Leveraging internet-98 technology for computer healthcare networks: to its limits and its limitations

To what extent can current Internet technology be leveraged to fulfill the vision of the electronic patient record (EPR) as a multimedia object and the healthcare information system as a secure distributed computing network? We explore provision of reliable, secure, intuitive, and inexpensive medical Intranets through simple scripting and configuration – avoiding the need for large programming teams. By prototyping the EPR as a secure newsgroup we demonstrate the feasibility of a basic workflow system that: preserves a signed-paper style visibility of patient data at all times; enriches presentation with multimedia online image exam viewing and user controlled animation; whilst protecting confidential patient data via encrypted data transmission, digital signatures, and authenticated user-access control. In the process several limitation of this technology are uncovered

A Web-Based Institutional DICOM Distribution System with the Integration of the Clinical Trial Processor (CTP)

To develop and test a fast and easy rule-based web-environment with optional de-identification of imaging data to facilitate data distribution within a hospital environment. A web interface was built using Hypertext Preprocessor (PHP), an open source scripting language for web development, and Java with SQL Server to handle the database. The system allows for the selection of patient data and for de-identifying these when necessary. Using the services provided by the RSNA Clinical Trial Processor (CTP), the selected images were pushed to the appropriate services using a protocol based on the module created for the associated task. Five pipelines, each performing a different task, were set up in the server. In a 75 month period, more than 2,000,000 images are transferred and de-identified in a proper manner while 20,000,000 images are moved from one node to another without de-identification. While maintaining a high level of security and stability, the proposed system is easy to setup, it integrate well with our clinical and research practice and it provides a fast and accurate vendor-neutral process of transferring, de-identifying, and storing DICOM images. Its ability to run different deidentification processes in parallel pipelines is a major advantage in both clinical and research setting

A Web-Based Flexible Communication System in Radiology

A web-based system for rapid multidirectional communication has been created in the Radiology department at San Francisco General Hospital. The system allows messaging among radiology attendings, residents, and technologists, as well as other members of the hospital community, such as Emergency Department physicians and nurses. Instead of being tied to a particular workflow, this system provides a flexible communication infrastructure which can be easily adapted for different functions and user roles. The system has so far been configured to successfully support the standard “wet reading” workflow, to support marking and tracking of critical results, as well as multiple educational and quality improvement workflows. In the 19 months of operation, the system has gained over 1,800 users (virtually all providers at our institution), it has been accessed by radiologists over 39,000 times and by non-radiologists over 34,000 times. It has become an integral part of the radiology department operations and non-radiology clinical workflows. Unlike most existing softwares, our system is not a task-specific application, but a multipurpose communication system. It is able to effectively accommodate multiple workflows and user roles through configuration (without additional programming). This flexibility has helped this system to be rapidly and widely adopted within our enterprise. The extended reach of the system enables improved monitoring and documentation of workflows, helping with management decision making, and quality assurance. We report a successful radiology communication system based on the principles of flexibility and inclusiveness of users inside and outside the radiology department

A web-based collaboration approach for teaching in medicine

Teaching medicine requires developing a vast range of manual, intellectual, visual and tactile skills as well as taking into account large amounts of factual information. Traditional medical teaching and individual learning in particular, can be complemented with electronic web based systems. One of the main impacts of e-Teaching in education resides in the fact that it provides opportunities to create resources that turn the learning process flexible. This implies a different relation between teachers and students and even between institutions, in the sense that the students participate on their own formation and the vertical hierarchy tends to become increasingly more horizontal. Awareness of the knowledge constructing process is increased, and consequently more satisfaction gained from learning. In this paper we describe a webbased collaboration approach for teaching that is being developed to simulate conversational dialogue in the area of Medicine, that enables the integration of highly heterogeneous sources of information into a coherent knowledge base accessed from web-based interfaces, either from the tutor’s point of view or the development of the discipline in itself, i.e. the system’s content is created automatically by the physicians as their daily work goes on

Reviewing the integration of patient data: how systems are evolving in practice to meet patient needs

<p>Abstract</p> <p>Background</p> <p>The integration of Information Systems (IS) is essential to support shared care and to provide consistent care to individuals – patient-centred care. This paper identifies, appraises and summarises studies examining different approaches to integrate patient data from heterogeneous IS.</p> <p>Methods</p> <p>The literature was systematically reviewed between 1995–2005 to identify articles mentioning patient records, computers and data integration or sharing.</p> <p>Results</p> <p>Of 3124 articles, 84 were included describing 56 distinct projects. Most of the projects were on a regional scale. Integration was most commonly accomplished by messaging with pre-defined templates and middleware solutions. HL7 was the most widely used messaging standard. Direct database access and web services were the most common communication methods. The user interface for most systems was a Web browser. Regarding the type of medical data shared, 77% of projects integrated diagnosis and problems, 67% medical images and 65% lab results. More recently significantly more IS are extending to primary care and integrating referral letters.</p> <p>Conclusion</p> <p>It is clear that Information Systems are evolving to meet people's needs by implementing regional networks, allowing patient access and integration of ever more items of patient data. Many distinct technological solutions coexist to integrate patient data, using differing standards and data architectures which may difficult further interoperability.</p

Health data management in the medical arena

In this paper it is presented an Agency for Integration, Archive and Diffusion of Medical Information (AIDA), which configures a data warehouse, developed using Multi-Agent technology. AIDA is like a symbiont, with a close association with core applications present at any health care facility, such as the Picture Archive Communication System, the Radiological Information System or the Electronic Medical Record Information System. Multi-Agent Systems also configure a new methodology for problem solving

PACS for the Developing World

Digital imaging is now firmly ensconced in the developed world. Its widespread adoption has enabled instant access to images, remote viewing, remote consultation, and the end of lost or misplaced film. Unfortunately, the current paradigm of Picture Archiving and Communication System (PACS), with advanced technology inseparable from high complexity, high purchase costs, and high maintenance costs, is not suited for the low-income developing world. Like the simple, easy to repair, 1950’s American cars still running on the streets of Havana, the developing world requires a PACS (DW-PACS) that can perform basic functions and survive in a limited-resource environment. The purpose of this article is to more fully describe this concept and to present a blueprint for PACS tailored to the needs and resources of the developing world. This framework should assist both users looking for a vendor-supplied or open-source solutions and developers seeking to address the needs of this emerging market

The LubMedNet services for data storage and télédistribution

This paper is reports several Radiological and Oncological Information Systems integrated by a very efficient medical network system. The system covers the entire image flowpath in the Diagnostic Radiology Department (i.e. image acquisition, processing, archiving, long term storage) and allows for transmitting medical images through Municipal Area Network. The system has been working reliably since November 1999. About 22000 CT examinations have been archived using our system. Over 300 special examinations for radiotherapy planning have been sent to the Lublin Oncology Centre