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Global information infrastructure.

The High Performance Computing and Communications Program (HPCC) is a multiagency federal initiative under the leadership of the White House Office of Science and Technology Policy, established by the High Performance Computing Act of 1991. It has been assigned a critical role in supporting the international collaboration essential to science and to health care. Goals of the HPCC are to extend USA leadership in high performance computing and networking technologies; to improve technology transfer for economic competitiveness, education, and national security; and to provide a key part of the foundation for the National Information Infrastructure. The first component of the National Institutes of Health to participate in the HPCC, the National Library of Medicine (NLM), recently issued a solicitation for proposals to address a range of issues, from privacy to 'testbed' networks, 'virtual reality,' and more. These efforts will build upon the NLM's extensive outreach program and other initiatives, including the Unified Medical Language System (UMLS), MEDLARS, and Grateful Med. New Internet search tools are emerging, such as Gopher and 'Knowbots'. Medicine will succeed in developing future intelligent agents to assist in utilizing computer networks. Our ability to serve patients is so often restricted by lack of information and knowledge at the time and place of medical decision-making. The new technologies, properly employed, will also greatly enhance our ability to serve the patient.

Computer Communication Networks

Health care professional workstations: where are we now? ... where should we be tomorrow?

This article looks back over four years during which major changes have occurred in healthcare informatics, both technically and from a policy perspective. A remarkable portion of what medical-informatics professionals were proposing in 1989 has subsequently come to pass. Thus, one lesson from reflections on the recent past is that now is the time for us to devise realistic expectations of what we will see happen in the next four years. Possible scenarios for the future are outlined, as are suggestions for how the informatics community might best prepare for what lies ahead.

Computer Communication Networks

In front of us.

The care of patients is an information-intensive activity in which a large number of decisions must be made. Through the support of more rapid, less expensive, and better decisions, workstations can contribute positively to the science, the art, and the economics of health-care. They have greatest potential value when they have access to a large amount of information relevant to the decisions which must be made jointly by patients and their care providers. Technological and psychological barriers to the acceptance of workstations are becoming increasingly surmountable. Workstations may increase patients' satisfaction with the care they are provided, reduce the total cost of care, and reduce the cost of clinical information to third parties, by economically enabling comprehensive, up-to-date, and accurate medical records from which information can be rapidly and cheaply extracted and made accessible to all who need to use it.

Computer Communication Networks

Workstations as enabling technologies for computer-based patient records.

Advances in computer-based technologies and cultural changes occurring in the workplace are changing the way we work and share information. Networked, distributed computing environments offer the promise of improving the quality of patient care and containing costs. Understanding and overcoming the cognitive and behavioral barriers of machine-man interactions will help us to fulfill that promise.

Computer Communication Networks

Development towards multimedia medical workstations.

In this paper, concepts and examples of medical workstations with multimedia and hypermedia capabilities will be presented. These workstations have special hardware and software requirements. Also described in the article are the developments in Europe (AIM project line) within this area.

Computer Communication Networks

An example of usability measurement in clinical software procedures.

As a consequence of the dramatic improvements achieved in information technology standards in terms of single hardware and software components, efforts in the evaluation processes have been focused on the assessment of critical human factors, such as work-flow organisation, man-machine interaction and, in general, quality of use, or usability. This trend is particularly valid when applied to medical informatics, since the human component is the basis of the information processing system in health care context. With the aim to establish an action-research project on the evaluation and assessment of clinical software procedures which constitute an integrated Hospital Information System, the authors adopted this strategy and considered the measurement of perceived usability as one of the main goals of the project itself: the paper reports the results of this experience.

Attitude of Health Personnel

[Information technology and medical record routines in hospitals in the health care region 2].

Structure, standard and efficient methods in paper medical records are important for a successful implementation of computerised medical records. We have conducted a survey among 26 somatic hospitals in a Norwegian region regarding present routines and use of information technology in patients records. The hospitals use six different patient administration systems, six laboratory, six radiology, and approximately 20 different specialist systems. 16 hospitals use three different electronic journal/documentation systems. Ten hospitals use the Word word processor for patient records. The full potential of word processing is not utilised. Digital dictation is seldom used; few hospitals have 24-hours service for documentation, and information technology is not used for documentation in nursing care. Four hospitals use microfilm. The survey shows that improvement is needed in order to achieve coordinated and effective use of information technology and manual routines in hospital medical records.

Hospital Communication Systems

Creating the integrated information infrastructure for the 21st century at the University of Washington Warren G. Magnuson Health Sciences Center.

Successful integrated information systems implementation requires an effective marriage of technology and information resources in response to critical institutional needs. The University of Washington technical infrastructure, developed over the past five years, includes ubiquitous, high-speed network access throughout the Health Sciences Center and hospitals, agreement on network standards and protocols, uniform interface to common databases (character-based and GUI) and network availability of a variety of databases and information resources at no charge to the individual. As a result of this heavy institutional investment in technical infrastructure, our implementation process will focus on expanding the number of available resources as well as developing and refining tools and services to enhance the utility of electronic information resources. Above all we will study and develop strategies for dealing with the myriad of information policy issues which confront and confound us all today.

Academic Medical Centers

Integrating PACS power.

While the technology side of PACS is strong, it's the way you implement your PACS--and especially the way you integrate your PACS with your hospital and radiology information system--that makes all the difference.

Hospital Information Systems

Health care professional workstation: software system construction using DSSA scenario-based engineering process.

This paper describes a new method for the evolutionary determination of user requirements and system specifications called scenario-based engineering process (SEP). Health care professional workstations are critical components of large scale health care system architectures. We suggest that domain-specific software architectures (DSSAs) be used to specify standard interfaces and protocols for reusable software components throughout those architectures, including workstations. We encourage the use of engineering principles and abstraction mechanisms. Engineering principles are flexible guidelines, adaptable to particular situations. Abstraction mechanisms are simplifications for management of complexity. We recommend object-oriented design principles, graphical structural specifications, and formal components' behavioral specifications. We give an ambulatory care scenario and associated models to demonstrate SEP. The scenario uses health care terminology and gives patients' and health care providers' system views. Our goal is to have a threefold benefit. (i) Scenario view abstractions provide consistent interdisciplinary communications. (ii) Hierarchical object-oriented structures provide useful abstractions for reuse, understandability, and long term evolution. (iii) SEP and health care DSSA integration into computer aided software engineering (CASE) environments. These environments should support rapid construction and certification of individualized systems, from reuse libraries.

Computer Systems