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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 Symp 1996;:618-22.

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.

 

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 multiple EMRS.

 

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 1996;:628-32.

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 1996;:623-7.

.. 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 May-Jun;3(3):191-207.

... 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 reviewed.

 

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 Oct;43(1-2):123-7.

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 appropriate clinic...

 

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 Care 1995;:551-5.

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 Symp 1996;:643-7.

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 savings.

 

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 Jun;34(3):289-96.

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 network clients.

 

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.