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IMR: Academic Articles
This collection of published articles on Web
based medical record systems was taken from a MEDLARS search of the past few
years. It is not a comprehensive review, but it does give one the
flavor of academic work up to about mid-1996. A few of these
articles are linked to web sites, press the
icon to view those sites. I have edited abstracts for brevity.
(See also Web References)
- Brannigan VM, Beier BR. Patient privacy in the era of
medical computer networks: a new paradigm for a new
technology. Medinfo 1995;8 Pt 1:640-3.
- ... the newest information technologies provide the
possibility of fundamentally changing the way information
is stored in the health care system and, by
"Depersonalizing the data", allow restoration
of a reasonable level of personal privacy, without
interfering with the legitimate needs for medical data.
The system would require a secure "identifier
control facility" and act as a network "file
access table" able to reconstruct widely distributed
bits of the patients record. A disaggregated
"virtual record" would replace the integrated
patient file, and the risks to data privacy inherent in
the use of names or permanent identification numbers
would be eliminated.
- Chute CG, Crowson DL, Buntrock JD. Medical information
retrieval and WWW browsers at Mayo. Proc Annu Symp Comput
Appl Med Care 1995;:903-7.
- Medical information retrieval from "Master
Sheet" entries specially indexed for research
retrieval has been part of the Mayo culture since 1909.
Providing easy to use and universally available WWW
access to these and other patient information databases
at Mayo via browsers, shines a bright light on issues of
privacy and confidentiality, user authentication, need to
know, data transmission security, and technical details
of interfacing disparate databases on a spectrum of
platforms to many types of workstations using a variety
of browsers. We review our recent experience, and
generalize pertinent issues.
- Cimino JJ, Socratous SA. Just tell me what you want!: the
promise and perils of rapid prototyping with the World
Wide Web. Proc AMIA Annu Fall Symp 1996;:719-23.
- Construction of applications using the World Wide Web
architecture and Hypertext Markup Language (HTML)
documents is relatively simple. We are exploring this
approach with an application, called PolyMed ... Our
experience confirms some advantages (ease of development
and customization, ability to exploit non-Web system
components, and simplified user interface design) and
disadvantages (lack of database management services).
Some predicted disadvantages failed to materialize
(difficulty modeling a clinical application with
hypertext and inconveniences associated with the
"connectionless" nature of the Web)...
- Flanagan JR, Chun J, Wagner JR. Evolution of a legacy
system to a Web patient record server: leveraging
investment while opening the system. Proc AMIA Annu Fall
- 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
- Gage JS. Using Java to design an automated patient record
for the Web. MD Comput 1997 Jan-Feb;14(1):36-8, 40.
- Hinds A, Greenspun P, Kohane IS. WHAM!: a forms
constructor for medical record access via the World Wide
Web. Proc Annu Symp Comput Appl Med Care 1995;:116-20.
- ... We describe WHAM!, a program that allows rapid
generation of customized interfaces to WWW-EMRS that
therefore deliver the customized functions across
- Kittredge RL, Estey G, Pappas JJ, Barnett GO.
Implementing a Web-based clinical information system
using EMR middle layer services. Proc AMIA Annu Fall Symp
- The Clinical Summary is a Web-based application for
accessing the clinical database at the Massachusetts
General Hospital. The application has been developed to
give physicians in our health care community access to
clinical information for patients they refer to our
hospital. "Middle layer" services, written
previously for the hospital's clinical workstation,
supply much of the application's functionality...
- Klimczak JC, Witten DM 2nd, Ruiz M, Mitchell JA, Brilhart
JG, Frankenberger ML. Providing location-independent
access to patient clinical narratives using Web browsers
and a tiered server approach. Proc AMIA Annu Fall Symp
- .. We have developed a mechanism to provide
location-independent access to clinical narrative reports
using a multi-tiered server model and World Wide Web
technologies for delivery... Using a "thin
client", such as a web browser, in our design
facilitates deployment and support while reducing cost
per user. This architecture allows the application to be
updated without modification to the end-user software and
eases maintenance over long distances.
- Kohane IS. Exploring the functions of World Wide
Web-based electronic medical record systems [see
comments] MD Comput 1996 Jul-Aug;13(4):339-46.
- The recent increase in publications regarding
implementations of World Wide Web-based electronic
medical record systems makes it necessary to compare
different systems and to understand how they support
particular needs. This paper develops a framework and a
coarse metric by which these Web-based systems can be
classified and eventually compared.
- Kohane IS, Greenspun P, Fackler J, Cimino C, Szolovits P.
Building national electronic medical record systems via
the World Wide Web. J Am Med Inform Assoc 1996
- ... The authors have implemented an initial prototype of
W3-EMRS that accesses the database of the Boston
Children's Hospital Clinician's Workstation.
- Kohane IS, van Wingerde FJ, Fackler JC,
Cimino C, Kilbridge P, Murphy S, Chueh H, Rind D, Safran
C, Barnett O, Szolovits P. Sharing electronic medical
records across multiple heterogeneous and competing
institutions. Proc AMIA Annu Fall Symp 1996;:608-12.
- Most early reports of implemented World-Wide Web (W3)
medical record systems describe single institution
architectures. We describe W3-EMRS, a multi-institutional
architecture, and its implementation. Thorny problems in
data sharing underlined by the W3-EMRS project are
- Konstan JA, Herbst SA, Ellis AI. Web-based delivery and
open-architecture database support in the ITreS Counselor
Information System. Proc AMIA Annu Fall Symp 1996;:782-6.
- ITreS is a prototype information system for substance
abuse counselors and clinicians. ITreS integrates client
records, on-line screening and assessment instruments,
and knowledge bases into a single integrated system. This
paper discusses two aspects of the development of ITres:
the use of the World Wide Web as a development and
delivery environment and the use of an attributed
translation-based data model to integrate data from
various sources into a single client record.
- Masys DR. Moving ahead on webbed feet [editorial;
comment] J Am Med Inform Assoc 1995 Sep-Oct;2(5):332-3.
- Neame R. Privacy and security issues in a wide area
health communications network. Int J Biomed Comput 1996
- In 1993 the first national health information service
went live in New Zealand, using commercial network
services for all communications. This system provides a
point of connection for all health personnel, and for
those with a legitimate interest in health care
information (e.g. insurers): it also provides access to a
number of information resources managed on behalf of the
government of New Zealand (e.g. index of health care
users), as well as to those developed by individual
network service providers...
- Pollard D, Kucharz E, Hammond WE. Implications of the
Java language on computer-based patient records. Proc
AMIA Annu Fall Symp 1996;:733-7.
- ... In this paper we examine the Java language and its
implications to the CBPR. A quantitative and qualitative
assessment was performed. The Java environment is
compared to HTML and Telnet CBPR environments.
Qualitative comparisons include level of interactivity,
server load, client load, ease of use, and application
capabilities. Quantitative comparisons include data
transfer time delays.
- Rappaport SH. Supporting the "clinic without
walls" with an event-directed messaging system
integrated into an electronic medical record. Proc AMIA
Annu Fall Symp 1996;:648-52.
- ...we have created an event-directed messaging system
integrated into our larger Ambulatory Care Information
System (ACIS). ACIS has been operational since 1992 and
currently supports an average of 350 patient visits per
day. The new messaging system permits a provider to send
a message to the next provider who will be caring for a
patient. The messages can be sent to any provider
offering care in the future, or they can be directed to
future visits with a particular clinical service. In
contrast to traditional electronic mail systems, messages
are not directed to specific providers or groups of
provider. Messages are instead directed to a specific
clinical event, namely a patient's visit to an
- Sittig DF, Kuperman GJ, Teich JM. WWW-based interfaces to
clinical information systems: The state of the art. Proc
AMIA Annu Fall Symp 1996;:694-8.
- A review of nine interfaces. See the list at Electronic
Medical Record System Demonstrations on the Web.
- Tachinardi U, Furuie SS, Bertozzo N, Moura L, Gutierrez
MA, Melo CP. Hypermedia patient data retrieval and
presentation through WWW. Proc Annu Symp Comput Appl Med
- WWW can be a helpful tool for PACS and HIS data retrieval
and presentation. The use of gateways to access both text
and hypermedia databases (images and video) enables
fetched data to be presented in virtually any computer
system. WWW browsers provide a very friendly interface
and require little training to operate. This paper
presents a prototype that uses a SQL gateway for
accessing relational patient databases. The dataset used
here include text data from reports of diagnostic
procedures as well as pointers to the corresponding
images. Images can be displayed by the browsers' viewers.
- van Wingerde FJ, Schindler J, Kilbridge
P, Szolovits P, Safran C, Rind D, Murphy S, Barnett GO,
Kohane IS. Using HL7 and the World Wide Web for unifying
patient data from remote databases. Proc AMIA Annu Fall
- W3-EMRS is an architecture designed to access clinical
data from remote heterogeneous electronic medical record
system (EMRS) databases. We describe the technologies
used in an experimental implementation of W3-EMRS that
concurrently collects data from several sources and
presents them in an integrated set of views. After
describing some of the organizational constraints, the
architectural decision, implementation methodology, and
operation of the completed project are discussed.
- Willard KE, Johnson JR, Connelly
DP. Radical improvements in the display of clinical
microbiology results: a Web-based clinical information
system. Am J Med 1996;101:541-9.
- Improved display of legacy information through web
technologies produced substantial improvements in the
quality of care while generating significant cost
- Willard KE, Sielaff BH, Connelly DP.
Integrating legacy laboratory information systems into a
client-server world: the University of Minnesota Clinical
Workstation (CWS) project. Methods Inf Med 1995
- The development of an innovative clinical
decision-support project such as the University of
Minnesota's Clinical Workstation initiative mandates the
use of modern client-server network architectures.
Preexisting conventional laboratory information systems
(LIS) cannot be quickly replaced with client-server
equivalents because of the cost and relative
unavailability of such systems. Thus, embedding
strategies that effectively integrate legacy information
systems are needed. Our strategy led to the adoption of a
multi-layered connection architecture that provides a
data feed from our existing LIS to a new network-based
relational database management system. By careful design,
we maximize the use of open standards in our layered
connection structure to provide data, requisition, or
event messaging in several formats. Each layer is
optimized to provide needed services to existing hospital
clients and is well positioned to support future hospital
- Zuckerman AE. Using the Java language to develop computer
based patient records for use on the Internet. Proc AMIA
Annu Fall Symp 1996;:772-6.
- The development of the Java Programming Language by Sun
Microsystems has provided a new tool for the development
of Internet based applications. Our preliminary work has
shown how Java can be used to program an Internet based
CBPR. Java is well suited to the needs of patient records
and can interface with clinical data repositories written
in MUMPS or SQL.
Last revised: 01 Feb 2002. © 1997, 1998
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