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[Cost effectiveness and patient benefit of digital image management systems for radiology].

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.

Computer Communication Networks↗

Data security issues arising from integration of wireless access into healthcare networks.

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.

Computer Communication Networks↗

The case for the HL7 standard.

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.

Computer Communication Networks↗

Molecular dynamics simulation on a network of workstations using a machine-independent parallel programming language.

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.

Algorithms↗

A high-speed network for cardiac image review.

A high-speed fiber-based network for the transmission and display of digitized full-motion cardiac images has been developed. Based on Asynchronous Transfer Mode (ATM), the network is scaleable, meaning that the same software and hardware is used for a small local area network or for a large multi-institutional network. The system can handle uncompressed digital angiographic images, considered to be at the "high-end" of the bandwidth requirements. Along with the networking, a general-purpose multi-modality review station has been implemented without specialized hardware. This station can store a full injection sequence in "loop RAM" in a 512 x 512 format, then interpolate to 1024 x 1024 while displaying at 30 frames per second. The network and review stations connect to a central file server that uses a virtual file system to make a large high-speed RAID storage disk and associated off-line storage tapes and cartridges all appear as a single large file system to the software. In addition to supporting archival storage and review, the system can also digitize live video using high-speed Direct Memory Access (DMA) from the frame grabber to present uncompressed data to the network. Fully functional prototypes have provided the proof of concept, with full deployment in the institution planned as the next stage.

Cardiology↗

A human tissue and data resource: an overview of opportunities, challenges, and development of a provider/researcher partnership model.

As we continue to strive to apply the findings of in vitro and animal studies to human disease and transition from genomics to proteomics, we will experience an ever-increasing need for human tissues. A web based system that provides access to tissues repositories and associated data will best facilitate the access to these vital resources and the application of research information to human disease treatment. There are organizational and design requirements that must be addressed in the implementation of the infrastructures that are needed to implement such a system, with special attention paid to the protection of patient anonymity. This report describes the implementation of a prototype human tissue network in the hope of encouraging implementation of similar systems among other consortia of providers and researchers.

Animals↗

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↗

[Long-term experience with a PACS subsystem].

Our experiences with a PACS-Subsystem have shown, that it would be more usefull and less expensive, first to install digital archiving systems in single areas. After a certain time of errorfree working the subsstems should be integrated into a superior information system. Fast data networks and userfriendly viewing stations are a basic requirement. Common standards of archiving, independent of the manufacturer, should be considered.

Angiography, Digital Subtraction↗

Overview of an architectural approach to the development of the Johns Hopkins Hospital distributed clinical information system.

The Johns Hopkins Hospital has initiated an ambitious program to apply modern technologies to the development of a new, comprehensive clinical information system. Since many components of a system exist and since the JHH management is decentralized, a distributed, networked system is being built. To properly accomplish this task an architectural basis for strategic systems planning was developed. This paper reviews briefly the layered architectural approach.

Computer Communication Networks↗

[Organization of social-hygienic monitoring in Zelenograd].

The paper deals with the experience of the Zelenograd Town Sanitary and Epidemiological Surveillance Center with sociohygienic monitoring. Its work on the recording and analysis of infectious and non-infectious diseases by using the present-day computers and local electronic networks is outlined. The paper shows it necessary to develop a unified approach to sociohygienic monitoring and standardization of databases in the corporative system of sanitary service.

Computer Communication Networks↗

Implementing network security guidelines in health care information systems.

A Health Care Establishment (HCE) is an establishment where medical services are rendered. These services are provided by the health care personnel. The infrastructure of a HCE may include Information Technology (IT) equipment that stores and processes HC information. The spread of distributed information technology in HCEs have necessitated the implementation of Network Security in Health Care Information System (HCISs), to assure confidentiality, integrity and availability of HC information being transmitted across HC networks. This paper presents a road map in implementing Network Security guidelines for the provision of Network Security in HCEs, work carried out within the Secure Environment for Information Systems in Medicine (SEISMED) project under the Advanced Informatics in Medicine (AIM) programme.

Computer Communication Networks↗

Information technology and the clinical curriculum: some predictions and their implications for the class of 2003.

Information technology, medical knowledge, and medical practice are on a collision course. The consequences of the impact will change the way physicians work, the way medical knowledge is processed, packaged, and distributed, and the way patients obtain medical care and information. Today's educators need to design an information technology curriculum to prepare students for this emerging world of practice. Computer labs, based on today's complex and unreliable desktop systems, are not the answer. What is needed by students who entered medical school in 1997-98 is an informatics curriculum that is based on the real-world requirements of 2003 and beyond. The authors draw upon academic studies and their own clinical and industry experiences to outline some predictable elements of what lies ahead. Their predictions--ubiquitous, simple network computing and "power tools" for managing medical knowledge--have implications for how schools cover such educational topics as patient confidentiality, systems thinking and error management, and knowledge resource evaluation.

Computer Communication Networks↗

Reverse-engineering gene-regulatory networks using evolutionary algorithms and grid computing.

OBJECTIVE: Living organisms regulate the expression of genes using complex interactions of transcription factors, messenger RNA and active protein products. Due to their complexity, gene-regulatory networks are not fully understood.However, by building computational models it is possible to gain insight into their function and operation. METHODS: Evolutionary algorithms are used to create computational models of gene-regulatory networks based on observed microarray data. These algorithms can be computationally intensive. They will be implemented within an existing grid computing infrastructure, that has been developed for data mining purposes, and which is able to deliver the required compute power. RESULTS: We discuss how models can built achieved using distributed and grid computing technology. In particular we investigate how Condor and JavaSpaces technology is suited to the requirements of our modeling approach. CONCLUSIONS: Determining network models of gene-regulatory networks using evolutionary algorithms not only requires considerable computational power, but also a modeling formalism that can explain the underlying dynamics.

Algorithms↗

A network-based training environment: a medical image processing paradigm.

The capability of interactive multimedia and Internet technologies is investigated with respect to the implementation of a distance learning environment. The system is built according to a client-server architecture, based on the Internet infrastructure, composed of server nodes conceptually modelled as WWW sites. Sites are implemented by customization of available components. The environment integrates network-delivered interactive multimedia courses, network-based tutoring, SIG support, information databases of professional interest, as well as course and tutoring management. This capability has been demonstrated by means of an implemented system, validated with digital image processing content, specifically image enhancement. Image enhancement methods are theoretically described and applied to mammograms. Emphasis is given to the interactive presentation of the effects of algorithm parameters on images. The system end-user access depends on available bandwidth, so high-speed access can be achieved via LAN or local ISDN connections. Network based training offers new means of improved access and sharing of learning resources and expertise, as promising supplements in training.

Computer Communication Networks↗

The futility of common firewall policies: an experimental demonstration.

Many healthcare organizations utilize network "firewalls" to protect their networks from being accessed by unauthorized external entities. These same firewalls are also often configured to deny access to certain external services from within the internal network. The latter policy can be subverted through a "protocol tunneling" strategy, which has been implemented as a set of programs called "Firehole." Organizations should be aware of this potential weakness in their network security designs. Policies that deny external services to users should be carefully evaluated in light of clearly defined organizational goals.

Computer Communication Networks↗

Health0: a new health and lifestyle management paradigm.

The paper describes Health0: an innovative healthcare and lifestyle management wearable system that aims to bring an individual focused approach to healthcare. A modular architecture is proposed that combines a Linux-based PDA with a distributed wireless sensor-network and innovative bandage-sized (2.5 cm2) sensor hardware. Real-world scenarios that can use the Health0 system are discussed.

Biomedical Technology↗

The health information network.

The health information network concept is certainly visionary. It has much merit but it is doomed to failure unless the proposed users of this information show much more concern for confidentiality.

Australia↗