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PalmCIS: a wireless handheld application for satisfying clinician information needs.

Wireless handheld technology provides new ways to deliver and present information. As with any technology, its unique features must be taken into consideration and its applications designed accordingly. In the clinical setting, availability of needed information can be crucial during the decision-making process. Preliminary studies performed at New York Presbyterian Hospital (NYPH) determined that there are inadequate access to information and ineffective communication among clinicians (potential proximal causes of medical errors). In response to these findings, the authors have been developing extensions to their Web-based clinical information system including PalmCIS, an application that provides access to needed patient information via a wireless personal digital assistant (PDA). The focus was on achieving end-to-end security and developing a highly usable system. This report discusses the motivation behind PalmCIS, design and development of the system, and future directions.

Computer Communication Networks↗

WebCIS: large scale deployment of a Web-based clinical information system.

WebCIS is a Web-based clinical information system. It sits atop the existing Columbia University clinical information system architecture, which includes a clinical repository, the Medical Entities Dictionary, an HL7 interface engine, and an Arden Syntax based clinical event monitor. WebCIS security features include authentication with secure tokens, authorization maintained in an LDAP server, SSL encryption, permanent audit logs, and application time outs. WebCIS is currently used by 810 physicians at the Columbia-Presbyterian center of New York Presbyterian Healthcare to review and enter data into the electronic medical record. Current deployment challenges include maintaining adequate database performance despite complex queries, replacing large numbers of computers that cannot run modern Web browsers, and training users that have never logged onto the Web. Although the raised expectations and higher goals have increased deployment costs, the end result is a far more functional, far more available system.

Clinical Medicine↗

Using an intranet for physician desk top data consolidation.

Kaleida Health developed one of the first web-based information delivery systems specific to patient care. Through an Intranet or secure dial-up connection, registered practitioners and staff access patient demographics, laboratory data, radiology results, and dictated reports. Additionally, standard forms, patient educational material, and other management information are available. The development team designed and wrote interfaces to existing systems and applications, designed security systems, instituted usage policies and procedures, and developed a name and logo. Since the program's launch in February of 1997, more than 800 users have been registered both in-house and off-site.

Computer Communication Networks↗

Physician PDA use and the HIPAA Privacy Rule.

Physicians need better access to information when making patient care decisions. Hospitals should allow electronic data transfers to physician PDAs to improve patient care, and physicians must institute measures to secure the confidentiality of patient information on their PDAs. By explicitly excluding copies from their designated record set, hospitals need not maintain copies or track access of information on personally owned PDAs.

Computer Security↗

Virtual management of radiology examinations in the virtual radiology environment using common object request broker architecture services.

In the Department of Defense (DoD), US Army Medical Command is now embarking on an extremely exciting new project--creating a virtual radiology environment (VRE) for the management of radiology examinations. The business of radiology in the military is therefore being reengineered on several fronts by the VRE Project. In the VRE Project, a set of intelligent agent algorithms determine where examinations are to routed for reading bases on a knowledge base of the entire VRE. The set of algorithms, called the Meta-Manager, is hierarchical and uses object-based communications between medical treatment facilities (MTFs) and medical centers that have digital imaging network picture archiving and communications systems (DIN-PACS) networks. The communications is based on use of common object request broker architecture (CORBA) objects and services to send patient demographics and examination images from DIN-PACS networks in the MTFs to the DIN-PACS networks at the medical centers for diagnosis. The Meta-Manager is also responsible for updating the diagnosis at the originating MTF. CORBA services are used to perform secure message communications between DIN-PACS nodes in the VRE network. The Meta-Manager has a fail-safe architecture that allows the master Meta-Manager function to float to regional Meta-Manager sites in case of server failure. A prototype of the CORBA-based Meta-Manager is being developed by the University of Arizona's Computer Engineering Research Laboratory using the unified modeling language (UML) as a design tool. The prototype will implement the main functions described in the Meta-Manager design specification. The results of this project are expected to reengineer the process of radiology in the military and have extensions to commercial radiology environments.

Algorithms↗

Overview on security standards for Healthcare information systems.

The intense need for Healthcare information exchange has revealed a lack of interoperability of systems and applications. Security controls, usually based on proprietary methods and techniques, aggravate the current situation. However, timely development of HIS security standards may improve the interoperability and enable the integration of systems. This chapter provides an overview of the standardisation work that is being done by official standardisation organisations in Europe and world-wide.

Computer Security↗

Electronic clinical trial protocol distribution via the World-Wide Web: a prototype for reducing costs and errors, improving accrual, and saving trees.

Clinical trials today typically are inefficient, paper-based operations. Poor community physician awareness of available trials and difficult referral mechanisms also contribute to poor accrual. The Physicians Research Network (PRN) web was developed for more efficient trial protocol distribution and eligibility inquiries. The Medical University of South Carolina's Hollings Cancer Center trials program and two community oncology practices served as a testbed. In 581 man-hours over 18 months, 147 protocols were loaded into PRN. The trials program eliminated all protocol hardcopies except the masters, reduced photocopier use 59%, and saved 1.0 full-time equivalents (FTE), but 1.0 FTE was needed to manage PRN. There were no known security breaches, downtime, or content-related problems. Therefore, PRN is a paperless, user-preferred, reliable, secure method for distributing protocols and reducing distribution errors and delays because only a single copy of each protocol is maintained. Furthermore, PRN is being extended to serve other aspects of trial operations.

Clinical Trials as Topic↗