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A CORBA-based object framework with patient identification translation and dynamic linking. Methods for exchanging patient data.

Exchanging and integration of patient data across heterogeneous databases and institutional boundaries offers many problems. We focused on two issues: (1) how to identify identical patients between different systems and institutions while lacking universal patient identifiers; and (2) how to link patient data across heterogeneous databases and institutional boundaries. To solve these problems, we created a patient identification (ID) translation model and a dynamic linking method in the Common Object Request Broker Architecture (CORBA) environment. The algorithm for the patient ID translation is based on patient attribute matching plus computer-based human checking; the method for dynamic linking is temporal mapping. By implementing these methods into computer systems with help of the distributed object computing technology, we built a prototype of a CORBA-based object framework in which the patient ID translation and dynamic linking methods were embedded. Our experiments with a Web-based user interface using the object framework and dynamic linking-through the object framework were successful. These methods are important for exchanging and integrating patient data across heterogeneous databases and institutional boundaries.

Database Management Systems↗

Picture archiving and communication systems.

Picture archiving and communication systems (PACS) are highly versatile data storage and retrieval systems that facilitate the transfer of digital images and patient data throughout a healthcare enterprise. Typically, they process images from diagnostic imaging modalities and are interfaced to radiology information systems (RISs) and hospital information systems (HISs) to improve overall workflow. For this Evaluation, we tested six PACS from six suppliers. Ideally, a PACS should allow the healthcare facility to achieve a fully automated workflow, in which patient image data is shared seamlessly from one system to another within a single electronic medical record (EMR). Although our testing found that this ideal has not yet been completely realized, many of the evaluated systems have taken significant steps in that direction. This Evaluation was limited to radiology PACS; however, more and more facilities are considering single PACS solutions to cover the needs of all their imaging departments.

Humans↗

Clinical, scholarly & campus information hypertext tools at Columbia-Presbyterian Medical Center.

In conjunction with other researchers at Columbia-Presbyterian Medical Center (CPMC) we have developed a number of hypertext and free text retrieval computer applications aimed at an extremely diverse audience which includes students and faculty in a university setting as well as health care providers and patients in hospital and clinic settings. Hypertext and free text systems offer features which make them ideal for presenting information in a wide variety of contexts; however, they also have several major weaknesses which must be addressed before these applications can be useful tools. We have learned to maximize the strengths and minimize the weaknesses to present material in a manner that is individualized to the needs of each user from the research scientist in the lab to the patient at the bedside.

Academic Medical Centers↗

Mobile decision support for transplantation patient data.

In high-critical medical fields instant information delivery is essential. Task-flow analyses within the transplantation unit of the Technische Universität München revealed that valuable time could be saved in pre-transplantation management being able to retrieve data of organ receivers ubiquitously. Inspired by this clinical scenario, a mobile application was designed and implemented providing surgeons with decision-relevant information on potential organ receivers. It assists them in considering the prospects of forthcoming organ transplantations and facilitates decision making and documentation with regard to high security demands. The described system services three organ receiver lists and is used by the surgeons in every transplantation procedure. After a 6-month period of clinical usage, the system has been evaluated in terms of handling, clinical benefit and total time savings. Intuitive, ubiquitous access to decision-relevant patient data and authenticated documentation were the major improvements with average total time savings of 50 min in comparison to the old system.

Computers, Handheld↗

Learning-induced activation of transcription factors among multiple memory systems.

Experimental evidence for multiple memory systems grew initially from reports that integrity of the medial temporal lobes is necessary for some, but not all, types of memory formation. A primary inference from many studies of multiple memory systems is that they operate independently during encoding, storage, and retrieval of information. An accumulation of recent evidence, however, suggests that multiple memory systems may interact under some conditions. At the cellular level of analysis, it is accepted widely that protein synthesis is necessary for the formation of long-term memory and recent efforts have focused on the mechanisms by which learning-induced gene transcription and translation are regulated. The present review examines learning-induced activation of transcription factors among multiple memory systems. The results indicate that studies of transcriptional regulation, in conjunction with other experimental approaches, can provide complementary lines of evidence to further understanding of the extent to which multiple memory systems are independent or interactive.

Amygdala↗

A simple method for extracting DICOM images from a magnetooptic disk.

OBJECTIVE: Our objective was to develop a simple and easy-to-use method to extract DICOM images from magnetooptic (MO) disks to the computer desktop for research purposes. CONCLUSION: The method we developed allows users to extract DICOM images directly from MO disks to a PC desktop. The hardware component that we used is commercially available and is plug-and-play. The system is lower in cost than a clinical workstation. Users do not need to have special computer skills to use our method. DICOM images can be transferred directly from the MO disks to computer desktop folders using drag-and-drop. In our implementation, we store the DICOM files in a shared folder in our hospital network, so users can access the data from their office or research computers.

Humans↗

Development of a radiology report monitoring system for case tracking.

OBJECTIVE: The objective was to develop an automated system to monitor and collect radiology reports for case-tracking purposes. CONCLUSION: The system we developed allows users to automate the case-tracking process for either clinical follow-up or teaching purposes. With this system, radiologists can initiate the tracking of a case by dictating a keyword into the report. Any existing and future reports associated with the same patient will be collected automatically. The schematic that we developed is based on the Health Level Seven (HL7) standard, which is platform-independent. In our implementation, we used an IBM-compatible computer and commercially available software. Users can monitor the case-tracking progress from Web browsers.

Humans↗

CoCoDat: a database system for organizing and selecting quantitative data on single neurons and neuronal microcircuitry.

We present a novel database system for organizing and selecting quantitative experimental data on single neurons and neuronal microcircuitry that has proven useful for reference-keeping, experimental planning and computational modelling. Building on our previous experience with large neuroscientific databases, the system takes into account the diversity and method-dependence of single cell and microcircuitry data and provides tools for entering and retrieving published data without a priori interpretation or summarizing. Data representation is based on the framework suggested by biophysical theory and enables flexible combinations of data on membrane conductances, ionic and synaptic currents, morphology, connectivity and firing patterns. Innovative tools have been implemented for data retrieval with optional relaxation of search criteria along the conceptual dimensions of brain region, cortical layer, cell type and subcellular compartment. The relaxation procedures help to overcome the traditional trade-off between exact, non-interpreted data representation in the original nomenclature and convenient data retrieval. We demonstrate the use of these tools for the construction, tuning and validation of a multicompartmental model of a layer V pyramidal cell from the rat barrel cortex. CoCoDat is freely available at . Its application is scalable from offline use by individual researchers via local laboratory networks to a federation of distributed web sites in platform-independent XML format using Axiope tools.

Action Potentials↗

Starting a reprint filing system.

A reprint collection represents an investment of time, money, and resources. As with any data base you gather, however, the problem is storing the information for retrieval. This article describes how to design and implement a filing system to make retrieval of reprints both quick and easy. Although reprints are the data base described in this article, the applicability of this filing system to other information can be seen readily.

Abstracting and Indexing↗

Use of hand-held computers to record and analyze intervention data.

Using the Wizard to document clinical activities has been well received by the clinical staff. What had previously been a dreaded task has become an ongoing part of daily activities. The revised Clinical Activity Log also provided the staff pharmacists with an easier method of documenting their clinical activities. The task of inputing the information from the staff pharmacists' paper logs into the computer is time consuming and is currently being done by the clinical staff. Procurement of additional Wizards for the staff pharmacists to use in the central pharmacy and satellite pharmacies is currently being considered. Using the Wizard has enabled the clinical staff to document clinical activities into the computer database in an ongoing manner throughout the day. Documentation has increased and is now more complete. Productivity is being monitored. Physician responses and patient outcomes are now being documented. Most importantly the computerized system allows for easy retrieval of the documented information for evaluation so that tracking and trending can be done and we can thereby continue to improve the quality of pharmaceutical care being provided.

Clinical Pharmacy Information Systems↗

Storage and retrieval of microarray data and open source microarray database software.

Microarray technology has been widely adopted by researchers who use both home-made microarrays and microarrays purchased from commercial vendors. Associated with the adoption of this technology has been a deluge of complex data, both from the microarrays themselves, and also in the form of associated meta data, such as gene annotation information, the properties and treatment of biological samples, and the data transformation and analysis steps taken downstream. In addition, standards for annotation and data exchange have been proposed, and are now being adopted by journals and funding agencies alike. The coupling of large quantities of complex data with extensive and complex standards require all but the most small-scale of microarray users to have access to a robust and scaleable database with various tools. In this review, we discuss some of the desirable properties of such a database, and look at the features of several freely available alternatives.

Database Management Systems↗

Concept-oriented indexing of video databases: toward semantic sensitive retrieval and browsing.

Digital video now plays an important role in medical education, health care, telemedicine and other medical applications. Several content-based video retrieval (CBVR) systems have been proposed in the past, but they still suffer from the following challenging problems: semantic gap, semantic video concept modeling, semantic video classification, and concept-oriented video database indexing and access. In this paper, we propose a novel framework to make some advances toward the final goal to solve these problems. Specifically, the framework includes: 1) a semantic-sensitive video content representation framework by using principal video shots to enhance the quality of features; 2) semantic video concept interpretation by using flexible mixture model to bridge the semantic gap; 3) a novel semantic video-classifier training framework by integrating feature selection, parameter estimation, and model selection seamlessly in a single algorithm; and 4) a concept-oriented video database organization technique through a certain domain-dependent concept hierarchy to enable semantic-sensitive video retrieval and browsing.

Abstracting and Indexing↗

Using software agents to preserve individual health data confidentiality in micro-scale geographical analyses.

Confidentiality constraints often preclude the release of disaggregate data about individuals, which limits the types and accuracy of the results of geographical health analyses that could be done. Access to individually geocoded (disaggregate) data often involves lengthy and cumbersome procedures through review boards and committees for approval (and sometimes is not possible). Moreover, current data confidentiality-preserving solutions compatible with fine-level spatial analyses either lack flexibility or yield less than optimal results (because of confidentiality-preserving changes they introduce to disaggregate data), or both. In this paper, we present a simulation case study to illustrate how some analyses cannot be (or will suffer if) done on aggregate data. We then quickly review some existing data confidentiality-preserving techniques, and move on to explore a solution based on software agents with the potential of providing flexible, controlled (software-only) access to unmodified confidential disaggregate data and returning only results that do not expose any person-identifiable details. The solution is thus appropriate for micro-scale geographical analyses where no person-identifiable details are required in the final results (i.e., only aggregate results are needed). Our proposed software agent technique also enables post-coordinated analyses to be designed and carried out on the confidential database(s), as needed, compared to a more conventional solution based on the Web Services model that would only support a rigid, pre-coordinated (pre-determined) and rather limited set of analyses. The paper also provides an exploratory discussion of mobility, security, and trust issues associated with software agents, as well as possible directions/solutions to address these issues, including the use of virtual organizations. Successful partnerships between stakeholder organizations, proper collaboration agreements, clear policies, and unambiguous interpretations of laws and regulations are also much needed to support and ensure the success of any technological solution.

Computer Security↗

Using electronic medical record data for clinical workflow and analysis: a single center experience.

This paper focuses on the use of data from an electronic medical record (EMR) within a multi-facility health care organization. It describes how health provider workflow is enhanced by extracting data from multiple sources in a near real-time fashion and presenting it to the user in ways that are unavailable in the electronic medical record applications.

Decision Support Systems, Clinical↗

ECGScan: a method for conversion of paper electrocardiographic printouts to digital electrocardiographic files.

BACKGROUND: Measurements of parameters from electrocardiograms (ECGs) are still largely performed from paper ECG records. Recent guidelines from regulatory agencies and, in particular, the requirement of the Food and Drug Administration to enforce the digital submission of annotated ECGs have triggered significant efforts in the pharmaceutical industry, which, to comply with the new guidelines, is adopting digital ECG technology. At the same time, the new requirements justify the need for tools to convert existing paper ECG records into digital format, particularly for retrospective studies. METHODS: This article presents ECGScan, a computer application developed for the conversion of paper ECG records to digital ECG files. An image processing engine is used to first detect the underlying grid and, subsequently, to extrapolate the ECG waveforms using a technique based on active contour modeling. RESULTS: ECGScan was validated using a set of 60 ECGs for which both the original digital waveform and paper printouts were available. Sample-by-sample comparisons provided evidence of a robust wave reconstruction (root mean square value from 169 PQRST complexes was 16.8+/-11.8 microV). Semiautomatic measurements of QT intervals performed on 144 complexes also indicated a strong agreement between original and derived ECGs (DeltaQT=0.577+/-5.41 milliseconds). CONCLUSIONS: ECGScan provides a robust reconstruction of a digital ECG, both in waveform reconstruction and in QT measurements performed on original (digital) ECGs and on digitized ECGs from paper printouts.

Artificial Intelligence↗