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An Internet service for manipulating 3D models of human organs reconstructed from computer tomography and magnetic resonance imaging.

Our paper describes an integrated methodology addressing the development of an Internet service for medical professionals, medical students and generally, people interested in medicine. The service (currently developed in the framework of IAEVA, a Telematics Application Programme project of the European Union), incorporates a mechanism for retrieving from a relational database (reference library) 3D volumetric models of human organs reconstructed from computer tomography (CT) and/or magnetic resonance imaging (MRI). Retrieval is implemented in a way transparent to the actual physical location of the database. Prospective users are provided with a Solid Object Viewer that offers them manipulation (rotation, zooming, dissection etc.) of 3D volumetric models. The service constitutes an excellent foundation of understanding for medical professionals/students and a mechanism for broad and rapid dissemination of information related to particular pathological conditions; although pathological conditions of the knee and skin are supported currently, our methodology allows easy service extension into other human organs ultimately covering the entire human body. The service accepts most Internet browsers and supports MS-Windows 32 platforms; no graphics accelerators or any specialised hardware are necessary, thereby allowing service availability to the widest possible audience. Nevertheless, the service operates in near real-time not only over high speed expensive network lines but also over low/medium network connections.

Computer Communication Networks↗

The integrated academic information management system at Columbia-Presbyterian Medical Center.

Over the past seven years, Columbia-Presbyterian Medical Center has been planning and implementing an integrated academic information management system. Accomplishments to date include establishing an institutional information architecture, installing a campus-wide network of workstations, recruiting the staff needed to develop and implement the system, and developing various applications. This paper presents the rationale and steps involved in these accomplishments, as well as data on use of the system so far.

Academic Medical Centers↗

Slovenian national health insurance card: the next step.

The Slovenian national health insurance company started a full-scale deployment of the insurance smart card that is at the present used for insurance data and identification purpose only. There is ample capacity on the cards that were selected, to contain much more data than needed for the purely administrative and charging purposes. There are plans to include some basic medical information, donor information, etc. On the other hand, there are no firm plans to use the security infrastructure and the extensive network, connecting the insurance company with the more than 200 self service terminals positioned at the medical facilities through the country to build an integrated medical information system that would be very beneficial to the patients and the medical community. This paper is proposing some possible future developments and further discusses on the security issues involved with such countrywide medical information system.

Computer Security↗

The card integrated into the Slovene Health Care Information System.

At the time of the congress, the health insurance card system national scale introduction in Slovenia is completed. This paper presents the main features of the implementation process and of the resulting system. In its first phase configuration, the system addresses administrative tasks in the health care and health insurance sectors. Yet, technological and organisational infrastructure introduced, as well as experiences gained, provide sound grounds for the system enhancement with new functions, the development of which has been carried out in parallel with the basic system implementation. Furthermore, the system is designed to be open to the integration into the overall health care information system and to be a component of the continuous process of bringing the health care to the citizens.

Computer Communication Networks↗

A systems approach to planning biomedical information services.

A systems approach to planning was applied within the Biomedical Information Communication Center at Oregon Health Sciences University when its User Services division launched a strategic planning effort. By looking at the choice subsystem, the organizational structure, and the behavioral subsystem, those engaged in planning attempted to assure that desired change would permeate the entire system. The challenge of applying a theoretically ideal planning model within an environment averse to planning is delineated.

Information Centers↗

Developing an integrated information system for specialized addiction treatment agencies.

This article outlines the development of an integrated information system for specialized alcohol and drug treatment agencies in Ontario, Canada. The system is being developed following a strategic planning process involving provincial funding ministries and coalitions of service providers. An overview of the system's development is provided and the implementation of one subcomponent, a client-tracking system, is described. Some challenges to the implementation of this component are identified.

Alcoholism↗

Biomedical information @ the speed of light: implementing desktop access to publishers' resources at the Paterson Institute for Cancer Research.

Shortly after midnight every Thursday morning, a list server in Massachusetts delivers an electronic table of contents message to the Kostoris Medical Library at the Paterson Institute for Cancer Research in Manchester, UK. The messageins details of the latest edition of the New England Journal of Medicine, complete with hyperlinks to the full text of the content online. Publishers' electronic current awareness services have been integrated into the dissemination process of the Library service to enhance the speed of communication and access to full text content. As a means of promoting electronic journal use, a system of e-mail delivery coupled with fast Internet access has allowed a migration from paper-based current awareness alerting to a seamless online product.

Computer Communication Networks↗

PACS adoption.

Once the decision has been made to adopt PACS instead of a film-based radiology practice, there are a number of hurdles to jump. Users need to be aware of the impact the change will make on end users and be prepared to address issues that arise before they become problems. Someone who understands the technology of PACS must be identified to help make an informed decision about vendor selection, network architecture, workstation functionality, and archives. A PACS administrator should have the tools available to avoid problems with the system after implementation and should be able to repair the inevitable mistakes that will happen. Hopefully, this article can serve as a starting point for a potential new PACS adoption.

Decision Making↗

Computerized guidelines for preventative care in general practice.

Computer-based guidelines for preventative care is an example of the way in which protocols can be put to use in an effective and useful way. However, computerised medical protocols will only be used on a large scale if they are integrated with the computer-based medical record. The AIM-project ISAAC is working on the development of integrated tools for use in Primary Health Care, and especially General Practice. One of the tools under development is prevention. In this article, prevention is used as an example of the implementation of protocols. After a short definition of prevention, the implementation of preventative modules (or protocols) in the ISAAC GP information system is discussed. There are several conditions or critical factors if the implementation of prevention (and protocols) in a GP information system and in a GP practice is to be successful. In the discussion, some of the opportunities that are emerging with the use of information systems and telematics in primary health care are also discussed, together with the potential of ISAAC and the crucial role that must be played by healthcare providers.

Europe↗

Extended applications with smart cards for integration of health care and health insurance services.

In 1999 in Romania has initiated the reformation of the national health care system based on health insurance. In 1998 we analyzed this system from the point of view of its IT support and we studied methods of optimisation with relational, distributed databases and new technologies such as Our objectives were to make a model of the information and services flow in a modern health insurance system, to study the smart card technology and to demonstrate how smart card can improve health care services. The paper presents only the smart cards implementations.

Computer Communication Networks↗

IAIMS at Columbia-Presbyterian Medical Center: accomplishments and challenges.

The concept of "one-stop information shopping" is becoming a reality at Columbia-Presbyterian Medical Center. Our goal is to provide access from a single workstation to clinical, research, and library resources; university and hospital administrative systems; and utility functions such as word processing and mail. We have created new organizational units and installed a network of workstations that can access a variety of resources and systems on any of seventy-two different host computers/servers. In November 1991, 2,600 different individuals used the clinical information system, 700 different individuals used the library resources, and 900 different individuals used hospital administrative systems via the network. Over the past four years, our efforts have cost the equivalent of $23 million or approximately 0.5% of the total medical center budget. Even small improvements in productivity and in the quality of work of individuals who use the system could justify these expenditures. The challenges we still face include the provision of additional easy-to-use applications and development of equitable methods for financial support.

Academic Medical Centers↗

Developing online support for clinical information system developers: the FAQ approach.

OBJECTIVE: We investigate a knowledge-based help system for developers of an integrated clinical information system (CIS). The first objective in the study was to determine the system's ability to answer users' questions effectively. User performance and behavior were studied. The second objective was to evaluate the effect of using questions and answers to augment or replace traditional program documentation. DESIGN: A comparative study of user and system effectiveness using a collection of 47 veritable questions regarding the CIS, solicited from various CIS developers, is conducted. Most questions were concerning the clinical data model and acquiring the data. MEASUREMENTS: Answers using current documentation known by users were compared to answers found using the help system. Answers existing within traditional documentation were compared to answers existing within question-answer exchanges (Q-A's). RESULTS: The support system augmented 39% of users' answers to test questions. Though the Q-A's were less than 5% of the total documentation collected, these files contained answers to nearly 50% of the questions in the test group. The rest of the documentation contained about 75% of the answers. CONCLUSIONS: A knowledge-based help system built by collecting questions and answers can be a viable alternative to large documentation files, providing the questions and answers can be collected effectively.

Artificial Intelligence↗

IAIMS development at Baylor College of Medicine.

At Baylor College of Medicine, we are developing the technical and intellectual resources needed to realize the Integrated Academic Information Management System (IAIMS) concept fully. The substantial technical, organizational, and financial commitments involved demand that we align our efforts with the strategic purposes of the college. The support of science, therefore, has become the principal, but not exclusive, focus of Baylor's IAIMS effort. Even so, the information technology architecture we have created for biomedical research is proving valuable in other settings as well. And the infrastructure we are creating--the communications architecture and the linkages to information resources--serves many purposes in addition to those of research. The architecture accommodates a diversity of workstations, networks, and informational and computational servers. This will be the greatest possible chance of transferring the fruits of our Phase III development to other academic medical centers.

Academic Medical Centers↗

A web-based library consult service for evidence-based medicine: Technical development.

BACKGROUND: Incorporating evidence based medicine (EBM) into clinical practice requires clinicians to learn to efficiently gain access to clinical evidence and effectively appraise its validity. Even using current electronic systems, selecting literature-based data to solve a single patient-related problem can require more time than practicing physicians or residents can spare. Clinical librarians, as informationists, are uniquely suited to assist physicians in this endeavor. RESULTS: To improve support for evidence-based practice, we have developed a web-based EBM library consult service application (LCS). Librarians use the LCS system to provide full text evidence-based literature with critical appraisal in response to a clinical question asked by a remote physician. LCS uses an entirely Free/Open Source Software platform and will be released under a Free Software license. In the first year of the LCS project, the software was successfully developed and a reference implementation put into active use. Two years of evaluation of the clinical, educational, and attitudinal impact on physician-users and librarian staff are underway, and expected to lead to refinement and wide dissemination of the system. CONCLUSION: A web-based EBM library consult model may provide a useful way for informationists to assist clinicians, and is feasible to implement.

Chicago↗

The impact of IAIMS at Georgetown: strategies and outcomes.

Integration of multiple information systems of a medical center will change the way physicians work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. Since 1983, Georgetown has been engaged in an Integrated Academic Information Management System (IAIMS) project to bring together multiple sources of information that reside on different computers and database systems. Georgetown is developing a Biotechnology and Biomedical Knowledge Network that includes informational and clinical databases, scholar workstations, instruction on computer use, a campuswide network with local area network nodes, and a modular approach to systems integration. The IAIMS project, spearheaded by the medical library, has enabled a broad spectrum of health professionals to benefit directly from new, dynamic information services. The network is heavily used; in 1991, more than 2,100 individual users conducted more than 148,500 computer functions and more than 104,000 searches. There is economy of scale in high-volume use. Overall, the average search cost is $1.57; for high use databases the cost is $0.38, and for low use, it is $9.41. As described in this paper, IAIMS offers a cost-effective means of enhancing patient care by improving information services to physicians. At Georgetown, IAIMS has advanced the concept of integration, accelerated use of computers in education, increased user acceptance of advanced technologies, and established cost factors for providing information resources. While progress made in improving the transfer of medical information is impressive, it is clear that IAIMS requires several more years of support to achieve full implementation.

Academic Medical Centers↗

The CD-ROM experience at Loma Linda: the issues of training, logistics, and creative financing.

Since the end of 1987, the Medical Center and University libraries at Loma Linda have progressed from stand-alone CD-ROM-based workstations for access to MEDLINE to networked CD-ROM access to a variety of databases. T.O.M.M.I. (Total Online Medical Material Integration) is a CD-ROM-based wide area network linking the Loma Linda University Medical Center, Loma Linda University, and other entities in Loma Linda, California. T.O.M.M.I., a microcomputer-based system, represents the implementation of IAIMS at Loma Linda. In addition to discussing the issue of "downsizing" campus-wide information networks, this article focuses on the issues of training, handling of logistical problems, and the use of creative financing.

CD-ROM↗