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Overview of an architectural approach to the development of the Johns Hopkins Hospital distributed clinical information system.

The Johns Hopkins Hospital has initiated an ambitious program to apply modern technologies to the development of a new, comprehensive clinical information system. Since many components of a system exist and since the JHH management is decentralized, a distributed, networked system is being built. To properly accomplish this task an architectural basis for strategic systems planning was developed. This paper reviews briefly the layered architectural approach.

Computer Communication Networks↗

[Organization of social-hygienic monitoring in Zelenograd].

The paper deals with the experience of the Zelenograd Town Sanitary and Epidemiological Surveillance Center with sociohygienic monitoring. Its work on the recording and analysis of infectious and non-infectious diseases by using the present-day computers and local electronic networks is outlined. The paper shows it necessary to develop a unified approach to sociohygienic monitoring and standardization of databases in the corporative system of sanitary service.

Computer Communication Networks↗

Implementing network security guidelines in health care information systems.

A Health Care Establishment (HCE) is an establishment where medical services are rendered. These services are provided by the health care personnel. The infrastructure of a HCE may include Information Technology (IT) equipment that stores and processes HC information. The spread of distributed information technology in HCEs have necessitated the implementation of Network Security in Health Care Information System (HCISs), to assure confidentiality, integrity and availability of HC information being transmitted across HC networks. This paper presents a road map in implementing Network Security guidelines for the provision of Network Security in HCEs, work carried out within the Secure Environment for Information Systems in Medicine (SEISMED) project under the Advanced Informatics in Medicine (AIM) programme.

Computer Communication Networks↗

Information technology and the clinical curriculum: some predictions and their implications for the class of 2003.

Information technology, medical knowledge, and medical practice are on a collision course. The consequences of the impact will change the way physicians work, the way medical knowledge is processed, packaged, and distributed, and the way patients obtain medical care and information. Today's educators need to design an information technology curriculum to prepare students for this emerging world of practice. Computer labs, based on today's complex and unreliable desktop systems, are not the answer. What is needed by students who entered medical school in 1997-98 is an informatics curriculum that is based on the real-world requirements of 2003 and beyond. The authors draw upon academic studies and their own clinical and industry experiences to outline some predictable elements of what lies ahead. Their predictions--ubiquitous, simple network computing and "power tools" for managing medical knowledge--have implications for how schools cover such educational topics as patient confidentiality, systems thinking and error management, and knowledge resource evaluation.

Computer Communication Networks↗

A network-based training environment: a medical image processing paradigm.

The capability of interactive multimedia and Internet technologies is investigated with respect to the implementation of a distance learning environment. The system is built according to a client-server architecture, based on the Internet infrastructure, composed of server nodes conceptually modelled as WWW sites. Sites are implemented by customization of available components. The environment integrates network-delivered interactive multimedia courses, network-based tutoring, SIG support, information databases of professional interest, as well as course and tutoring management. This capability has been demonstrated by means of an implemented system, validated with digital image processing content, specifically image enhancement. Image enhancement methods are theoretically described and applied to mammograms. Emphasis is given to the interactive presentation of the effects of algorithm parameters on images. The system end-user access depends on available bandwidth, so high-speed access can be achieved via LAN or local ISDN connections. Network based training offers new means of improved access and sharing of learning resources and expertise, as promising supplements in training.

Computer Communication Networks↗

The futility of common firewall policies: an experimental demonstration.

Many healthcare organizations utilize network "firewalls" to protect their networks from being accessed by unauthorized external entities. These same firewalls are also often configured to deny access to certain external services from within the internal network. The latter policy can be subverted through a "protocol tunneling" strategy, which has been implemented as a set of programs called "Firehole." Organizations should be aware of this potential weakness in their network security designs. Policies that deny external services to users should be carefully evaluated in light of clearly defined organizational goals.

Computer Communication Networks↗

The health information network.

The health information network concept is certainly visionary. It has much merit but it is doomed to failure unless the proposed users of this information show much more concern for confidentiality.

Australia↗

[Digital picture archiving, processing and communication in diagnostic imaging with a Siemens Network (SIENET): initial results].

The concept of Picture Archiving and Communication System (PACS) in digital imaging offers substantial advantages: better data security, faster access to archived images, simultaneous availability of images at different sites, minimal space demand for archive medium, retrospective image post-processing opportunities and lower costs resulting from reduced film consumption and length of stay. However, practical experiences concerning reliability and efficiency of real PAC networks in radiological departments have to be made yet in order to improve network structure, software design and hardware performance. The ongoing stepwise installation and test of a Siemens PACS (SIENET) at the Department of Radiology at the Medical University of Lübeck will support the introduction of PACS concept into radiological practice.

Computer Communication Networks↗

Molecular dynamics simulation on a network of workstations using a machine-independent parallel programming language.

Molecular dynamics simulations investigate local and global motion in molecules. Several parallel computing approaches have been taken to attack the most computationally expensive phase of molecular simulations, the evaluation of long range interactions. This paper reviews these approaches and develops a straightforward but effective algorithm using the machine-independent parallel programming language, Linda. The algorithm was run both on a shared memory parallel computer and on a network of high performance Unix workstations. Performance benchmarks were performed on both systems using two proteins. This algorithm offers a portable cost-effective alternative for molecular dynamics simulations. In view of the increasing numbers of networked workstations, this approach could help make molecular dynamics simulations more easily accessible to the research community.

Algorithms↗

SHINE: Strategic Health Informatics Networks for Europe.

The mission of SHINE is to construct an open systems framework for the development of regional community healthcare telematic services that support and add to the strategic business objectives of European healthcare providers and purchasers. This framework will contain a Methodology, that identifies healthcare business processes and develops a supporting IT strategy, and the Open Health Environment. This consists of an architecture and information standards that are 'open' and will be available to any organisation wishing to construct SHINE conform regional healthcare telematic services. Results are: generic models, e.g., regional healthcare business networks, IT strategies; demonstrable, e.g., pilot demonstrators, application and service prototypes; reports, e.g., SHINE Methodology, pilot specifications & evaluations; proposals, e.g., service/interface specifications, standards conformance.

Community Health Planning↗

STRUCTURELAB: a heterogeneous bioinformatics system for RNA structure analysis.

STRUCTURELAB is a computational system that has been developed to permit the use of a broad array of approaches for the analysis of the structure of RNA. The goal of the development is to provide a large set of tools that can be well integrated with experimental biology to aid in the process of the determination of the underlying structure of RNA sequences. The approach taken views the structure determination problem as one of dealing with a database of many computationally generated structures and provides the capability to analyze this data set from different perspectives. Many algorithms are integrated into one system that also utilizes a heterogeneous computing approach permitting the use of several computer architectures to help solve the posed problems. These different computational platforms make it relatively easy to incorporate currently existing programs as well as newly developed algorithms and to best match these algorithms to the appropriate hardware. The system has been written in Common Lisp running on SUN or SGI Unix workstations, and it utilizes a network of participating machines defined in reconfigurable tables. A window-based interface makes this heterogeneous environment as transparent to the user as possible.

Algorithms↗

An open distributed medical image and signal data server network with World Wide Web front-end.

In modern patient care and medical research diagnostic imaging from multiple modalities plays an essential role. In general these digital image data are acquired at different locations. An efficient access to the data via network is often not provided due to technical, organisational and political reasons. This article presents an approach to solve the problem by means of an open distributed data server network with Web-based front-ends and describes the prototype DACHS that has been developed at the University Hospital of the Technical University of Munich.

Computer Communication Networks↗

A multimedia medical communication link between a radiology department and an emergency department.

The most critical aspect of a radiologist's work is communicating his findings to the attending physician responsible for the patient's care. This is also the part of the process that is least well organized and the most subject to failure. At the University of Ottawa Medical Communications Research Centre we are investigating technical means to improving communications between radiologists and attending physicians. We first introduce the radiology communication service problem and show why it is essentially a multimedia communication problem. We then briefly describe a multimedia communication system designed and implemented by our research team. The multimedia system consists of several work stations linked by the Hospital's local area network (LAN). Each physician work station comprises a Compaq 386/20-Mhz microcomputer with 16 Mbytes of RAM, a 500-Mbyte image disk, and an image memory that drives a 1,000-line monochrome monitor. The images are digitized using a Konica laser-based film digitizer (2430 by 2000 10-bit pixels for a standard chest radiograph). The multimedia file server manager station is built around a PC-AT compatible with a Northern Telecom Meridian SL-1ST digital PBX and a Meridian Mail digital voice messaging system. This last device is used to store voice data and is linked via the PBX to the workstations' digital telephones. A Sytek 6,000 LAN links all work stations to the file server. All data, image, and graphic information is transmitted via this network, while the twisted pair connections linking the digital PBX to the telephone sets are used for transmitting voice data.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗

[Computers in general practice of the established gynecologist: market status--electronic data processing solutions--electronic data processing problems--future perspectives].

Since the end of the seventies a great change of edp-use in gynecological private practice took place. Many applications (for example ICD-coding) are not feasible in short time. In medicine, the electronic data processing is not as practicable as the technical progress permits. In only a few programs we can find gynecological specific electronic data processing solutions, networks between private practices, hospitals and Internet access. It is necessary to claim edp-solutions for gynecological private practice and define standards for programming electronic data processing in medicine.

Computer Communication Networks↗

Communication technologies in health care environments.

A successful implementation of hierarchical health care networks is dependent on a number of different technical and non technical factors. This paper investigates how the networking technologies, both 'traditional' and broadband, can support the communication requirements of medical environments. The general purpose is to implement communication infrastructures and services, which will improve the collaboration between the different partners in the health sector in offering better healthcare services at affordable costs.

Computer Communication Networks↗

Information for trained nurses in remote areas: do electronically networked resources provide an answer?

This paper reports on a research project which examined the potential of the Internet, and other networked information resources, to improve access to information for trained nurses working in remote areas. This paper provides a review of current literature in the field. It describes the research carried out, presents a summary of the research findings and discusses the implications of these findings. The paper concludes that the Internet and networked resources do have considerable potential to improve access to information for nurses working in remote and rural areas. However, information skills, along with professional guidance, are also required.

Community Health Services↗

Heuristic walkthrough evaluation of a prototype computer network service for occupational therapists.

AIM: To identify utility and design criteria for a computer network service for occupational therapists. DESIGN: Heuristic walkthrough evaluation. The evaluators explored a prototype and then commented upon the design in plenary sessions. SUBJECTS: One group of information system design experts and one of occupational therapists. RESULTS: The central utility criteria were the possibility to organize dynamic work groups for development of the occupational therapy profession and access to databases on assistive technologies. The main system design criteria identified were navigation, structure, tools, and content. CONCLUSION: A computer network service can support the development of the therapy professions. Generic issues exist which need to be considered in the detailed design. The heuristic walkthrough method is useful for identifying these.

Computer Communication Networks↗

Understanding and using DICOM, the data interchange standard for biomedical imaging.

The Digital Imaging and Communications in Medicine (DICOM) Standard specifies a non-proprietary data interchange protocol, digital image format, and file structure for biomedical images and image-related information. The fundamental concepts of the DICOM message protocol, services, and information objects are reviewed as background for a detailed discussion of the functionality of DICOM; the innovations and limitations of the Standard; and the impact of various DICOM features on information system users. DICOM addresses five general application areas: (1) network image management, (2) network image interpretation management, (3) network print management, (4) imaging procedure management, (5) off-line storage media management. DICOM is a complete specification of the elements required to achieve a practical level of automatic interoperability between biomedical imaging computer systems--from application layer to bit-stream encoding. The Standard is being extended and expanded in modular fashion to support new applications and incorporate new technology. An interface to other Information Systems provides for shared management of patient, procedure, and results information related to images. A Conformance Statement template enables a knowledgeable user to determine if interoperability between two implementations is possible. Knowledge of DICOM's benefits and realistic understanding of its limitations enable one to use the Standard effectively as the basis for a long term implementation strategy for image management and communications systems.

Computer Communication Networks↗