Evolution of a legacy system to a Web patient record server: leveraging investment while opening the system.
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A layered system is under development to enhance our legacy system as a backend in a WEB-enabled system. Each layer of the system has defined functionality, leverages the investment in the layer below, and follows the strategy of reducing support requirements for workstations. The mainframe system provides administrative integration of sub-systems, security, and the central data repository for most information. The second layer is a graphical user interface (GUI) to the system for Windows platforms. Support needs are limited by relying chiefly on X-terminals and application servers. The "Intranet" layer is a WEB Server building upon the second layer gateways to provide platform-independent access to selected information and images. The fourth layer, under evaluation, will extend access to the central data repository for Internet users of web browsers that support private-key/public-key encryption. (+info)
Picture archiving and communication system-asynchronous transfer mode network in a midsized hospital.
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This article describes the pathway to full implementation of a hospital information system-picture archiving and communication system-wide area network (HIS-PACS-WAN) in a 300-bed acute care hospital, and the linking of that system to two other off-site medical centers. The PACS included direct digital capture of computed tomography (CT), magnetic resonance (MR) imaging, nuclear medicine, and ultrasonography images into an Olicon archive. Plain radiographs and fluoroscopy images were digitized manually and archived into an Olicon system. The active archive included current images on each Olicon workstation and the juke box. Long-term archiving of the images on removable optical discs, which would be loaded manually by an operator every time a request for one of these studies appeared on the operator's monitor, also was implemented. Ability to store, retrieve, and display simultaneously the physician's report of each procedure along with the images was an ultimate goal. The WAN is to be used for teleradiology and teleconferencing among the three medical centers involved in this study as well as other off-site locations. Phase I included the design and installation of the local area network (LAN) in the Department of Radiology at Olive View-UCLA Medical Center. This included the clinics and the inpatient and hospital-wide fiber-optic network and its linkage to the local telephone company. Phase II involved linkage of the Olicon workstations to imaging equipment. This implementation has been delayed significantly because of inadequate needs assessment, absence of planning for forward-compatibility to imaging equipment, and incompatibilities in DICOM conformance among vendors. Every PACS project must include an in-depth needs analysis, which should be updated yearly because of rapid turnover of technology. Although this analysis should have a heavy emphasis on clinical needs, it must incorporate the hospital-wide needs for an integrated information systems network. Integration of PACS, HIS, RIS, and a dictation/transcription system is a complex task that requires a full-time, clinically oriented project officer for successful completion. (+info)
CD-based image archival and management on a hybrid radiology intranet.
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This article describes the design and implementation of a low-cost image archival and management solution on a radiology network consisting of UNIX, IBM personal computer-compatible (IBM, Purchase, NY) and Macintosh (Apple Computer, Cupertino, CA) workstations. The picture archiving and communications system (PACS) is modular, scaleable and conforms to the Digital Imaging and Communications in Medicine (DICOM) 3.0 standard for image transfer, storage and retrieval. Image data is made available on soft-copy reporting workstations by a work-flow management scheme and on desktop computers through a World Wide Web (WWW) interface. Data archival is based on recordable compact disc (CD) technology and is automated. The project has allowed the radiology department to eliminate the use of film in magnetic resonance (MR) imaging, computed tomography (CT) and ultrasonography. (+info)
Use of relational database management system by clinicians to create automated MICU progress note from existent data sources.
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We designed and built an application called MD Assist that compiles data from several hospital databases to create reports used for daily house officer rounding in the medical intensive care unit (MICU). After rounding, the report becomes the objective portion of the daily "SOAP" MICU progress note. All data used in the automated note was available in digital format residing in an institution wide Sybase data repository which had been built to fulfill data needs of the parent enterprise. From initial design of target output through actual creation and implementation in the MICU, MD Assist was created by physicians with only consultative help from information systems (IS). This project demonstrated a method for rapidly developing time saving, clinically useful applications using a comprehensive clinical data repository. (+info)
Clinical communication among health providers and systems using Web tools.
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Three needs have driven the development of a Web front end to our legacy system. 1) A Web Intranet is needed to provide service for the quantity and diversity of platforms within our health care system. 2) Information transfer in our system is required in more than one format: in viewer-friendly, HTML format and in a database-friendly, down-loadable format. 3) The system encounters the need to electronically exchange information with providers that are not employees of our health care enterprise. This presents a problem with the authentication aspect of security for which we have devised a system to allow the carefully-monitored exchange of records with care providers who are "strangers" to our system. (+info)
The PartnerWeb Project: a component-based approach to enterprise-wide information integration and dissemination.
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A component-based health information resource, delivered on an intranet and the Internet, utilizing World Wide Web (WWW) technology, has been built to meet the needs of a large integrated delivery network (IDN). Called PartnerWeb, this resource is intended to provide a variety of health care and reference information to both practitioners and consumers/patients. The initial target audience has been providers. Content management for the numerous departments, divisions, and other organizational entities within the IDN is accomplished by a distributed authoring and editing environment. Structured entry using a set of form tools into databases facilitates consistency of information presentation, while empowering designated authors and editors in the various entities to be responsible for their own materials, but not requiring them to be technically skilled. Each form tool manages an encapsulated component. The output of each component can be a dynamically generated display on WWW platforms, or an appropriate interface to other presentation environments. The PartnerWeb project lays the foundation for both an internal and external communication infrastructure for the enterprise that can facilitate information dissemination. (+info)
A UMLS-based method for integrating information databases into an Intranet.
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The Internet and the World Wide Web provide today end-users with capabilities to access universally to information in various and heterogeneous databases. The biomedical domain benefits from this new technology, specially for information retrieval by searching and browsing various sites. Nevertheless, end-users may be disoriented by specific ways to access information on different servers. In the framework of an Intranet design and development, we present a method for integrating information databases based on knowledge sources of the UMLS. The method provides designers of a Web site with facilities to implement an easy and homogeneous access to information. The pages are built dynamically and displayed according to a style sheet and their content stored in a database during the design phase. The database also describes the links between pages. Moreover, this organization provides administrators with powerful capabilities to manage Web sites. (+info)
Lightweight, mobile E-mail for intra-clinic communication.
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We have developed a mobile messaging system designed for use in the clinic setting. The system is designed to facilitate quick, informal, interactions that occur in a clinical setting, e.g., requests for assistance or information. The system includes safeguards to make sure that the sender of a message is aware if a message is not read in a timely fashion. Evaluation of the system shows message delivery was about 50% slower than our target of 30 seconds. Although the mobile device used is fairly small when combined with a radio unit, it is too bulky and users did not necessarily carry the system with them. This led to delays (over eleven minutes on average) before messages were seen. We expect that improvements in hardware and clinical software will lead to more common use of such adjunct software systems. (+info)