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Fox Chase Cancer Center has adopted the "cluster concept" of networking to avoid redundancy and loss of computing time. In this manner, transfer of clinical and research data is easily accomplished.
Digital cameras have been used for clinical photography in the Medical Illustration Department at Great Ormond Street Hospital NHS Trust for eight years. In that time methods have evolved to take advantage of both technological advances and experiences gained in operating a routine digital photographic service. The management of a large number of digital images requires assiduous attention to all stages of production. Current techniques are described for: controlling quality and exposure in the acquisition of images with a digital camera; temporary and permanent storage, backing up and archiving procedures; and cataloguing of clinical images. Planning for network delivery, the Electronic Patient Record and the management of images in teaching collections are discussed.
A concept of mobile telemedicine has been proposed to provide emergency care in a moving vehicle. The practicality of this technique was investigated through technical considerations required to realize mobile telemedicine. Some problems with this technique were identified, and measures to resolve the problems were devised. Then, theoretical analysis verified the feasibility of the proposed technique. Different multiplexing techniques for the multiple medical data transmission by mobile communication were investigated. An experimental system that can simultaneously transmit color images, an audio signal, three-channel ECGs, and blood pressure from a moving vehicle to a fixed station was developed. Experiments on the transmission of multichannel medical data from a moving ambulance, a navigating ship, and a flying aircraft were conducted. The results of these experiments verified the practical feasibility of the proposed technique. In the practical application of this technique, there may be some legal problems: for example, whether medical treatment through a communication medium would be legally acceptable or not, and whether the transmission of medical data violates the protection of personal privacy. However, considering the emergency nature of this technique and the significance of the results, both problems seem to be either legally or technically solvable. This application of mobile communication to telemedicine is not confined to merely a proposal to use new techniques. It can also bring about a methodological change in the concept of conventional telemedicine by changing it from static to dynamic, and by enlarging its scope from a local area to a global or cosmic area. It may also have an impact on conventional emergency medicine in that it will open up a new field of application that applies to moving vehicles.
A computerized system capable of transmitting digitally formatted images of the central nervous system has been used to develop a neurosurgical wide-area network in western Pennsylvania. This system links remote or primary care hospitals with a large, tertiary-care, Level 1 trauma center for the constant availability of neurosurgical evaluation by receiving and interpreting computed tomography and magnetic resonance images sent via ordinary public telephone lines. This network has been used in over 20 cases to receive and interpret transmitted cranial computed tomographic images consisting of subarachnoid hemorrhage, intracerebral hematoma, cerebral neoplasm, cerebral abscess, cerebrovascular accident, and normal studies. There has been no known instance of false-positive or false-negative interpretation or of a patient being adversely managed by this method. On the contrary, it appears that patient management has been positively affected through the ability of the neurosurgical evaluation to include a review of the radiological studies. The initial experience has led to the conclusion that this network is an effective, accurate, and cost-effective means of delivering neurosurgical care to underserved areas.
Because of the severe financial hardships associated with the transition to a market economy in the Newly Independent States (NIS) of the former Soviet Union, the Internet has become a major link to health care resources for many health care workers. In 1992, the University of Illinois at Chicago Library of the Health Sciences (UIC LHS) initiated a special support project with goals of enhancing access to international biomedical information and facilitating international professional networking for interested NIS organizations and individuals. Project objectives included an information needs assessment, development of culturally sensitive Internet training applications, information and referral services, and follow-up e-mail consultations for NIS participants. This paper reviews the historical context of the health care partnerships between the United States and the NIS, and of the UIC LHS International Health Information Networking Project. In the context of UIC, international networking cross-cultural observations, teaching techniques, a Russian training experience, and the development of a Web-based course are reported.
This article is the second of two on the subject of computer security in hospital management in the first part, the authors dramatized the need for not only information security awareness but also the need for implementation of security measures to protect valuable information. This second article provides an overview of the components of a good computer security plan, contains a brief explanation of some of the new network security technology available today, and gives the reader several sources that can provide further information on information security.
Multidisciplinary collaboration in multi-center trials needs a formalized data management structure to ensure true progress monitoring and high quality research data. Cadans, a customized facility for data management, related to the Interuniversity Cardiology Institute of the Netherlands, designed a computer-based data management system for multidisciplinary multi-center collaborative research projects. In this paper we describe the system and the role of integrated access to research databases on a data network. Areas of concern are also discussed.
Over the past several years, thousands of networked information resources have become available to individuals and institutions with access to the Internet. Unfortunately, the dizzying array of computing and networking environments often frustrates end users' attempts to navigate the Internet. Librarians have begun to take responsibility not only for instructing users in the use of basic network tools such as file transfer, remote log-in, and electronic mail, but also for answering questions concerning network access and even information system design. The authors show how, by continuing to adapt to this new and volatile environment, health sciences librarians find themselves playing increasingly important roles in shaping the information policies and practices of their institutions. To illustrate these new roles, the authors review the experiences of health sciences librarians at the University of California, Los Angeles, and the University of California, San Diego. These institutions have varying and complex networking environments, and their biomedical libraries have taken lead roles in clarifying and interpreting their particular Internet features.
Internal and world-wide communication, access to medical databases, and information services are essential demands in the science of medicine not only for research, but also for improving patient care. A network connection between the medical network of the Erlangen University Hospital and other international networks was examined as a concept within the scope of a Erlangen Hospital Communication System (EKKS) project and tested with an actual installation.
No computer system or computer network can today be operated without the necessary security measures to secure and protect the electronic assets stored, processed and transmitted using such systems and networks. Very often the effort in managing such security and protection measures are totally underestimated. This paper provides an overview of the security management needed to secure and protect a typical IT system and network. Special reference is made to this management effort in healthcare systems, and the role of the information security officer is also highlighted.
The good news is that newer, faster technology is opening up new horizons for networked applications. The bad news? Figuring out how much bandwidth to install to meet future demands, without overbuilding and suffering a poor ROI.
The definition of health information is growing to include multimedia audio, video, and high-resolution still images. This article describes the telemedicine program at East Carolina University School of Medicine, including the telemedicine applications presently in use and the virtual reality applications currently under development' Included are the major design criteria that shape the telemedicine network some of the lessons learned in developing the network, and a discussion of the future of telemedicine, including efforts to incorporate telemedicine within a fully integrated health information system.
A community health information network (CHIN) provides technology-based information services to help maintain optimal health for all the residents of a community. Defining features of a CHIN are that its services are available to all stakeholders and that competitors collaborate to share information. The initial impetus for a CHIN is usually to facilitate paying for health care or to share clinical records. Complex legal, organizational, funding, and control issues confront CHIN initiators, and reliable models do not exist today. During development, issues of program focus and technology selection arise, followed by concerns about information privacy and the CHIN's role in quality of care. Once basic capabilities are implemented, a mature CHIN can offer extensive cost-recovering health-related services to providers, related agencies, and consumers. Developments are underway that eventually will allow a CHIN to support a fully integrated longitudinal health record. A national network of mature CHINs would offer health care professionals further collaborative possibilities that could change the shape of future health care.
The era of the networked society--and medical care depending on networked intelligence--is dawning. Physicians need to plan for office practice information systems in common, with an eye to conveying data electronically between all the locations of care and all the providers involved in caring for defined populations of people. The shared database will become the most important asset of the collection of providers who make up the delivery system that creates it. This will be accomplished by layering technology on local and wide-area networks of group practices, hospitals, health plans, and payers and developing standards that make data accessible in the same format to all users, no matter where they are.
In many countries today, politicians are faced with the difficulty of having to reduce the overproportional increase in the cost of healthcare. In this context the contribution of medical technology to costs in the total spent are nearly always overestimated and its potential for savings underestimated. Based on international studies, investment and subsequent running costs for large, high-tech systems for diagnosis and therapy will be shown to account for only about 1% of the total cost of healthcare. Impressive examples of the application of computed tomography, magnetic resonance tomography and digital angiography deliver statistics regarding valid patient benefits and efficiency of modern diagnostic imaging systems. Studies about related therapeutic possibilities of angioplasty and extra-corporal lithotripsy demonstrate the overall economic advantages of modern medical technology. Arising from the positive results due to the use of such equipment, the additional cost savings potential to be expected by networking these digital modalities with one another, as well as with other information and communications technology systems, will be analysed. The results will be assessed and compared to experience gained from routine clinical operation of such integrated systems. 72% of the total turnover of the Medical Engineering Group of Siemens AG for diagnostic imaging modalities in 1991/1992 arose from digital imaging modalities, and this percentage is expected to continue to increase. This paper will concentrate on these modern digital methods.
The versatility of having Ethernet speed connectivity without wires is rapidly driving adoption of wireless data networking by end users across all types of industry. Designed to be easy to configure and work among diverse platforms, wireless brings online data to mobile users. This functionality is particularly useful in modern clinical medicine. Wireless presents operators of networks containing or transmitting sensitive and confidential data with several new types of security vulnerabilities, and potentially opens previously protected core network resources to outside attack. Herein, we review the types of vulnerabilities, the tools necessary to exploit them, and strategies to thwart a successful attack.
An effort begun in the spring of 1987 by a group of executives within the healthcare industry to establish a Level 7 networking standard (HL7) is rapidly gaining momentum. This article discusses a draft Level 7 protocol which has been produced to ease the complications inherent in the multi-vendor environment of healthcare communications.
Molecular dynamics simulations investigate local and global motion in molecules. Several parallel computing approaches have been taken to attack the most computationally expensive phase of molecular simulations, the evaluation of long range interactions. This paper develops a straightforward but effective algorithm for molecular dynamics simulations using the machine-independent parallel programming language, Linda. The algorithm was run both on a shared memory parallel computer and on a network of high performance Unix workstations. Performance benchmarks were performed on both systems using two proteins. This algorithm offers a portable cost-effective alternative for molecular dynamics simulations. In view of the increasing numbers of networked workstations, this approach could help make molecular dynamics simulations more easily accessible to the research community.