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PubMed1994

The professional workstation as enabler: conference recommendations. International Medical Informatics Association.

This paper reports on the Working Conference on Healthcare Professional Workstation sponsored by the International Medical Informatics Association (IMIA) and held in Washington DC, 14-16 June 1993. It sets forth the vision of a health care infostructure in which the workstation acts as enabler, giving professionals access to information when, where, and how it is needed. The paper explains upon the conference methodology and provides the conference cochairs' summary recommendations, both short- and long-term. These recommendations are based upon the work of five breakout groups, which addressed Functional Requirements, User Interfaces, Data and Knowledge Management, Processing, and Sharing and Communications. Presented in detailed and display formats, these summary recommendations address issues in the areas of architecture, linkages, evaluation, security, standards, education, and training. The paper also sets forth immediate next steps for the workstation initiative, including the formation of a formal IMIA Working Group on Workstations.

Computer Communication Networks↗
PubMed1994

Design and processing issues for the health care professional workstation: summary and recommendations.

The health care professional workstation is a window to a heterogeneous set of functions that need to be ported to various types of hardware for different types of users. Processing aspects, which belong with the interface, storage and communication, to the architectural dimension of the workstation should not be considered outside of a more comprehensive model including the user, function and time dimensions. Several recommendations, which could provide the appropriate environment for development and help maintain a viable approach as the variables change along the four dimensions of the workstation model, are proposed. They concern the adaptation of the enterprise infrastructure to integrate workstations, the need for a reference architecture for health care workstation development and recommendations for the evaluation and dissemination of results.

Computer Communication Networks↗
PubMed2006

Duke Surgery Research Central: an open-source Web application for the improvement of compliance with research regulation.

BACKGROUND: Although regulatory compliance in academic research is enforced by law to ensure high quality and safety to participants, its implementation is frequently hindered by cost and logistical barriers. In order to decrease these barriers, we have developed a Web-based application, Duke Surgery Research Central (DSRC), to monitor and streamline the regulatory research process. RESULTS: The main objective of DSRC is to streamline regulatory research processes. The application was built using a combination of paper prototyping for system requirements and Java as the primary language for the application, in conjunction with the Model-View-Controller design model. The researcher interface was designed for simplicity so that it could be used by individuals with different computer literacy levels. Analogously, the administrator interface was designed with functionality as its primary goal. DSRC facilitates the exchange of regulatory documents between researchers and research administrators, allowing for tasks to be tracked and documents to be stored in a Web environment accessible from an Intranet. Usability was evaluated using formal usability tests and field observations. Formal usability results demonstrated that DSRC presented good speed, was easy to learn and use, had a functionality that was easily understandable, and a navigation that was intuitive. Additional features implemented upon request by initial users included: extensive variable categorization (in contrast with data capture using free text), searching capabilities to improve how research administrators could search an extensive number of researcher names, warning messages before critical tasks were performed (such as deleting a task), and confirmatory e-mails for critical tasks (such as completing a regulatory task). CONCLUSION: The current version of DSRC was shown to have excellent overall usability properties in handling research regulatory issues. It is hoped that its release as an open-source application will promote improved and streamlined regulatory processes for individual academic centers as well as larger research networks.

Academic Medical Centers↗
PubMed1999

TIDE: an intelligent home-based healthcare information & diagnostic environment.

The 21st century promises to usher in an era of Internet based healthcare services--Tele-Healthcare. Such services augur well with the on-going paradigm shift in healthcare delivery patterns, i.e. patient centred services as opposed to provider centred services and wellness maintenance as opposed to illness management. This paper presents a Tele-Healthcare info-structure TIDE--an 'intelligent' wellness-oriented healthcare delivery environment. TIDE incorporates two WWW-based healthcare systems: (1) AIMS (Automated Health Monitoring System) for wellness maintenance and (2) IDEAS (Illness Diagnostic & Advisory System) for illness management. Our proposal comes from an attempt to rethink the sources of possible leverage in improving healthcare; vis-à-vis the provision of a continuum of personalised home-based healthcare services that emphasise the role of the individual in self health maintenance.

Artificial Intelligence↗
PubMed1994

The health care professional's workstation: a call to action.

The environment of health care delivery is changing dramatically, matched by design trends in the organizations that are responsible for care delivery, whether at the hospital or the national level. However, the emerging goals of these organizations have a certain amount of uniformity independent of background, cultural assumptions or organizational size: they are all committed to the delivery of services that maximize satisfaction of system beneficiaries at a minimum of expense. Achievement of these goals will in part require the development of a management and delivery coordination infrastructure that links the key resource utilizers and administrative operators at the point of production. Merged computer and telecommunications systems connecting at user interface nodes called workstations represent a critical enabling technology for meeting the organizational goals described above. Future delivery systems will need to provide compassionate care, retaining the most highly regarded traditions of medical practice without ignoring considerations of cost, clinical outcome and financial sustainability. This paper describes some of the limitations of the current delivery system, and attempts to identify key design concepts and paradigms that might serve to guide future system development.

Computer Communication Networks↗
PubMed1998

HL7 version 3--an object-oriented methodology for collaborative standards development.

In January of 1997, Health Level Seven (HL7) began developing Version 3.0 of its standard. The Version 3 effort represents a transformation of the way that HL7 and its Technical Committees will develop future HL7 information interchange standards. This transformation involves applying object-oriented modelling to the development and specification of information interchange standards. This paper discusses the rationale that led HL7 to undertake this change and provides an overview of the Version 3 Message Development Framework which is HL7's new methodology. It also considers the features of the Version 3 methodology that can facilitate the development of international collaboration and consensus in health informatics standards.

Computer Simulation↗
PubMed2000

[A combined PACS and Internet information system in a university medical center].

PURPOSE: The Department of Radiology at the University Hospital Innenstadt Munich provides all clinical departments of a large university hospital with several radiology units at different locations. During the last four years all units have been fully digitalized with a stepwise installation of a PACS. The PACS also processes images from the Nuclear Medicine Department. METHODS: As image modalities, archive systems and review workstations, we use devices from multiple vendors, which are integrated into a consistent system using the DICOM standard. The hospital has developed its own RIS and an Internet information system, which provides access to all reports and images from radiology for all clinical departments inside the hospital. Additionally, other clinical information such as laboratory results or ECG examinations are available through the system. RESULTS: After one year of operation, the system succeeded in the clinical routine work as the primary source for radiological reports and images as well as for laboratory values. CONCLUSION: The advantages of digitalization were, besides reduction of film cost, especially optimizations of work flow with access to digital images from everywhere at any time.

Academic Medical Centers↗
PubMed2003

Decision support at the point of care: challenges in knowledge representation, management, and patient-specific access.

Many applications in a clinical information system can benefit from the incorporation of medical knowledge to provide patient-specific, point-of-care decision support. These include computer-based provider order entry, referral, clinical result interpretation, consultation, adverse event monitoring, scheduling, shared patient-doctor decision-making, and generation of alerts and reminders, among others. To be executable, knowledge must be represented in the form of rules, constraints, calculations, guidelines, and other logical/algorithmic formats. The main difficulty is that the integration of such knowledge into clinical applications, when it occurs, tends to be very system- and application-specific, often encoded in a programming language, or even in the formating specifications of a user interaction display. Also, the data references and services invoked are highly dependent on the system/platform and electronic medical record implementation. This makes it difficult and time-consuming to encode authoritative evidence-based knowledge, severely limits the ability to disseminate and share successes, and hampers efforts to review and update the logic as medical knowledge changes. Solutions to this problem involve the development of standards-based representations for medical knowledge, and tools for authoring/editing, dissemination, adaptation to local environments, and execution. Numerous approaches are being pursued, all of which will be described in this presentation.

Decision Support Systems, Clinical↗
PubMed2000

Introduction of a clinical information system in a regional general state hospital of Athens, Greece.

The introduction of a Clinical Information System (CIS) in a healthcare organisation is a particularly complex process, requiring thorough design and the close co-operation of many key-position people within the organisation. Moreover the whole process is extremely time-consuming. This contribution presents the first phases of such an introduction in a regional state hospital in Greece. During these phases a number of preparatory actions took place in order to establish and set available in the hospital all the necessary infrastructure. Then the CIS was introduced in two pilot clinics, interconnected with the existed administrative system and customised in order to meet the needs of the various clinical departments.

Computer Communication Networks↗
PubMed1997

DIPE: a distributed environment for medical image processing.

DIPE is a distributed environment that provides image processing services over integrated teleradiology services networks. DIPE integrates existing and new image processing software and employs sophisticated execution scheduling mechanisms for the efficient management of computational resources within a distributed environment. It can also be extended to provide various added-value services, such as management and retrieval of image processing software modules, as well as advanced charging procedures based on quality of service. DIPE can be viewed as the natural evolution of the legacy field of medical image processing towards a service over the emergent health care telematics networks.

Computer Communication Networks↗
PubMed1992

Prototyping an institutional IAIMS/UMLS information environment for an academic medical center.

The paper describes a prototype information environment designed to link network-based information resources in an integrated fashion and thus enhance the information capabilities of an academic medical center. The prototype was implemented on a single Macintosh computer to permit exploration of the overall "information architecture" and to demonstrate the various desired capabilities prior to full-scale network-based implementation. At the heart of the prototype are two components: a diverse set of information resources available over an institutional computer network and an information sources map designed to assist users in finding and accessing information resources relevant to their needs. The paper describes these and other components of the prototype and presents a scenario illustrating its use. The prototype illustrates the link between the goals of two National Library of Medicine initiatives, the Integrated Academic Information Management System (IAIMS) and the Unified Medical Language System (UMLS).

Academic Medical Centers↗
PubMedDate not supplied

Information management of a department of diagnostic imaging.

It is well-known that while RIS allows the management of all input and output data of a Radiology service, PACS plays a major role in the management of all radiologic images. However, the two systems should be closely integrated: scheduling of a radiologic exam requires direct automated integration with the system of image management for retrieval of previous exams and storage of the exam just completed. A modern information system of integration of data and radiologic images should be based on an automated work flow management in al its components, being at the same time flexible and compatible with the ward organization to support and computerize each stage of the working process. Similarly, standard protocols (DICOM 3.0, HL7) defined for interfacing with the Diagnostic Imaging (D.I.) department and the other components of modules of a modern HIS, should be used. They ensure the system to be expandable and accessible to ensure share and integration of information with HIS, emergency service or wards. Correct RIS/PACS integration allows a marked improvement in the efficiency of a modern D.I. department with a positive impact on the daily activity, prompt availability of previous data and images with sophisticated handling of diagnostic images to enhance the reporting quality. The increased diffusion of internet and intranet technology predicts future developments still to be discovered.

Appointments and Schedules↗
PubMedDate not supplied

IAIMS and UMLS at Columbia-Presbyterian Medical Center.

The authors use an example to illustrate combining Integrated Academic Information Management System (IAIMS) components (applications) into an integral whole, to facilitate using the components simultaneously or in sequence. They examine a model for classifying IAIMS systems, proposing ways in which the United Medical Language System (UMLS) can be exploited them.

Computer Peripherals↗
PubMed1999

[Consultation per video-conferencing with regional hospitals: the MEDKOM project of the Hannover Medical University].

Consultations between doctors are necessary tools for decisions in diagnosis and treatment of patients. The mainstay is a sound communication between the participants, using verbal and audio-visual means. Usually clinical findings and imaging results are included. Using video technology with ISDN (integrated services digital network), such consulting can be performed across any distance. The department of hematology and oncology of the Medical School Hanover has introduced such a system in 1989 for conferencing with 12 regional hospitals and two private practices. It is now a well recognized and established system being applied for 270 sessions and for 1100 Patients per year. It is an integrated part of the co-operation, also allows medical education and quality improvement.

Computer Systems↗
PubMedDate not supplied

A model-based context assessment approach for the informatics nurse specialist consultant.

As the number of informatics nurse specialists (INS) has grown, they have become increasingly involved in information system (IS) consultation practice. Their combined clinical and informatics expertise makes these specialists highly marketable and successful IS consultants. As healthcare settings have shifted their IS development toward interdisciplinary-integrated clinical information systems (CIS) that support a patient-focused care continuum, INS have been required to broaden their consultation approaches beyond a domain-specific focus. This article illustrates a model-based context assessment approach that can be used by INS to expand their consultation repertoire.

Computer Systems↗
PubMed1996

The creation and integration of the high tech operatory.

Dentistry is in the early stages of a major technological transformation. For the most part, however, computers and many of the other technological tools dentists use to gather or display clinical information, including intraoral cameras, digital radiography, and multimedia systems, have been less productive then they could be. This paper examines several offices where this technology is currently in use to provide working models of how integrated technology can be implemented into operatories to make them more flexible, productive, and resourceful environments for clinicians, and assist the clinician in creating a corresponding improvement in patient care.

Computer Systems↗