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The virtual hospital. Providing multimedia decision support tools via the Internet.

Physicians in the clinical setting remain isolated from important sources of medical information. The authors have created a multimedia database known as The Virtual Hospital that improves access to current medical data, which is used to improve patient care decisions. The Virtual Hospital is a digital health sciences library stored on a server (computer) at The University of Iowa and delivered via the Internet to inexpensive personal computers in the workplace. The emerging standard of the World Wide Web is used to provide cross-platform distribution.

Computer Communication Networks↗

Integrated clinical decision support using an object-oriented database management system.

Clinical decision support systems assist in diagnosis, alert to abnormal conditions, and manage patient data. Such systems tend to emphasize one of these features at the expense of the others and tend to be developed on an ad hoc basis. In this work, a technique is developed for creating an integrated clinical decision support system wholly within a general-purpose object-oriented database management system. The diagnostic and alerting requirements are accomplished with encapsulated methods and a novel use of the object-oriented database management class-hierarchy structure. The patient data management requirement is satisfied by the normal data management capabilities of the object-oriented DBMS.

Aphasia↗

Seize the day.

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Computer-Assisted Instruction↗

Automation at the point of care.

Clinical Information Systems (CISs) are systems of microcomputers used at patient bedsides to collect, process, retrieve and display information related to patient care. At our facility, 65 terminals are used in selected units and the CIS has virtually replaced paper charts in daily practice and documentation. Though currently employed in only a small number of hospitals, the use of CISs is expected to grow rapidly during the coming decade.

Computer Systems↗

Collaborative health care information system development through sharable infrastructure, services, and paradigms.

The Decision Systems Group has focused for several years on software architectures and software engineering approaches to support collaborative development for health care information systems. The goal is to be able to more readily develop complex applications that require integration of a variety of information resources. Our efforts are aimed at four primary capabilities: (1) a software environment, Arachne, for developing applications by incorporation of components created by disparate developers, developing component classes, for providing cross-platform graphical user interface support with remote rendering, and incorporating evolving software engineering standards; (2) a library of domain-specific components for medical applications; (3) a user interaction paradigm that provides a framework for applications that integrate both clinical data and other information resources for education and decision support; and (4) improved understanding of the collaborative process per se and the development of methodologies to support it.

Information Systems↗

Pseudonyms for cancer registries.

In order to conform to the rigid German legislation on data privacy and security we developed a new concept of data flow and data storage for population-based cancer registries. A special trusted office generates a pseudonym for each case by a cryptographic procedure. This office also handles the notification of cases and communicates with the reporting physicians. It passes pseudonymous records to the registration office for permanent storage. The registration office links the records according to the pseudonyms. Starting from a requirements analysis we show how to construct the pseudonyms; we then show that they meet the requirements. We discuss how the pseudonyms have to be protected by cryptographic and organizational means. A pilot study showed that the proposed procedure gives acceptable synonym and homonym error rates. The methods described are not restricted to cancer registration and may serve as a model for comparable applications in medical informatics.

Anonyms and Pseudonyms↗