Ebook: Medical Informatics Europe'97

The MIE'97 Conference (Medical Informatics Europe) is the fourteenth conference in the area of medical informatics that commenced in 1978 in Cambridge. This conference is held for two consecutive years in Europe before migrating in the third year to a country outside Europe where it is held under the name of MEDINFO. Through the years this conference has evolved into the major international event in the medical informatics area.

The proceedings contain 192 high quality papers in the area of medical informatics that set the tone for future developments in this field of science. These papers were selected from 255 submissions based on reviews by two or more impartial reviewers. The paper selection criteria were based on 1) significance to medical informatics, healthcare and/or medicine, 2) quality of scientific and/or technical content, 3) originality and innovativeness, 4) reference to related prior work, and 5) organisation and clarity of presentation.

Since the main theme of the conference is Information Highways in Medicine, the conference contents were broken up into four major themes related to this main theme. These themes are 1) health care information systems, 2) computer based patient records, 3) images and PACS, and 4) education/technology assessment. Thus the contents of these proceedings follow these four categories, although there are papers that belong to more than one category. In these cases, the papers were placed in the category that was considered by the editors as being closest to the contents of the papers. It is believed that these papers will provide a solid basis for the further development of medical informatics in the future through the information highways.

We wish to thank all who contributed to these proceedings, namely 1) the authors, 2) the reviewers and the EFMI board for their valuable advice, 3) the Laboratory of Medical Informatics for providing the editorial and E-mail facilities, and 4) IOS Press for giving advice during the preparation process and for their flexibility in the planning and printing of this book.

Costas Pappas, Chief Editor, Greece

Nicos Maglaveras, Greece

Jean-Raoul Scherrer, Switzerland

In this paper an overview and comparison of the basic concepts and methods behind different systemintegrational implementations is given, including the DHE, which is based on the coming Healthcare Information Systems Architecture pre-standard HISA, developed by CEN TC251. This standard and the DHE (Distributed Healthcare Environment) not only provides highly relevant standards, but also provides an efficient and wellstructured platform for Healthcare IT Systems

Integrating autonomous applications is a difficult task since they usually represent similar informations in different data schemes. Any communication requires an agreement of sender and receiver on a common data representation. The number of interfaces to convert one data representation into another is minimized if all participants of an information system agree on one data representation such as Health Level Seven (HL7) or Edifact. Even more convenient is the use of a middleware solution like the Distributed Healthcare Environment (DHE) that keeps message transfer completely transparent to the integration process. This paper discusses a project that aims at the integration of a cancer registry system into a DHE based Hospital Information System (HIS).The project is a cooperation between the universities of Gießen and Magdeburg within the framework of the European Communities Telematics Research Project HC 1019 HANSA (Healthcare Advanced Networked System Architecture).The concept of a so called ‘DHE-Adapter’ to integrate existing legacy systems is explained. This adapter converts a data or message format of a legacy system into calls of the DHE programming interface. To develop a DHE-Adapter for our cancer registry system we intend to design a DHEA-dapter- Generator which would be able to produce DHE-Adapters for different systems and export formats, e.g. HL7 or Edifact. That would allow a variety of software vendors to integrate their products into the DHE without entering deeply into the DHE’s programming interface.

The development of healthcare systems in accordance to the “Shared Care” paradigm results in co-operative health information systems across the boundaries of organisational, technological, and policy domains. Increasingly, these distributed and heterogeneous systems are based on middleware approaches, such as CORBA. Regarding the sensitivity of personal and medical data, such open, distributed, and heterogeneous health information systems demand a high level of data protection and data security, both with respect to patient information and with respect to users. The security concepts and measures available and additionally needed in health information systems based on CORBA architecture are described in this paper. The proposed security solution is also open to other middleware approaches, such as DHE or HL7.

The need for collaboration and data sharing among systems dedicated to individual functional areas and user groups has initiated major efforts towards the development of an integrated hospital information system. Major issues in the development of any integrated architecture that incorporates autonomous departmental systems include the development of commonly accepted interaction mechanisms, standardisation, the structure of the computerised patient record, its extensibility, as well as limitations multimedia data impose. This paper presents work done within project IHIS, a nationally funded project for the development of an integrated hospital information system that provides ICU staff with access to both the ICU assisting laboratory information system's data as well as radiological multimedia data.

Changing requirements for health care information systems force the development of an open, modular architecture in which components can be integrated. This offers a flexible means for integrating different (heterogeneous) systems used by different users. Migration towards such an open, modular architecture is a difficult task. It consists of breaking down existing systems in components and integrating these components. Many authors on migration strategies focus attention on the ordering of the steps to be taken without detailing how these steps were arrived at. This paper presents a more rigorous approach for deriving a migration strategy.

The purpose of this program package is to provide computer-based assistance for the work performed in paramedical investigation laboratories: functional investigations, radiology, biochemical investigations, pathological anatomy, nuclear medicine, in hospitals, polyclinics, medical practices. The common characteristics regarding the management of the work done in such laboratories has made a global approach of the problem possible. The modular design of the program package has allowed its stagewise development, thus offering the possibility of integration with the medical information management in each laboratory.

The program package for paramedical investigations has a two level structure

• programs and data bases pertaining to the main program

• programs and data bases specific to each type of computerised laboratory.

An existing database on pesticides, running in the DOS/Windows environment, is operative at the National Institute of Health and has yielded useful informations for several published researches. The database is currently being restructured for the purpose of making it available on the Web. An HTML interface, allowing to formulate queries on the database from the Web is presently under development, and it will be made available, once the problems related to confidentiality of certain parts of the database are solved. The database in its present form is presented and necessary changes foreseen in the Web edition are discussed.

In this paper, a Pre-hospital Health Emergency Management System (PHEMS) is presented, which is being developed on the basis of a common reference architecture that has been defined at a European level by partners from ten EU member states in the course of the ongoing HECTOR project. The PHEMS, which is implemented as an autonomous system, will be integrated as an addedvalue service into the Regional Health Telematics Network of Crete. The PHEMS architecture is based on a ‘perception-cognition-action’ paradigm.

The World Wide Web is now the most used multimedia information system on Internet allowing, by means of Web browsers such as Netscape Navigator or Mosaic, distribution or consultation of hypermedia documents. Although the Web has appeared only recently, the growth of its use has generated the emergence of numerous information and knowledge bases in the medical field. We suggest to investigate extended functionalities in order to introduce cooperative activities in our medical information system. These new activities allow asynchronous exchange of records and synchronous cooperation for a better coordination of the work within and between hospitals.

The potential of telematics services is investigated with respect to learning needs of medical physicists and biomedical engineers. Telematics services are integrated into a system, the PRONET, which evolves around multimedia computer based courses and distance tutoring support. In addition, information database access and special interest group support are offered. System architecture is based on a component integration approach. The services are delivered in three modes: LAN, ISDN and Internet. Mammographie image processing is selected as an example content area.

Telemedicine is attracting attention as a new means of delivery health care, but research indicates a low level of useful analysis of projects This paper reviews the potential of telemedicine and suggests the use of appropriate evaluation techniques can enable that potential to be realised. The importance of quantifying benefits and introduction of wider perspectives is discussed and advocated.

The state of medical telecommunication networks in Ukraine is described. The concepts of creating and architecture of the National Direct Access Computer Network ‘UkrMedNet’ are given.

This paper describes a system enabling data collection in multicenter clinical trials via WWW and Internet. The form-based data entry is based on HTML documents with JavaScript linked to a relational database (mSQL) via a cgi program (w3-msql). The design has been applied to a multi-national study in acute abdominal pain, for which eight clinical forms have been developed. The system is now in test use and experiences with this approach are presented.

Current database management systems, client-server architecture and the internet infrastructure are simplifying the exchange of information. Large and widespread electronic medical record systems are accessible via platform-independent browsing applications. The following brief summary shows one of the manifold conceivable applications of these technologies in medicine. It describes a survey among physicians with the scope of quality assurance in medicine. The dynamic, platformindependent, world-wide access to databases offers interesting aspects in medical informatics.

Nurse scheduling is an important, but also a very complicated management task. Performing this task results in a nursing schedule. These nursing schedules strongly influence the performance of a nursing ward. This paper describes research results on the application of several knowledge acquisition techniques for the development of a decision support system. This system informs the nurse scheduler about the quality of an arranged schedule. This paper next shows how this system can be used to improve multiple schedules in combination with the application of telematics. This improvement is based on the communication between schedulers who have a shortage or a surplus of nurses at certain days of the schedule. By means of internal reallocation of nurses for a short period of time, the total schedule quality of all nursing schedules can be improved.

The objective of Citizens Advisory Systems for Health in Europe is to provide background information in preventive health care, to offer data-based and knowledge-based facilities and to reduce costs within the national and European wide health systems. In order to do so, easily accessible human-computerdialogues and systems have to or have been already developed, allowing every citizen to obtain the right information at the right place at any time with any intensity which is wished. The paper will describe the already existing standards, will explain the ideal type and the technical and social implications which have to be taken into consideration for these systems.

MERMAID is an EU financed telemedicine project with global reach and 24-hour, multilingual capability. It aspires to provide a model for the provision of health care services based on the electronic transmission of medical information, via ISDN based videoconferencing. This model will not be limited to medical diagnostics but it will encompass all cases where the actual delivery of health care services involves a patient who is not located where the provider is. Its implementation requires the commissioning of an expensive telecommunications infrastructure and the exploration of a number of solutions. In fact, all categories of telemedical applications (audio and video conferencing, multimedia communications, flat file and image transfer with low, medium and high bandwidth data requirements) will be considered while the full range of network choices (Digital land lines, Cellular/Wireless, Satellite and Broadband) will be tested in terms of cost/performance tradeoffs that are inherent to them and the developmental stage each of these options occupies in their in its life cycle. Finally, out that MERMAID utilises advanced land based line transmission technologies to aid the remote patient by making available the specialist care that is best suited in the particular case.

A networkable kardiomonitor CM-3 is described as well as the associated central monitoring device CEMON. CM-3 allows archiving as well as efficient control of all relevant measurements, alarms and trend data in the last 2 years of use of the equipment. This data is easily reviewed, printed or saved on removable media to be included in the hospital patient documentation. The network is based on standard Ethernet bus architecture and PC Ethernet adapters. This high speed medium allows efficient real time control and immediate reaction to each alarm situation. Easy integration with other parts of the hospital information system is possible. In addition, critical monitor files can be efficiently backed up and possibilities are open for hierarchical storage with high security options.

Color visual field analysis has proven highly sensitive for early visual impairments diagnosis in M. S., yet it has never attained widespread popularity usually because the procedure is difficult to standardize, the devices are costly, and the test is fatiguing. We propose a computerized procedure running on standard PC, cost effective, clonable, and easy handled.

264 colored patches subtending 1° angle of vision, with selected hues and low saturation levels are sequentially and randomly displayed on gray equiluminous background of the PC screen subtending 24°x40° angle of vision. The subject is requested to press a switch at the perception of the stimulus. The output provides colored maps with quantitative informations.

Comparison between normals and a selected population of Patients with Multiple Sclerosis and with Glaucoma without luminance visual field defects, showed high statistical difference.

RHINE is an inter-regional network in Europe having as an aim, the promotion of know-how transfer in the area of Information Technology methods and tools in the regions involved. The RHINE network's significance will be demonstrated in the health sector. Within the main scope of the project, the aims and objectives of RHINE and the participating partners encompass the extension of the nucleus network and the furtherance of Information Technology research. Application areas include distributed data base and knowledge base technologies for open regional information systems supported by other technologies for business processes.

The paper describes an integrated methodology for the development of a WWW computer system which addresses issues of the organisation, retrieval and manipulation of 3D volumetric models of pathological human organs. The library of organs is distributed on the WWW since medical expertise and needs are typically expensive resources and also because many pathological conditions are often restricted to local diffusion. Users are provided with a WWW viewer for interactive manipulation of the models of the organs. The system supports low-cost MSWindows 32 platforms and requires no specialised hardware. Early results demonstrate that the compression techniques employed provide near real-time response for retrieval/manipulation, not only over high-speed expensive network lines, but also over low/medium network connections.

Human Genome Analysis and Image Processing are part of the ‘Grand Challenges’ in High Performance Computing. The traditional mainframe has become insufficient for these applications in Biocomputing. Scalable parallel processor systems have entered the marketplace with superior price/performance. The evaluation process of such a system by an application-oriented benchmark test suite is described. Meanwhile a large system is integrated in the client/server structure of the Deutsches Krebsforschungszentrum where the traditional mainframe is completely replaced by scalable systems.