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CHIME-Net is a state-wide community health information network project which uses a frame-relay approach to interfacility and internet connectivity. This is a collaborative effort among competitive institutions, which embraces technologies new to the health care industry. The experiences of implementation of the CHIME-Net pilot project are presented as a first milestone for the state-wide effort.
Concurrent Engineering Research Center (CERC), under the sponsorship of NLM (National Library of Medicine) is in the process of developing a computerized patient record system for a clinical environment distributed in rural West Virginia. This realization of the CCN (Community Care Network), besides providing computer-based patient records accessible from a chain of clinics and one hospital, supports collaborative health care processes like referral and consulting. To evaluate the effectiveness of the system, a study was designed and is in the process of being executed. Three surveys were designed to provide subjective measures, and four experiments for collecting objective data. Data collection is taking place in several phases: baseline data are collected before the system is deployed; the process is repeated with minimal changes three, then six months later or as often as new versions of the system are installed. Results are then to be compared, using whenever possible matching techniques (i.e. the preliminary data collected on a provider will be matched with the data collected later on the same provider). Surveys are conducted through questionnaires distributed to providers and nurses and person-to-person interviews of the patients. The time spent on patient-chart related activities is measured by work-sampling, aided by a computer application running on a laptop PC. Information about missing patient record parts is collected by the providers, the frequency by which new features of the computerized system are used will be logged by the system itself and clinical outcome measures will be studied from the results of the clinics' own patient chart audits. Preliminary results of the surveys and plans for the immediate and distant future are discussed at the end of the paper.
Health information networks could link health care providers throughout the community. Development activities in the United States are varied and numerous. Collaboration is key to the ultimate "network of networks" and is actively fostered.
The Washington Heights-Inwood Community Health Management Information System (WHICHIS) at the Columbia-Presbyterian Medical Center (CPMC) provides 15 community physician practices with seamless networking to the CPMC Wide-Area Network. The costs and benefits of the project were evaluated. Installation costs, including hardware, office management software, cabling, network routers, ISDN connection and personnel time, averaged $22,902 per office. Maintenance and support costs averaged $6,293 per office per year. These costs represent a "best-case" scenario after a several year learning curve. Participating physicians were interviewed to assess the impact of the project. Access to the CPMC Clinical Information System (CIS) was used by 87%. Other resource usage was: non-CPMC Web-based resources, 80%; computer billing, 73%; Medline and drug information databases, 67%; and, electronic mail, 60%. The most valued feature of the system was access to the CPMC CIS. The second most important was the automatic connection provided by routed ISDN. Frequency of access to the CIS averaged 6.67 days/month. Physicians reported that the system had significantly improved their practice of medicine. We are currently exploring less expensive options to provide this functionality.
OBJECTIVE: For fetal monitoring and assessment of high risk mother and fetus at regional hospitals, we developed a new computer network system. METHODS: The system incorporates a notebook-type personal computer (PC-9801nv) at regional hospital for communication in with 3 servers (IBM5580-YOC) connected via 2 Ethernet LANs to 2 host computers (IBM3080, IBM3174) and 5 workstations (IBM5521 V2b), and transmits the compressed data by telephone. When the data arrive, the doctor in perinatal center can immediately display and interpret the data on his workstation and give appropriate advice to the doctor at the regional hospital. RESULTS: The rate of reliable data transmission was 100%. Each 1 hour recording session and characteristic perinatal information was transmitted in less than 2 minutes. Regional medical institutions can easily access the center, and thereby can receive both simplified automatic diagnosis by fetal cardiotocography and pregnancy-risk evaluation. CONCLUSIONS: Because this system uses telephone circuits, it can be accessed from all regions of the country. Thus, our system is useful for perinatal management of high risk mother and fetus.
In hospital and in private practice huge amounts of data have to be managed. Conventional storage and documentation techniques are being replaced more and more by the use of computers. Local area networks based on the interconnection of stand-alone PC workstations offer several advantages over non-communicating systems. The use of computer networks solves many communication problems and in this way improves the flow of information. The interconnection may be achieved by step-by-step integration of preexisting elements. This paper presents a database system for archiving routine histology data and illustrates the use of a computer network in a dermatology department.
The perceptions of community service providers about access to public technology and uses of technology to support population health were investigated. Perceptions about policies regarding access to technology for the public were also pursued. Qualitative semistructured interviews with service providers in the community were used. One-hour semistructured interviews were conducted with representatives from five community organizations and one business in an urban centre with a population of 400,000. Respondents believed that computers are here to stay, that that they can provide a valuable means for information access and that they have the potential to support communication in local communities. Perceived barriers were also identified.
The need for timely and accurate communication among healthcare providers has prompted the development of computer-based health information networks that allow patient and client information to be shared among agencies. This article reports the findings of a study to assess whether residents of an upstate New York community were ready for a computer-based health information network to facilitate delivery of long term care services. Focus group sessions, which involved both consumers and professionals, revealed that security of personal information was of concern to healthcare providers, attorneys, and consumers. Physicians were the most enthusiastic about the possibility of a computer-based health information network. Consumers and other healthcare professionals, including nurses, indicated that such a network would be helpful to them personally. Nurses and other healthcare professionals need to be knowledgeable about the use of computer-based health information networks and other electronic information systems as this trend continues to spread across the U.S.
The paper presents a concept of an experimental module designed to recognise spoken utterances that cover a limited range of words indispensable in dialogues with computer medical systems. Research into the recognition of spoken words by a module based on artificial neural network is described. Usefulness of the obtained results for surgery-assisting multimedia systems and for a patient simulator supporting medical education of students in case history-taking and diagnosing is also discussed.
This study describes an analysis of 1832 papers dealing with electronic patient records, and indexed in NLM's MEDLINE. Of each retrieved publication the country of origin and the journal in which it was published was determined. Furthermore, insight into the subjects of the publication was obtained by analysing the MeSH terms by which it was indexed. Since 1990 the number of publications on electronic patient records has increased. Publications originated from 43 different countries representing all continents. However, 75% stemmed from only 4 countries. The publications appeared in 379 different journals, of which 26 journals had 10 or more publications. Of all publications, 5.3% had appeared in journals with an impact factor of at least 4.5. The topics most often dealt with were: Hospital Information Systems, Computer Communication Networks, User-Computer Interface, Confidentiality and Computer Security. No obvious trends, other than an increased interest in confidentiality and computer security, were observed.
Computer network devices and systems have been introduced in dentistry for several years, but more and more software applications support not only the individual dentist as well as the complete dental profession in the progress for quicker information, better teaching and greater possibilities in postacademic education. Internet, Bulletin Board Systems. Electronic Mail and Computer Aided Learning are now very useful tools and will become indispensable and even essential in the near future.
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