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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

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

Practical mini-PACS based on a hybrid video and digital network.

The Department of Radiology of the Shinshu University Hospital is presently in the process of developing a new type of mini-PACS with a hybrid architecture consisting of a video and a digital image archiving network. The video block consists of a server station with a video write-once optical disk (LD) and three workstations which are connected to two ultrasound imaging devices and an MRI device. The video images from any of these imaging devices are transferred immediately onto an LD. The examiner can observe the archived images immediately without any interruption of the examination. The image transmission time, including the record and play-back, is within 3 s. The digital block consists of a personal computer server and various workstations linked to the ETHERNET. This digital system supports database management, and archives digital images. This prototype system was used for daily clinical examinations from February 1989 to January 1990 and 31,366 images from 1561 patients were stored on the video disk. This one year experience suggests that a hybrid mini-PACS system is practical for total image archiving when the image matrix is less than 512 x 512 and selected digital image archiving.

Computer Communication Networks

Telematics: a new tool for epidemiological surveillance of diarrhoeal diseases in the Aquitaine sentinel network.

A sentinel health information system using telematics and a network of general practitioners was set up in Aquitaine in south western France in 1986. Among the health problems under surveillance was acute diarrhoea. Data for each patient who fulfilled the usual case definition for acute diarrhoea were reported by general practitioners using home terminals (Minitels) connected to a central computer by telephone. Over one year 2234 cases of diarrhoea were reported, the incidence varying from 0.8 to 1.5 cases per doctor per week. Seasonal variations in incidence were observed, with peaks in the winter and in the summer. Only 379 (17%) episodes of diarrhoea were classified as severe, and these patients consulted their general practitioners earlier than patients whose diarrhoea was less severe. Foreign travel was rarely found in the patients' histories, but clusters of cases were found in communities (4.6%) and in families (22.3%). The advantages of this system were easy reporting and immediate feedback, but it was difficult to extrapolate the data, and the system was inadequate for intervening in outbreaks of diarrhoeal disease. Our knowledge of diarrhoeal diseases in south west France improved.

Acute Disease

MATCH: a maternal and child health information network.

The Maternal and Child Health Information Network--MATCH--was begun in 1984 as a demonstration project with support from the Division of Maternal and Child Health of the Health Resources and Services Administration, Public Health Service. The primary purpose of the project was the development of a system to manage data related to prenatal, child health, family planning, and genetic services that are delivered with State support in clinics in the State of Ohio. The design of MATCH enables the same data base to be used at both the State and local levels. Because it allows all participants, central and district, to manipulate the raw data, it is called an end-user--as opposed to a batch retrieval--system. Data recorded on individual forms during each client's visit to local service clinics are collected and entered into a microcomputer whose software package is a commercial data base. The clinic can then use the data for its purposes: program planning, management, evaluation, client referrals, appointment followup, quality control, and billing. The same data are also uploaded by central office staff to the State's DEC mainframe from data-filled disks mailed in by the clinics. Personnel who staff local projects can access their own data on the mainframe computer to generate reports for local use and send and receive messages electronically. That is, the system is "interactive." The intent is to first link data generated by the primary care and preventive programs of maternal and child health (MCH) in an information system,then link that system to other health data arriving at the State health department (for example, birth and death certificates), and, finally, to use the system as the basis for a State level MCH primary care data system in Ohio for surveillance, planning,management, quality control, accountability,and research purposes.

Child Health Services

Use of a satellite-assisted computer link for long-distance research collaboration.

Research collaboration between investigators located at some distance from each other is not only possible but also feasible. By using satellite-assisted computer-to-computer links, researchers across the United States and overseas work with the staff and facilities of the Cardiovascular Research and Training Center (CVRTC) in the University of Washington, Seattle. This report presents the mechanics, advantages, and results of using such an approach to collaborate with distant colleagues.

Cardiovascular Diseases

Interfacing a flow cytometer computer with a PC-based patient information system.

We have established an interface between our flow cytometer's computer and the personal computer (PC) which supports our patient database system. The PC has been equipped with a commercially available IEEE-488 bus interface board which is connected to the interface bus of the cytometer's Hewlett-Packard 9000/300 computer (HP). The PC is set as a bus device with the same address as that of the HP's printer. It is programmed to examine the stream of data sent to the printer and extract from it and store in an MS-DOS text file selected information which subsequently may be transferred to the database system.

Computer Communication Networks

The use of X-terminals as clinical workstations.

The Medical Computer Facility at the Fox Chase Cancer Center has installed X-terminals in patient examination rooms and at nursing stations for clinical data access by physicians and nurses. The X-terminals are connected to UNIX operating system RISC processors via Ethernet. The RISC processors communicate with databases on a minicomputer cluster. Simultaneous presentation of textual (e.g., pathology and radiology reports) and graphical (e.g., clinical laboratory results) clinical data is provided under X-Windows. CT and MRI images can also be displayed in windows. Our experiences implementing X-terminal clinical workstations in a production environment will be discussed.

Cancer Care Facilities

Defining the application portfolio for an integrated hospital information system: a tutorial.

Although many successful applications in the hospital environment have been introduced and implemented, hospital information systems have had little impact upon the daily operation of hospitals. Furthermore, integrated hospital information systems, although vital to the hospitals' functioning, have proved to be more complicated to develop and difficult to harness than expected. This paper discusses the need for an integrated hospital information system and provides a framework for the development of its application portfolio. The scope of such a system is the integration of the medical, administrative and fiscal information elements of the hospital into a unified systems environment.

Computer Communication Networks

Extending the capabilities of a laboratory computer system through cooperative processing.

The concept of cooperative processing within the context of a hospital or laboratory computer systems environment is introduced. Two examples that produce graphical display of laboratory data are described to illustrate cooperative processing's ability to enhance a system's functionality without placing significant additional burden on system resources.

Clinical Laboratory Information Systems

Distributed computer system for capture, analysis and display of biological data.

A distributed real-time computer system has been developed to automate the collection, analysis and display of biological (pharmacological) data. It comprises a series of laboratory interface devices (CED 1401/1609) connected to a micro-VAX II via multiple IEEE-488 buses. The micro-VAX II is integrated to the main site computers using Ethernet running DECnet. The micro-VAX II system supports a multi-user, multipreparation and multitasking environment and it provides rapid transfer, storage, analysis and display of data. The system saves the pharmacologists from the manual analysis of their data, typically saving them four days of analysis per experiment and has improved both the quality of data detected and their subsequent analysis. Also, the development of a standard data capture procedure on common hardware along with the modular design of application software has almost quartered project development times.

Computer Communication Networks

Use of computers in pediatrics: basic aspects.

Computer: 1. An electronic device designed to accept data, perform prescribed mathematical and logical operations at high speed, and display the results of these operations. 2. A person who computes; computist (1640-50).

Computer Communication Networks

Introduction to microcomputer hardware and software.

Although general purpose computers have been available for more than 40 years, the dramatic plunge in the cost of electronics in the past 10 years has finally made significant computing power affordable to almost anyone. However, a large number of people including professionals have little idea of how a computer really works or what it can and cannot do. Presented here is an introduction to the hardware and software of microcomputers which assumes no working knowledge of electronics or programming. The fundamental pieces of a microcomputer are explained, giving some insight into the reasons why present microcomputers are built the way they are. This is followed by a discussion of the fundamentals of how software is used to make the hardware compute. The various levels of software are discussed, then the most commonly used types of user application software are described, and finally some suggestions are made on how to choose a personal computer.

Computer Communication Networks

Mini-micro-mainframe computer marriage: combining technologies in a radiology results reporting system.

The minicomputer-based information system in the Department of Radiology at the Medical College of Georgia Hospital and Clinics was placed in service in February, 1982. This system represents a sizable investment in minicomputer hardware in addition to more than 6 years of software customization. One serious deficiency in the original system was the lack of a radiology results reporting facility. Several options were considered to provide the department with this capability. The most obvious option was retiring the existing system and replacing it with one of a number of commercial products already offering results reporting. In-house development of a reporting facility lent itself more readily to microcomputers than to the existing minicomputer system. Due to system customization, economic and time constraints, it was decided to merge an in-house developed microcomputer-based report module into our existing minicomputer system. The minicomputer was able to communicate with and transfer files to and from both micro and mainframe systems. Combining technologies allowed us to continue taking advantage of our sizable investment in money, time, and customization while providing a microcomputer-based report module. Radiology reports are now typed on microcomputer word processors and bulk transferred to the minicomputer. The minicomputer provides access to both unapproved and approved reports on system terminals throughout the department. It also enhances reports by merging patient demographics and registration information. Using existing communications facilities to the hospital mainframe system, reports are provided throughout the institution.

Computer Communication Networks