a local area network between our Satakunta Central Hospital and the Health Care Center in Noormarkku and Kankaanpää, so we have very good environment to do this kind of research. Our network is quite fast, we can use the 10 Mbps bitrate and in this network there are no other activities in this moment, so there are not any interferences. There is a surgery specialist in the hospital and a doctor in the health care center with a patient. The specialist looks at the monitor, where there is a videopicture of the patient from the health care center. Then the specialist makes the treatment plan for the patient.
Adolescent↗
Power of heterogeneous computing as a vehicle for implementing E3 medical decision support systems.
A computer system of PCs, workstations, minicomputers etc., connected together via a local area network or wide area network represents a large pool of computational power. Our aim is to use this power for the implementation of E3 (efficiency, effectiveness, efficacy) medical decision support system, which can be based on different models; the best of them are providing an explanation together with an accurate and reliable response. One of the most viable among models are decision trees, already used for many medical decision making purposes. In this paper we would like to present a heterogeneous implementation of genetic algorithm for the induction of decision trees with emphasis on solving the mitral valve prolapse syndrome.
Algorithms↗
[Results of a questionnaire survey about "standardization" of connection methods in Laboratory Automation System or Laboratory Information System by the National University Hospital Clinical Laboratory Divisions].
"Standardization" is very important in the field of clinical laboratory medicine. Enzyme reference materials(ERM) and standard plasma proteins(CRM470) have already been developed. Reference methods for some clinical chemical tests have also been developed. We are studying "standardization" of electric communication methods between computers and automatic analyzers in Laboratory Automation System(LAS) or Laboratory Information System(LIS). We present the results of a questionnaire survey of 73 LAS or LIS making Companies in this paper. Although "standardization" of electric communications or local area network in LAS or LIS has been done in only 22 companies(34.9%), we are planning more functional standard electric communication methods such as Health Level 7(HL7) or American Society for Testing and Materials(ASTM).
Autoanalysis↗
[Electronic medical records: medical and legal aspects, privacy, safety, and legal validity].
Medical records must collect all data concerning in-hospital management of patients: data have to be verified and easily retrievable. Clinicians are responsible for both format and content of medical records. Respect of patient's privacy must be made sure both during on-line management and long-term storage of records. Computerization can offer many advantages to clinicians, but needs some significant adjustments: training and motivation of operators, arrangement of clinical processes and of administrative rules to technological developments. Nevertheless, some important results can be afforded: standardization of procedures, distribution of univocal, verified and ubiquitous data to all concerned operators, protection against undesired retrieval, reliability of effective reports. Preliminary condition is a clinical local area network, widespread into the institution. Database implementation must follow well accepted methodology: flow chart design of data dictionary, standardization of data coding, input of verified data, effective reporting. Access to data must be controlled by sophisticated and sure password system. Back-up of data must be automatically available with adequate timing and methodology. Respect of rules on patient's privacy must be realized whenever possible. Complex clinical records should be made available, containing data, signals and images (both single frames and dynamic sequences), due to continuous technical progress of diagnostic tools. Medical records must be available for long periods of time: database engine and managing tools must be selected among well accepted and largely available producers; informatic assistance must be assured for management and evolution of systems over the years.
Computers↗
A novel interactive electronic protocol review system.
This report describes a new protocol review system which was designed as a Lotus Notes database. This system encompasses all elements of investigator protocol generation, review and approval by the laboratory animal veterinarian and institutional animal care and use committee (IACUC), and notification of approval to personnel responsible for animal ordering. Unique features of the system are interactive dialog between IACUC members and the investigator and confidential protocol discussion among IACUC members. The advantages of the system are multiple: 1. it allows for interactive protocol discussion online; 2. it is an essentially paperless process; 3. inclusion of the outside IACUC member is easily accomplished by using an offsite personal computer and secure remote local-area network access; 4. the time required for protocol generation, review, and approval is streamlined due to the automatic features of the database and the speed of e-mail; and 5. all documentation relating to the protocol and the approval process is archived online.
Animals↗
Economic analysis of a filmless system based on the hospital information system.
A filmless system (FLS) based on a picture archiving and communication system (PACS) equipped with UNIX work- stations and a local area network (LAN) specialized for viewing radiographs has not been deemed acceptable, for reasons of economics. However, personal computers (PCs) have recently become more powerful, to the point where PCs approach UNIX workstations in terms of capabilities. As a result, a PC-based image viewing workstation (IVW) has sufficient functions for practical use. Diagnostic resolution is not equal to that of film, but is comparable. Since the hospital information system (HIS) includes many PC terminals connected by a LAN, the cost problem can be resolved by using these PC terminals as the IVWs. In order to investigate the practicability of this idea, two types of FLSs using HIS facilities were designed: one is a system based on the use of high-resolution cathode ray tubes (H-CRTs), and the other is based on the use of conventional CRTs and radiologist reports, minimizing the number of H-CRTs. The total costs of the two systems were analyzed. As a result, the former FLS was found to be about 15% more expensive than the latter, which was less expensive than a film-based system (FBS). However, whether the FLS is more profitable than the FBS from the viewpoint of hospital management strongly depends on the medical insurance system.
Costs and Cost Analysis↗
The integrating ion imager: a device for determining heavy ion doses during irradiations.
We have designed and built an integrating ion imaging system (I3) that records the spatial distribution of the dose of heavy ions incident on samples irradiated at the radiobiology beamline of the Alternating Gradient Synchrotron at Brookhaven National Laboratory. The images of dose are integrated over the duration of the exposure. Unlike the images formed on X-ray film, these images are linear with the incident dose. Heavy ions are incident on a phosphor that is located just behind the sample position. Visible light emitted from the phosphor is collected by a lens and focused onto a scientific grade charge coupled device (CCD) cooled to about -45 degrees C. The phosphor and CCD camera are integral parts of a modular sample holder designed for irradiating molecular samples, which is easily mounted on the sample platform of the beamline. The imager can be adapted to other types of samples. The present CCD image is digitized to 14 bits (16,384 intensity levels), but the dynamic range is extended by adjusting the aperture of the CCD camera lens. Digital images from the CCD are routinely transferred over the BNL local area network for archival storage on a UNIX server, from which they can be opened from any authorized computer with access to the Internet. Images obtained with no sample in place record the dose at all points on the target field. When a sample is in place, an image of the sample appears providing its exact location with respect to fiducial marks recorded for all images. Areas surrounding the image of the sample are used in comparison with companion no-sample images to get exact doses over the sample. The contrast mechanism responsible for image formation is the shift along the Bragg curve resulting from loss of energy of the ions as they pass through the sample--not from a change in ion flux reaching the phosphor. The sharpness of the images formed with the DNA samples we have recorded indicates that neither scattering of the incident heavy ions or the generation of secondary ions contribute significantly.
Elementary Particles↗
[New development of a cytological examination ordering system at Osaka National Hospital].
Effective and rapid use of cytological data are issue in Japan. We addressed this problem by development of an ordering system for cytological examinations at Osaka National Hospital. This system is located in the department of pathology and is a client-server system that consisted of 1 server and 6 clients. Five of the 6 clients are related to cytology and there are connections to microscopes with digital cameras. One client is for acceptance of cytological specimens at the department of pathology. Through a local area network, 100 Mbps, this system is connected to the hospital information system, which is of the order-entry type. After a clinician orders a cytological examination, these data are sent to both the Accounts and Pathology departments. A small bar-code label is simultaneously printed out, which is stuck on the form. By checking this label at the department of pathology by using a label reader, relevant clinical information is sent to the pathology server. After the cytological diagnosis has been made by senior cytotechnologist and cytopathologist, data on the diagnosis and microscopic images are sent to the hospital information system. Thus, clinicians can review the cytological diagnosis together with the photomicrographs. This new cytology system has brought great benefits to both cytotechnologist and clinicians with regard to the rapid transfer of cytological examination, and it seems to contribute to more advanced and efficient medical care.
Cytodiagnosis↗
The cost-effectiveness of telehealth in metropolitan hospitals.
We established a telehealth link between two inner-city health services about 10 km apart. The video-link between the sites was based on IP videoconferencing; ISDN connections were maintained as a form of system redundancy and to connect to sites beyond the local area network. The cost of a conventional consultation, in which the patient travelled to an outpatient appointment, was 170 Australian dollars. Because existing equipment and telecommunications could be used, the cost of a telehealth consultation was only 74 Australian dollars. During the study approximately 15 teleconsultations were completed and a number of patient transfers were cancelled because they were deemed clinically unnecessary. The preliminary results suggest that the cost-savings from telehealth can be substantial. In addition there were major benefits to continuity of patient care and clinical communication within the organization.
Ambulatory Care↗
[Surgical day hospital: technical possibilities and organizational model].
The Authors propose an organizational model for a surgical day hospital program, which is being used for a pilot day surgery unit in the I Department of Surgery of the Rome University "La Sapienza". The program requires little capital investment, as it is closely linked, geographically and administratively, to the main surgical unit, and uses the present staff, facilities and support services. The model is based on a computerized LAN (Local Area Network), providing fast recording, scheduling, management and trannsfer of medical data for each patient. The present situation is reported in detail. Data from the authors' outpatient department for 1988, have been recorded and elaborated. The results show a low use of surgical day care, limited to minor surgical procedures, and with not a single operation performed under general anesthesia. The authors hope to see a growth in the use of day surgery and a more selective use of inpatient care.
Adolescent↗