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Access to information becomes more valuable with the continuing proliferation of medical knowledge and the increasing economic pressure being experienced by health care organizations. This is particularly so for community hospitals in rural or isolated areas, where the economic pressures are at least as great as in urban areas and where access to information is often inadequate. These conditions have implications for the quality of patient care and for economic viability. In response to this, the National Library of Medicine, the University of Washington, and seven community hospitals in five Pacific Northwest states have joined forces in a broad-scale technology diffusion project to facilitate the application of research work to clinical care. There are three components to the project: 1) a pilot connections component to extend Internet access to the community hospitals, 2) a research component to test the performance of a client/server model for network access to anatomical text and images, and 3) a clinical component to develop a registry of DNA diagnostic laboratories facilitating the provision of genetic information to clinicians. The pilot connections component is described and preliminary findings are reported.

The Just-In-Time system is an operations technique that was developed in Japan and became a growing trend in U.S. industry. JIT applications are relatively new to the hospital industry. Entry into a JIT arrangement requires a good deal of forethought and planning prior to implementation. Hospitals, in order to profitably implement JIT, must commit to a limited number of suppliers, share "vital" information about their operations, and importantly, remove functions they are presently performing as the supplier provides additional services. Introducing JIT in hospital operations involves more than simple edicts from management. If implemented correctly, it has the ability to slash costs, increase productivity levels, utilization of equipments, reduce the need for certain indirect labor, such as material handlers and increase profits.

Investigations into a digitized image communications system were prompted by a need to bring expert consultation to physicians in community practice. Pathologists desired the capability to concomitantly view, annotate, and discuss images with referring physicians at distant sites. Methods included evaluation of the human and procedural domain into which the system was to be integrated. The GDCN computer consultation system has the consultant nephropathologist first evaluate the processed biopsy slides, digitize representative images, transmit them with the diagnosis to referring nephrologist, and, finally, conduct an interactive consultation and review of the biopsy and case. Image resolution and compression variables must be set for each individual medical consulting application. For the GDCN, it was found that the 640 x 496 x unlimited color with compression ratios not exceeding 1:32 are acceptable. An obvious improvement of this computerized system over the noncomputerized review sessions is the ability to immediately share and discuss a new image that had not been previously sent. In the old noncomputerized consultation, only images that had been mailed could be discussed. The computerized sessions allow transmission (10 sec) of a new image that the consultation might demand. The computerized sessions also provide the ability to show the referring nephrologist an area of biopsy interest that the pathologist had not previously transmitted. Biopsy slides can be viewed during the consultation, an area digitized, and that image transmitted to the nephrologist during the consultation. Hardware and costs for the sending station were: [table: see text] This system far exceeds the requirements for this particular application; however, it is sufficient to support future, higher-technology computer applications. If necessary, this same system could be used with a less expensive computer, a less expensive camera, software compression, and a single monitor. These alterations could lessen the expenditures by some $8000 and result in a total cost of $10,000. Hardware and costs for the receiving station were: [table: see text] Cost of the receiving station could be reduced by using a less expensive computer and a single monitor system, thereby saving up to $5000 and resulting in a total cost of $7,400. DCCEC and GDCN have elected to use the more expensive, user-friendly and more rapid image transmission system SEND-->IT, rather than the less expensive system mainly because of experience with incorporating the system into the daily activities of the GDCN. SEND-->IT best met the essentials for GDCN.(ABSTRACT TRUNCATED AT 400 WORDS)

Innovative methods of providing workplace education for health care professionals may be a key to the survival of rural hospitals in America. Such methods must overcome time, distance, cost and organizational constraints, and take into account the structure of the learning experience. The Texas Hospital Education and Research Foundation has recently been involved in two programs that tested new approaches to worker education using distance-learning strategies. The projects--resource sharing among rural directors of nursing and training for cancer tumor registrars--used computer-conferencing technology. A new model using existing satellite, audio-conferencing, and computer-based instruction augmented by computer conferencing is proposed. The Computer-Related Assisted Distance Learning Enhancement (CRADLE) model integrates existing technologies to provide education to health care workers at their desktop. The Cancer Learning Center (CLC) tested peer collaboration, the primary component of the model. The ultimate goal is to have the system available to all tumor registrars in Texas, and to secure funding to implement rural nursing and rural high-school health occupations education projects. Current projects from set-up through results are presented.

Washington's brisk winter winds may signal a brisk change in the way healthcare insurance claims are processed. A series of events this fall appear to be jump-starting stalled efforts to effect a paradigm shift.

America has benefited from decades of outstanding health services. However, the American health system now is in crisis--with runaway medical cost inflation, hospital closures, and unacceptably high and increasing numbers of uninsured people. Key solutions for bringing the health system into balance remain untapped in the potentials of health-oriented telecommunication, or HOT applications. HOT applications could rally the immense unused personal resources of the public for improving their own health, help upgrade the delivery and efficiency of healthcare and its administration, and improve public health's ability to deal with present and emerging system-level problems impacting health.

Like electronic imaging, EDI is intended to eliminate paper. Will it also eliminate imaging?

Electronic data interchange has the potential to save billions of healthcare dollars--that's the gospel according to Joe Brophy. The Travelers Insurance Company president and co-chair of the Health and Human Services Workgroup on Electronic Data Interchange is taking this sermon to the people.

Public demand for healthcare cost reductions has not only risen to the top of the political agenda this fall, it has become strident. Legislators are under pressure to act quickly. Suddenly, electronic claims submission is being understood for its ability to lop billions off of the staggering cost of healthcare administration. Several initiatives are now in the works that are set to bring ECS into widespread use.

Integration of multiple information systems of a medical center will change the way physicians work and practice medicine in the future. Several major steps must be taken by an institution to make this a reality. Since 1983, Georgetown has been engaged in an Integrated Academic Information Management System (IAIMS) project to bring together multiple sources of information that reside on different computers and database systems. Georgetown is developing a Biotechnology and Biomedical Knowledge Network that includes informational and clinical databases, scholar workstations, instruction on computer use, a campuswide network with local area network nodes, and a modular approach to systems integration. The IAIMS project, spearheaded by the medical library, has enabled a broad spectrum of health professionals to benefit directly from new, dynamic information services. The network is heavily used; in 1991, more than 2,100 individual users conducted more than 148,500 computer functions and more than 104,000 searches. There is economy of scale in high-volume use. Overall, the average search cost is $1.57; for high use databases the cost is $0.38, and for low use, it is $9.41. As described in this paper, IAIMS offers a cost-effective means of enhancing patient care by improving information services to physicians. At Georgetown, IAIMS has advanced the concept of integration, accelerated use of computers in education, increased user acceptance of advanced technologies, and established cost factors for providing information resources. While progress made in improving the transfer of medical information is impressive, it is clear that IAIMS requires several more years of support to achieve full implementation.

In this paper the results of the standardization efforts and an evaluation study concerning electronic data interchange (EDI) performed by the 31 (Inter Institutional Information exchange)-project are described. In an earlier paper the results of a preliminary study were reported. EDI concerns communication between autonomous information systems and therefore needs standardization of the messages to be exchanged. In the 31-project ten different types of standard messages have been defined. The use of these messages for exchanging information between hospitals, GPs and pharmacies is described. It is concluded that relatively large time savings can be obtained when communicating electronically. It is also concluded that the electronic data interchange between hospitals and GPs can be performed without additional costs. The electronic communication of prescriptions between GPs and pharmacies does raise the costs of communication at the moment. The impact of EDI on the functioning of people in the organizations involved varies widely.

Since the end of 1987, the Medical Center and University libraries at Loma Linda have progressed from stand-alone CD-ROM-based workstations for access to MEDLINE to networked CD-ROM access to a variety of databases. T.O.M.M.I. (Total Online Medical Material Integration) is a CD-ROM-based wide area network linking the Loma Linda University Medical Center, Loma Linda University, and other entities in Loma Linda, California. T.O.M.M.I., a microcomputer-based system, represents the implementation of IAIMS at Loma Linda. In addition to discussing the issue of "downsizing" campus-wide information networks, this article focuses on the issues of training, handling of logistical problems, and the use of creative financing.

In 1982, Robert Benjamin published a forecast of the state of information technology in the year 1990. He wrote that the information systems environment was in "a considerable state of flux" and information systems managers could benefit from a prediction of the "end-point scenario [in order to] focus major planning strategies." Ten years later, it's time to provide a new set of landmarks for another decade of flux. Benjamin and his coauthor, Jon Blunt, envision the information technology world of 2000. What can we expect? What should we not expect? And what can we not even begin to guess?

Teleradiology systems require the use of wide area networks (WANs). Design and implementation of a WAN depend on the number of images to be transmitted, desired digital image throughput (based on signaling rate), and cost of the communications link. Image transmission load must be estimated before the communications link can be selected. Communications links used in WANs include T-1 carrier point-to-point service, digital service (DS)-1 dial-up service, DS-3 point-to-point service, DS-0 dial-up service, digital microwave, fiberoptic local loop carriers, and metropolitan area networks (MANs). Depending on the distance between sites, T-1 service may be less costly than DS-1 service; however, for distances more than 200 miles, DS-1 service can be less expensive and more flexible. Both of these services and DS-0 service have lower signaling rates than DS-3 service, which is the fastest and most expensive link. Microwave and fiberoptic links are less expensive but have distance limitations of 14 and 30 miles, respectively. MANs are still being developed but hold the promise of higher signaling rates at lower costs.

Bar coding should be a staple in every hospital by now--but it's not. The author tells how bar coding and the use of radio frequency transmission of inventory data direct to their mainframe computer has saved them time and money.

This article presents the concepts of a computerized information system and its potential applications to Emergency Medical Services (EMS). It is an informational article intended to provide administrators clear concepts of how computers may be best used to provide information in integrated networked systems for EMS needs. It addresses the function of a system, processes of computerizing a department, planning, and provides an overview of computer hardware.

In the development of any new industry, certain events signal a paradigm shift. Those affected by the "new way" finally seem to grasp that change is inevitable. The paradigm shift has begun for electronic claims submission.

Health and Human Services wants to trim the administrative fat from the country's $666 billion healthcare bill. The Hartford Foundation is letting bids for a system that allows individual communities to share healthcare data for a variety of purposes. Both efforts draw significantly on electronic media claims.

Early CT scanning leads to the early diagnosis and referral of intracranial lesions, particularly in head injuries. Such early scanning is more feasible with the advent of CT scanners in most peripheral hospitals. However, the neurosurgical service in most countries remains regional with limited bed capacity and involves a potentially hazardous inter-hospital transfer of critically ill patients. We investigated the value and reliability of new information technology in the management of emergency neurosurgical referrals in the Mersey region. One hundred and ninety-nine emergency referrals were studied. In 147 referrals the patient was scanned in the referring hospital and the images were transmitted immediately to the neurosurgical unit. Of these, 51 (34.7%) patients were transferred immediately, 14 (9.5%) the following day and 11 (7.5%) electively. Of those patients who were transferred immediately, 48 (94.1%) underwent emergency surgery. Seventy-one (48.3%) patients were not transferred due to diffuse head injury (40), a cerebral infarct (15), poor grade subarachnoid haemorrhage (10) and normal scans (6). Another 52 patients were transferred to the unit without image transfer, of whom 12 (23.1%) underwent emergency surgery, 17 (32.7%) went back to the referring hospital within 24 h, 17 (32.7%) were electively operated and six (11.5%) died. Comparison of 100 original CT scan films with the corresponding transmitted images showed no significant difference in the quality of the image, diagnosis or clinical decision. Image transfer together with the clinical history has reduced potentially hazardous inter-hospital transfer of patients (p < 0.001). It is reliable, fast, cheap and leads to considerable economic savings.

The Regional Medical Center at Memphis--the oldest hospital in Tennessee--acknowledged that information technology is a critical key to the pursuit of medical and managerial excellence. By outsourcing much of the center's computing and telecommunications needs, the MED's CEO, Lucy Shaw, feels she has maximized information technology benefits to her institution with maximum cost control.

Teleradiology refers to the transmission of clinical images from their source to remote sites. In this paper a low-cost means of establishing teleradiology using conventional personal computers is described. This is a simple and effective means of transmitting valuable clinical data from hospital to hospital, and hospital to individual, markedly enhancing the quality of clinical communication. The system described herein has proved invaluable in a busy neurosurgical department, in both emergency and more routine settings. Teleradiology has the potential to transform the early management of critically ill and injured patients, especially those from remote parts of Australia.

Teleradiology networks transmit digital radiographic images from one location to another. These networks are wide area networks. Teleradiology networks are used for diagnostic purposes and preview tasks. Wide area networks for teleradiology use public service switching. The use of fiber optics networks provide reduced costs and increased flexibility. An example is presented that compares the cost of teleradiology networks.

Information at every nurse researcher's fingertips. That is the goal of an information system for nursing services in Europe. Not only would it be able to provide fast information for analyzing and developing nursing but it also aspires to end the costly duplication of research work regionally and worldwide. Below, a report on how a European network can be developed to become a potential hub for a global nursing system.

This article explores the state-of-the-art in electronic health claims processing. Beginning with an examination of the step-by-step manual process, it moves on to explore the current use of microcomputers to both speed up the processing, and to improve the accuracy and completeness of claim submission. The article also examines some of the benefits cited by microcomputer claims systems users, and it concludes with a look at what features could be incorporated in the future to create a fully electronic claims processing environment.

This article describes an extramural university course in epidemiology and medical statistics taught using a computer conferencing system, microcomputers and data communications. Computer conferencing was shown to be a powerful, yet quite easily mastered, vehicle for distance education. It allows health personnel unable to attend regular classes due to geographical or time constraints, to take part in an interactive learning environment at low cost. This overcomes part of the intellectual and social isolation associated with traditional correspondence courses. Teaching of epidemiology and medical statistics is well suited to computer conferencing, even if the asynchronicity of the medium makes discussion of the most complex statistical concepts a little cumbersome. Computer conferencing may also prove to be a useful tool for teaching other medical and health related subjects.