[Logical integration of a work site into the unit concept].
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Hypermedia and hypertext are the focus of intense interest in multiple disciplines in medicine, particularly pathology. This communication provides explanation of theories and applications that serve as motivation for the expansion of use of these technologies. The Dartmouth Interactive Medical Record (IMR) project is discussed.
To make operative two medical computerized programs, one dedicated to the cardiological clinical record (PAC) and the other to permanent cardiac stimulation (PGP), we codified about 4000 terms concerning the general medical field and particularly the cardiological area. The importance of standardization of the medico-cardiological language is emphasized, specially in relation to the systematization of the information, necessary to work with computerized systems.
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The PACS-project of Graz was started two years ago in cooperation with Siemens Erlangen. The system environment consists of three CT-devices (DR2, DR3, DRH) connected to an Ethernet-based LAN (CTnet), which is linked to a second Ethernet via a MicroVAX II. This computer works as a gateway, as an image-converter and as an archive. All CT-images of one device (DRH) are transmitted to the PACS system. The images are organized in patient-oriented folders. The physician is able to make reports about those examinations for which he is responsible. The availability of tools for secondary image processing during the reporting session (windowing, zooming, displaying statistic information, etc.) and further image-functions should make the PACS system more convenient for the physician than film-based images. After reporting, all scans which are relevant for the diagnosis (according to the physician's opinion) are selected, automatically reorganized in folders and transmitted to the archive. This needs about one to two minutes per examination. Some internal data-structures and further future aspects concerning the improvement of reliability and user acceptance are mentioned.
A so-called bottom-up approach of a Picture Archiving and Communication System (PACS) is initiated by existing clinical questions. It is investigated how far existing Data-Acquisition (DA) modalities combined with the existing computer infrastructure of the hospital can provide soil to a, at first local, PACS system. Examples of current research projects in Digital Subtraction Angiography (DSA), Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) demonstrate how image and raw data processing evolve from applications based on a general matrix manipulation software package to projects within the field of PACS. Starting from the existing facilities a stepwise increase of connections and expansions of required features is going to be brought about by separately considering the picture system, the communication system and the archive system. A three step phasing is proposed: (1) Software linking; (2) Hardware linking: small scale; and (3) Hardware linking: local area network. Examples are given from the first phase, i.e. the development and expansion of software on existing DA-modalities or processing hardware to receive the data on floppy disk, hard disk or tape. Data are converted and transported for further processing: (a) within the department; (b) between hospital departments; and (c) between research centres. With regard to the picture system special attention has to be given to the requirements for digitizing analogue film images and the reading of images from monitor screens instead of films on lightboxes.
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As part of the Unified Medical Language System (UMLS) project, we have been exploring the use of semantic net representation to build a medical ontology that can adapt to the needs and perspective of differing kinds of users with varying purposes. A principal objective is to facilitate indexing and retrieval of objects in a variety of target databases, using their own source vocabularies, while maintaining the representation of concepts to which these source vocabularies refer in a single consistent form, so that retrievals that span resource types can be accommodated. In addition, a particular area of deficiency of the existing UMLS Metathesaurus is that of clinical findings, a part of the problem being the multiple alternative views and granularity levels at which clinical findings are described in different target databases. The problem is particularly obvious when one examines the way in which image findings are described, which may be at a purely perceptual level, or at varying levels of aggregation into higher level observations or interpretations. We have developed a recursive model for representing observations and interpretations in a semantic net along a continuum of degree of aggregation, that appears to lend itself well to adaptation to varying perspectives.
The costly application of informatics in practical medicine should be associated with unequivocal clear motivation. Three important problems are presented whose solution is possible only by computer use: integration of health information on each citizen in the country with recording of this information in a modern carried which is possessed by each patient, wide availability of modern medical computerized medical documentation for research and statistical analysis, and computer-assisted rational economics of health care services.
Computers, like the X-ray and stethoscope can be seen as clinical tools, that provide physicians with improved expertise in solving patient management problems. As tools they enable us to extend our clinical information base, and they also provide facilities that improve the delivery of the health care we provide. Automation (computerisation) in the health domain will cause the computer to become a more integral part of health care management and delivery before the start of the next century. To understand how the computer assists those who deliver and manage health care, it is important to be aware of its functional capabilities and how we can use them in medical practice. The rapid technological advances in computers over the last two decades has had both beneficial and counterproductive effects on the implementation of effective computer applications in the delivery of health care. For example, in the 1990s the computer hobbyist is able to make an investment of less than $10,000 on computer hardware that will match or exceed the technological capacities of machines of the 1960s. These rapid technological advances, which have produced a quantum leap in our ability to store and process information, have tended to make us overlook the need for effective computer programmes which will meet the needs of patient care. As the 1990s begin, those delivering health care (eg, physicians, nurses, pharmacists, administrators ...) need to become more involved in directing the effective implementation of computer applications that will provide the tools for improved information management, knowledge processing, and ultimately better patient care.
The Organization Engine is an early example of Virtual Data Integration--providing the appearance of integration at the desktop without modifying existing infrastructure. Starting with the Organization Engine, eight programming days were needed to provide uniform desktop access to a CODASYL-compliant hospital information system and to a MUMPS-based radiology information system (the technique is equally effective for relational and other data bases). The resulting tool provides a seamless integration of these two systems, image storage, pre-recorded audio, and document storage. In addition to providing uniform access, the tool allows healthcare providers to organize the data to suit their individual needs. The ease of this integration lies in two simple techniques: the transformation of data from all sources into a single, homogeneous representation, and the use of simple customization files to describe new object types and formats. The approach is sufficiently general to allow the integration of applications which present external interfaces of radically different forms. Two such forms are discussed here: data map publication and transactions.
An interdisciplinary field, namely the differential diagnosis of balance disorders and vertigo, is used to describe how a medical expert system can be developed using modern computer analysis, medical expertise, and human pattern recognition techniques. The advantages, results, and unresolved issues of close cooperation between biomedical engineers and physicians are described. The aim of this cooperation was to ensure that complicated data were presented in simple graphic form and that large amounts of diagnostic data were optimally linked together for the generation of a recommended diagnosis. Similar techniques may usefully be employed in other areas of medicine.