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Future shock. Lutheran Medical Center builds network for tomorrow's applications.

UNLABELLED: Lutheran Medical Center, a 501-bed acute care teaching hospital in Brooklyn, with eight health centers located throughout New York City. PROBLEM: Lutheran's current patient care systems did not have enough scalability or bandwidth to support its applications. SOLUTION: A networking partner to deliver an infrastructure designed to meet Lutheran's applications' needs. RESULTS: An efficient, effective and easy-to-manage network. Routing performance and capacity issues are no longer a problem. KEYS TO SUCCESS: "Ask yourself what networking applications your organization will need in 2008 and then upgrade your systems to meet those needs."

Fiber Optic Technology↗

Education on medical informatics integrated in the campus information network system at Shimane Medical University.

An integrated campus information network system at Shimane Medical University has been developed to organize medical information generated from each section and provide information services useful for education, research, and clinical practice. This report outlines: the education-research system in connection with a campus information network system, the MUMPS programming self-directed learning software, and the curriculum of education on medical informatics.

Computer Systems↗

Contemporary issues in HIM. Wireless LANs.

Wireless LANs are a relatively new form of network whose popularity is growing rapidly. Although they probably will not completely replace wired networks, wireless LANs can fill several important niches in network applications. In this article, we looked at rationales for wireless LANs, discussed several broad categories of wireless applications, and described two transmission techniques currently dominant in wireless networks. We then reviewed several different wireless network structures and wireless hardware connections, and looked at ranges and transmission rates. The article closed with a presentation of some relevant considerations regarding wireless LANs.

Hospital Information Systems↗

Three-tiered integration of PACS and HIS toward next generation total hospital information system.

The Seoul National University Hospital (SNUH) started a project to innovate the hospital information facilities. This project includes installation of high speed hospital network, development of new HIS, OCS (order communication system), RIS and PACS. This project aims at the implementation of the first total hospital information system by seamlessly integrating these systems together. To achieve this goal, we took three-tiered systems integration approach: network level, database level, and workstation level integration. There are 3 loops of networks in SNUH: proprietary star network for host computer based HIS, Ethernet based hospital LAN for OCS and RIS, and ATM based network for PACS. They are linked together at the backbone level to allow high speed communication between these systems. We have developed special communication modules for each system that allow data interchange between different databases and computer platforms. We have also developed an integrated workstation in which both the OCS and PACS application programs run on a single computer in an integrated manner allowing the clinical users to access and display radiological images as well as textual clinical information within a single user environment. A study is in progress toward a total hospital information system in SNUH by seamlessly integrating the main hospital information resources such as HIS, OCS, and PACS. With the three-tiered systems integration approach, we could successfully integrate the systems from the network level to the user application level.

Hospital Information Systems↗

Contemporary, emerging, and ratified wireless security standards: an update for the networked dental office.

Wireless networking is not new to contemporary dental offices around the country. Wireless routers and network cards have made access to patient records within the office handy and, thereby, saving valuable chair side time and increasing productivity. As is the case with any rapidly developing technology, wireless technology also changes with the same rate. Unless, the users of the wireless networking understand the implications of these changes and keep themselves updated periodically, the office network will become obsolete very quickly. This update of the emerging security protocols and pertaining to ratified wireless 802.11 standards will be timely for the contemporary dentist whose office is wirelessly networked. This article brings the practicing dentist up-to-date on the newer versions and standards in wireless networking that are changing at a fast pace. The introduction of newer 802.11 standards like super G, Super AG, Multiple Input Multiple Output (MIMO), and pre-n are changing the pace of adaptation of this technology. Like any other rapidly transforming technology, information pertaining to wireless networking should be a priority for the contemporary dentist, an eventual end-user in order to be a well-informed and techno-savvy consumer.

Computer Security↗

Picture archiving and communication system (PACS) networking: three implementation strategies.

This paper outlines the diverse Picture Archiving and Communication Systems (PACS) networking implementation strategies at the University of California at Los Angeles, the University of Florida, and the University of Kansas. At the University of California at Los Angeles, a very high-speed network has been integrated into a hierarchical networking strategy, resulting in an entirely customized network for the local transmission of images. The University of Florida has chosen to implement networks for local transmission of images using commercially available equipment. The University of Kansas, specializing in teleradiology applications, uses commercial telecommunication circuits to implement long distance referral services to small hospitals.

Florida↗

Information management of a department of diagnostic imaging.

It is well-known that while RIS allows the management of all input and output data of a Radiology service, PACS plays a major role in the management of all radiologic images. However, the two systems should be closely integrated: scheduling of a radiologic exam requires direct automated integration with the system of image management for retrieval of previous exams and storage of the exam just completed. A modern information system of integration of data and radiologic images should be based on an automated work flow management in al its components, being at the same time flexible and compatible with the ward organization to support and computerize each stage of the working process. Similarly, standard protocols (DICOM 3.0, HL7) defined for interfacing with the Diagnostic Imaging (D.I.) department and the other components of modules of a modern HIS, should be used. They ensure the system to be expandable and accessible to ensure share and integration of information with HIS, emergency service or wards. Correct RIS/PACS integration allows a marked improvement in the efficiency of a modern D.I. department with a positive impact on the daily activity, prompt availability of previous data and images with sophisticated handling of diagnostic images to enhance the reporting quality. The increased diffusion of internet and intranet technology predicts future developments still to be discovered.

Appointments and Schedules↗

[Local information systems at the Pediatric Clinic at the University Clinical Center in Sarajevo--experience and perspectives].

Computer were first introduced at Pediatric hospital in Sarajevo in 1989 and since 1990 first programs for managing data have been started. They were used for administration of patients and history taking, as well as for collecting clinical data of them. In the beginning, introduction was slow because lot of doctors and nurses were reluctant in using new techniques. But, in a year most of them realized all the advantages PC offers. At that time all the PCs were separated, that has limited their full facilitated data gathering especially in the periods when we lacked all other office materials (paper, typing machines ... even pencils). Thanks to them we have preserved all medical data about patients in 4 years war period. After the end of the War we started project of making clinical network and program that should run most of the work that is performed at Pediatric Hospital in Sarajevo. Everything that is done at hospital and could be helped by the use of the computers was recorded and algorithms were made. The network consists of 15 PC units. Program was developed through several phases from the admittance of the patients and administration regarding it to the discharge letter. Outpatient work was incorporated, as well as gathering all the medical findings of the patients at one place. First experiences are extremely positive. We have speeded up "paper work" and freed much time that medical stuff can spend with patients. The main problems that we encounter are need for permanent education in working with system, lack of more powerful server that can handle more data and introducing of the pictures in the medical records. We conclude that clinical network with the use of good program for managing all the data gathered in the hospital is essential for today's work.

Bosnia and Herzegovina↗

[Radiology information system using HTML, JavaScript, and Web server].

We have developed a radiology information system using intranet techniques, including hypertext markup language, JavaScript, and Web server. JavaScript made it possible to develop an easy-to-use application, as well as to reduce network traffic and load on the server. The system we have developed is inexpensive and flexible, and its development and maintenance are much easier than with the previous system.

Local Area Networks↗

Internet2-based 3D PET image reconstruction using a PC cluster.

We describe an approach to fast iterative reconstruction from fully three-dimensional (3D) PET data using a network of PentiumIII PCs configured as a Beowulf cluster. To facilitate the use of this system, we have developed a browser-based interface using Java. The system compresses PET data on the user's machine, sends these data over a network, and instructs the PC cluster to reconstruct the image. The cluster implements a parallelized version of our preconditioned conjugate gradient method for fully 3D MAP image reconstruction. We report on the speed-up factors using the Beowulf approach and the impacts of communication latencies in the local cluster network and the network connection between the user's machine and our PC cluster.

Algorithms↗

On the way to a Web based hospital information system: concepts for the use of a medical data dictionary to present context sensitive information in an intranet environment.

Many authors have promoted the www-paradigm to build modern hospital information systems. However currently web-based applications are better suited to information "browsing" than to build complex data entry features. This prompted us to start with our first web based developments inside the Giessen University Hospital Information System in the field of pure presentation of stored knowledge and information. This article describes the concepts which will be used in Giessen to convert available information sources to the www paradigm and to implement context-sensitive knowledge presentation mechanisms inside the clinical information system. The approach is based upon a web-based medical data dictionary server. The data dictionary is used to map terms of interest, chosen from the clinical user during work with a HIS-application, to a semantic network of relationships. The dictionary server will follow those semantic links in order to find and display the webpages, which are linked to the subject.

Dictionaries as Topic↗

Wireless POCT data transmission.

Despite the many advantages of POCT, the biggest obstacle for the lab often becomes documentation and billing of tests performed at remote locations. To solve this problem, this lab took advantage of a wireless radiofrequency network that had been installed for the pharmacy to transmit and receive patient histories. They decided to use this same system to communicate between the analyzers and the LIS.

Blood Gas Analysis↗

[An attempt to adopt computer technology in the pathology bureau].

The experience of computer facilities introduction in Taganrog regional pathology bureau (TRPB) is presented. A special program "Autopsy" for pathologists developed by TRPB specialists is described. The hardware and the structure of TRPB local computer network is described. Application of the program in the activities of the bureau is detailed. The results of the program trial in 1995 and prospects of the program introduction in the activities of pathology service of the Rostov region are outlined.

Local Area Networks↗

Regional medical information network using optical memory cards and integrated services for digital network.

Since 1986, we have been developing a regional health and welfare system using optical memory cards. We have expanded the system and performed model experiments and evaluations this time. There are approximately 3000 card-holders and 23 card-reader terminals in use. They cover 50 percent of the medical facilities in the city of Isehara. Two medical clinics within neighboring cities have joined our project. Standard Deviation Index (SDI) has been introduced to standardize the numeric results of examinations. The terminals are connected with Integrated Services for Digital Network (ISDN) allowing remote access to the optical memory cards. This enhanced connectivity has allowed greater cooperation in delivering quality medical services.

Aged↗

Providing consumer health information through institutional collaboration.

In the past several years, The Claude Moore Health Sciences Library of the University of Virginia Health Sciences Center (HSC) has noted a growing demand for consumer health information. However, because the primary role of the library is to provide information services to health professionals at the HSC, questions have been raised as to the amount of time, energy, and money that should be expended to provide health care information to consumers. The library staff, because it can provide special expertise regarding the availability and utilization of consumer health materials, has felt the responsibility to participate in HSC initiatives that reach a broad audience. Library efforts in that regard include assisting with inventory and management of patient education materials, participating in a community health promotion task force, collaborating with hospital departments in planning a consumer health information center, establishing a consumer health information reference section in the library, and obtaining a grant to offer a networked health information system to local public and community college libraries. Consumers of health information benefit from the enhanced services that result from combining the expertise of health professionals and patient educators with the information management skills of library staff.

Consumer Advocacy↗

Structuring WAN and LAN for EPR use in community health care.

After describing determinants for the creation of a successfully used community health care network, our new project of making a mechanism fostering steady development of WAN and LAN among community is presented. Most of the difficulties that inhibit the sound development of community health care system are solved.

Community Health Services↗

Medical video server construction.

The paper discusses two implementation options for a Digital Video Library, a repository used for archiving, accessing, and browsing of video medical records. Two crucial issues to be decided on are a video compression format and a video streaming platform. The paper presents numerous decision factors that have to be taken into account. The compression formats being compared are DICOM as a format representative for medical applications, both MPEGs, and several new formats targeted for an IP networking. The comparison includes transmission rates supported, compression rates, and at least options for controlling a compression process. The second part of the paper presents the ISDN technique as a solution for provisioning of tele-consultation services between medical parties that are accessing resources uploaded to a digital video library. There are several backbone techniques (like corporate LANs/WANs, leased lines or even radio/satellite links) available, however, the availability of network resources for hospitals was the prevailing choice criterion pointing to ISDN solutions. Another way to provide access to the Digital Video Library is based on radio frequency domain solutions. The paper describes possibilities of both, wireless and cellular network's data transmission service to be used as a medical video server transport layer. For the cellular net-work based solution two communication techniques are used: Circuit Switched Data and Packet Switched Data.

Hospital Communication Systems↗

Construction of a regional telementoring network for endoscopic surgery in Japan.

This paper introduces a regional telementoring network for endoscopic surgery in Japan. The telecommunication center was established at Osaka University and it has been operational since 1997 using six ISDN B-channels. The network, composed of five remote hospitals, aimed to tele-educate young surgeons in constituent hospitals, and it was applied not only to tele-education in routine endoscopic surgery, but also to telementoring in advanced operations. As the significance of telementoring in surgery has been gradually recognized, several networks following our model are now under consideration in other areas of Japan. Although there remains several problems around wide and general propagation of telesurgery, such as coverage of the expenditure or privacy protection, it will be beneficial to prevent professional isolation to share limited resources of surgical experts, and it is expected to contribute to patients receiving advanced surgical therapies.

Endoscopy↗