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The goal of PACS in Nagoya University Hospital.

In Nagoya University Hospital, a Radiology Intelligent Information System (RIIS) is under construction which will be linked with the Hospital Intelligent Information System (HIIS). RIIS is composed of the radiation oncology information system and the diagnostic radiology information system which is named Imaging Diagnosis Intelligent Information System (IDIIS). IDIIS consists of three parts: (a) the Imaging Diagnosis Management System (IDMS); (b) the Picture Archiving and Communication System (PACS); (c) the Report Generation Support System for Imaging Diagnosis (RGSS-ID). Artificial intelligence methodology is applied to RGSS-ID and IDMS which includes the ordering and scheduling system of diagnostic imaging. IDIIS has an important role to improve the quality of patient care and medical education as well as image management and is an essential component for the implementation of HIIS.

Computer Systems

The Physician Data Query (PDQ) cancer information system.

PDQ is an online database that provides information about the prognosis and treatment of all major types of cancer. It represents a major effort by the NCI to communicate advances in cancer treatment using computer technology, and serves as a major component of the Institute's program to reduce cancer mortality nationwide. PDQ utilizes a modern large-scale computer to provide processing speed, a general purpose database management system to provide retrieval and display functions, and commercial telecommunication networks to provide online access to up-to-date information on cancer treatment. A series of user-friendly menus allow searching, browsing, and displaying without having to learn a specialized search language. PDQ is accessible through the National Library of Medicine's computer system via a computer terminal or personal computer and is available to the medical community at over 2000 medical libraries and centers and through individual access codes. PDQ is also available as an online database under a special license agreement with NCI through two medical information systems produced by commercial database vendors: BRS/Saunders' COLLEAGUE and Mead Data Central's MEDIS.

Drugs, Investigational

The physician data query (PDQ) cancer information system.

PDQ is an online database that provides information about the prognosis and treatment of all major types of cancer. It represents a major effort by the NCI to communicate advances in cancer treatment using computer technology, and serves as a major component of the Institute's program to reduce cancer mortality nationwide. PDQ utilizes a modern large-scale computer to provide processing speed, a general purpose database management system to provide retrieval and display functions, and commercial telecommunication networks to provide online access to up-to-date information on cancer treatment. A series of user-friendly menus allow searching, browsing, and displaying without having to learn a specialized search language. PDQ is accessible through the National Library of Medicine's computer system via a computer terminal or personal computer and is available to the medical community at over 6,000 medical libraries and centers and through individual access codes. PDQ is also available as an online database under a special license agreement with NCI through two medical information systems produced by commercial database vendors: BRS/Saunders' COLLEAGUE Mead Data Central's MEDIS, and Telmed, a Swiss database.

Clinical Trials as Topic

Database management in family medicine.

A computerized database will serve a practice well if physicians and staff make their expectations and needs explicit, establish clear database specifications, and use those specifications as the basis for selecting appropriate data management software and computer hardware. Any computerized database management system introduced into a practice should be thoroughly documented, and the process of implementing the system should be planned in advance. Finally, because a practice's information-related needs, expectations, and capabilities change over time, database usage should be reviewed and refined regularly.

Family Practice

Intelligent management of epidemiologic data.

In the lifecycle of epidemiologic data three steps can be identified: production, interpretation and exploitation for decision. Computerized support can be precious, if not indispensable, at any of the three levels, therefore several epidemiologic data management systems were developed. In this paper we focus on intelligent management of epidemiologic data, where intelligence is needed in order to analyze trends or to compare observed with reference value and possibly detect abnormalities. After having outlined the problems involved in such a task, we show the features of ADAMS, a system realized to manage aggregated data and implemented in a personal computer environment.

Artificial Intelligence

A clinical information system for foster care in Israel.

It is a source of great concern in Israel that children placed out of home may lose permanence and may drift in the child welfare system. One way to avoid this danger is to improve the monitoring of the children by using modern information technology as a practice aid. A clinical information system is being installed that responds to the information needs of practitioners on all levels of the foster care system. The viability of the system and its possible effects on practice and on clinical judgment are examined.

Child

Automated therapeutic drug monitoring in an ambulatory care endocrine clinic.

OBJECTIVE: To develop and implement an automated therapeutic drug monitoring system for accessing data from endocrine clinic patients who had been prescribed insulin, oral hypoglycemic agents (OHA), or levothyroxine. DATA SOURCES: We designed a computer system to retrieve clinical data from the Medical Information System (MIS), a centralized hospital computer system, and import this information directly into a Macintosh personal computer. Physician entry of prescriptions for insulin, OHA, or levothyroxine into MIS formed the basis for a computer program to retrieve daily diagnostic and prescription information, demographics, and laboratory analyses, including blood glucose and glycosylated hemoglobin for insulin and OHA orders and free and total thyroxine, total triiodothyronine, and thyroid stimulating hormone for levothyroxine orders. The information was imported into a database program (4th Dimension). RESULTS: The system identifies laboratory values outside of predetermined therapeutic ranges, maintains an up-to-date patient profile, and edits and generates reports. Preliminary experience suggests that automation eliminates 75-90 percent of the time required to manually collect the same information, and improves the accuracy, comprehensiveness, and utility of reports. CONCLUSIONS: Automated therapeutic drug monitoring minimizes the time required to collect clinical data, alerts clinicians to potential problems, and provides a means to assess overall therapeutic management. Our methodology can be used to evaluate other medications in a variety of general or specialty clinics.

Ambulatory Care

Computer systems for dental practice management. A new generation of independent dental software.

A new generation of computer programs for dental patient management eliminates total dependence on the vendor for programming support. The software design enables information collected with the dental system to be transferred to popular off-the-shelf programs designed for business. A simplified example is used to illustrate for practitioners the advantages of this type of data structure management. Programs designed on this basis offer optimum performance and expandibility for both present and future needs.

Computer Systems

Establishment of a large collection of extracted teeth for research.

A collection of over 14,000 teeth extracted at the Prince Philip Dental Hospital since 1982 has been organized and catalogued on a computerized database management system. The computer catalogue provides, for each tooth in the collection, information on the age and sex of the patient, and the date of extraction and condition of the tooth. The catalogue can be searched according to any combination of the descriptive variables in the database record. Researchers, including visiting scientists, can borrow teeth from the central "tooth library" on a temporary or permanent basis. Further information on particular teeth (e.g. patient's medical and dental histories, dental radiographs) can be obtained from patients' charts. Establishment of this collection has greatly facilitated the work of researchers in clinical dentistry, dental anatomy, and dental anthropology.

Humans

New role of a medical documentation system.

Architecture of a new medical documentation system (MDS) is proposed. First, we studied the traditional MDS in terms of organizational structure, main functions, means (resources) and personnel. Special emphasis is given to the information retrieval (IR) system which is the kernel of a MDS. Then, some achievements of information technology is summarized, and concept of a mixed IR system which is the kernel of the new system is presented. New architecture is then presented. Units which compose the entire system are: host documentation centre, local documentation centres, and documentation units. Eventually, objective and features of every part are discussed.

Database Management Systems

Marburger concept for computer-aided acquisition, processing and documentation of patient data in the intensive care unit.

The authors report on their experience with the computer-aided acquisition, processing and documentation of patient data in an intensive care unit. The goal of an effective data and information collection system in the intensive care unit is to make therapy, and the patients respond to it, recognizable and understandable through the clear and complete representation of the patients conditions. The focal point of the data documentation is the medical record. In the implementation of a computer-aided data documentation and processing system the application of one central PC is unpractical. Each bed will be equipped with its own PC, and all the individual PCs will be connected to one central PC, which functions as server, and to connected to another PC in the doctors room. The data will be managed in a powerful database-management-system and be stored on an optical-disk. The development of an effective man/machine interface is especially important. In addition we can promote the user acceptance in other ways, so as to ensure a concrete benefit for each user group.

Electronic Data Processing

CD-ROM source data uploaded to the operating and storage devices of an IBM 3090 mainframe through a PC terminal.

A powerful method of processing MEDLINE and CINAHL source data uploaded to the IBM 3090 mainframe computer through an IBM/PC is described. Data are first downloaded from the CD-ROM's PC devices to floppy disks. These disks then are uploaded to the mainframe computer through an IBM/PC equipped with WordPerfect text editor and computer network connection (SONNGATE). Before downloading, keywords specifying the information to be accessed are typed at the FIND prompt of the CD-ROM station. The resulting abstracts are downloaded into a file called DOWNLOAD.DOC. The floppy disks containing the information are simply carried to an IBM/PC which has a terminal emulation (TELNET) connection to the university-wide computer network (SONNET) at the Ohio State University Academic Computing Services (OSU ACS). The WordPerfect (5.1) processes and saves the text into DOS format. Using the File Transfer Protocol (FTP, 130,000 bytes/s) of SONNET, the entire text containing the information obtained through the MEDLINE and CINAHL search is transferred to the remote mainframe computer for further processing. At this point, abstracts in the specified area are ready for immediate access and multiple retrieval by any PC having network switch or dial-in connection after the USER ID, PASSWORD and ACCOUNT NUMBER are specified by the user. The system provides the user an on-line, very powerful and quick method of searching for words specifying: diseases, agents, experimental methods, animals, authors, and journals in the research area downloaded. The user can also copy the TItles, AUthors and SOurce with optional parts of abstracts into papers under edition. This arrangement serves the special demands of a research laboratory by handling MEDLINE and CINAHL source data resulting after a search is performed with keywords specified for ongoing projects. Since the Ohio State University has a centrally founded mainframe system, the data upload, storage and mainframe operations are free.

CD-ROM

The knowledge workstation: an electronic environment for knowledge management.

This paper focuses on the creation of the IAIMS workstation in the context of the outcomes of a year-long IAIMS strategic planning process at the Johns Hopkins Medical Institutions (JHMI). These outcomes include a long-term institutional vision for a functional knowledge management environment, a JHMI IAIMS model, a strategic plan, and two model prototypes. The functional requirements and specific implementation strategies for the IAIMS workstation, the prototype for managing the knowledge base of the published biomedical literature, are discussed in detail.

Academic Medical Centers

PROPHET--a national computing resource for life science research.

PROPHET is a national computing resource tailored to meet the data management and analysis needs of life scientists working in a wide variety of disciplines, ranging from pharmacology to molecular biology. The PROPHET system offers a fully integrated graphics-oriented environment designed for the manipulation and analysis of tabular data, graphs, molecular structures, biological simulation models, and protein and nucleic acid sequences, and it includes access to molecular structure and sequence databases.

Computer Communication Networks

Heterogeneous databases integration in a hospital information systems environment: a bottom-up approach.

The paper describes the problem of heterogeneous databases, discusses the need for an integrated hospital information system and provides a five-step method for integrating heterogeneous databases in the hospital environment. The scope of this method facilitates the integration of medical, administrative and fiscal information elements of a hospital into a unified environment.

Computer Communication Networks

Evaluation of Meta-1 for a concept-based approach to the automated indexing and retrieval of bibliographic and full-text databases.

SAPHIRE is a concept-based approach to information retrieval in the biomedical domain. Indexing and retrieval are based on a concept-matching algorithm that processes free text to identify concepts and map them to their canonical form. This process requires a large vocabulary containing a breadth of medical concepts and a diversity of synonym forms, which is provided by the Meta-1 vocabulary from the Unified Medical Language System Project of the National Library of Medicine. This paper describes the use of Meta-1 in SAPHIRE and an evaluation of both entities in the context of an information retrieval study.

Abbreviations as Topic