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PubMed1995

[Information processing and perinatology--experiences with GebLan at the Mainz University Gynecologic Clinic].

Modern perinatal information management is a subject of growing complexity. The requirements for perinatal computer applications changed totally during the last years. Today we need applications with a high integration level of data from diverse sources, a modern graphical interface and a powerful data management for example a Client Server architecture. The experience with the perinatal documentation and information system "GebLan" in a local area network is very sufficient though we conclude that stand-alone-systems should only be used in smaller obstetrical departments.

Computer Systems↗

PubMed1993

Digital image communication.

Networks for digital image communication are an essential prerequisite for picture archiving and communication systems (PACS). The scenario of a 'filmless' radiology is based on the assumption that complete sets of medical images can be transferred throughout the hospital without a noticeable delay even though digital images represent data volumes of a thousand-fold greater size than, for example, office documents. This paper deals with an in-depth analysis of the anticipated image communication requirements in a future PACS environment. It gives a survey of technologies for data communication with emphasis on the basic concepts of established local area networks (LAN) and their limiting factors with respect to the specific PACS demands. Likewise, a description of a network particularly developed to satisfy the users-to-be of PACS systems is included. Furthermore, this paper treats the connection of image data with patients' data, i.e. the interlinking of PACS and RIS/HIS structures. Another topic of interest is the extension of the PACS structure beyond the limits of the individual hospital (extramural PACS operation). Moreover, current standardization attempts are discussed here.

Computer Communication Networks↗

PubMed2001

The telematic network of referee hospital "V. Monaldi" in Naples: state of the art and perspectives.

The new advances in I.T. both in Hardware (wideband network) and in Software are rapidly changing the Health Information Systems scenario. In many hospitals of Campania Region this leads in many case to rebuild, starting from zero, both infrastructure and applications. Ericsson Enterprise has recently developed for the A.O. Monaldi and Integrated information System which consists of an advanced LAN (Local Area Network), a number of software infrastructures and some application systems as WEB site, Dicom PACS, E-mail server, Streaming Video from Operating Theatres, Internal TV Network. This integrated system represents the starting point for modern health information systems, which is compliant with new standards. The start-up of such systems represents always a problem for the organization and management point of view, therefore a number of problems concerning: training, education, security, privacy, operative procedures, co-ordination with existing applications, system management at the start-up and after. This paper deals with the technical aspects of this information system and discusses the problem met in introducing these IT products in a big and important hospital of Campania Region in Italy, in order to suggest a model, useful for other similar experiences.

Computer Systems↗

PubMed2000

[Information processing in the gynecological endocrinological laboratory. Current concepts and integration strategies].

While computer applications are widely accepted in clinical chemical departments, small numbers of computer systems are used in gynecological endocrinological laboratories. Modern applications should be integrated in local area networks and clinical information systems that improve communication and data exchange within hospitals and the outer resources. Better communication may improve medical quality and will lead to a better therapy for gynecological endocrinological patients.

Clinical Laboratory Information Systems↗

PubMed1995

[A new concept in imaging pelvic recurrence of curatively operated rectal carcinoma--image fusion of nuclear magnetic resonance tomography and anti-CEA immunoscintigraphy (SPECT): technique and clinical example].

We present a new technique of image fusion (IF) of magnetic resonance imaging (MRT) and anti-CEA-immunoscintigraphy (Behring 431/26) and single photon emission computed tomography (SPECT). We performed SPECT and MRT within 8 hours on the same day. Glucagon intravenously was used to reduce artefacts due to intestinal motility. Before image fusion we analysed the SPECT and MRT images independently of each other. The MRT and SPECT were connected by a local area network (LAN) to a Gateway computer, which is also used as a picture archive. There a program automatically starts, translates the MRT data from the ACR/NEMA format to the Elscint one and these data are sent for image fusion to the nuclear medicine computer Elscint SP1. By means of a clinical example we present anatomic concordant superimposition and explain the findings and the clinical value of our technique. This system and technique are equally applicable to other digital imaging investigations. By IF, on the basis of the certain evidence of the tracer depot of a pathological lesion diagnosed by MRT and the reliability of the anatomical assignment of a focal lesion diagnosed by SPECT, early detection of local recurrence after surgical treatment of rectal cancer, the correct localisation of recurrent disease and its distinction from non-malignant tissue becomes possible. This enables planning of further therapeutical strategies.

Adenocarcinoma↗

PubMed1994

The J. Otto Lottes Health Sciences Library and the Microcomputer Learning Laboratory.

Opened in 1985, the J. Otto Lottes Health Sciences Library at the University of Missouri-Columbia has adapted to changes in information technology by installing a fiber optic backbone, establishing local area networks and file servers with databases and software programs, establishing a microcomputer learning laboratory, and responding to the needs of a problem-based learning curriculum. The library works cooperatively with the Medical Informatics Group, which is housed in the library and runs the micro laboratory, to support student and faculty computing.

CD-ROM↗

PubMed1996

Remote instrument telemaintenance.

In the past decade, great technological progress has been made in telemaintenance of mainframe and mini computers. As hardware technology is now available at an acceptable cost, computer aided trouble-shooting can be adapted to laboratory instrumentation in order to significantly improve repair time, avoid instrument downtime by taking advantage of predictive methods, and provide general diagnostic assistance. Depending on the size of the instrument, the telemaintenance facility can be dedicated to a single instrument or alternatively a telemaintenance server can manage multiple distributed small instruments through a Local Area Network. As complex failures can occur, the local diagnosis capabilities may be exceeded and automatic dialing for connection to computerized Remote Maintenance Centers is needed. The main advantages of such a centre, as compared to local diagnosis systems, are the increased access to more information and experience of failures from instrument installations, and consequently the provision of training data updates for Artificial Neural Networks and Knowledge Based Systems in general. When an abnormal situation is detected or anticipated by a diagnosis module, an automatic alert is given to the user, local diagnosis is activated, and for simple solutions, instructions are given to the operator. In the last resort, a human expert can be alerted who, with remote control tools, can attend to the failures. For both local and remote trouble-shooting, the data provided by the instrument and connected workstation is of paramount importance for the efficiency and accuracy of the diagnosis. Equally, the importance of standardization of telemaintenance communication protocols is addressed.

Clinical Laboratory Information Systems↗

PubMed2004

[Digital echocardiography laboratory].

The implementation of a digital echocardiography laboratory exists today using the DICOM (Digital Imaging Communication in Medicine) standard to acquire, store and transfer echocardiographic digital images. The components of a laboratory include: 1) digital echocardiography machines with DICOM output, 2) a switched high-speed local area network, 3) a DICOM server with abundant local storage, and 4) a software to manage image and measurement information. The aim of this article was to describe the critical components of a digital echocardiography laboratory, discuss strategies for implementation, and describe some of the pitfalls that we encountered in our own implementation of the digital third level echocardiography laboratory.

Ambulatory Care Facilities↗

PubMed2005

ICASP: an intensive-care acquisition and signal processing integrated framework.

This paper presents an intensive-care acquisition and signal processing integrated framework in the area of intensive care units. The framework includes nearly all monitored biosignals in the intensive care, along with metadata and processing results. It is structured on two basic applications, i.e., the acquisition and the database one, running in two different PCs that are connected through a local area network, facilitating real-time data exchange between them. The analytical rundown shows that the proposed framework is a serious effort to give a complete clinical condition of a patient and a form of a diagnostic analysis implement in the intensive care by taking in real-time processing.

Hospital Information Systems↗

PubMed1988

Radiology systems of the nineties: meeting the challenge of change.

Digital imaging technology, particularly reconstructed images such as computed tomography and magnetic resonance imaging, has fueled the increased demand for radiologic services but has intensified storage and communications problems. Today more than 25% of radiologic examinations are digital in origin and, with progressive replacing of film images by digital images likely through the introduction of imaging plate technology, the radiology profession is undertaking the massive effort of evolving a new system where digital images will be transmitted, stored, retrieved and displayed by a multicomponent system connected by a local area network. Through this system, images will be nearly instantly accessible to anyone who needs them. A leading hypothesis is that when the volume of digital examinations reaches 50% of the whole, cost and efficiency considerations will lead to a massive conversion to the digital image management system, which will progress spontaneously. This conversion, unless planned for in today's equipment acquisitions, could lead to great economic stress in hospitals. The 50% point may be reached by the early 1990s.

Database Management Systems↗

PubMedDate not supplied

Global case management: Scotland. Real-time monitoring of patient flow as an instrument to optimize quality of care in acute receiving units.

Recent audits within our hospital suggest that especially during peak phases the patient flow from our acute admission units downstream into hospital beds is not directed in the most efficient way and patients may be placed inappropriately. This inevitably causes time delays and potentially increases the risk of malpractice as patients have to spend an extended period of time in admission areas with a high workload and very busy staff. Using latest information technology, such as wireless local area networks and handheld devices, can improve the efficiency of patient management and can increase the quality of care by helping to avoid unnecessary treatment delays in overcrowded admission areas.

Acute Disease↗

PubMed1993

Electronic forms: a next step in hospital automation.

Information consists of two parts, facts and communication. It is not enough for one person to know a fact; the fact must be communicated for it to be of any value to anyone else. Forms were invented to do just that--communicate facts in a systematic manner from one party to the next. Automating forms with computers on a local area network or a wide area network allows for hospital personnel to input a patient's information once and electronically share the information from one department to another, simultaneously. Switching from a paper-based forms system to a fully automated workflow forms system or combining the two can save a healthcare institution money, errors, time and even lives. The levels of an automated forms system include: electronic forms design, demand printing, typewriter replacement, intelligent forms, intelligent mail and true workflow automation.

Communication↗

PubMed2006

Performance of a wireless telemedicine system in a hospital accident and emergency department.

We developed a mobile, wireless videoconferencing system suitable for use in a hospital accident and emergency (A&E) department. Four consultants, eight junior doctors and 11 nurses working in the A&E department tested the system. Transmission of three types of data (audio, still images and video) was tested. The audio for the breath and heart sounds was judged to have some disturbance. One consultant rated the diagnostic quality as good and one rated it as fair. The quality of the still images was judged to be from fair to excellent. The quality of the video was rated as good. Possible interference between the wireless local-area network and various medical devices in the A&E department were examined, but none was detected. The four consultants who tested the system were very positive in their initial comments. Eight of the 11 nurses remained sceptical about its use. Of a total of 20 patients who answered a survey, 13 were slightly anxious about the use of the system to transmit their data to a distant point. Overall, the performance of the system was satisfactory for use in the A&E role.

Attitude of Health Personnel↗

PubMed2003

Development of a tele-echography system by using an echographic diagnosis robot.

We have developed a tele-diagnosis system of echography (tele-echography system) using an Echographic Diagnosis Robot. The examiner moves the robot by using a control device at a distance from the patient and obtaining the echogram and the situation around the patient. The examiner and the patient locations are connected by a wireless local area network. Remote control is realized by the Object Request Broker (ORB) technique. We experimentally verified possibility of our system for clinical use. The robot was safe and stable even when there was slight movement of the patient and an adult patient never felt any discomfort due to the robot weight. Remote diagnosis of echograms was proved to be possible with sufficient image quality after a skilled examiner got used to controlling the robot. Since the required bandwidth of this system was at most 1Mbps, we confirmed the ability of this system for mobile robotic telemedicine.

Humans↗

PubMed1993

Implementing computerized tracking at a community health center: challenges and solutions.

A computerized tracking system for both preventive care and chronic disease tracking was implemented at a community health center, using a PC based local area network interfaced with a mainframe scheduling and billing system. Initial database construction used downloads of historical billing data, but ongoing database maintenance is accomplished by using an optical mark-sense scanner to construct both billing and clinical tracking files from custom-designed encounter forms. In this way, expanded clinical data is collected with an actual reduction in manually keyed data, reducing the ongoing cost of the system.

Ambulatory Care Information Systems↗

PubMed1991

Optical mark reader technology and data base development in anesthesiology and critical care medicine at the Johns Hopkins Medical Institutions.

The Department of Anesthesiology and Critical Care Medicine (DACCM) has substantially upgraded its computer resources within the past two years by installing a local area network (LAN) and replacing low-end PC's with PC's utilizing Intel 80286 or 80386 microprocessor technology. Data base development has now become a priority. Data bases are being developed for both clinical and administrative purposes. We are replacing the traditional method of "keypunching" with optical card scanners which results in faster and more accurate data entry directly into the data bases. Previously, such card scanners have been confined to large organizations. We describe a method of data capture and data base development with wide applicability in medicine.

Anesthesiology↗

PubMed1996

Management software for a universal device communication controller: application to monitoring and computerized infusions.

We designed a virtual device for a local area network observing, operating and connecting devices to a personal computer. To keep the widest field of application, we proceeded by using abstraction and specification rules of software engineering in the design and implementation of the hardware and software for the Infusion Monitor. We specially built a box of hardware to interface multiple medical instruments with different communication protocols to a PC via a single serial port. We called that box the Universal Device Communication Controller (UDCC). The use of the virtual device driver is illustrated by the Infusion Monitor implemented for the anaesthesia and intensive care workstation.

Anesthetics↗

PubMed1993

[Computerized database system for pure tone audiometry].

The management and storage of pure tone audiometry data creates a major problem for otolaryngological clinics. We have devised a new computerized database system to overcome this problem. The hardware involved includes multiple audiometers and computers interfaced with a glassfiber local area network (Pi-Net). The software used is database 3 plus, a popular database language and utility software package. Programs were written for data entry, data transfer, reference, entry of patient ID, and evaluation of tympanoplasty. The following benefits of the system are noted. 1) Data entry is possible at every terminal (audiometer and computer). 2) Storage capacity is sufficient for more than 10 years of operation. 3) All data can be retrieved rapidly at any terminal. Evaluations of pre- and post-tympanoplasty hearing loss are facilitated by this system. This system is very effective for follow up of hearing disorders.

Audiometry, Pure-Tone↗