Integration of a picture archiving and communication system with videocapture and computed radiography in a dental hospital

A method for the integration of a picture archiving and communication system (PACS) at Kyushu University Dental Hospital with radiological information (RIS) and hospital information (HIS) systems is described. CT, US and DSA from different manufacturers were integrated by videocapture and then subsequently integrated with computed radiography (CR) by means of DICOM. The approximate amount of data stored each month on optical discs is 2 GB. The system does not incorporate intra-oral radiography.

Remote-rendered 3D CT angiography (3DCTA) as an intraoperative aid in cerebrovascular neurosurgery

OBJECTIVE

To assess the viability and utility of network-based rendering in the treatment of patients with cerebral aneurysms, we implemented an intraoperative rendering system and protocol using both three-dimensional CT angiography (3DCTA) and perspective volume rendering (PVR).

MATERIALS AND METHODS

A Silicon Graphics InfiniteReality engine was connected via a Fast Ethernet network to a workstation in the neurosurgical operating room. A protocol was developed to isolate bone and vessels using an appropriate transfer function. Three-dimensional CT angiogram images were volume rendered and transmitted to the workstation using a bandwidth-conserving remote rendering system, and were rotated, cut using clipping planes, and viewed using normal and perspective views. Twelve patients with intracranial aneurysms were examined at surgery using this system.

RESULTS

Rendering performance at optimal operating bandwidths (50-60 Mb/s) was excellent, with regeneration of a high-resolution image in less than 1 s. Network performance varied in two cases, slowing image regeneration. Surgeons found the images to be useful as an adjunct to conventional imaging in understanding the morphology of complex aneurysms and their relationship to the skull base.

CONCLUSIONS

Intraoperative volume rendering using 3DCTA is achievable over a network, can reduce hardware costs by amortizing hardware among multiple users, and provides useful imaging information during the surgical treatment of cerebral aneurysms. Future operating suites may incorporate network-transmitted three-dimensional images as additional sources of imaging information.

Using management information systems to enhance health care quality assurance

Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved.

The digital transformation of oral health care. Teledentistry and electronic commerce

BACKGROUND

Health care is being changed dramatically by the marriage of computers and telecommunications. Implications for hospitals and physicians already have received extensive media attention, but comparatively little has been said about the impact of information technology on dentistry. This article illustrates how the digital transformation will likely affect dentists and their patients.

CONCLUSIONS

Based on recent experiences of hospitals and medical practices, dentists can expect to encounter revolutionary changes as a result of the digital transformation. The Internet, the World Wide Web and other developments of the information revolution will redefine patient care, referral relationships, practice management, quality, professional organizations and competition.

PRACTICE IMPLICATIONS

To respond proactively to the digital transformation of oral health care, dentists must become familiar with its technologies and concepts. They must learn what new information technology can do for them and their patients and then develop creative applications that promote the profession and their approaches to care.

[A combined PACS and Internet information system in a university medical center]

PURPOSE

The Department of Radiology at the University Hospital Innenstadt Munich provides all clinical departments of a large university hospital with several radiology units at different locations. During the last four years all units have been fully digitalized with a stepwise installation of a PACS. The PACS also processes images from the Nuclear Medicine Department.

METHODS

As image modalities, archive systems and review workstations, we use devices from multiple vendors, which are integrated into a consistent system using the DICOM standard. The hospital has developed its own RIS and an Internet information system, which provides access to all reports and images from radiology for all clinical departments inside the hospital. Additionally, other clinical information such as laboratory results or ECG examinations are available through the system.

RESULTS

After one year of operation, the system succeeded in the clinical routine work as the primary source for radiological reports and images as well as for laboratory values.

CONCLUSION

The advantages of digitalization were, besides reduction of film cost, especially optimizations of work flow with access to digital images from everywhere at any time.

Economic analysis of teleradiology applications with KAMEDIN

The teleradiology system KAMEDIN (German Telekom), installed on HP-Unix- and NT-Workstations, was evaluated in different scenarios and a cost-benefit-analysis was performed. CT examinations were transferred from a PACS workstation (GE) to KAMEDIN using DICOM-3 protocol. Teleconferences were realized with an intensive care unit by LAN, with a radiology department at 5 km. distance by ISDN, and with an on duty radiologist 22 km. away by ISDN. On average, 36 CT slices per patient were transferred. Overall costs (costs for hardware, software, support, ISDN-fees, and staff) were compared to possible cost reduction, mainly concerning transportation and films. These three scenarios could be realized during daily routine work. Differing in their amount of transportation cost reduction, two applications (intensive care unit, radiologist on duty) showed a break-even at 1817, respectively 528 teleconferences/year. Improvement of cost-effectiveness can be obtained on the conditions that existing hardware will be used and that the automatic data transfer will be improved. Combining all optimisation factors, the break-even decreased to a minimum of 167, respectively 77 teleconferences/year. The optimisation of patient management is an additional--but in this study, not yet counted--advantage of teleradiology.

Incidence and costs of adverse drug reactions during hospitalisation: computerised monitoring versus stimulated spontaneous reporting

OBJECTIVE

To implement a computer-based adverse drug reaction monitoring system and compare its results with those of stimulated spontaneous reporting, and to assess the excess lengths of stay and costs of patients with verified adverse drug reactions.

DESIGN

A prospective cohort study was used to assess the efficacy of computer-based monitoring, and case-matching was used to assess excess length of stay and costs.

SETTING

This was a study of all patients admitted to a medical ward of a university hospital in Germany between June and December 1997.

PATIENTS AND PARTICIPANTS

379 patients were included, most of whom had infectious, gastrointestinal or liver diseases, or sleep apnoea syndrome. Patients admitted because of adverse drug reactions were excluded.

METHODS

All automatically generated laboratory signals and reports were evaluated by a team consisting of a clinical pharmacologist, a clinician and a pharmacist for their likelihood of being an adverse drug reaction. They were classified by severity and causality. For verified adverse drug reactions, control patients with similar primary diagnosis, age, gender and time of admission but without adverse drug reactions were matched to the cases in order to assess the excess length of hospitalisation caused by an adverse drug reaction.

RESULTS

Adverse drug reactions were detected in 12% of patients by the computer-based monitoring system and stimulated spontaneous reporting together (46 adverse reactions in 45 patients) during 1718 treatment days. Computer-based monitoring identified adverse drug reactions in 34 cases, and stimulated spontaneous reporting in 17 cases. Only 5 adverse drug reactions were detected by both methods. The relative sensitivity of computer-based monitoring was 74% (relative specificity 75%), and that of stimulated spontaneous reporting was 37% (relative specificity 98%). All 3 serious adverse drug reactions were detected by computer-based monitoring, but only 2 out of the 3 were detected by stimulated spontaneous reporting. The percentage of automatically generated laboratory signals associated with an adverse drug reaction (positive predictive value) was 13%. The mean excess length of stay was 3.5 days per adverse drug reaction. 48% of adverse reactions were predictable and detected solely by computer-based monitoring. Therefore, the potential for savings on this ward from the introduction of computer-based monitoring can be calculated as EUR56 200/year ($US59 600/year) [ 1999 values].

CONCLUSION

Computer monitoring is an effective method for improving the detection of adverse drug reactions in inpatients. The excess length of stay and costs caused by adverse drug reactions are substantial and might be considerably reduced by earlier detection.

Comparing user acceptance of a computer system in two pediatric offices: a qualitative study

The purpose of this qualitative study was to examine user acceptance of a clinical computer system in two pediatric practices in the southeast. Data were gathered through interviews with practice and IS staff, observations in the clinical area, and review of system implementation records. Five months after implementation, Practice A continued to use the system but Practice B had quit using it because it was unacceptable to the users. The results are presented here, in relation to a conceptual framework, which was originally developed to describe the process of successful implementation of research findings into practice. Five main themes were identified relative to the differences in user acceptance at the two practices: 1) Benefits versus expense of system use varied, 2) Organizational cultures differed, 3) IS staff's relationship with practices differed, 4) Post-implementation experiences differed, and 5) Transfer of technology from the academic center to private practice proved challenging in Practice B. The findings indicate a need for the development and validation of tools to measure healthcare organizational climate and readiness for change.

Factors that cause industries to lead or lag in use of information technology: does health care lag?

The rate of diffusion of information technology varies among industries, as does its resultant added value. The different paces of work transformation are determined by the opportunities of the differing work processes, efficiency of exchange of workplace ideas, and relationships among constituencies. The differences raise the question of why the maturation process is accelerated (or restrained) in different industries, how the health care industry fares in comparison, and how information technology may be more effectively used as health care evolves toward new forms of work interaction, control mechanisms, and information technology management paradigms and as information processing moves toward higher levels of complexity.

Maximizing the potential of your systems

In the last two decades, manufacturing businesses throughout the United States have learned that the most important way to ensure the maximum potential of their manufacturing systems when implementing manufacturing resource planning is how they approach the implementation itself--not just their choice of or expenditure for software.

A low-cost PCI-bus-based ultrasound system for use in image-guided neurosurgery

A low-cost PCI-bus-based ultrasound sub-system has been developed and integrated into the image-guided neurosurgery system currently in use at the Cleveland Clinic. Two software applications have been developed that integrate real-time ultrasound images with preoperative MR and CT data sets. By tracking the position of the ultrasound probe during surgery, it is possible to display a real time ultrasound image and the corresponding (preoperative) oblique CT or MR slice. This provides immediate positional feedback to the neurosurgeon during the surgical procedure.