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Architectural decisions with respect to the introduction of PACS.

In this paper we report on a study on the possible scenarios for the introduction of PACS that was conducted at the LUMC in 2002 by a workgroup. The results of this study should facilitate the decision on PACS to be taken by the management of the LUMC at a later stage. In this paper our main research question is to what extent the decisions to be made at the introduction of PACS can be derived from an information system architecture in place, and vice versa: how can these decisions help to refine an information system architecture that is still immature.

Computer Systems↗

Integrating images into a central medical information system.

Of the information items that must be easily available to the different actors involved in the care process, radiological images are not the least important. While until recently it was not feasible to include these into the medical information system, this situation has changed. Still, emphasis in PACS (Picture Archiving and Communication Systems) is primarily on the technological aspects. In this paper, in contrast, we stress the importance of integration of images into the overall workflow and into the overall medical record. We do so using illustrations from the PACS project of the University Hospitals Leuven. We briefly indicate that tight integration at the user interface level is needed, and that this requires more than standardized communication between subsystems.

Computer Systems↗

Automated therapeutic drug monitoring in an ambulatory care endocrine clinic.

OBJECTIVE: To develop and implement an automated therapeutic drug monitoring system for accessing data from endocrine clinic patients who had been prescribed insulin, oral hypoglycemic agents (OHA), or levothyroxine. DATA SOURCES: We designed a computer system to retrieve clinical data from the Medical Information System (MIS), a centralized hospital computer system, and import this information directly into a Macintosh personal computer. Physician entry of prescriptions for insulin, OHA, or levothyroxine into MIS formed the basis for a computer program to retrieve daily diagnostic and prescription information, demographics, and laboratory analyses, including blood glucose and glycosylated hemoglobin for insulin and OHA orders and free and total thyroxine, total triiodothyronine, and thyroid stimulating hormone for levothyroxine orders. The information was imported into a database program (4th Dimension). RESULTS: The system identifies laboratory values outside of predetermined therapeutic ranges, maintains an up-to-date patient profile, and edits and generates reports. Preliminary experience suggests that automation eliminates 75-90 percent of the time required to manually collect the same information, and improves the accuracy, comprehensiveness, and utility of reports. CONCLUSIONS: Automated therapeutic drug monitoring minimizes the time required to collect clinical data, alerts clinicians to potential problems, and provides a means to assess overall therapeutic management. Our methodology can be used to evaluate other medications in a variety of general or specialty clinics.

Ambulatory Care↗

The role of object representation in the design of the intelligent radiology workstation.

The paper describes the design of the Intelligent Radiology Workstation (IRW) that is intended to handle heterogeneous radiologic data (text, image, video) and radiologic knowledge in such a way that it is easy to store, access, use, and repurpose. An object-based structure is used to combine the relational database, hybrid knowledge base, and hypermedia within a common framework. Functions such as data entry and retrieval, browsing, and intelligent processing of data are available in the single environment. IRW open architecture allows radiologic digital resources to be used for clinical practice, diagnosis support, education, and research.

Artificial Intelligence↗

The CRISP system: an untapped resource for biomedical research project information.

CRISP (Computer Retrieval of Information on Scientific Projects) is a large database maintained and operated by the National Institutes of Health (NIH). It contains comprehensive scientific and selected administrative data on research carried out by the U.S. Public Health Service (PHS) or supported by PHS grants and contracts. Developed originally to meet the needs of NIH, it is an excellent, largely untapped resource for health information professionals at large, revealing new trends, methods, and techniques, often before they appear in the published literature. CRISP uses its own controlled vocabulary, developed to permit indexing of new and active research areas. Queries can combine subject headings with a great variety of administrative data elements (e.g., research category or principal investigator's name). Output is available in a variety of formats and media. While information professionals cannot directly access the CRISP system, abridged CRISP records are merged into the FEDRIP (Federal Research in Progress) database, and FEDRIP is publicly accessible through DIALOG. CRISP records in toxicology are also furnished to the National Library of Medicine's TOXLINE database. This paper discusses the indexing, information retrieval, publication products, and search services of the CRISP system, and how users of medical information can benefit from it.

Abstracting and Indexing↗

An integrated, hospital information system based obstetrical medical record and database.

Described in this paper is the implementation and integration of an obstetrical medical record and database into an existing hospital information system. A unique feature of this system was the integration of existing data captured by the established hospital information systems with the newly implemented obstetrical database to form a complete patient data profile. This complete database integrated data from hospital functions such as demographic data obtained at patient registration, outpatient visits and tests, inpatient admission historical data, tests and procedures, newborn data and miscellaneous data required for birth registration. An important second feature was the utilization of physicians and nurses to enter the obstetrical data. This permitted immediate access to patient data from any hospital information system terminal, immediate retrieval for generating reports, and subsequently, ad hoc queries, statistical analysis and the electronic transfer of birth registration data to the State Vital Statistics Registry.

Academic Medical Centers↗

Development and implementation of the Veterans Administration's multihospital radiology information system.

Unknown to most radiology professionals, the Veterans Administration (VA) is implementing an automated radiology information system as an integrated component of its Decentralized Hospital Computer Program. The basic design has been evaluated and refined over the past 5 years. It is now becoming available in all 172 VA medical facilities. Radiology services are provided in a complex management and fiscal environment. The primary purpose of the information system is to improve the efficient processing, performance, and reporting of requests for radiologic consultations and procedures. The automatic capturing of demographic and medical statistics will provide local and national managers more complete data with which to plan future financial, equipment, and personnel requirements. The VA radiology module has the potential to influence the shape of all future systems, commercial and public. This report describes the development of this radiology information system, its current status, and its potential impact on the largest health care system in the country. The module serves as an example of what can or should be expected from the radiology portion of a comprehensive medical information management system.

Computer Systems↗

Methods for detecting teratogenic agents in man.

At a multidiscipline international meeting sponsored by L'Institut de la Vie held at Guadeloupe in January 1974, current methods for detecting teratogenic agents were outlined and discussed. Recommendations of the participants of the conference were: recognize the limitations of the present defenses against teratogenic agents; educate the public and medical profession about the known human teratogenic agents; select for animal teratogenicity screening among new and existing agents by emphasizing substances to which the entire population will be exposed, agents to which pregnant women are exposed, viruses which are found to persist in the human fetus, and agents which have become suspect from clinical experience; recognize that nearly all compounds have a fetotoxic dose but that this does not imply teratogenicity; encourage the development of new, quick in vitro testing methods for detecting teratogenic agents; monitor for sudden increases in the frequency of specific malformations in newborn infants and in aborted fetuses; assure that expert multidiscipline committees are available to evaluate the threat when suspected teratogens are reported; improve teratology information storage and retrieval systems by record linkage of clinical data, linkage between computer systems, and universal identifier system for chemical compounds and congenical malformations; foster the exchange of data, particularly those held by the pharmaceutical industry.

Amniocentesis↗

Migration of medical image data archived using mini-PACS to full-PACS.

This study evaluated the migration to full-PACS of medical image data archived using mini-PACS at two hospitals of the Yonsei University Medical Center, Seoul, Korea. A major concern in the migration of medical data is to match the image data from the mini-PACS with the hospital OCS (Ordered Communication System). Prior to carrying out the actual migration process, the principles, methods, and anticipated results for the migration with respect to both cost and effectiveness were evaluated. Migration gateway workstations were established and a migration software tool was developed. The actual migration process was performed based on the results of several migration simulations. Our conclusions were that a migration plan should be carefully prepared and tailored to the individual hospital environment because the server system, archive media, network, OCS, and policy for data management may be unique.

Computer Systems↗

Nursing documentation in the computer-based patient record.

This paper describes the INFORMM NIS (Information Network for On-line Retrieval & Medical Management Nursing Information System) charting system developed by the Departments of Nursing and Information Systems at the University of Iowa Hospitals and Clinics (UIHC). The documentation system features automated work lists, defaulted charting responses, decision support, automatic computations, chart forms and reports, and graphical displays of clinical data. The impact of the on-line charting system has been demonstrated by content standardization with Nursing Interventions Classification (NIC), improved standards compliance, increased efficiency, enhanced timeliness, expanded accessibility, and an augmented data archive.

Forms and Records Control↗

The management of a large data base in IRIS.

IRIS (Illinois Resource Information System) is a retrieval and analysis system for land-use planners. The system stores the attributes of land parcels. Currently two major data bases are in use: a 78,000 parcel data base covering eight counties around Chicago and a 16,000 parcel data base covering six counties around Chicago.

Computers↗

Large database management in clinical dental research.

Previously the management and analysis of large databases for longitudinal clinical dental research has been severely restricted by the costs of custom-made software and access to suitable computing equipment. However, the recent availability of powerful personal computers and the use of the Scientific Information Retrieval Database Management System (SIR/DBMS) in association with BMDP Statistical Software has now created an enormously powerful tool for extensive and fast data manipulation requiring relatively few commands and the capability to easily perform detailed statistical analyses.

Computer Graphics↗

Free text analysis.

In the context of hospital information systems (HIS) medical free text analysis is reviewed with respect to current automated approaches to literature retrieval, case retrieval and fact retrieval from textual data in the patient record. The Unified Medical Language System (UMLS) project has enormously stimulated current research. It is expected that UMLS knowledge sources and SNOMED III (which need a translation into other languages as soon as possible) as well as the conceptual graphs formalism, could become standards to utilize free text information contained in HIS databases.

Abstracting and Indexing↗

Hard disk online caches in picture archiving and communication systems archives: how big is beautiful?

The objective of our study was to support algorithmic recommendations for the appropriate sizing of picture archiving and communication system (PACS) caches. For a large PACS installation, a detailed analysis of current radiographic (CR), CT and MRI studies (n=400 consecutive studies, respectively) was performed. In this process every available prior examination was also considered. A new algorithmic procedure for appropriate sizing of PACS caches was developed and applied to the given cache implementation. The number of all priors was 7.6+/-12.3. Of them, 61% were relevant priors with an average age of 203+/-385 days. A basic cache (BC) that covers 12 months of current imaging results in a pre-fetching quote of 15.4% (8.6% for 24 months). In the PACS installation examined, a minimal threefold increase in cache capacity was recommended. Studies that are retrieved, prior to viewing, from the long-term archive require additional space in the extended cache (EC). An intimate and mutual interaction between hospital information system (HIS), radiology information system (RIS) and PACS minimizes this requirement and increases the time during which actual image material from the BC is available online. A basic cache size covering actual imaging of 12 months up to 24 months is recommended. The parameters governing the individual dimensions of both cache spaces and a mathematical algorithm are demonstrated.

Algorithms↗

Poisonous plant information system (PPIS).

There is a need for efficient storage and retrieval of information about poisonous plants. The purpose of this article is to describe the Poisonous Plant Information System (PPIS) and to discuss basic issues in building and maintaining databases within the larger context of combined veterinary databases. This paper defines the database of PPIS and discusses its contents. Access methods are explained and sample search techniques are given.

Information Systems↗