articles+ search results

Hospitals, United States, Computers standards, Information Systems standards, and Software standards

Humans, Pedigree, Data Collection, Database Management Systems, Genetic Diseases, Inborn, and Software

This work examines some of the problems encountered in developing small and large database application systems involving human genetics data collection efforts that include data on individuals as well as family pedigree data. Rapid prototyping of a database application requires software tools to produce the application with little or no programming. Features of MEGADATS-4 that provide for rapid prototyping and for producing stand-alone applications are examined.

Database Management Systems, Medical Informatics Applications, Programming Languages, Software Design, Information Systems, and Software

AIDA consists of a set of software tools to allow for fast development and easy-to-maintain Medical Information Systems. AIDA supports all aspects of such a system both during development and operation. It contains tools to build and maintain forms for interactive data entry and on-line input validation, a database management system including a data dictionary and a set of run-time routines for database access, and routines for querying the database and output formatting. Unlike an application generator, the user of AIDA may select parts of the tools to fulfill his needs and program other subsystems not developed with AIDA. The AIDA software uses as host language the ANSI-standard programming language MUMPS, an interpreted language embedded in an integrated database and programming environment. This greatly facilitates the portability of AIDA applications. The database facilities supported by AIDA are based on a relational data model. This data model is built on top of the MUMPS database, the so-called global structure. This relational model overcomes the restrictions of the global structure regarding string length. The global structure is especially powerful for sorting purposes. Using MUMPS as a host language allows the user an easy interface between user-defined data validation checks or other user-defined code and the AIDA tools. AIDA has been designed primarily for prototyping and for the construction of Medical Information Systems in a research environment which requires a flexible approach. The prototyping facility of AIDA operates terminal independent and is even to a great extent multi-lingual. Most of these features are table-driven; this allows on-line changes in the use of terminal type and language, but also causes overhead. AIDA has a set of optimizing tools by which it is possible to build a faster, but (of course) less flexible code from these table definitions. By separating the AIDA software in a source and a run-time version, one is able to write implementation-specific code which can be selected and loaded by a special source loader, being part of the AIDA software. This feature is also accessible for maintaining software on different sites and on different installations.

Drug Information Services, Netherlands, Hospital Information Systems, Pharmacy Service, Hospital, and Software

The CENTRASYS system for the Hospital Pharmacy, developed as part of a research project of the Department of Medical Informatics is described. The role of AIDA, a fourth-generation software package, as a prototyping tool is discussed. It is concluded that AIDA facilitates prototyping and is also very suitable as a vehicle for systems in operation. It is further concluded that prototyping is of great help in the developmental phase of a project, but that great care has to be taken during evaluation of the prototypes: minimize the number of test sites and try to avoid that users become dependent on the system, because every prototype needs further tuning before it really becomes an operational system.

Evaluation Studies as Topic, Hospital Information Systems, Pharmacy Service, Hospital, Primary Health Care, Software Design, and Software

A system for hospital pharmacies (CENTRASYS) and a system for primary health care (ELIAS), both developed using prototyping and a fourth-generation tool (AIDA), are introduced. Differences in development strategies are analyzed and conclusions are drawn with respect to the use of AIDA for management, development and operation of the systems. The use of AIDA increases development speed enormously, enabling a productivity of over 40 lines per day, which is more than twice the amount that is accepted as reasonable.

Animals, Cricetinae, Netherlands, Pilot Projects, Software Design, User-Computer Interface, Information Systems, Primary Health Care, and Software

In this article the development of a computer system for General Practice, ELIAS, is described. The use of the 4th-generation software toolkit AIDA proved to be very helpful in increasing the speed of development as well as the quality of the ELIAS software. The programming support that AIDA offered, not only in increasing the rate of development but also in the flexible way in which parts of the system and the database can be adjusted (in prototyping as well as in the operational system) and its self-documenting functions, contributed to the ease of development. The consistent lay-out of the frames and uniform screen-handling, the opportunity of data validation and the availability of help information at every item in screen frames--all facilitated by AIDA--rendered ELIAS a very user-friendly system.

Decision Making, Organizational, Models, Theoretical, United States, Computer Systems, Management Information Systems organization administration, and Public Health Administration organization administration

Human services agencies are closer than ever to fulfillment of their authoritative role. A critical step is transformation of the Reporting System to a Management Information System. This creates the information structure and mind set necessary to generate new, data-based ideas. There are too many obstacles to traditional MIS development approaches in agencies, however. New strategies such as selective use of end-user technology and prototyping can provide methods that overcome these obstacles.

Blood Glucose Self-Monitoring, Diabetes Mellitus blood, Diabetes Mellitus physiopathology, Diet, Diabetic, Exercise, Humans, Insulin physiology, Microcomputers, Numerical Analysis, Computer-Assisted, Prognosis, Blood Glucose metabolism, Diabetes Mellitus drug therapy, Expert Systems, Insulin administration dosage, and Therapy, Computer-Assisted

This paper describes the principles and prototyping of a computer-based system being developed to assist in the management of diabetes mellitus. Unlike other approaches based upon mathematical modelling or the use of computer algorithms, this system adopts one derived from artificial intelligence, seeking to incorporate the dynamics of glucose and insulin in a manner which reflects their clinical importance. The resultant logical model (qualitative algebra) defines the relationships between changes in insulin dose and site and time of injection and glycaemic response. In this manner the computer-based system, implemented in Prolog, can be used to provide advice concerning insulin therapy by means of making qualitative predictions of patient outcome of blood glucose profile resulting from alternative insulin regimens.

Adult, Decision Making, Computer-Assisted, Humans, Pulmonary Gas Exchange, Signal Processing, Computer-Assisted, Carbon Dioxide blood, Expert Systems, Respiratory Insufficiency therapy, Software, and Ventilators, Mechanical

The KUSIVAR is an expert system for mechanical ventilation of adult patients suffering from respiratory insufficiency. Its main objective is to provide guidance in respirator management. The knowledge base includes both qualitative, rule-based knowledge and quantitative knowledge expressed in the form of mathematical models (expert control) which is used for prediction of arterial gas tensions and optimization purposes. The system is data driven and uses a forward chaining mechanism for rule invocation. The interaction with the user will be performed in advisory, critiquing, semi-automatic and automatic modes. The system is at present in an advanced prototype stage. Prototyping is performed using KEE (Knowledge Engineering Environment) on a Sperry Explorer workstation. For further development and clinical use the expert system will be downloaded to an advanced PC. The system is intended to support therapy with a Siemens-Elema Servoventilator 900 C.

Efficiency, Models, Theoretical, Planning Techniques, United States, and Hospital Information Systems

One way automation can increase efficiency is through rapid prototyping, particularly of user interfaces. AI and logic programming, argues this author, offer good user interface tools and a suitable prototyping environment.

Magnetic Resonance Imaging, Tomography, Emission-Computed, Tomography, X-Ray Computed, Ultrasonography, Image Processing, Computer-Assisted methods, Software, Software Design, and User-Computer Interface

A comprehensive software package, called ANALYZE, has been developed (1) which permits detailed investigation and evaluation of multidimensional biomedical images. ANALYZE can be used with 3-D imaging modalities based on x-ray computed tomography, radionuclide emission tomography, ultrasound tomography, and magnetic resonance imaging. The software is written entirely in "C" and runs on standard UNIX workstations. The ANALYZE package features integrated, complimentary tools for fully interactive display, manipulation and measurement of multidimensional image data. The software architecture permits systematic enhancements and upgrades which has fostered development of a readily expandable package. It provides an effective shell for custom software prototyping and turnkey applications. This paper provides a general description of this software as well as specific details on the methodology employed to develop it, both conceptual and technical. Applications of the software are illustrated.

Amino Acid Sequence, Chemical Phenomena, Chemistry, Protein Conformation, Information Systems, and Proteins

An object-oriented database system has been developed which is being used to store protein structure data. The database can be queried using the logic programming language Prolog or the query language Daplex. Queries retrieve information by navigating through a network of objects which represent the primary, secondary and tertiary structures of proteins. Routines written in both Prolog and Daplex can integrate complex calculations with the retrieval of data from the database, and can also be stored in the database for sharing among users. Thus object-oriented databases are better suited to prototyping applications and answering complex queries about protein structure than relational databases. This system has been used to find loops of varying length and anchor positions when modelling homologous protein structures.

The aim of this study was to evaluate and improve the menu interface design of an existing expert system. The system provided expertise concerned with evaluating human response to environments and was implemented onto a computer with a simple tree menu system. Two laboratory based experiments were carried out in which alternative menu interface designs were developed rapidly and compared with the original design. User acceptance tests which incorporated objective and subjective measures were iteratively used to evaluate and improve the interface designs. The results of these experiments indicated that, for the particular system under study, a graphic based design which displayed 58 options divided into levels on a single screen was preferred by users over the original menu interface which displayed one menu at a time with seven options per screen. The final interface remains to be tested under field conditions.

Hospital Information Systems, Microcomputers, North Carolina, Software, Computer Communication Networks, Information Systems, Medical Records Systems, Computerized, and User-Computer Interface

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these system are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development using rapid prototyping object-oriented programming tools of a Physician's Workstation which integrates information from five different applications running on three separate computer systems.

Clinical Laboratory Information Systems, Critical Care, Decision Making, Computer-Assisted, Denmark, Diagnosis, Computer-Assisted, Expert Systems, Finland, Microcomputers, Monitoring, Physiologic, Sweden, Therapy, Computer-Assisted, User-Computer Interface, and Artificial Intelligence

A Nordic research and development programme, 'KBS in Medicine' (KUSIN-MEDICINE), was run in 1986-89. Its main goal was to acquire an understanding of applying knowledge-based techniques in medicine and of the limitations of present-day artificial intelligence (AI) methodologies. The programme comprised four experimental installation sites (Tampere in Finland, Uppsala and Linköping in Sweden, and Aalborg in Denmark) each prototyping in one or more medical domains. The programme was financed by the Nordic Fund for Technological and Industrial Development, by national funds for applied research and by a number of industries. Prototype decision support systems were produced in the following domains: intensive care (Tampere, Uppsala, Linköping, Aalborg), clinical chemistry (Tampere, Uppsala) and clinical neurophysiology (Aalborg in collaboration with Turku and Uppsala). These served to transfer this technology to industry and helped to identify limitations of this technology.

Computer Graphics, Computer Simulation, Computer User Training, Fourier Analysis, General Surgery methods, Magnetic Resonance Imaging, Radiotherapy methods, Tomography, X-Ray Computed, Ultrasonography, Diagnostic Imaging, Image Interpretation, Computer-Assisted, Models, Anatomic, and Software Design

A comprehensive software system called ANALYZE has been developed which permits detailed investigation and evaluation of 3-D biomedical images. The software can be used with any 2-D or 3-D imaging modality, including x-ray computed tomography, radionuclide emission tomography, ultrasound tomography, magnetic resonance imaging and both light and electron microscopy. The package is unique in its synergistic integration of fully interactive modules for direct display, manipulation and measurement of multidimensional image data. Several original algorithms are included which improve image display efficiency and quality. One of the most versatile and powerful algorithms is interactive volume rendering, which is optimized to be fast without compromising image quality. An important advantage of this technique is to display 3-D images directly from the original data and to provide on-the-fly combinations of selected image transformations and/or volume set operations (union, intersection, difference, etc.). The inclusion of a variety of interactive editing and quantitative mensuration tools significantly extends the usefulness of the software. Any curvilinear path or region-of-interest can be manually specified and/or automatically segmented for numerical determination and statistical analyses of distances, areas, volumes, shapes, densities and textures. ANALYZE is written entirely in "C" and runs on several standard UNIX workstations. It is being used in a variety of applications by over 40 institutions around the world, and has been licensed by Mayo to several imaging companies. The software architecture permits systematic enhancements and upgrades which has fostered development of a readily expandable package. ANALYZE comprises a powerful "visualization workshop" for rapid prototyping of specific application packages, including applications to interactive surgery simulation and radiation treatment planning. ANALYZE offers the potential to accurately and reproducibly examine, from images, the structure and function of any cell, tissue, limb, organ or organ system of the body, much like a surgeon or pathologist might do in real life, but entirely non-invasively, without pain or destruction of tissue. These capabilities promise exciting new insights into the basic processes of life, and major advances in health care delivery through improved diagnosis and treatment of disease.

Brain diagnostic imaging, Humans, Skull diagnostic imaging, Software, Image Processing, Computer-Assisted methods, and Radiography

Computer applications in radiology are evolving rapidly, tied to incremental improvements in hardware, software, and methods. In computer hardware, the emergence of dramatically improved graphic and computational performance for engineering workstations enables their use for visualization. Major changes in networking, storage, and display technology play a major role in influencing applications. The use of three-dimensional digitizers to perform localization of real three-dimensional points in conjunction with images and the rendering of objects using rapid prototyping methods, such as stereolithography, were recently reported. Major software advances have taken place through the availability of applications packages that are operated with menu-driven or point-and-click user interfaces, data flow languages, or complete turnkey applications. Imaging methods including CT, MR imaging, digital radiography, biomagnetism, and optical range sensing, which take advantage of advanced computer technology, are new this year. Image processing for multimodality fusion or image registration, visualization, reconstruction, and quantification of images, have been reported at a wide variety of conferences and in key publications. New computer methods to fabricate custom orthopaedic implants, and to improve imaging technology assessment were introduced.

Computer Graphics, Programming Languages, Hospital Information Systems, Medical Records Systems, Computerized, and User-Computer Interface

The PRIST-2 system has been designed as an interactive and high-productivity tool for the rapid prototyping and development of medical applications. Three major issues were addressed in this research project which derived from the evolution of a previous 4th generation software package, called PRIST (patient record information system tool): a high transportability on different hardware and operating systems, a conversational and interactive user-interface and user-independence Relational Data Base Management System (RDBMS). Although we developed PRIST-2 on the top of the ORACLE RDBMS, it does not depend on SQL commercial products because the ORACLE features have been directly used only for SQL relational data base management. The application design methodology implemented in the system architecture allows an interactive and formal description of the application constraints in terms of the semantic data model rather than in terms of the data structure. The translation of the conceptual constraints into SQL tables is performed by several pre-defined routines. In the PC based release (MS/DOS, OS/2, Xenix operating systems), the Graphic-User Interface (GUI) has been developed using Microsoft Windows Software Development Kit. The UNIX release will use a GUI developed on top of the X-Windows environment.

Adult, Breast Neoplasms pathology, Carcinoma pathology, Computer Systems, Decision Theory, Decision Trees, Diagnosis, Computer-Assisted, Expert Systems, Female, Humans, Programming Languages, Decision Support Techniques, Medical Informatics, and Software Design

The concept of object-oriented design and programming has recently received a great deal of attention from the software engineering community. This paper highlights the realisable benefits of using the object-oriented approach in the design and development of clinical decision support systems. These systems seek to build a computational model of some problem domain and therefore tend to be exploratory in nature. Conventional procedural design techniques do not support either the process of model building or rapid prototyping. The central concepts of the object-oriented paradigm are introduced, namely encapsulation, inheritance and polymorphism, and their use illustrated in a case study, taken from the domain of breast histopathology. In particular, the dual roles of inheritance in object-oriented programming are examined, i.e., inheritance as a conceptual modelling tool and inheritance as a code reuse mechanism. It is argued that the use of the former is not entirely intuitive and may be difficult to incorporate into the design process. However, inheritance as a means of optimising code reuse offers substantial technical benefits.

Drug Prescriptions, Medical Records Systems, Computerized, Nursing, Ambulatory Care, Artificial Intelligence, and Practice Guidelines as Topic

As we understand the process of ambulatory care better, the need to effectively implement standards of practice becomes more apparent. To facilitate successful use of practice guidelines, we have integrated an artificial intelligence system of Medical Logic Modules into our computerized medical record. A rule shell allows rapid development and prototyping of rules which can be practice reminders, information gathering utilities, or standing orders. A set of utilities allows non-programmer clinicians to develop and maintain the rule set. We will demonstrate these enhancements in the context of the comprehensive patient record.

Cost-Benefit Analysis, Decision Making, Organizational, Decision Support Techniques, Models, Structural, Planning Techniques, Product Line Management economics, Professional Staff Committees economics, Professional Staff Committees organization administration, United States, Industry organization administration, and Product Line Management methods

Extended development cycles put companies at risk through loss of sales, margins, market share, and credibility as innovators. The author suggests constructing early-stage models to provide a dress rehearsal for new products and help companies develop products in less time.

Equipment Design, Signal Processing, Computer-Assisted, Software Design, User-Computer Interface, Rehabilitation instrumentation, and Software

Rapid prototyping is a quick, efficient way to evaluate new electrical instruments. A hardware interface between a computer and an instrument can be simulated in software. The authors demonstrate the technique of rapid prototyping by developing interfaces for two therapeutic strength-testing devices and an electromagnetic tracker/digitizer. The LabVIEW rapid prototyping software tool was used to create "virtual instruments," which combine to form interfaces. The functions and connections of each virtual instrument are described.

Rapid prototyping or 'virtual prototyping' of human-machine interfaces offers the possibility of putting the human operator 'in the loop' without the effort and cost associated with conventional man-in-the-loop simulation. Advocates suggest that rapid prototyping is compatible with conventional systems development techniques. It is not clear, however, exactly how rapid prototyping could be used in relation to conventional human factors engineering analyses. Therefore, an investigation of the use of the VAPS virtual prototyping system was carried out in five organizations. The results show that a variety of task analysis approaches can be used to initiate rapid prototyping. Overall, it appears that rapid prototyping facilitates an iterative approach to the development of the human-machine interface, and that is most applicable to the early stages of systems development, rather than to detailed design.

Computer Communication Networks, Computer Systems, Databases, Bibliographic, Databases, Factual, Information Storage and Retrieval, National Library of Medicine (U.S.), United States, Academic Medical Centers, Integrated Advanced Information Management Systems, and Unified Medical Language System

The paper describes a prototype information environment designed to link network-based information resources in an integrated fashion and thus enhance the information capabilities of an academic medical center. The prototype was implemented on a single Macintosh computer to permit exploration of the overall "information architecture" and to demonstrate the various desired capabilities prior to full-scale network-based implementation. At the heart of the prototype are two components: a diverse set of information resources available over an institutional computer network and an information sources map designed to assist users in finding and accessing information resources relevant to their needs. The paper describes these and other components of the prototype and presents a scenario illustrating its use. The prototype illustrates the link between the goals of two National Library of Medicine initiatives, the Integrated Academic Information Management System (IAIMS) and the Unified Medical Language System (UMLS).

Clinical Protocols, Semantics, Database Management Systems organization administration, Hospital Information Systems organization administration, Software Design, and User-Computer Interface

A 4th generation tool, called PRIST-2, is presented that has been designed as an interactive environment for the rapid prototyping of clinical applications in a large-scale Hospital Information System project. We adopted an SQL-based commercial Relational Data Base Management Systems (RDBMS) to guarantee portability on different hardware and operating systems. Relational databases, however, are characterized by a simple data structure and do not incorporate the application semantics required to ensure a high degree of data independence. To reach this goal, we propose an extension to the relational model, adding some of the main characteristics of the Object Oriented Data Base Management Systems (OODBMS) approach, such as "types" and "encapsulation".

Computer Literacy, Humans, Mid-Atlantic Region, Organizational Culture, Organizational Innovation, User-Computer Interface, Ambulatory Care Information Systems statistics numerical data, Attitude to Computers, Managed Care Programs, and Physicians psychology

Kaiser Permanente Mid-Atlantic States has developed a fully integrated outpatient information system which currently runs on an IBM ES9000 on a VM platform written in MUMPS. The applications include Lab, Radiology, Transcription, Appointments. Pharmacy, Encounter tracking, Hospitalizations, Referrals, Phone Advice, Pap tracking, Problem list, Immunization tracking, and Patient demographics. They are department specific and require input and output from a dumb terminal. We have developed a physician's work station to access this information using PC compatible computers running Microsoft Windows and a custom Microsoft Visual Basic 2.0 environment which draws from these 14 applications giving the physician a comprehensive view of all electronic medical records. Through rapid prototyping, voluntary participation, formal training and gradual implementation we have created an enthusiastic response. 95% of our physician PC users access the system each month. The use ranges from 0.2 to 3.0 screens of data viewed per patient visit. This response continues to drive the process toward still greater user acceptance and further practice enhancement.

Computer Systems, Humans, Physicians, Hospital Information Systems statistics numerical data, Medical Records Systems, Computerized statistics numerical data, and Software Design

The M.D. Rounds Report program was developed and implemented in June of 1992 as an adjunct to the HELP System at Rex Hospital. The program facilitates rapid access to information on allergies and current medications, laboratory results, radiology reports and therapist notes for a list of patients without physicians having to make additional menu or submenu selections. In planning for an upgrade of the program, utilization statistics and user feedback provided valuable information in terms of frequency of access, features used and unused, and the value of the program as a reporting tool in comparison to other online results reporting applications. A brief description of the functionality of the M.D. Rounds Report, evaluation of the program audit trail and user feedback, planned enhancements to the program, and a discussion of the prototyping and monitoring experience and the impact on future physician subsystem development will be presented.

Humans, Medical Records Systems, Computerized, Microcomputers, Ambulatory Care Information Systems, Family Practice, and User-Computer Interface

ISAAC (Integrated System Architecture for Advanced Primary Care) is a project aiming at developing information technology and telematic support in the specific field of General Practice--and more broadly in the Primary Health Care sector--within the health care systems of different European Countries. The project aims at improving the work of the General Practitioners through the development of a useful and usable medical workstation for day-to-day patient care. Moreover ISAAC has the goal of prototyping an integration architecture for the improvement of the communications between the ISAAC workstation and heterogeneous application environments, namely other components of the health care system. This paper deals with a general description of the design along with a discussion of the adopted approach to fulfill the integration requirements.

Computer Communication Networks standards, Computer Systems standards, Data Collection standards, Forecasting, Humans, Medical Informatics Applications, Medical Records Systems, Computerized standards, Telemedicine standards, Unified Medical Language System, Medical Informatics standards, Multimedia standards, and Radiology Information Systems standards

This paper is attempting given a summery of the major building blocks and driving forces in the developments of medical informatics and medical imaging in special. The role of multi-media and broadband communication will be described. The paper should give an indication where the author sees medical imaging in the world of informatics, focusing from R&D to product developments, with emphases on standards and prototyping. The author will also define the molecule and atoms of medical informatics and medical imaging. The architecture of the CEN TC 251/4 draft standard will be described in relation to the general objectives of CEN TC 251.

Blood Glucose metabolism, Diabetes Mellitus, Type 1 blood, Evaluation Studies as Topic, Expert Systems, Humans, Microcomputers, Models, Theoretical, Sensitivity and Specificity, Software, Diabetes Mellitus, Type 1 drug therapy, Insulin administration dosage, Software Validation, and Therapy, Computer-Assisted

This paper describes the principles and prototyping of a computer system to assist in the treatment of patients with insulin-dependent (type 1) diabetes mellitus. The system adopts a mixed approach involving rule-based qualitative algebra and a dynamic mathematical model to define the relationships between insulin dosage, diet and glycaemic response. The rule-based system (KBS), implemented in PROLOG, can be used to generate qualitative therapeutic advice. These suggestions are quantified and rank-ordered by the use of a mathematical model of glucose-insulin interaction in type 1 diabetes mellitus, with parameters adjusted for individual patients. In this paper an overview of the integrated prototype, linking the KBS and model, is provided and a case study used to demonstrate the principles of the system in operation. The results of verification and validation work performed on the KBS are described.

Humans, Skull anatomy histology, Skull diagnostic imaging, Tomography, X-Ray Computed, and Image Processing, Computer-Assisted methods

This paper describes current research into the creation of solid models which replicate anatomical structures using rapid prototyping techniques. Stereolithography is particularly efficient in the production of highly-complex structures. This technique was applied to the fabrication of a plastic model of a human skull. A geometric definition of the object was obtained by transferring the three-dimensional medical image volume (x-ray CT) and processing the data on a computer graphics workstation. A 3-D biomedical visualisation software package (ANALYZETM) was used to perform segmentation of structures. A 3-D triangular-mesh representation of the selected structure was calculated and converted to a format suitable for processing and construction using stereolithography (SLA). Improvements in the quality of the anatomical model produced will result from improved data processing techniques. Future work is proposed to investigate the influence of imaging parameters and data processing techniques on the resultant plastic models.

Clinical Protocols, Data Display, Database Management Systems, Databases, Factual, Humans, Medical Oncology, Software Design, Computer Graphics, Expert Systems, Neoplasms therapy, and User-Computer Interface

We describe a graphic user interface for an expert system in oncology. The main objectives of our work has been to facilitate the adaptation of the system to different clinical environments and potentiate the factors which more directly determine the acceptance of the system by its users. We present the design principles derived from the features of the clinical domain chosen and from the objectives of the system. These principles are reflected on the design of the screen and of the interaction and in the style of integration of the interface with the other components of the system. Underlying the application we describe is a graphic user interface management system which provides facilities for the fast prototyping and integration of interfaces. We describe here those features of this tool which make the practical application of the design principles we consider possible.

Nonlinear Dynamics, Algorithms, and Neural Networks, Computer

This paper describes a novel neural network architecture named ClusNet. This network is designed to study the trade-offs between the simplicity of instance-based methods and the accuracy of the more computational intensive learning methods. The features that make this network different from existing learning algorithms are outlined. A simple proof of convergence of the ClusNet algorithm is given. Experimental results showing the convergence of the algorithm on a specific problem is also presented. In this paper, ClusNet is applied to predict the temporal continuation of the Mackey-Glass chaotic time series. A comparison between the results obtained with ClusNet and other neural network algorithms is made. For example, ClusNet requires one-tenth the computing resources of the instance-based local linear method for this application while achieving comparable accuracy in this task. The sensitivity of ClusNet prediction accuracies on specific clustering algorithms is examined for an application. The simplicity and fast convergence of ClusNet makes it ideal as a rapid prototyping tool for applications where on-line learning is required.

Humans, Patient Care Team, Program Evaluation, Computer Systems, Documentation, and Hospital Information Systems

The implementation of a comprehensive bedside documentation system is a major project that demands careful analysis and planning. Since the cost of a typical bedside system can easily exceed $3 million, a design oversight could have disastrous effects on the benefits of the system.

Computer Graphics and Clinical Laboratory Information Systems

The computing strategy in our laboratories evolved from research in Artificial Intelligence, and is based on powerful software tools running on high performance desktop computers with a graphical user interface. This allows most tasks to be regarded as design problems rather than implementation projects, and both rapid prototyping and an object-oriented approach to be employed during the in-house development and enhancement of the laboratory information systems. The practical application of this strategy is discussed, with particular reference to the system designer, the laboratory user and the laboratory customer. Routine operation covers five departments, and the systems are stable, flexible and well accepted by the users. Client-server computing, currently undergoing final trials, is seen as the key to further development, and this approach to Pathology computing has considerable potential for the future.

Chemistry, Clinical, Critical Care, Humans, and Clinical Laboratory Information Systems

Interoperability may be defined as the ability of knowledge-based systems to function together in a symbiotic manner. Cooperativity implies interoperability but with the added benefit that the output quality of the cooperative network exceeds the overall performance of the participating sub-systems. A number of candidate architectures to support interoperability and cooperativity between medical knowledge-based systems in laboratory medicine domains are now becoming available. Using rapid prototyping techniques, we have demonstrated the feasibility of one of these approaches by carrying out pilot implementations in two unrelated laboratory medicine domains (an internal consistency checking system for validating patients' results in the laboratory and a system for generating alarms and alerts in high dependency units based on laboratory data). The results of this study are discussed in the context of the available techniques so as to provide a basis for further development of cooperative systems in laboratory medicine.

Computer Systems, Software, and Systems Integration

Computer scientists working in medical informatics have to face the problem that software offered by industry is more and more adopted for clinical use by medical professionals. A new challenge arises of how to combine commercial solutions with typical medical software that already exists for some years and proved to be reliable with these off-the-shelf solutions [1]. With the HERMES project, this new challenge was accepted and possible solutions to integrate existing legacy systems with state-of-the-art commercial solutions have been investigated. After a period of prototyping to assess possible alternative solutions, a system based on an indirect client-server model was implemented with help of the industry. In this paper, its architecture is described together with the most important features currently covered. Based on the HERMES architecture, both systems for clinical data analysis and patient care (cardiology) are currently developed.

Ambulatory Care Information Systems, Computer Communication Networks, and Computer Systems

PWS is a physician's workstation research prototype developed to explore the use of information management tools by physicians in the context of patient care. The original prototype was implemented in a client/server architecture using a broadcast message server. As we expanded the scope of the prototyping activities, we identified the limitations of the broadcast message server in the areas of scalability, security, and interoperability. To address these issues, we reimplemented PWS using the Open Software Foundation's Distributed Computing Environment (DCE). We describe the rationale for using DCE, the migration process, and the benefits achieved. Future work and recommendations are discussed.

Animals, Databases, Factual, Genome, Humans, Chromosome Mapping, and Database Management Systems

We are developing a laboratory notebook system known as the Genetics Deductive Database. Currently our prototype provides storage for biological facts and rules with flexible access via an interactive graphical display. We have introduced a formal basis for the representation and reasoning necessary to order genome map data and handle the uncertainty inherent in biological data. We aim to support laboratory activities by introducing an experiment planner into our prototype. The Genetics Deductive Database is built using new database technology which provides an object-oriented conceptual model, a declarative rule language, and a procedural update language. This combination of features allows the implementation of consistency maintenance, automated reasoning, and data verification.

Cockayne Syndrome pathology, Humans, Facial Expression, Image Processing, Computer-Assisted methods, Photography methods, and Physiognomy

As long ago as 1878 attempts have been made to define photographically the typical facial characteristics of persons exhibiting particular appearances or afflictions. State-of-the-art numerical computing techniques facilitate definition of highly accurate facial composites. Such images are devoid of ghosting caused by nonalignment of facial features. Composites can help to define the prototypical visual appearance of facial types and as such have applications in visual cognitive psychology and clinical imaging. This article describes the imaging process and discusses how clinical presentation of different diseases can be visualized using physiognomic information and how this has the potential to be developed as a diagnostic tool.

Artificial Intelligence, Computer Communication Networks, Database Management Systems, Delivery of Health Care, Humans, Information Storage and Retrieval, Software Design, User-Computer Interface, Computer Systems, Integrated Advanced Information Management Systems, and Software

The development of medical workstations for the support of patient care, the assessment of care, management support, and education is just at its beginning. During the Working Conference on the Health care Professional Workstation held in Washington DC, June 1993, several aspects of such workstations were discussed, but it was also recognized that prototyping or learning by experience could be a rich source to further promote the progress in this field. Eight such prototypes or already operational medical workstations were demonstrated and a preliminary user assessment was done to obtain a first insight in the advantages and the type of criteria of such evaluations. It was concluded that such assessments were of great value to (i) give feedback to the designers of medical workstations, (ii) indicate areas of strength and for further research, and (iii) to offer criteria to potential users of such workstations for making decisions on using such systems. The assessment criteria deal with functionality, architecture, user interfaces, communications and integration, and data and knowledge management.

Adolescent, Bone Plates, Computer Systems, Female, Humans, Lasers, Malocclusion surgery, Mandibular Neoplasms surgery, Microcomputers, Middle Aged, Osteotomy, Cephalometry instrumentation, Computer Simulation, Image Processing, Computer-Assisted instrumentation, Models, Anatomic, and Tomography, X-Ray Computed instrumentation

3-D-modelling of the skull is useful referring to improve diagnostics, for surgical planning and simulation of surgical procedure. Stereolithography is a constructive process producing a model by building it up layer by layer with plastic using an "ultraviolet" laser to catalyse the polymerization of a liquid plastic solution. This fast prototyping derives from using a new interface between a CT-Scanner and a SLA. By avoiding the tool path problems inherent in conventional computerdriven CNC milling machines we succeeded in producing closed cavities and even intraosseous course of vessels and nerves. The compact and smooth surface makes manual postprocessing unnecessary. By using a new software (interpolation +/- 0.25 mm) we could improve the accuracy. At our studies we found a maximum aberration of at least 0.25 mm.

Data Display, Database Management Systems, Software Design, and User-Computer Interface

We have looked at general descriptions and illustrations of several software development tools, such as tools for prototyping, developing DFDs, testing, and maintenance. Many others are available, and new ones are being developed. However, you have at least seen some examples of powerful CASE tools for systems development.

Humans, Skull anatomy histology, Image Processing, Computer-Assisted, Skull diagnostic imaging, and Tomography, X-Ray Computed

A study was undertaken to determine the dimensional accuracy of anatomical replicas derived from X-ray 3D computed tomography (CT) images and produced using the rapid prototyping technique of stereolithography (SLA). A dry bone skull and geometric phantom were scanned, and replicas were produced. Distance measurements were obtained to compare the original objects and the resulting replicas. Repeated measurements between anatomical landmarks were used for comparison of the original skull and replica. Results for the geometric phantom demonstrate a mean difference of +0.47 mm, representing an accuracy of 97.7-99.12%. Measurements of the skull produced a range of absolute differences (maximum +4.62 mm, minimum +0.1 mm, mean +0.85 mm). These results support the use of SLA models of human anatomical structures in such areas as pre-operative planning of complex surgical procedures. For applications where higher accuracy is required, improvements can be expected by utilizing smaller pixel resolution in the CT images. Stereolithographic models can now be confidently employed as accurate, three-dimensional replicas of complex, anatomical structures.

Computer Graphics, Computer Literacy, Hospital Records, Humans, Anesthesia, Attitude to Computers, Medical Records Systems, Computerized, and User-Computer Interface

Objective: The objective of our study was to assess the acceptability of a proposed user interface to visually interfaced computer-assisted anesthesia record (VISI-CAARE), before the application was begun. The user interface was defined as the user display and its user orientation methods.
Methods: We designed methods to measure user performance and attitude toward two different anesthesia record procedures: (1) the traditional pen and paper anesthetic record procedure of our hospital, and (2) VISI-CAARE. Performance measurements included the reaction speed (identifying the type and time of an event) and completion speed (describing the event). Performance also included accuracy of the recorded time of the event and accuracy of the description. User attitude was measured by (1) the physician's rating on a scale of 0 to 9 of the potential usefulness of computers in anesthesia care; (2) willingness to use the future application in the clinical environment; and (3) user suggestions for change. These measurements were used in a randomized trial of 21 physicians, of which data from 20 were available.
Results: After exposure to VISI-CAARE, the experimental subjects' ranking of computer usefulness in anesthesia care improved significantly (4.2 +/- 1.1 to 7.6 +/- 1.5, p = 0.0001), as did controls' (5.2 +/- 2.6 to 8 +/- 1.5, p = 0.0019). All the volunteers were willing to try the proposed prototype clinically, when it was ready. VISI-CAARE exposure was associated with faster and more accurate reaction to events over the traditional pen and paper machine, and slower and more accurate description of events in an artificial mock setting. VISI-CAARE 1.1 demonstrated significant improvements in both reaction speed and completion speed over VISI-CAARE 1.0, after changes were made to the user display and orientation methods.
Conclusion: With graphic user interface prototyping environments, one can obtain preliminary user attitude and performance data, even before application programming is begun. This may be helpful in revising initial display and orientation methods, while obtaining user interest and commitment before actual programming and clinical testing.

Data Display, Computers, Exhibitions as Topic, and Radiology

The computerized scientific exhibit (CSE) is gaining acceptance as a tool for delivering scientific information at meetings of radiologic societies. CSEs allow presentation of more material in a more space-efficient manner than do conventional exhibits, and the viewer can control the order and detail in which material is reviewed. As a disadvantage, currently, the radiologist must use a support team and learn new tools to create a CSE. The preparation and cost may also be greater. Meeting attendees must overcome a reluctance to use computers to benefit from a CSE. Creation of a CSE has design, production, and presentation phases. A team of content authors, software author, graphics acquisition person, and project manager works together through brainstorming, conceptual ordering, storyboarding, prototyping, and selection of authoring tools to design the exhibit. Production must include use of common word processing and image file formats, as well as standardization of image resolution. Accurate equipment specification is needed to ensure that the exhibit can be run on the equipment provided by the meeting organizers. In addition, some security steps are needed to prevent misuse of the exhibit. In addition to display at assemblies, the CSE can be made available to a larger audience by delivery on media such as compact disks and the Internet and can be continually modified as new material becomes available.

Decision Support Techniques, Expert Systems, Systems Integration, Artificial Intelligence, Clinical Laboratory Information Systems, Decision Making, Computer-Assisted, Programming Languages, and Reminder Systems

This article reviews the efforts of HBO & Company in the production of a first phase clinical alerting system based on the Arden Syntax. The alerting system was integrated with a clinical data repository and clinical workstation to process returning laboratory results. Investigations with expert systems resulted in a C language alerting system. GUI prototyping of an authoring environment led to a Smalltalk language authoring system. Future development is expected to broaden the system scope and address the evolution of the Arden Syntax.

Ear surgery, Humans, Prostheses and Implants, Diagnostic Imaging, Face anatomy histology, Face surgery, Skull anatomy histology, Skull surgery, and Surgery, Plastic

The acquisition, processing, and use of three-dimensional (3D) imaging provide new insights into normal and abnormal craniofacial anatomy. In this article, characteristics of CT and MRI scanning are reviewed along with the methods used to delineate tissues and produce 3D patient displays, including contouring, shaded surface, and volumetric processing. The use of 3D model fabrication for surgical planning is discussed with examples of the production of a custom CT-based auricle model and the use of rapid prototyping technology to create models for custom alloplastic implant surgery. The review concludes with some speculation about the future of 3D medical imaging as it will influence surgical training and practice over the coming decades.

Computer Security, General Surgery, Humans, Information Systems, User-Computer Interface, Computer Communication Networks, Computer Systems, Data Display, and Medical Records Systems, Computerized

We have experimented with developing a prototype Surgeon's Workstation which makes use of the World Wide Web client-server architecture. Although originally intended merely as a means for obtaining user feedback for use in designing a "real" system, the application has been adopted for use by our Department of Surgery. As they begin to use the application, they have suggested changes and we have responded. This paper illustrates some of the advantages we have found for prototyping with Web-based applications, including security aspects.