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Intranet technology in hospital information systems.

The clinical information system architecture at the Columbia-Presbyterian Medical Center in New York is being incorporated into an intranet using Internet and World Wide Web protocols. The result is an Enterprise-Wide Web which provides more flexibility for access to specific patient information and general medical knowledge. Critical aspects of the architecture include a central data repository and a vocabulary server. The new architecture provides ways of displaying patient information in summary, graphical, and multimedia forms. Using customized links called Infobuttons, we provide access to on-line information resources available on the World Wide Web. Our experience to date has raised a number of interesting issues about the use of this technology for health care systems.

Computer Security↗

Computerized education in a multi hospital university medical center.

The advantages of using authoring, instructional, and informational computer applications in a university-based multi-hospital medical teaching center are vast. Software applications are used by the staff development educators at The Presbyterian Hospital, Columbia University Medical Center (CPMC) for test construction and administration, information processing, instruction, assessment, and evaluation. The media formats include Windows and DOS based CAI programs, CD ROM, IVD, INTERNET sites, and other on-line resources. This presentation will focus on how nurse educators use the various types of software applications available on the CPMC network and in the multimedia center, and on the benefits experienced by learners, educators, and nursing management and administration.

Academic Medical Centers↗

E-discourse and continuing professional education: the fusion of nursing knowledge and informatics to close the theory-practice gap.

Several modes of electronic discourse (e-discourse) are currently used by nurses, and have potential for meeting their formal and informal continuing professional education (CPE) needs. After defining e-discourse in relation to computer-mediated communications (CMC), the author outlines some recent examples of it use. There follows discussion of the argument that, through e-discourse, nurses can reflect on their practice, incorporating and developing theory and meet their CPE needs. Some important constraining issues are presented, and the author suggests that, for many nurses, e-discourse will have more educational application than multimedia in the foreseeable future. The paper is set within the context of UK requirements, but the issues raised are pertinent to nurses around the world, particularly where CPE is incorporated within the re-registration cycle.

Communication↗

Advances in digital video for electronic media.

From media's early days of film strips and records, to today's multimedia CD-ROMs, nurses have embraced educational tools. Today, the capabilities of these tools have placed a tremendous demand for providing information any time, any where. This has led to increasing digitization of sights and sounds. Once digitized, this information can travel over information highways made up of telephone lines, fiberoptic cables, microwaves and satellites, or it can be stored on magnetic and optical media. Technological advances have made it possible for computer users to create, store and retrieve high quality digital still and moving video and audio for inclusion in electronic media. Methods for digitizing include capturing and converting the information with cameras, scanners and capture boards. Digital video compression/decompression (codec) standards vary in quality. Potential uses of digital video abound including video on demand, videoconferencing, distance learning, telemedicine, on-line education and computer-based training. Examples illustrating the differences in digital video formats will be shown during the presentation.

Analog-Digital Conversion↗

Development of a CAI program entitled 'Introduction to Nursing Process'. Requirement for nursing education in Japan.

A new teaching strategy is required in nursing education in Japan. A multimedia CAI (Computer Assisted Instruction) program entitled "Introduction to Nursing Process." was developed. The aim of this study was to examine whether CAI could assist students' knowledge acquisition, and increase their motivation and readiness to learn clinical nursing practice. This study involved the process of developing CAI and a pilot study for measuring and evaluating the CAI program. Results demonstrate that CAI can increase students' understanding about the nursing process, enhance their motivation to learn, and provide realistic situations describing the concept of nursing the process.

Computer-Assisted Instruction↗

A simulation program that teaches clinical decision making in nursing.

The aim of this project is to produce a multimedia computer simulation program, to be used in the training of clinical decision making with nursing students in Swedish schools of nursing. The program is based on a number of clinical scenes filmed in a ward and dealing with the postoperative care of a patient who has undergone reconstruction of the crucial ligament. The student's task is to assess the need for care for a newly postoperative patient and to plan the care for the first 24 hours. Special emphasis is given to pain assessment, pain relief and drug administration.

Computer-Assisted Instruction↗

Intranet and HTML at a major university hospital--experiences from Munich.

Intranet-technology is the application of Internet-Tools in local networks. With this technique electronic information systems for large hospitals can be realized very easily. This technology has been in routine use in 'Klinikum Grosshadern' for more than one year on over 50 wards and more than 200 computers. The following clinical application areas are described: drug information, nursing information, electronic literature retrieval systems, multimedia teaching und laboratory information systems.

Computer Communication Networks↗

PRONET services for distance learning in mammographic image processing.

The potential of telematics services is investigated with respect to learning needs of medical physicists and biomedical engineers. Telematics services are integrated into a system, the PRONET, which evolves around multimedia computer based courses and distance tutoring support. In addition, information database access and special interest group support are offered. System architecture is based on a component integration approach. The services are delivered in three modes: LAN, ISDN and Internet. Mammographic image processing is selected as an example content area.

Biomedical Engineering↗

Medical emergency aid through telematics: design, implementation guidelines and analysis of user requirements for the MERMAID project.

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) will be considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) will be tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Emergency Medical Services↗

Quality criteria for electronic publications in medicine.

This paper defines "electronic publications in medicine (EPM)" as computer based training programs, databases, knowledge-based systems, multimedia applications and electronic books running on standard platforms and available by usual distribution channels. A detailed catalogue of quality criteria as a basis for development and evaluation of EPMs is presented. The necessity to raise the quality level of electronic publications is stressed considering aspects of domain knowledge, software engineering, media development, interface design and didactics.

Publishing↗

ATTRACT--applications in telemedicine taking rapid advantage of cable television network evolution.

ATTRACT is a project that intends to provide telemedicine services over Cable Television Networks. ATTRACT is an European Commission funded project (Healthcare Telematics). The main objective of ATTRACT is to take advantage of emerging European Cable Television network infrastructures and offer cost-effective care to patients at home. This will be achieved through a set of broadband network applications that competitively provide low cost interactive health-care services at home. The applications will be based on existing or developing European Cable Television network infrastructures in order to provide all kind of users with affordable homecare services. It is ATTRACT's intention that citizens and users benefit from high quality access to home telemedical services which also implies cost savings for patients, their families and the already over burdened health institutions. In addition, the European industries will have extensive opportunities to develop, evaluate and validate broadband network infrastructures providing multimedia and interactive telemedical services at home. ATTRACT contributes to the EU telecommunications and telematics policy objectives that promote the development and validation of "applications and services" which "provide an intelligent telematic environment for the patient in institutions and other points of care that helps the patient to continue, as far as possible, normal activities and external communication".

Persons with Disabilities↗

Tragedy prompts depression awareness, suicide prevention campaigns.

The tragic suicide of Robert C. Goltz prompted associates at the integrated marketing and communications company he founded in Green Bay, Wis., to develop two multimedia campaigns, one focusing on depression awareness and the other on suicide prevention.

Adult↗

Six opinions on IT security. Panel discussion.

Physicians consult over the Internet. Diagnoses are delivered via E-mail. Data is kept in multimedia repositories. Health care IT is filled with data security challenges. Here's what six experts think about the possibilities and vulnerabilities.

Chronology as Topic↗

[Introduction of the project "Westdeutsche Allgemeine Zeitung (WAZ) for visually impaired" (a talking electronic daily newspaper)].

In order to complete the range of topical media, that is currently available for the visually impaired, a working group is developing and testing the "Westdeutsche Allgemeine Tageszeitung (WAZ) for the visually impaired", an auditive electronic daily newspaper. The intention of this project is to take into consideration the needs of the visually impaired, especially of those who acquired the handicap in middle or later age and might feel that not being able to read the daily newspaper anymore reduces their quality of life to a great extent. The central aim therefore is to put the modern computer technology at the disposal of the impaired in a way that enables them to make use of the newspaper without having had previous experience. In a first phase of several months twelve probands in different personal settings will test a first prototype of the newspaper reading machine, a modified and optimated multimedia computer system with modern and speech output, at home. During this period the users will be intensively looked after and undergo psychodiagnostic examination. By means of analysing the data collected in extended talks and questionnaires concrete proposals on how to improve the machine are to be made and a statement about the potential impact of the electronic newspaper on the quality of life of the visually impaired--in the sense of a contribution to their rehabilitation--is to be given.

Adolescent↗

Design and implementation of a World Wide Web teaching files database on diagnostic radiology.

INTRODUCTION: The aim of this project was to demonstrate the feasibility and effectiveness of a teaching files database on diagnostic radiology accessible via the Internet and the World Wide Web. The Italian experience in developing a national database named "RadioDB" is presented. MATERIALS AND METHODS: "RadioDB" is sponsored by the Italian Society of Radiology (SIRM) and is based on a multicenter academic collaboration. It constitutes a collection of multimedia case record and teaching files. "RadioDB" is based on a Pentium workstation running a Structured Query Language (SQL) database and a World Wide Web server. Each case record contains at least one radiological image and a text file for case comment with key words and codes from the American College of Radiology (ACR). In most cases, a complete teaching file is also available. Peer reviewed teaching files available on this server are contributed via anonymous file transfer protocol (FTP) through the Internet from various Italian academic Departments of Radiology. RESULTS: Worldwide users can easily access and search "RadioDB" database through a World Wide Web query interface and retrieve on-the-fly case record and teaching files. Users can search the database by author name, description, key words, free text or ACR codes. CONCLUSIONS: "RadioDB" enlarges the base of current off-line educational materials offering and it allows radiologists to improve their medical education.

Education, Medical, Continuing↗

Clinical laboratory technician to clinical laboratory scientist articulation and distance learning.

Laboratory workers and educators alike are challenged to support access to education that is current and provides opportunities for career advancement in the work place. The clinical laboratory science (CLS) program at the Medical College of Georgia in Augusta developed a clinical laboratory technician (CLT) to CLS articulation option, expanded it through distance learning, and integrated computer based learning technology into the educational process over a four year period to address technician needs for access to education. Both positive and negative outcomes were realized through these efforts. Twenty-seven students entered the pilot articulation program, graduated, and took a CLS certification examination. Measured in terms of CLS certification, promotions, pay raises, and career advancement, the program described was a success. However, major problems were encountered related to the use of unfamiliar communication technology; administration of the program at distance sites; communication between educational institutions, students, and employers; and competition with CLT programs for internship sites. These problems must be addressed in future efforts to provide a successful distance learning program. Effective methods for meeting educational needs and career ladder expectations of CLTs and their employers are important to the overall quality and appeal of the profession. Educational technology that includes computer-aided instruction, multimedia, and telecommunications can provide powerful tools for education in general and CLT articulation in particular. Careful preparation and vigilant attention to reliable delivery methods as well as students' progress and outcomes is critical for an efficient, economically feasible, and educationally sound program.

Computer-Assisted Instruction↗

A convincing case for the provision of telemedicine services to ocean going vessels: the MERMAID paradigm.

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) are considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) are being tested in terms of cost/performance tradeoffs that are inherent to them and the developmental state each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

Emergency Medical Services↗

Medical informatics education.

Medical Informatics is a multidisciplinary field, dealing mainly with informatics and technology applications in health care. Medical Informatics is composed from a number of sub-areas such as computer based patient record (CPR), processing of multimedia information (signals, images), coding and transmission through high speed networks of medical information (telematics), medical decision support systems, data security and integrity, integration of technologies in hospital and regional environments, and development of educational tools. The people who receive such an education are capable of development, integration and maintenance of complex hospital and health information systems both at departmental and regional levels. A very important issue however is the acceptance of information technology (IT) solutions engineered by medical informaticians from the medical personnel. In this paper we shall deal with the set-up of a medical informatics and medical technology educational environment, as well as the areas from medical informatics that the average user needs to be familiar with in order for the successful deployment of IT solutions in health care.

Curriculum↗