The Integrated Medical Application (IMA) gives the physician access to medical services and functionality from a single graphical desktop. The desktop offers services for the local and remote access to electronic patient records of hospitals, specialist clinics, and general practitioners. The distributed patient records within a hospital or practice are logically combined by means of a meta-patient record. A meta-patient record provides information about the local multimedia patient documents. In addition to basic data such as document type, location, and creation date, the record provides information concerning the document structure (see chapter “Multimedia Documents”).The information supplied by the meta-record from each practice and hospital can be combined to form the complete, virtual patient record. The management and access to each record and each document is carried out by the Open Distributed Management System (see chapter “Realization of an Open Distributed Management System”). An object-oriented model has been used throughout. Each local implementation of the record may be different, depending on the facilities of the local environment, but each presents the same external interface to the outside. This mechanism enables the scalable integration over a wide area of all patient documents. At present, the two implemented meta-records provide information and access to all the multimedia documents of the German Heart Institute and the University Hospital Rudolf Virchow departments of cardiology and radiology.

The central components of the IMA provide functionality for the transparent access of local and remote documents obtained through selected meta-record services, the navigation in the patient record, the visualization of multimedia documents, and the processing of images. Other tools that have been integrated in the graphical desktop include advanced image processing capabilities e.g. for quantification of stenosis, communications services such as email, text processing, desktop conferencing, and access to external information sources such as the Internet World-Wide Web.

The IMA is presently being used locally in the campus of the German Heart Institute and the Rudolf Virchow Hospital in Berlin and in a field trial providing the remote access to documents for 9 practitioners and 5 external hospitals.