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Access to DNA and protein databases on the Internet.

During the past year, the number of biological databases that can be queried via Internet has dramatically increased. This increase has resulted from the introduction of networking tools, such as Gopher and WAIS, that make it easy for research workers to index databases and make them available for on-line browsing. Biocomputing in the nineties will see the advent of more client/server options for the solution of problems in bioinformatics.

Amino Acid Sequence

Web-based access to an online atlas of anatomy: the Digital Anatomist Common Gateway Interface.

A World Wide Web Common Gateway Interface package is described for accessing existing online interactive atlases of anatomy. The Web interface accesses the same 2-D and 3-D images of human neuroanatomy, knee anatomy and thoracic viscera that are currently accessed by a custom interactive atlas in distance learning courses. Although the Web interface is too slow to replace the existing atlas, it provides a parallel access path that has much broader potential for development of a distributed distance learning network in anatomy. By maintaining both access methods to the same information sources we continue to satisfy the fast interactivity needs for our local courses, while at the same time providing a migration path to the Web as the capabilities of Web browsers evolve.

Anatomy, Artistic

Privacy and security issues in a wide area health communications network.

In 1993 the first national health information service went live in New Zealand, using commercial network services for all communications. This system provides a point of connection for all health personnel, and for those with a legitimate interest in health care information (e.g. insurers): it also provides access to a number of information resources managed on behalf of the government of New Zealand (e.g. index of health care users), as well as to those developed by individual network service providers. Much of the data exchanged across this network is personalised. Since the recipient may not be known personally to the sender, it is vital that the sender has confidence that the recipient will treat personal information according to agreed criteria for privacy. A Code of Practice covering health information was developed under the New Zealand Privacy Act to ensure that the confidence to share confidential data was supported. For large organisations such as hospitals to function efficiently, they need the flexibility to be able quickly to assign user privileges to selected staff without the need for extra paperwork seeking approval from the centre. But the audit trail requires unique identification of the individual undertaking each transaction. This requirement has been addressed. Some of the data moved across the network relates to life-critical issues, e.g. clinical warnings about allergies or serious medical conditions. A failure of communications causing this vital information to be improperly represented in some way on the receivers system could have disastrous consequences. To ensure the integrity of data transfers, user installations have to be certified compliant with standard test scripts before they are authorized for access to these resources.

Accreditation

The use of clinical computer workstations as an educational adjunct in prosthodontics.

Current computer systems improve the health professional's ability to store, retrieve, and present visual data in a way never before possible. Health professionals in general are beginning to use computer-based digital imaging to improve the diagnosis and treatment planning of disease processes. The use of computer-based networks to transmit medical and dental data is in its infancy but promises to be the main form of data transmission of the future. This article outlines a few applications presently being used and developed at the Ohio State University College of Dentistry in the preclinical and clinical courses in prosthodontics.

Computer Communication Networks

A component-based, distributed object services architecture for a clinical workstation.

Attention to an architectural framework in the development of clinical applications can promote reusability of both legacy systems as well as newly designed software. We describe one approach to an architecture for a clinical workstation application which is based on a critical middle tier of distributed object-oriented services. This tier of network-based services provides flexibility in the creation of both the user interface and the database tiers. We developed a clinical workstation for ambulatory care using this architecture, defining a number of core services including those for vocabulary, patient index, documents, charting, security, and encounter management. These services can be implemented through proprietary or more standard distributed object interfaces such as CORBA and OLE. Services are accessed over the network by a collection of user interface components which can be mixed and matched to form a variety of interface styles. These services have also been reused with several applications based on World Wide Web browser interfaces.

Computer Communication Networks

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

An X-protocol based medical teleconsultation system using low or high speed networks. A specific-design approach.

The objective of this proposal is to provide solutions for the necessities of teleconsultation or telediagnosis among medical professionals, using work stations within the X-Windows environment and applicable in communication lines with an extensive range of bandwidths and operating system independence. Among the advantages sought are savings in transportation, improvement in the quality of the medical attention provided and continued training for the medical professional.

Computer Communication Networks

Networking consumer health information: bringing the patient into the medical information loop.

The Library of the Health Sciences at the University of Illinois at Chicago obtained a grant from the Illinois State Library to implement a statewide demonstration project that would provide consumer health information (CHI) using InfoTrac's Health Reference Center CD-ROM database. The goals of the project were to cooperate with targeted public libraries and clinics in providing CHI at the earliest point of need; to provide access to the database via a dial-up network server and a toll-free telephone number; and to work with targeted sites on database training, core CHI reference sources, and referral procedures. This paper provides background information about the project; describes the major systems and technical issues encountered; and discusses the outcomes, impact, and envisioned enhancements.

CD-ROM

The UK Human Genome Mapping Project online computing service.

This paper presents an overview of computing and networking facilities developed by the Medical Research Council to provide online computing support to the Human Genome Mapping Project (HGMP) in the UK. The facility is connected to a number of other computing facilities in various centres of genetics and molecular biology research excellence, either directly via high-speed links or through national and international wide-area networks. The paper describes the design and implementation of the current system, a 'client/server' network of Sun, IBM, DEC and Apple servers, gateways and workstations. A short outline of online computing services currently delivered by this system to the UK human genetics research community is also provided. More information about the services and their availability could be obtained by a direct approach to the UK HGMP-RC.

Computer Communication Networks

The benefits and perils of system integration.

The current health care environment is complex, with no single systems solution dominating the marketplace. A new approach utilizes Networked Systems Integration to link disparate systems together. This paper discusses the Systems Integration approach and suggests that it encourages user commitment, provides greater modularity, is cost effective, and supports solutions that offer greater functionality. However, it is noted that this approach is not without problems that can dramatically effect the realization of benefits.

Competitive Bidding

[Computer-assisted patient data management: from department-specific individual solutions to Vienna-wide network comprehensive solution].

Up to now the daily routine work and statistics have been facilitated by using some self-developed microcomputer based data collection systems. No network has been established. Currently we implemented in out hospital "Krankenanstalt Rudolfstitung" a country-wide patient oriented data collection net system. In future it will be possible to compare all patients datas, methods and success of treatment of all Viennese hospitals.

Austria

A World Wide Web-based user interface for a data management system for use in multi-institutional clinical trials--development and experimental operation of an automated patient registration and random allocation system.

We have employed the Hypertext Transfer Protocol (HTTP) and Hypertext Markup Language (HTML) to develop an automated patient registration and random allocation system for use in a multi-institutional clinical trial. We made it available on-line to World Wide Web clients in each hospital through a user friendly graphical user interface. During experimental operation, the physicians found it satisfactory from the viewpoint of both ease of operation and response time. For the development of a graphical user interface in network-based information system for use in multi-institutional clinical trials, HTTP/HTML has several advantages over an ordinary client-server model. Therefore, we concluded that we would adopt HTP/HTML for the construction of user interfaces for physicians in each spital and for data managers in our coordinating center.

Chemotherapy, Adjuvant

An efficient and cost effective nuclear medicine image network.

An image network that is in use in a large nuclear medicine department is described. This network was designed to efficiently handle a large volume of clinical data at reasonable cost. Small, limited function computers are attached to each scintillation camera for data acquisition. The images are transferred by cable network or floppy disc to a large, powerful central computer for processing and display. Cost is minimized by use of small acquisition computers not equipped with expensive video display systems or elaborate analysis software. Thus, financial expenditure can be concentrated in a powerful central computer providing a centralized data base, rapid processing, and an efficient environment for program development. Clinical work is greatly facilitated because the physicians can process and display all studies without leaving the main reading area.

Computer Communication Networks

[Problems of using computer technics in hospitals of various profiles].

The main causes restraining the introduction of computers in medical establishments have been analyzed. It is noted that the most rational way of introducing computers into medical establishments consists in the development of local computer network (LCN). An optimal variant of multicomputer association is represented by LCN based on star topology having a multidrop line as a shunt. Such a solution has some distinct advantages since in this case a multidrop line can operate both as an autonomous mini-LCN and together with other multidrop lines. Besides, heterogenic computers can be grouped into similar multidrop lines.

Computer Communication Networks

The "SentiWeb" method for exploring a database on the Net.

Return of information is one of the main goals of any public health information system. About 25,000 maps and 10,000 graphs may be obtained from the time-series collected in the database of the French Communicable Diseases Network (FCDN). Furthermore, this huge epidemiological atlas is updated each week. What is the optimal way of returning such information? This report discloses the strategies used for enhancing the access facilities to the FCDN database for any users, particularly those without specific training in epidemiology or database query language. The technical options implemented in the SentiWeb server (http:/(/)www.b3e.jussieu.fr) are discussed.

Communicable Diseases

Lossy compression techniques, medical images, and the clinician.

There has been increasing interest in the storage and retrieval of medical images in hospitals and clinics here in Brazil and elsewhere. At the Heart Institute of São Paulo, with thousands of image-based procedures performed each month, the pursuit of optimal transmission and storage methods for digital images is a major concern. The use of data-compression techniques can reduce the enormous amount of imaging data to be stored or transmitted across a computer network, so that the efficiency of the computing system is preserved. The techniques for image compression can be categorized as "lossless" or "lossy," with "lossy" techniques being those in which some, supposedly irrelevant information is lost. Lossy techniques are much more efficient than lossless ones, achieving data-compression ratios as high as 100:1.

Algorithms

Protecting the privacy of patient information in clinical networks: regulatory effectiveness analysis.

Patient privacy is one of the major issues in the development of modern clinical information system networks. Such networks will have to demonstrate an appropriate concern for privacy as a precondition of operation. Regulatory effectiveness analysis is a novel technique for measuring compliance with a technological regulatory system. By examining the public policies, legal structures, and technical tools involved in the regulatory system, it is possible to discover discontinuities that may result in noncompliance with the regulatory system.

Civil Rights

Privacy and security requirements of distributed computer based patient records.

Privacy and security issues increase in complexity as we move from the conventional patient record to the computer based patient record (CPR) supporting patient care and to cross-institutional networked CPRs. The privacy and security issues surrounding the CPR are outlined. Measures for privacy and security protection are summarized. It is suggested that we lack a key component of an information sharing culture. We need means for semantic indexing in the form of a metadata base at the level of the instantiation of a data base rather than at the level of its schemas.

Computer Communication Networks