Kazuhiko Ohe : firstname.lastname@example.org
Shigekoto Kaihara : email@example.com
Koichi B. Ishikawa : firstname.lastname@example.org
Teruyoshi Hishiki : email@example.com
Toshiko Nagase : firstname.lastname@example.org
Tunetaro Sakurai : email@example.com
2 Expected functions of the Internet for HIS
3 Towards HIS integrated with the Internet
3.1 Availability of the Internet
3.2 University Medical Information Network (UMIN) in Japan
3.3 Sharing Medical Knowledge among Hospitals and Clinics
3.4 Creating High-Quality Database Useful for Healthcare Staffs
3.5 Security Issue
Under this circumstances, HIS is expected to provide the staffs with various, world-wide information for decision making and better communication environment which can be used just on the computer terminals for everyday's works.
Furthermore, tele-communication between a central hospital and a satellite clinic/hospital has become more and more necessary especially when a physician consult with domain experts in other hospitals concerning his/her patients' care.
We think that only the Internet can satisfy such needs as above. This paper describes how the Internet can contribute its useful functions to HISs, and introduces the network environment of HIS at University of Tokyo Hospital and some experimental projects using the Internet.
Although other attractive functions like tele-surgery are also available in near future of course, above functions are currently at hand, if local area network in a hospital is connected to the Internet.
At the University of Tokyo Hospital, the hospital computer network is connected, through a firewall gateway, to the campus high speed LAN ╩(FDDI) which is connected to the Internet. Connected this hospital computer network, there are about 450 UNIX workstations, with which physicians and nursing staffs enter clinical orders, check labo data and schedule of next visit for patients, in outpatient clinics and wards.
There are a WWW server and a mail server which are located on the LAN inside the firewall gateway and they can be accessed only from inside the hospital. Another WWW server for public access is installed outside the firewall gateway and provides public people with useful health care information as well as the guide for visitors. All staffs can use not only the server inside the hospital but servers outside the hospital through the gateway. Since e-mails are transferred via the gateway bidirectionally, staffs can use e-mail environment without consciousness of the existence of the gateway.
Whenever a user requires electronic communications or world wide useful information, he or she can enjoy all the attractive services of the Internet directly from the workstation using pre-installed client applications , e.g., Mosaic for accessing to WWW or Gopher server, e-mail client program communicated with POP3 mail server, telnet application for connecting on-line MEDLINE services provided by the medical library of the university outside the hospital or University Hospital Information Network (UMIN).
Fig.1 shows a hardcopy of the home page provided on the WWW server inside the hospital from which a user can select various network services. From the item No.1 to No. 12 are served on the WWW server itself, and from No.13 to No.19 provide the links to other servers outside the hospital. Every staff can reach this home page from his/her personal computer, e.g. Macintosh and PC, connected to the HIS-LAN as well as from the clinical workstation.
Fig.1 A home page of WWW in University of Tokyo Hospital
The statistics of mail server showed that about 60 e-mails a day were sent from inside the hospital to outside, and about 80 e-mails a day were received from outside in average during February '95. Another statistics shows that nursing staffs are active users of the e-mail system within the hospital. The reason is probably that e-mail system assists personal communications with their intimate colleagues whose working time are different. As regarding WWW, junior residents often use Mosaic on the workstations at staff rooms in ward floor, and have access to the several electronic textbooks and educational WWW pages for clinical case presentation which are experimentally served at UMIN, Osaka Medical School, University of Nagoya, and other several sites in United States.
UMIN started WWW services, an anonymous FTP service, Gopher services, NetNews services and an e-mail service through the Internet since 1994. Every staff in most of the national university hospitals can have access to these services directly from any computer terminal which is used for daily health care jobs in HIS. This environment gives daily communication among health care staffs in different university hospitals and promotes the information exchange about their medical experiences acquired through their daily jobs. Fig. 2 is a sample hardcopy of the UMIN home page
Sharing medical knowledge in the UMIN computer center with the clinics in the district was tested via the Internet in 1994 by us and Hi-Vision Promotion Center, and color photographic, high resolution images of pathological samples could be transferred successfully via the Internet as well as the explanations and patients' profile data. Because a clinic and the nearest node of the commercial provider of the Internet were connected through ISDN-64 (64Kbps max.) and a modem of 19.2Kbps was used in the project, an average rate of transferring the image data was about 1.4 Kbytes/sec and the necessary time for transferring one medical image was about 80 seconds. Through this experimental project, it was reported by the physicians in the clinics that the Internet is feasible for sharing medical knowledge between university hospitals and the clinics in the districts.
Compared to package media like CD-ROM, the advantage of the online access via the Internet is that fresh knowledge can be distributed at a minimum time lag. Further, it is suggested that tele-conference among university hospitals and clinics talking about current medical topics is expected in near future.
Publishers of medical textbooks should promote the conversion of their paper books into electronically available style such as HTML or SGML and publish them through the Internet so that healthcare staffs might use such comprehensive, high-quality medical knowledge from the computer terminals in HIS.
Experimentally we converted all the data including texts and images from three famous Japanese medical textbooks for clinical practitioners into electronically available format written in HTML with the cooperation of the publishing company. Since the original data was available through CD-ROM and described with semantic tag like SGML, the most conversion process was automatically done by the computer program developed for the purpose. This database has been installed and tested since October 1994 both on the WWW server in the University of Tokyo Hospital and on the WWW server of the UMIN.
Through the experiment, we could suggest that creating high-quality medical database efficiently from paper books is one of the key issues for the Internet environment to become widespread in HIS.
We are now starting the investigation of feasibility and implications of privacy enhanced mail (PEM) technique adopted for hospital environment. Fig.2 A home page of WWW in University Medical Information Network