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CD-ROM source data uploaded to the operating and storage devices of an IBM 3090 mainframe through a PC terminal.

A powerful method of processing MEDLINE and CINAHL source data uploaded to the IBM 3090 mainframe computer through an IBM/PC is described. Data are first downloaded from the CD-ROM's PC devices to floppy disks. These disks then are uploaded to the mainframe computer through an IBM/PC equipped with WordPerfect text editor and computer network connection (SONNGATE). Before downloading, keywords specifying the information to be accessed are typed at the FIND prompt of the CD-ROM station. The resulting abstracts are downloaded into a file called DOWNLOAD.DOC. The floppy disks containing the information are simply carried to an IBM/PC which has a terminal emulation (TELNET) connection to the university-wide computer network (SONNET) at the Ohio State University Academic Computing Services (OSU ACS). The WordPerfect (5.1) processes and saves the text into DOS format. Using the File Transfer Protocol (FTP, 130,000 bytes/s) of SONNET, the entire text containing the information obtained through the MEDLINE and CINAHL search is transferred to the remote mainframe computer for further processing. At this point, abstracts in the specified area are ready for immediate access and multiple retrieval by any PC having network switch or dial-in connection after the USER ID, PASSWORD and ACCOUNT NUMBER are specified by the user. The system provides the user an on-line, very powerful and quick method of searching for words specifying: diseases, agents, experimental methods, animals, authors, and journals in the research area downloaded. The user can also copy the TItles, AUthors and SOurce with optional parts of abstracts into papers under edition. This arrangement serves the special demands of a research laboratory by handling MEDLINE and CINAHL source data resulting after a search is performed with keywords specified for ongoing projects. Since the Ohio State University has a centrally founded mainframe system, the data upload, storage and mainframe operations are free.

CD-ROM↗

Cooperative multiagent congestion control for high-speed networks.

An adaptive multiagent reinforcement learning method for solving congestion control problems on dynamic high-speed networks is presented. Traditional reactive congestion control selects a source rate in terms of the queue length restricted to a predefined threshold. However, the determination of congestion threshold and sending rate is difficult and inaccurate due to the propagation delay and the dynamic nature of the networks. A simple and robust cooperative multiagent congestion controller (CMCC), which consists of two subsystems: a long-term policy evaluator, expectation-return predictor and a short-term rate selector composed of action-value evaluator and stochastic action selector elements has been proposed to solve the problem. After receiving cooperative reinforcement signals generated by a cooperative fuzzy reward evaluator using game theory, CMCC takes the best action to regulate source flow with the features of high throughput and low packet loss rate. By means of learning procedures, CMCC can learn to take correct actions adaptively under time-varying environments. Simulation results showed that the proposed approach can promote the system utilization and decrease packet losses simultaneously.

Algorithms↗

Image and report distribution on the Internet.

The Internet links together millions of computers to share a wide variety of information--words, sounds and images--which makes it ideally suited for applications in diagnostic imaging departments. Timely availability of patient information is critical to patient care. In the form of a report, image or both, information is the final product of every imaging department. Internet applications can allow physicians easy access to and review of patient information. Many imaging departments already have the basic components of Internet technology in place, which may include an existing image distribution network. At the University of Kansas Medical Center (UKMC), we had a good network base and digital digitation and distribution system, but had not found an appropriate PACS for image distribution and display. When a home page was designed for the radiology department at UKMC, it was intended for report distribution. However, we quickly discovered that it could also function as a low-cost/low-resolution image distribution system. Before making confidential patient information accessible on the Internet, appropriate information security requirements must be in place. At UKMC, access is strictly controlled through the medical records department. Programmers in the radiology department at UKMC are also using the Internet to develop applications for on-line review, editing and electronic signature. Early experience with the Internet as a basis for radiology image and report distribution has been extremely successful and popular with referring physicians at UKMC.

Academic Medical Centers↗

Information issues in telemedicine systems.

This paper examines the use of the Integrated Services Digital Network (ISDN) for telemedicine from the computer scientist's point of view. As increased bandwidth becomes available at reasonable cost, it becomes possible to employ graphical user interfaces in telemedicine systems. This means that human-computer interaction (HCI) techniques can be applied to the interface design. This paper describes some of these as applied to telemedicine by other authors. HCI techniques can be considered to be part of the development process of telemedicine systems. An integrated, multimedia-based telemedicine system which emulated the concept of a hospital information system would have many benefits, such as a consistent user interface with appropriate clinical metaphors, integrated patient records with facilities to store graphical information, and remote access. Telemedicine has much to offer in terms of providing higher standards of patient care through improved response times by clinicians who have the required information immediately available. The patient also benefits from convenience factors, such as being able to consult locally a remote specialist.

Computer Communication Networks↗

Network-based informatics support of research collaborations in the Human Genome Project and the Human Brain Project.

Sophisticated network-based informatics support will increasingly be required for collaborating biomedical laboratories located in different geographic locations, both to accommodate the massive amount of data being generated in certain fields, and to allow different types of data produced at different laboratories to be analyzed in an integrated fashion. The paper describes the experience of the Yale Center for Medical Informatics in providing informatics support for collaborative projects in gene mapping (as part of the national Human Genome Project) and neuroscience (as part of the national Human Brain Project). The paper describes the informatics needs of the two projects and the solutions being developed, describes certain lessons learned, and discusses certain broader issues that arise.

Brain Mapping↗

Use of a statewide Maternal and Child Health Information Network.

The Maternal and Child Health Information Network (MATCH) contains numerous data elements. The process of converting these data into information is an essential component of comprehensive management information system planning. This process must address not only the end-user mechanics of data retrieval, but also the framework for how data can be used in program administration. Although potential data use contributes to and may in fact drive system design, the reality of integrating computer and data usage into daily activities presents a different set of challenges in system implementation. For both state and local end-users, barriers to system use had to be addressed. In terms of directing system use, it was helpful to provide a format for categorizing data needs. The broad categories of data needs identified for program administration were planning, research, evaluation, management, and collaboration. Numerous initiatives have evolved for each of these categories.

Child↗

Digital dental radiography needs assessment utilizing the Delphi process.

This article reports the results of a needs assessment using the Delphi process. The purpose of this study was to determine the architecture and equipment (radiographic and computer network) for establishing and supporting an enterprise's vast digital dental radiographic program. Two panels of subject matter experts identified the needs for a digital dental radiography system; one expert panel consisted of dentists while the other panel's members were information management/information technology (IM/IT) experts. Panelists rated digital dental radiography needs using descriptive statistics and a 7-point bipolar scale. Among dentists, the four most important needs were the capability to store images, image appearance, centralized image storage, and a dedicated back-up server; among IM/IT panelists, they were ensuring HIPAA compliance, use of a standard formatting procedure, excellent print quality, and use of encryption for data transmission. This study's findings are useful for any organization seeking to initiate or improve its own digital radiography program.

Computer Communication Networks↗

Neural network based optimal routing algorithm for communication networks.

This paper presents the capability of the neural networks as a computational tool for solving constrained optimization problem, arising in routing algorithms for the present day communication networks. The application of neural networks in the optimum routing problem, in case of packet switched computer networks, where the goal is to minimize the average delays in the communication have been addressed. The effectiveness of neural network is shown by the results of simulation of a neural design to solve the shortest path problem. Simulation model of neural network is shown to be utilized in an optimum routing algorithm known asflow deviation algorithm. It is also shown that the model will enable the routing algorithm to be implemented in real time and also to be adaptive to changes in link costs and network topology.

Algorithms↗

Implementing hospital library automation: the GaIN project. Georgia Interactive Network for Medical Information.

The GaIN (Georgia Interactive Network for Medical Information) Hospital Libraries' Local Automation Project was a one-year, grant-funded initiative to implement an integrated library system in three Georgia hospitals. The purpose of the project was to install the library systems, describe the steps in hospital library automation, and identify issues and barriers related to automation in small libraries. The participating hospitals included a small, a medium, and a large institution. The steps and time required for project implementation were documented in order to develop a decision checklist. Although library automation proved a desirable approach for improving collection accessibility, simplifying daily routines, and improving the library's image in the hospital, planners must be sure to consider equipment as well as software support, staffing for the conversion, and training of the library staff and end users.

Catalogs, Library↗

Integrating multiple clinical information systems using the Java message service framework to enable the delivery of urgent exam results at the point of care.

The aim of this study is to determine if network-enabled personal digital assistants (PDAs) can be used to facilitate the timely delivery of urgent radiological exam results by reducing the interval from when the radiologist's initial interpretation is available to when it is first viewed by an emergency department (ED) physician. A web- and Java message service (JMS)-based application was built to replace the original fax-based wet-read procedure. The new system allows radiologists to enter wet-reads from the picture archiving and communication system (PACS) display station and to track discrepancies between the wet-read and final report. It also notifies the ED physicians when exam results are available via the PDAs and permits them to view the full text of the wet-read and final reports from the devices. The new system is compared to the original procedure with the results showing improvements with the wireless method. Furthermore, feedback from a qualitative survey of PDA users was positive, suggesting that PDAs may provide one means for accessing urgent clinical data at the point of care.

Computer Communication Networks↗

Electronic clinical trial protocol distribution via the World-Wide Web: a prototype for reducing costs and errors, improving accrual, and saving trees.

Clinical trials today typically are inefficient, paper-based operations. Poor community physician awareness of available trials and difficult referral mechanisms also contribute to poor accrual. The Physicians Research Network (PRN) web was developed for more efficient trial protocol distribution and eligibility inquiries. The Medical University of South Carolina's Hollings Cancer Center trials program and two community oncology practices served as a testbed. In 581 man-hours over 18 months, 147 protocols were loaded into PRN. The trials program eliminated all protocol hardcopies except the masters, reduced photocopier use 59%, and saved 1.0 full-time equivalents (FTE), but 1.0 FTE was needed to manage PRN. There were no known security breaches, downtime, or content-related problems. Therefore, PRN is a paperless, user-preferred, reliable, secure method for distributing protocols and reducing distribution errors and delays because only a single copy of each protocol is maintained. Furthermore, PRN is being extended to serve other aspects of trial operations.

Clinical Trials as Topic↗

Virtual workspaces in I2Cnet.

The objective of I2Cnet (Image Indexing by Content network) is to provide network-transparent content-based access to medical image archives as an Internet/intranet value-added service. Through a typical web browser, healthcare professionals interact with image collections, browse images similar to a query image, compare these images to images from other collections, and contribute their own images or comments. Specific I2Cnet services available on the World Wide Web (WWW) include image processing and feature extraction, content- and annotation-based search for images and image-related information, and authoring of annotations and image descriptions. Virtual workspaces provide the necessary mechanisms to support user sessions in I2Cnet, providing for service interoperability, persistence, and user interaction. In the course of a user session, which begins with a workspace log-in and ends explicitly with a workspace log-out or implicitly by exiting the browser, virtual workspaces maintain the common context.

Computer Communication Networks↗

Protection of patient data in multi-institutional medical computer networks: regulatory effectiveness analysis.

Privacy protection is one of the major issues in the development of multi-institutional clinical information networks. Judicial decisions have confirmed patient's rights to protection of a "reasonable expectation of privacy". Incorporating this protection into a system requires analysis of appropriate models. The National Practitioner Data Bank (NPDB) contains confidential data concerning physician competence. The medical profession had substantial input into the privacy protection features of the NPDB, which are much more comprehensive than those used in many clinical information systems. The NPDB represents the privacy protection which physicians expect for their own data. Regulatory Effectiveness Analysis can be used to analyze the suitability of the NPDB as a model for patient privacy protection. Judicial opinions set public policy and legal structures for privacy, and the NPDB provides an inventory of useable technical tools. After eliminating minor discontinuities, the NPDB can be used as a model to create a useable standard for privacy for multi institutional data transfers.

Civil Rights↗

Models@Home: distributed computing in bioinformatics using a screensaver based approach.

MOTIVATION: Due to the steadily growing computational demands in bioinformatics and related scientific disciplines, one is forced to make optimal use of the available resources. A straightforward solution is to build a network of idle computers and let each of them work on a small piece of a scientific challenge, as done by Seti@Home (http://setiathome.berkeley.edu), the world's largest distributed computing project. RESULTS: We developed a generally applicable distributed computing solution that uses a screensaver system similar to Seti@Home. The software exploits the coarse-grained nature of typical bioinformatics projects. Three major considerations for the design were: (1) often, many different programs are needed, while the time is lacking to parallelize them. Models@Home can run any program in parallel without modifications to the source code; (2) in contrast to the Seti project, bioinformatics applications are normally more sensitive to lost jobs. Models@Home therefore includes stringent control over job scheduling; (3) to allow use in heterogeneous environments, Linux and Windows based workstations can be combined with dedicated PCs to build a homogeneous cluster. We present three practical applications of Models@Home, running the modeling programs WHAT IF and YASARA on 30 PCs: force field parameterization, molecular dynamics docking, and database maintenance.

Computational Biology↗

Comprehensive, technology-based clinical education: the "virtual practicum".

This article discusses the application of technology to promote more comprehensive clinical education in the biopsychosocial aspects of primary care. Comprehensive refers to the inclusion, in addition to scientific and technical knowledge, of knowledge that is less easily characterized, quantified, and taught: empathy, intuition, the demonstration of artistry. Clinical education will be increasingly facilitated by the proliferation of computers capable of displaying combinations of text, graphics, video, and sound; broadband networks capable of delivering these multiple media to the home or office; and new methods for using these technologies for education and training. However, current models for technology-based learning are limiting, lagging behind the rapid technological evolution driving our entry into the Information Age. Some recent educational models (Schon's reflection-in-action and reflective practicums [1], Boisot's E-space [2], Kolb's learning cycle [3]) provide for a more comprehensive and complete view of health professional education. This article describes these models in depth and proposes a new model for technology-based clinical training, the "Virtual Practicum," based on them. The Virtual Practicum is illustrated with a new interactive CD-ROM program, dealing with primary care of patients with HIV/AIDS. The concepts presented here are generally useful in thinking about clinical education, regardless of the means used.

CD-ROM↗

Simulation of emission tomography using grid middleware for distributed computing.

SimSET is Monte Carlo simulation software for emission tomography. This paper describes a simple but effective scheme for parallel execution of SimSET using NetSolve, a client-server system for distributed computation. NetSolve (version 1.4.1) is "grid middleware" which enables a user (the client) to run specific computations remotely and simultaneously on a grid of networked computers (the servers). Since the servers do not have to be identical machines, computation may take place in a heterogeneous environment. To take advantage of diversity in machines and their workloads, a client-side scheduler was implemented for the Monte Carlo simulation. The scheduler partitions the total decay events by taking into account the inherent compute-speeds and recent average workloads, i.e., the scheduler assigns more decay events to processors expected to give faster service and fewer decay events to those expected to give slower service. When compute-speeds and sustained workloads are taken into account, the speed-up is essentially linear in the number of equivalent "maximum-service" processors. One modification in the SimSET code (version 2.6.2.3) was made to ensure that the total number of decay events specified by the user is maintained in the distributed simulation. No other modifications in the standard SimSET code were made. Each processor runs complete SimSET code for its assignment of decay events, independently of others running simultaneously. Empirical results are reported for simulation of a clinical-quality lung perfusion study.

Computer Communication Networks↗

An e-consent-based shared EHR system architecture for integrated healthcare networks.

OBJECTIVES: Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model. METHODS: A literature survey summarizes considerations of current architectural approaches. Complemented by a methodical analysis in two regional settings, a formal architecture model was specified and implemented. RESULTS: Results presented in this paper are a survey of architectural approaches for shared health records and an architecture model for a virtual shared EHR, which combines a patient-centred integration policy with provider-oriented document management. An electronic consent system assures, that access to the shared record remains under control of the patient. A corresponding system prototype has been developed and is currently being introduced and evaluated in a regional setting. CONCLUSION: The proposed architecture is capable of partly replacing message-based communications. Operating highly available provider repositories for the virtual shared EHR requires advanced technology and probably means additional costs for care providers. Acceptance of the proposed architecture depends on transparently embedding document validation and digital signature into the work processes. The paradigm shift from paper-based messaging to a "pull model" needs further evaluation.

Computer Communication Networks↗

Secure interoperability of patient data cards in health networks.

In the healthcare area, chip card based information systems occur in the shape of patient data cards providing informational self determination and mobility of the users as well as quality, integrity, accountability, and availability of the data stored on the card, thus improving the shared care of patients. Dealing with sensitive personal medical information, shared care information systems have to provide appropriate security services, only authorized users allowing restricted rights to the patients' data according to the "need to know" principle. The DIABCARD project aims the implementation and evaluation of a chip card based medical information system (CCMIS) for facilitating communication and co-operation between health professionals in different organisations or departments caring the same patient with Diabetes as an example. In co-operation with the EC-funded TrustHealth project, the communication and application security services needed are provided as strong authentication and the derived services like authorization, access control, accountability, confidentiality etc. The solution is based on Health Professional Cards and Trusted Third Party services. Besides the secure handling of the patient's chip cart in DIABCARD workstations, also the secure communication between these workstations and related departmental systems has been implemented. Finally, a few legal issues, future trends like the XML standard set and their implications for the solution presented as well as for distributed health information systems in general are shortly discussed.

Computer Communication Networks↗