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Dial-in access to CD-ROM databases: beyond the local area network.

Although it has meant additional work, CDLink has enhanced the productivity and effectiveness of the library's public services program. CDLink enables the library to offer dial-in access to databases, either in CD-ROM or other MS-DOS formats. The VAX MS-DOS connection is a cost-effective way to combine the benefits of remote access and multiple simultaneous use. From the user's perspective, CDLink provides free, twenty-four-hour remote access to databases in a friendly, menu-driven environment. For the library staff, the CDLink service represents the achievement of a long-awaited goal.

CD-ROM

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

Fulfilling the promise: implementing IAIMS at Georgetown University.

Predictions are that the integration of multiple information systems of a medical center will change the way doctors work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. The IAIMS program sponsored by the NLM is designed to achieve integration of resources in the medical center environment. The purpose of the IAIMS project at Georgetown is to develop a medical decision support system by bringing together multiple sources of information that reside on disparate computers and different database systems. This immense and complex task is described in this paper from an organizational, academic and technical perspective. Georgetown is developing a Biotechnology and Biomedical Knowledge Network which includes several informational and clinical databases, a variety of scholar workstations, instruction on use of computers, a campus-wide network with local area network nodes and a modular approach to systems integration. The IAIMS project is spearheaded by the medical library which has enabled a broad body of medical center users to benefit directly from new, dynamic services.

Academic Medical Centers

[Experiences with a Token Ring Network in blood bank administration of the Hannover medical university].

The Token Ring Network is a Local Area Network of IBM. It is a very helpful tool for modulating working processes by personal computers. The Token Ring is a network of the third generation and constructed like a star net. The blood bank of the Medical University of Hannover (MHH) is using the Token Ring for the administration of blood storage and donors. Medical data of foreign laboratories are transmitted into the blood bank computer. During the last year, we had no difficulties working with this software tool in response time and data security and it seemed to us a very cheap opportunity for data integration and data collection on decentralized systems.

Blood Banks

Digital image management: networking, display, and archiving.

The requirements for implementing a radiology imaging network are similar to those for local area networks now being designed for other purposes to manage large data films. A radiology department serving a 500-bed hospital generates about 927 megabytes of digitally formatted data per working day. These data are expected to be on line for the patient's hospitalization period. The retrieval rate of these data among the interactive diagnosis display stations requires data throughput rates of between 2 and 5 megabits per second. This throughput rate requires signaling rates of between 20 and 50 megabits per second. Analog hard-copy generation of the images on the network is required by the referring physician for selected images that support the consultation report. Digital laser recorders using paper may be quite satisfactory. Long-term archiving must be low in cost and requires a database scheme capable of managing more than a terabyte of image data. Radiology networks must be required to bridge with other hospital information systems.

Archives

RADPLANET--a functional radiology digital image network.

RADPLANET is a functioning LAN (Local Area Network) designed to integrate the many and varied facilities of a university medical center radiology department (Department of Radiation Sciences) into an efficient unified resource providing state-of-the-art diagnostic capabilities and delivering precision radiotherapy. RADPLANET links diagnostic work stations, radiation-therapy planning work stations, and therapy machine stations into an integrated whole. The RADPLANET project exploits technology currently evolving in the PACS (Picture Archiving and Communicating Systems) community but also addresses digital image networking requirements peculiar to radiation therapy. RADPLANET is designed as a modular, expandable, piecemeal updatable system in order to incorporate new, more cost-effective technology as it becomes available and to provide new resources to meet the needs of a growing department and an increasingly sophisticated medical profession. The paper discusses design criteria and rationale, current status of the network, and plans for continuing expansion and enhancement.

Hospital Departments

[Basic data in informatics illustrated by their application in surgery].

As an introduction to a study day devoted to informatic in surgery, some basis knowledges are summarized: architecture and function of computers, programmation language, data bases. They are illustrated by various applications made in the "Cliniques St Luc" te Brussel namely patient monitoring, artificial pancreas, office system and operating room management system. The future use of local area network is proposed in order to achieve medical department independence and the needed cooperation between all users of medical and hospital informatic.

Belgium

Digital image management: networking, display, and archiving.

The requirements for implementing a radiology imaging network are similar to those for local area networks now being designed for other purposes to manage large data films. A radiology department serving a 500-bed hospital generates about 927 megabytes of digitally formatted data per working day. These data are expected to be on line for the patient's hospitalization period. The retrieval rate of these data among the interactive diagnosis display stations requires data throughput rates of between 2 and 5 megabits per second. This throughput rate requires signaling rates of between 20 and 50 megabits per second. Analog hard-copy generation of the images on the network is required by the referring physician for selected images that support the consultation report. Digital laser recorders using paper may be quite satisfactory. Long-term archiving must be low in cost and requires a database scheme capable of managing more than a terabyte of image data. Radiology networks must be required to bridge with other hospital information systems.

Computers

Integrated information-processing system in clinical orthodontics: an approach with use of a computer network system.

A computer network system has been developed in the Orthodontic Clinic, Osaka University Dental Hospital, to improve treatment efficiency and patient service. The system consists of a 32-bit host computer, its peripheral units, and personal computers connected to the host computer by data-transmission circuits, making up a local area network (LAN). It is possible in this system to integrate various types of data, such as the patient's basic information, treatment records, image data, and diagnostic analysis results to construct a relational database. It has been shown that the computer system developed in the orthodontic clinic has various clinical advantages.

Databases, Factual

The MAClinical Workstation Project at Georgetown University.

The intent of the MAClinical Workstation Project is to develop computer workstations for medical students of the sort they will use in future medical practice. The idea is to instill information query habits in the daily clinical activities of these young physicians-in-training. The Georgetown University Medical Center Library spearheads the project in conjunction with the School of Medicine. The library handles technical support, including software development, user training, equipment maintenance, and network installations. The project began in 1988 with nine Macintosh computers; today thirty machines are distributed throughout the Georgetown University Hospital conference rooms, faculty and resident offices, and at four affliated hospitals. The Macintosh computers are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The MAClinical workstations serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics by using a variety of software systems installed at the stations: the H&P Writer, a history and physical system written in the C programming language, can be used by students to prepare the admission record on patients they examine; also, students can keep patient records, check findings against a diagnostic system, look up drugs and treatment protocols, develop medical sketches, and find additional information when needed in the medical literature.

Computer Systems

Radiology systems of the nineties: meeting the challenge of change.

Digital imaging technology, particularly reconstructed images such as computed tomography and magnetic resonance imaging, has fueled the increased demand for radiologic services but has intensified storage and communications problems. Today more than 25% of radiologic examinations are digital in origin and, with progressive replacing of film images by digital images likely through the introduction of imaging plate technology, the radiology profession is undertaking the massive effort of evolving a new system where digital images will be transmitted, stored, retrieved and displayed by a multicomponent system connected by a local area network. Through this system, images will be nearly instantly accessible to anyone who needs them. A leading hypothesis is that when the volume of digital examinations reaches 50% of the whole, cost and efficiency considerations will lead to a massive conversion to the digital image management system, which will progress spontaneously. This conversion, unless planned for in today's equipment acquisitions, could lead to great economic stress in hospitals. The 50% point may be reached by the early 1990s.

Database Management Systems

Optical mark reader technology and data base development in anesthesiology and critical care medicine at the Johns Hopkins Medical Institutions.

The Department of Anesthesiology and Critical Care Medicine (DACCM) has substantially upgraded its computer resources within the past two years by installing a local area network (LAN) and replacing low-end PC's with PC's utilizing Intel 80286 or 80386 microprocessor technology. Data base development has now become a priority. Data bases are being developed for both clinical and administrative purposes. We are replacing the traditional method of "keypunching" with optical card scanners which results in faster and more accurate data entry directly into the data bases. Previously, such card scanners have been confined to large organizations. We describe a method of data capture and data base development with wide applicability in medicine.

Anesthesiology

Effective staff communications in a large I.C.U.

A byproduct of the Quality Assurance process is the continual review of individual and group practice. The aim is to eliminate errors and to improve care. For managers and directors to know what issues are currently important to the staff members an upward channel of communication is also needed. In our SICU with over 120 staff there was no documentation of communication in either direction. Casual survey did not reveal a major problem - but the need to document the dissemination of information, particularly new policies - especially to satisfy accrediting agencies - led us to develop MEMOS, an electronic mail system for staff members within the local area network (LAN) in the SICU. The system will run on an individual PC. The network is used because of the physical configuration of the intensive care units. The system is used by nurse managers to keep staff members up to date. Features include: Easy file maintenance. Individual password access. A defined group of system operators with access to all system functions Limited access to all other users. As many as 40 definable sub-groups for the purposes of mail distribution. Easy operator tallying of those delinquent in reading their mail. Hard copy with distribution list for all memos added to system. Browse feature to allow re-reading of old memos. Feedback channel regularly read by system operators. This system has improved the level of staff awareness in the SICU and helped build morale.

Computer Systems

PADS (Patient Archiving and Documentation System): a computerized patient record with educational aspects.

Rapid acquisition and analysis of information in an Intensive Care Unit (ICU) setting is essential, even more so the documentation of the decision making process which has vital consequences for the lives of ICU patients. We describe an Ethernet based local area network (LAN) with clinical workstations (Macintosh fx, ci). Our Patient Archiving and Documentation System (PADS) represents a computerized patient record presently used in a university hospitals' ICU. Taking full advantage of the Macintosh based graphical user interface (GUI) our system enables nurses and doctors to perform the following tasks: admission, medical history taking, physical examination, generation of problem lists and follow up notes, access to laboratory data and reports, semiautomatic generation of a discharge summary including full word processor capabilities. Furthermore, the system offers rapid, consistent and complete automatic encoding of diagnoses following the International Classification of Disease (ICD; WHO, [1]). For educational purposes the user can also view disease entities or complications related to the diagnoses she/he encoded. The system has links to other educational programs such as cardiac auscultation. A MEDLINE literature search through a CD-ROM based system can be performed without exiting the system; also, CD-ROM based medical textbooks can be accessed as well. Commercially available Macintosh programs can be integrated in the system without existing the main program thus enabling users to customize their working environment. Additional options include automatic background monitoring of users learning behavior, analyses and graphical display of numerous epidemiological and health care related problems. Furthermore, we are in the process of integrating sound and digital video in our system. This system represents one in a line of modular departmental models which will eventually be integrated to form a decentralized Hospital Information System (HIS).

Computer User Training

Simulation of patient flow in a picture archival and communications system network.

As hospital radiology departments expand their use of digitally formatted imaging devices, these machines will be connected in local area networks called Picture Archival and Communications Systems (PACS). The purpose of this paper is to demonstrate the use of computer simulation to analyze the process of patients using a PACS. The flexibility of using simulation on a proposed PACS is shown, starting with the description of a basic model. Different machine networks are run and the results compared. Simulation modeling provides a valuable tool to hospital and department administrators in detecting possible problem areas which may occur with proposed PACS configurations under assumed patient loads.

Computer Communication Networks

Network system: the integrated picture archiving and communication system with the hospital information system.

We describe the outline of Hokkaido University picture archiving and communication system (HU-PACS) and its network functions. HU-PACS processes 0.5 Gbytes of images daily through 10 acquisition devices. Functional integration of hospital information system (HIS) and PACS has been implemented. The HU-PACS can access common data base with HIS. Multi-image data-base systems provide fast throughput of image retrieval. The system is composed of 4 modules: (1) 2 image data-base systems (IDS), (2) 1 image management system (IMS), (3) image display terminals (IDT), and (4) 8 image acquisition nodes interfaced to 10 modalities and 1 film scanner. These 4 modules are connected by branch and loop type local area networks (LAN). HU-PACS has functions other than basic PACS functions. Images in optical disk library (ODL) are loaded onto magnetic disks (MD) in advance according to patient booking information, the images expected to be viewed are transferred to the local storage automatically, and the desired images can be pre-downloaded into local storage by instruction through HIS terminals.

Computer Communication Networks

[Computer networks in clinical practice--a histology data bank system].

In hospital and in private practice huge amounts of data have to be managed. Conventional storage and documentation techniques are being replaced more and more by the use of computers. Local area networks based on the interconnection of stand-alone PC workstations offer several advantages over non-communicating systems. The use of computer networks solves many communication problems and in this way improves the flow of information. The interconnection may be achieved by step-by-step integration of preexisting elements. This paper presents a database system for archiving routine histology data and illustrates the use of a computer network in a dermatology department.

Computer Communication Networks