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Hospital Information System and the Internet

Hospital Information System and the Internet

April 30, 1995

Kazuhiko Ohe : kohe@hcc.h.u-tokyo.ac.jp
Shigekoto Kaihara : kaihara-jyo@h.u-tokyo.ac.jp
Koichi B. Ishikawa : kishikaw@ncc.go.jp
Teruyoshi Hishiki : hishiki-jyo@h.u-tokyo.ac.jp
Toshiko Nagase : nagase-jyo@h.u-tokyo.ac.jp
Tunetaro Sakurai : sakurai-jyo@h.u-tokyo.ac.jp


Abstract


Hospital Information System (HIS) is expected to provide the staffs with various, world-wide information for decision making and better communication environment. The Internet can satisfy such needs. When HIS aims the direction toward an integrated environme╩nt with the Internet, several key issues should be discussed. The first important issue is that the Internet environment should be available everywhere in a hospital. The second is communication environment between hospitals. The third is sharing medical knowledge among hospitals and clinics. The forth is how to create a useful high-quality database available through the Internet. And the last is the security issue.



Contents

1 Introduction

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

References

Author Information


1 Introduction


Hospital Information System (HIS) has evolved as an integration system of order entry systems, an administrative system, and departmental subsystems within a hospital. It has become more and more necessary for every health care staff in a hospital to use a computer terminal at almost everyday's works.

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.

2 Expected functions of the Internet for HIS

Current useful functions of the Internet to HISs are categorized into

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.

3 Towards HIS integrated with the Internet

To use the above functions of the Internet effectively from HISs, there are several key issues to be discussed. The first important issue is that the Internet environment should be available everywhere in a hospital. The second is communication environment among hospitals. The third is sharing medical knowledge among hospitals and clinics via the Internet. The forth is how to create a useful high-quality database available through the Internet. And the last is the security issue. This section discusses these five issues toward the HIS integrated with the Internet.

3.1 Availability of the Internet

It is important that all the staffs in a hospital have to be able to access information services just on the same computer terminals of HIS that they use for daily health care jobs, because their demands for information retrieval or communications with other staffs occur while entering clinical orders from the terminal, making a therapeutic plan based on the labo results on the display and so on.

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.

3.2 University Medical Information Network (UMIN) in Japan

The Internet is expected to provide the new environment for the communication among hospitals. In other words, the application of the Internet to HIS is not only communications at one hospital connected to the Internet, but for communications of inter-hospitals/clinics. The UMIN project[1], which started in 1988 aiming to construct nation-wide computer network among all 42 national university hospitals in Japan, serves the various useful information resources to the world. Through the Internet, hospitals can also use the hardware resources to archive and serve their own information which is useful for other hospitals.

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
( http://cc.umin.u-tokyo.ac.jp/).

3.3 Sharing Medical Knowledge among Hospitals and Clinics

Sharing medical knowledge among the university hospitals and clinics in the district far from the hospitals is an important issue required. So the feasibility study of sharing medical knowledge using the Internet environment was necessary. The main problems were 1) whether the Internet connection through ISDN-64 from clinics in the district to univerisity hospitals is feasible or not, 2) whether online access to medical knowledge in univeristy hospitals is useful or not, compared to package media like CD-ROM.

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.

3.4 Creating High-Quality Database Useful for Healthcare Staffs

Health care staffs are always eager to get correct, up-to-date medical knowledge. To satisfy them, there must be a high-quality, comprehensive, useful, up-to-date medical database or knowledge-base available through the Internet. Unfortunately, most of such comprehensive knowledge is currently available through paper books from the historical reasons. Although there are not a few electronic medical textbooks available through World Wide Web, most of them are not beyond experimental prototype, which are created by personal efforts. Only several online databases, e.g. MEDLINE, for searching bibliographies are provided through the Internet.

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.

3.5 Security Issue

Since the Internet is essential environment for recent HISs, the discussion of security issue is inevitable. However, this is general issue to be always discussed when local area network is connected to the Internet. The key technologies are encryption, firewall, digital signature, and authentication.

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


References

[1]
K. Ohe, T. Sakurai, T. Nagase, S. Kaihara, "Current Overview of the University Medical Information Network (UMIN) " Medical & Biological Engineering & Computing, Vol. 29, Suppl, pp. 825, 1991

Author Information

Kazuhiko Ohe, M.D. is Associate Professor, Assistant Director of Hospital Computer Center, Univerisity of Tokyo Hospital. Postal mail address is 7-3-1 Hongo, Bunkyo, Tokyo, 113 Japan
Shigekoto Kaihara is Professor, Director of Hospital Computer Center, Univerisity of Tokyo Hospital.


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