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[A cost & benefit management system for investment equipments].

Being aimed at the management of investment equipments, the flow of data has been put forward and the two main modes of data calculating have been established by our relying on No.1 Network of Military Healthy. The real-time management has been realized by the system in regard to eguipments' contact, charges, payouts, interest, payment, forecast and decision-makiing. It has been steadily test-running for more than 10 months in our hospital, and data have been processed exactly and creditably.

Computer Communication Networks↗

[Making a low cost IPSec router on Linux and the assessment for practical use].

We installed Linux and FreeS/WAN on a PC/AT compatible machine to make an IPSec router. We measured the time of ping/ftp, only in the university, between the university and the external network. Between the university and the external network (the Internet), there were no differences. Therefore, we concluded that CPU load was not remarkable at low speed networks, because packets exchanged via the Internet are small, or compressions of VPN are more effective than encoding and decoding. On the other hand, in the university, the IPSec router performed down about 20-30% compared with normal IP communication, but this is not a serious problem for practical use. Recently, VPN machines are becoming cheaper, but they do not function sufficiently to create a fundamental VPN environment. Therefore, if one wants a fundamental VPN environment at a low cost, we believe you should select a VPN router on Linux.

Computer Communication Networks↗

Extracting data from a DICOM file.

DICOM v3.0 is a vendor-independent standard for digital medical images that describes a file format and network protocol for the exchange of images between computer systems. When simply viewing a DICOM file, it is not necessary for the user to understand the details of the entire DICOM standard. However, understanding parts of the standard is essential when DICOM files are read and processed by a user-generated program. This paper offers an overview of information a user needs to write a program for extracting the image and acquisition parameters from a DICOM file.

Computer Communication Networks↗

High-performance computing in radiation cancer treatment.

In 1989 a consortium of the Radiation Oncology and Computer Science Departments at the University of North Carolina, BellSouth Corporation, GTE, and the MCNC was formed in response to the high-speed network initiative proposed by the National Science Foundation and the Defense Advanced Research Projects Agency. One of the purposes of this effort has been to demonstrate that applications exist that require gigabit per second networks. Our consortium, known as VISTAnet, proposed to use real-time radiation therapy treatment planning as the application that would require the use of a gigabit network. The plan was to develop a system that could rapidly calculate and display a three-dimensional radiation dose distribution for any configuration of radiation beams. The gigabit network would be used to tie the dose calculations done with the Cray Y-MP at the Research Triangle to the graphics engine at the Department of Computer Science (Pixel-Planes 5) and the medical workstation at Radiation Oncology. The system would then provide the radiation physician with the capability of considering hundreds of potential treatment plans, instead of the usual two or three, with the goal of arriving at a highly optimized plan within a few minutes.

Computer Communication Networks↗

Upgrading legacy systems for the Integrating the Healthcare Enterprise (IHE) initiative.

As technology vendors have adopted standardized communication protocols, including Digital Imaging and Communications in Medicine (DICOM) and Health Level 7 (HL7), interconnectivity between various devices has been simplified. The recent Integrating the Healthcare Enterprise (IHE) initiative will further promote the use of standards for interconnectivity. Until these standards are universally accepted, we must live in a transitional world where some components will communicate without any modification, while others require upgrades to allow them to meet the new standards. In designing and implementing the network at University of California Los Angeles (UCLA) Medical Center, some integration problems were found that are common to the industry. Creating departmental workflow with only a limited number of acquisition devices supporting the DICOM worklist was the initial problem addressed. Although many manufacturers provide this function for their new scanners, upgrading existing equipment is often cost-prohibitive. To ensure the quality of the demographic information in the image data and the workflow of the system, third-party worklist components were required to upgrade the legacy acquisition devices. These worklist components provided a standards-compliant facade on top of the legacy equipment, allowing seamless integration with the remainder of the network. To support the distribution of worklist information and the feedback of procedure status, a bidirectional HL7/DICOM protocol bridge was required. Although many radiology information system (RIS) manufacturers will be providing native DICOM capabilities in future product releases, the majority of current RIS installations have no DICOM functionality. Similar to the legacy scanners, the HL7/DICOM bridge provided a DICOM-compliant facade to the non-DICOM RIS. The additional use of web-based technology for worklist display further extended flexibility of this facade. We have demonstrated standards-compliant facade technology allowing legacy components to operate seamlessly in an IHE environment at a fraction of the cost of upgrading to new equipment.

Computer Communication Networks↗

Integrating Hospital Information Systems. The challenges and advantages of (re-)starting now.

With the new technologies available today, more complex and useful Hospital Information Systems (HIS) can be designed and implemented. These new technologies have allowed that information from different sources and nature such as documents, images and signals be integrated within a single environment. Open standards, reliable networks, powerful hardware and software and lower prices are among the issues that make all this possible. One of the main issues is what to do with old systems that do not adhere to this new HIS concept. At the Heart Institute (InCor), a decision was made towards starting developing a new system called I3S. This paper gives a brief description of that system.

Brazil↗

An image management and communications (IMAC) system for radiology.

Managing x-ray films is a difficult problem in a hospital. Advances in digital imaging, high speed networks and high fidelity displays make it possible to develop an image management and communication system for a hospital. As many of the technical problems are solved, many operational problems remain. Experience with a prototype installation became the basis for a much more comprehensive implementation of a fully digital filmless imaging support system in a number of hospitals. The use of IMAC technology will bring about profound changes in the radiology community; physicians, administrators, manufactures of imaging systems and the users of radiology service, the patients.

Academic Medical Centers↗

Grid-enabled biosensor networks for pervasive healthcare.

Current advances in biosensor technology allow multiple miniaturized or textile sensors to record continuously biosignals, such as blood pressure or heart rate, and transmit the information of interest to clinical sites. New applications are emerging, based on such systems, towards pervasive healthcare. This paper describes an architecture enabling biosensors, forming a Body Area Network (BAN), to be integrated in a Grid infrastructure. The Grid services proposed, such as access to recorded data, are offered via the BAN console, an enhanced wearable computer, where the recordings of multiple biosensors are integrated. Medical Grid-enabled Nodes can have access to biosensor measurements upon demand, or can agree to get notifications and alerts. Thus, in such a distributed environment, data and computational resources are independent, yet cooperating unobtrusively, contributing to the notion of pervasive healthcare.

Blood Pressure Monitoring, Ambulatory↗

Practice brief. Securing wireless technology for healthcare.

Wireless networking can be a very complex science, requiring an understanding of physics and the electromagnetic spectrum. While the radio theory behind the technology can be challenging, a basic understanding of wireless networking can be sufficient for small-scale deployment. Numerous security mechanisms are available to wireless technologies, making it practical, scalable, and affordable for healthcare organizations. The decision on the selected security model should take into account the needs for additional server hardware and administrative costs. Where wide area network connections exist between cooperative organizations, deployment of a distributed security model can be considered to reduce administrative overhead. The wireless approach chosen should be dynamic and concentrate on the organization's specific environmental needs. Aspects of organizational mission, operations, service level, and budget allotment as well as an organization's risk tolerance are all part of the balance in the decision to deploy wireless technology.

Computer Communication Networks↗

A clinical pharmacy-oriented drug surveillance network: I. Program description.

The limitations of the new drug development process, particularly in regard to the evaluation of drug safety, have resulted in a need for monitoring drug experience in the postmarketing period. Although a number of systems have evolved to perform postmarketing surveillance, each has important limitations, suggesting the need for an alternative, innovative approach that would permit rapid identification of potential problems and support studies of multiple drugs and/or disease states in patient populations large enough to permit identification of uncommon, but significant adverse drug reactions. This has led to the organization of a nationwide network of clinical pharmacists with an active role in patient-care monitoring to collect information regarding the safety and effectiveness of drugs. At the present time there are 383 clinical pharmacists from all 50 states participating in the network. These individuals collectively monitor more than 150,000 inpatient hospital beds, more than 40,000 nursing home beds, and more than 800,000 ambulatory care visits per year. Participating clinical pharmacists, using standardized data collection forms, perform concurrent monitoring of drug-therapy outcome in targeted patient populations. Careful analysis and interpretation of this information will yield clinically relevant information regarding the outcome of drug therapy under actual clinical conditions.

Computer Communication Networks↗

Functional evaluation of telemedicine with super high definition images and B-ISDN.

In order to determine whether a super high definition (SHD) image running at a series of 2048 resolution x 2048 line x 60 frame/sec was capable of telemedicine, we established a filing system for medical images and two experiments for transmission of high quality images were performed. All images of various types, produced from one case of ischemic heart disease were digitized and registered into the filing system. Images consisted of plain chest x-ray, electrocardiogram, ultrasound cardiogram, cardiac scintigram, coronary angiogram, left ventriculogram and so on. All images were animated and totaled a number of 243. We prepared a graphic user interface (GUI) for image retrieval based on the medical events and modalities. Twenty one cardiac specialists evaluated quality of the SHD images to be somewhat poor compared to the original pictures but sufficient for making diagnoses, and effective as a tool for teaching and case study purposes. The system capability of simultaneously displaying several animated images was especially deemed effective in grasping comprehension of diagnosis. Efficient input methods and creating capacity of filing all produced images are future issue. Using B-ISDN network, the SHD file was prefetched to the servers at Kyoto University Hospital and BBCC (Bradband ISDN Business chance & Culture Creation) laboratory as an telemedicine experiment. Simultaneous video conference system, the control of image retrieval and pointing function made the teleconference successful in terms of high quality of medical images, quick response time and interactive data exchange.

Computer Communication Networks↗

IAIMS at Columbia-Presbyterian Medical Center: accomplishments and challenges.

The concept of "one-stop information shopping" is becoming a reality at Columbia-Presbyterian Medical Center. Our goal is to provide access from a single workstation to clinical, research, and library resources; university and hospital administrative systems; and utility functions such as word processing and mail. We have created new organizational units and installed a network of workstations that can access a variety of resources and systems on any of seventy-two different host computers/servers. In November 1991, 2,600 different individuals used the clinical information system, 700 different individuals used the library resources, and 900 different individuals used hospital administrative systems via the network. Over the past four years, our efforts have cost the equivalent of $23 million or approximately 0.5% of the total medical center budget. Even small improvements in productivity and in the quality of work of individuals who use the system could justify these expenditures. The challenges we still face include the provision of additional easy-to-use applications and development of equitable methods for financial support.

Academic Medical Centers↗

How changes in computer technology are revolutionizing the practice of chemistry.

During the early 1980s, two major developments in computer technology changed the way chemists approached their science. The advent of the micropressor and then the PC changed experimental chemistry, while the availability of two classes of computer, the superminicomputer and supercomputer, greatly influenced computational chemistry. In the past two years, graphics workstation computers have begun to affect the practice of chemistry by combining fast, high-resolution, multiwindow graphics with superminicomputer power. In 1988, the advent of a new class of computer--the graphics supercomputer--offers extraordinary promise to both theoretician and experimentalist. In these systems, near-Cray compute power is combined with ultrahigh-speed 3-dimensional graphics for unparalleled visualization of molecular processes and other complex events. This is made practical not just by computing and graphics power but by use of ultrahigh internal bandwidths inside the graphics supercomputers. Another major development in scientific computing is the evolving concept of the laboratory computer network. Current network designs include hierarchical configurations incorporating various levels of computers--through supercomputers--either locally or via national or regional networks. New software methods are also having impact on chemical research, allowing, for example, the scientist to better abstract information from noisy or incomplete experimental data. Use of parallelism (multiple CPUs) in new design workstation computers will extend their power, by the early 1990s, past that of current supercomputer mainframes. Within five years the chemist will have $10 million of 1985 computer power on his desk, for considerably less than $100,000, along with visualization tools and software only dreamed of in 1985.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemical Phenomena↗

Development of a statewide Maternal and Child Health Information Network.

The Maternal and Child Health Information Network (MATCH) was a national demonstration project funded in 1983 by a Special Projects of Regional and National Significance (SPRANS) grant. The network's major objectives have been to correlate collected clinical service data items into usable information, to expand the database through linkage with other systems within the Ohio Department of Health, and to analyze the conjugated data in an effort to expand current knowledge of maternal and child health. The network is interactive between local funded agencies and the state Health Department. Both data entry and data retrieval are distributed at the end-user information centers. Training and support, major components of the project, are provided to each participant and user of the network. One advantage of MATCH is that it allows linkage of clinical service records with vital records as an outcome of prenatal care and/or a history for child health clients. This aspect of the system permits an expanded look at the population being served by funds designated for maternal and child health programs and the ultimate outcome of such services, and permits comparison with those not receiving preventive health services.

Child Health Services↗

[Experiences with a Token Ring Network in blood bank administration of the Hannover medical university].

The Token Ring Network is a Local Area Network of IBM. It is a very helpful tool for modulating working processes by personal computers. The Token Ring is a network of the third generation and constructed like a star net. The blood bank of the Medical University of Hannover (MHH) is using the Token Ring for the administration of blood storage and donors. Medical data of foreign laboratories are transmitted into the blood bank computer. During the last year, we had no difficulties working with this software tool in response time and data security and it seemed to us a very cheap opportunity for data integration and data collection on decentralized systems.

Blood Banks↗

Prototyping an institutional IAIMS/UMLS information environment for an academic medical center.

The paper describes a prototype information environment designed to link network-based information resources in an integrated fashion and thus enhance the information capabilities of an academic medical center. The prototype was implemented on a single Macintosh computer to permit exploration of the overall "information architecture" and to demonstrate the various desired capabilities prior to full-scale network-based implementation. At the heart of the prototype are two components: a diverse set of information resources available over an institutional computer network and an information sources map designed to assist users in finding and accessing information resources relevant to their needs. The paper describes these and other components of the prototype and presents a scenario illustrating its use. The prototype illustrates the link between the goals of two National Library of Medicine initiatives, the Integrated Academic Information Management System (IAIMS) and the Unified Medical Language System (UMLS).

Academic Medical Centers↗

[Clinical experiences with PACS: digital radiology].

We present our experience during the first 21 months of using hospital-wide network technology and digital archiving in connection with digital radiology in the Radiology Department at the SMZO/Danube hospital in Vienna. This means digital generation, archiving and distribution of radiographs as well as monitor reporting embedded in HIS and RIS. The clinical use of PACS demands full integration of all subsystems and modalities in a digital way, as was first realized at the Danube Hospital. With this approach, a reduction in radiation dose, improved communication and thus a reduction in the length of hospital stay and health care cost are attained.

Austria↗

Developing trends in clinical computing.

With the emergence of personal computers and graphical interfaces during the 1980s, advanced computational power has at last become accessible and affordable for practising clinicians in both inpatient and outpatient settings. Many observers have accordingly noted the relatively low level of direct computer use by physicians in their practices. This paper summarises developing trends in clinical computing, emphasising the role of local and wide-access networks, the revolutionary potential of optical storage techniques, and the notion of integrated workstations that will bring a critical mass of diverse functions to the physician. An important lesson of this review is the current availability of most of the technologies needed for high-quality and acceptable clinical computing tools. The barriers to successful implementation tend to be logistical, financial, and political. Despite these obstacles, new technologies, coupled with educational efforts, should allow the computer to emerge as a crucial aid to clinicians in the decade ahead.

Attitude to Computers↗