Personal digital educators.
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Computer Communication Networks↗
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Integration of the digital imaging and communications in medicine standard into an oral and maxillofacial image management and communication system.
OBJECTIVE: The purpose of this study was to provide developmental information about digital imaging and communications in medicine (DICOM) support applications for an image management and communication system (IMACS). STUDY DESIGN: An oral and maxillofacial radiology IMACS that uses a proprietary image format was implemented in March 1997 in a general hospital dental clinic that supports more than 100 cubicles. DICOM was implemented into this system in 1998. RESULTS: In March 1997, the clinic directly began processing oral and maxillofacial radiographs with digital image acquisition devices or converted them into proprietary digital format with a film digitizer. The digital images could then be viewed at workstations in the 11 different divisions of the department. A DICOM module was implemented to convert proprietary images into DICOM in June 1998. After the release of DICOM Supplement 32 on a digital x-ray, DICOM was implemented into the oral and maxillofacial radiology IMACS with a DICOM server and browser in June 1999. We describe the steps we took to implement this system in our institution with a brief report on the evaluation of this system. CONCLUSION: We implemented a DICOM oral and maxillofacial IMACS that complies with the American College of Radiology and the National Electrical Manufacturers Association Standard DICOM, version 3.0. Most DICOM service classes and roles are supported.
Computer Communication Networks↗
Cognitive representations, control, and understanding of complex systems: a field study focusing on components of users' mental models and expert/novice differences.
Users' mental models of systems are frequently asserted to be important in their interactions with those systems. Although there are few explicit definitions of mental models in the literature, mental models are assumed to be important and researchers have seemed to accept and understand the concept intuitively. In our research, we have extracted three themes from the definitions of mental models including: (1) the relations among features or components of a system; (2) the capability of the mental model to aid in the control of the system; and (3) the capability of the mental model to enhance the user's understanding of the system. The relationships among the components of users' mental models, including procedural and declarative knowledge, perceptions of the use of system features, and the relations among the similarity of use of system features, were investigated in a field study. Trained and untrained novice users of a new business phone system rated the similarity of use of nine standard features on the phone. These ratings were used to derive cognitive representations of the relations among the system features. Users' ratings of features on univariate scales about the use of the features and scores obtained on a test of procedural knowledge were related to these representations. The two novice groups' mental models were similar except for the perception of one feature; it was more accurately depicted in the trained users' representation than those who did not attend a training programme. Two types of experts' similarity of use ratings were evaluated to determine an 'appropriate' representation of the use of the system features; this was then compared to the novices'. This comparison suggested that there were deficiencies in the mental models of novices. Designing training programmes and instructional aids for systems using the discrepancies between novices' and experts' mental models are discussed.
Adult↗
SatelLife. Partnerships in global communication for health.
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Computer Communication Networks↗
Electromagnetic fields in offices.
With the increased use of electric and electronic equipment in our offices, our daily exposure to electromagnetic fields has become increasingly complex due to the great variety of the frequency content of the fields. Today focus has shifted from monitors as the dominating sources of electromagnetic fields to other electronic equipment, cabling, nearby substations, power lines and stray currents in buildings. In the last 5 years wireless communication has become common in our offices. These devices use radio frequency waves to communicate and are therefore sources of radio frequency fields in our offices. To a certain degree, they all add to the complicated issue of the extensive field frequencies found in offices. The exposure of office workers is generally considered to be low and not in conflict with the existing guidelines, but if a precaution approach is applied there are a number of measures that can be taken to reduce the electromagnetic fields in offices in order to obtain a good electrical environment.
Computer Communication Networks↗
Development of an Internet Security Policy for health care establishments.
The Internet provides unprecedented opportunities for interaction and data sharing among health care providers, patients and researchers. However, the advantages provided by the Internet come with a significantly greater element of risk to the confidentiality and integrity of information. This paper defines the basic security requirements that must be addressed in order to use the Internet to safely transmit patient and/or other sensitive Health Care information. It describes a suitable Internet Security Policy for Health Care Establishments and provides the set of technical measures that are needed for its implementation. The proposed security policy and technical approaches have been based on an extensive study of the related recommendations from the security and standard groups both in EU amid USA and our related work and experience. The results have been utilized in the framework of the Intranet Health Clinic project, where the use of the Internet for the transmission of sensitive Health Care information is of vital importance.
Computer Communication Networks↗
Implementing context and team based access control in healthcare intranets.
The establishment of an efficient access control system in healthcare intranets is a critical security issue directly related to the protection of patients' privacy. Our C-TMAC (Context and Team-based Access Control) model is an active security access control model that layers dynamic access control concepts on top of RBAC (Role-based) and TMAC (Team-based) access control models. It also extends them in the sense that contextual information concerning collaborative activities is associated with teams of users and user permissions are dynamically filtered during runtime. These features of C-TMAC meet the specific security requirements of healthcare applications. In this paper, an experimental implementation of the C-TMAC model is described. More specifically, we present the operational architecture of the system that is used to implement C-TMAC security components in a healthcare intranet. Based on the technological platform of an Oracle Data Base Management System and Application Server, the application logic is coded with stored PL/SQL procedures that include Dynamic SQL routines for runtime value binding purposes. The resulting active security system adapts to current need-to-know requirements of users during runtime and provides fine-grained permission granularity. Apart from identity certificates for authentication, it uses attribute certificates for communicating critical security metadata, such as role membership and team participation of users.
Computer Communication Networks↗
From data to knowledge in e-health applications: an integrated system for medical information modelling and retrieval.
The system described in this paper uses the technological advances in information technology in order to influence and improve healthcare practice by enabling the flexible modelling, direct representation and adaptable use of medical knowledge. It aims at resolving a number of difficulties encountered by current information repositories, such as costly customization, reusability, high maintenance and poor information modelling, by employing the architecture of the functional data model (FDM), while maintaining full interoperability with existing systems by means of XML. On the information-modelling front the system supports a variety of modelling techniques that are especially relevant to medical applications, such as complex objects, incomplete or missing information, partially structured data and multimedia content. A prototype implementation of the system has been developed which consists of a multimedia-enhanced version of the functional database language FDL, and a web-based, two-way translator interface between the application's native language and XML. This interface provides full interoperability with other, heterogeneous systems over the web, thus, significantly reducing the complexity of developing distributed healthcare systems and e-health applications.
Computer Communication Networks↗
AIDS and electronic communications news.
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Acquired Immunodeficiency Syndrome↗
Integrated access to metabolic and genomic data.
The EcoCyc system consists of a knowledge base (KB) that describes the genes and intermediary metabolism of Escherichia coli, and a graphical user interface (GUI) for accessing that knowledge. This paper addresses two problems: How can we create a GUI that provides integrated access to metabolic and genomic data? We describe the design and implementation of visual presentations that closely mimic those found in the biology literature, and that offer hypertext navigation among related entities, and multiple views of the same entity. We employ a frame knowledge representation system (FRS) called HyperTHEO to manage the EcoCyc knowledge base. Among the advantages of FRSs are an expressive data model for capturing the complexities of biological information, and schema-evolution capabilities that facilitate the constant schema changes that biological databases tend to undergo. HyperTHEO also includes rule-based inference facilities that are the foundation of expert systems, a constraint language for maintaining data integrity, and a declarative query language. A graphic KB editor and browser allow the EcoCyc developers to interactively inspect and modify this evolving KB.
Artificial Intelligence↗
Instructional set and internet use by low-income adults.
This research examined the effects of instructional set on Internet use by low-income adults during a 16-month longitudinal study. Participants (n = 117) received instructions that focused on either the Internet's communication tools or its information tools. Internet use was continuously and automatically recorded. Survey measures of computer and Internet experiences, affect and attitudes were obtained to examine their mediational role in the relationship between instructional set and Internet use. Results indicated that instructions focused on the Internet's information tools led to greater Internet use than instructions focused on its communication tools or only basic instructions about how to use the Internet. Implications for reducing the digital divide are discussed.
Adult↗
Digital still image recording during video endoscopy.
With the advances in telemedicine and virtual consultation services comes the need for state-of-the-art endoscopic imaging techniques and equipment. Concomitant with current day concerns of cost containment, the ability to utilize the aforementioned tools in a cost-effective fashion that lowers operating expenses, accurately depicts procedures, and expedites chart documentation is paramount. We report on a fast and efficient way to obtain and store images during endoscopic procedures, which can be stored on standard 3.5-inch floppy disks using an innovative digital image recorder. These images are stored as high-resolution (640x480x24) JPEG files, which can be placed in electronic medical records, imported into Internet Web pages, incorporated into slide presentations, and, most importantly, stored in easily accessed archives.
Computer Communication Networks↗
Four years with teleradiology: a technical description.
Since September 1992, Troms Military Hospital (Norway) has been connected to the larger University Hospital of Tromsø by a teleradiology link transmitting about 6000 examinations annually. In the spring of 1995, the system was upgraded with a digital X-ray unit, thereby almost eliminating the scanning of analog radiographs. This article describes the technical development of the link. The discussion suggests ways of improving the teleradiology link, particularly in terms of integrating the radiology information system (RIS) and picture archiving and communication system (PACS).
Computer Communication Networks↗
Telemedicine using a desktop conference system (Phoenix) in Kyushu, Japan.
OBJECTIVE: The Kyushu area of southwestern Japan has several mountains and 157 inhabited islands. We assessed the feasibility of implementing a desktop conference (DTC) system to improve medical care in this area. TELECOMMUNICATIONS TECHNOLOGY AND EQUIPMENT: The Phoenix DTC system (NTT Corporation, Tokyo, Japan) for personal computers includes a microphone, speaker, color CCD camera, and appropriate software. We used a digital camera for still pictures and image-analysis software for radiographs and CT and MRI films. The system was installed on a Pentium 133 MHz computer, which was connected by ISDN line at a 128 kbps data rate to a clinic on a small island where one physician cares for 1000 residents, two small nursing offices where each nurse tends 100 residents, two nursing homes, a hospital in a mountainous area, and the residence of a patient with atopic dermatitis. Connections were made once a week for a period of 6 months. RESULTS: The transmitted still pictures; e.g., senile nevus, atopic dermatitis, chickenpox, and a radiograph of a suspected fracture, were useful for diagnosis and clinical decision making. We received and responded to inquiries from residents of the participating nursing homes on nutrition, senile depression, nevus, decubitus ulcers, urinary tract infection, and protection against Legionella infection. We also used the system to deliver lectures on pediatrics to nurses; provided case discussions on diaphragmatic herniation and subtentorial tumor; and had on-line presentation of a patient with beta-thalassemia using presentation software. CONCLUSION: The DTC system used in the present study seemed technically satisfactory and useful in improving medical care in remote sites of Japan.
Child, Preschool↗
Telemedicine information analysis center.
Congress mandated a pilot project to demonstrate the feasibility of establishing a Department of Defense (DoD) telemedicine information analysis center (TIAC). The project developed a medical information support system to show the core capabilities of a TIAC. The productivity and effectiveness of telemedicine researchers and clinical practitioners can be enhanced by the existence of an information analysis center (IACs) devoted to the collection, analysis, synthesis, and dissemination of worldwide scientific and technical information related to the field of telemedicine. The work conducted under the TIAC pilot project establishes the basic IAC functions and assesses the utility of the TIAC to the military medical departments. The pilot project capabilities are Web-based and include: (1) applying the science of classification (taxonomy) to telemedicine to identify key words; (2) creating a relational database of this taxonomy to a bibliographic database using these key words; (3) developing and disseminating information via a public TIAC Web site; (4) performing a specific baseline technical area task for the U.S. Army Medical Command; and (5) providing analyses by subject matter experts.
Computer Communication Networks↗
Toward technical interoperability in telemedicine.
For telemedicine to realize the vision of anywhere, anytime access to care, the question of how to create a fully interoperable technical infrastructure must be addressed. After briefly discussing how "technical interoperability" compares with other types of interoperability being addressed in the telemedicine community today, this paper describes reasons for pursuing technical interoperability, presents a proposed framework for realizing technical interoperability, identifies key issues that will need to be addressed if technical interoperability is to be achieved, and suggests a course of action that the telemedicine community might follow to accomplish this goal.
Computer Communication Networks↗
Interfaces between computer systems.
Interfaces between computer systems are reviewed. An interface establishes a physical connection between two computer systems, a conversational syntax, a format for logical messages passed between the systems, and a data-encoding structure understood by both systems. Interfaces are usually implemented as software modules and consist of three "layers." The physical layer contains the actual physical connection and the hardware, firmware, and software that make the connection work. The protocol layer ensures that the bits of data sent across the interface by the sending system are received intact and in the correct sequence. The logical layer organizes the data to be sent into a form that can be read by the other system. Interfaces can be described by whether they operate in batch or real time, whether they are unidirectional or bidirectional, and the medium used to establish the physical connection (e.g., the exchange of a floppy disk or with an RS-232 serial connection). The real challenge to producing an interface lies in ensuring that the transactions between the two systems are meaningful. An interface engine allows one computer system to interface with several others through a single connection. A good interface has invisibility, reliability, timeliness, flexibility, terseness, and utilities. In planning an interface, goals and the proposed exchanges of data should be clearly defined. The interface should be the simplest one that meets a pharmacy's needs. When the specifications for the interface are completed, the pharmacy should thoroughly test the interface.(ABSTRACT TRUNCATED AT 250 WORDS)
Computer Communication Networks↗
The powers and perils of e-mail.
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Computer Communication Networks↗