Jean-Raoul Scherrer

Happy birthday DIOGENE: a hospital information system born 20 years ago

Since its birth in 1978, DIOGENE, the Hospital Information System of Geneva University Hospital has been constantly evolving, with a major change in 1995, when migrating from a centralized to an open distributed architecture. Since a few years, the hospital had to face health policy revolution with both economical constraints and opening of the healthcare network. The Hospital Information System DIOGENE plays a significant role by integrating four axes of knowledge medico-economical context for better understanding and influencing resources consumption the whole set of patient reports and documents (reports, encoded summaries, clinical findings, images, lab data, etc.) patient-dependent knowledge, in a vision integrating time and space external knowledge bases such as Medline (patient-independent knowledge) integration of these patient-dependent and -independent knowledges in a Case-Based Reasoning format, providing on the physician desktop all relevant information for helping him to take the most appropriate adequate decision.

Three- to five-dimensional biomedical multisensor imaging for the assessment of neurological (dys)function

This report describes techniques and protocols implemented at the Geneva Canton University Hospitals (HUG) for the combination of various biomedical imaging modalities and sensors including electromagnetic tomography, to study, assess, and localize neurological (dys)function. The interest for this combination stems from the broad variety of information brought out by (functional) magnetic resonance imaging, magnetic resonance spectroscopy, computed tomography, single-photon emission tomography, positron emission tomography, and electromagnetic tomography. Combining these data allows morphology, metabolism, and function to be studied simultaneously, the complementary nature of the information from these modalities becoming evident when studying pathologies reflected by metabolic or electrophysiologic dysfunctions. Compared with other current multimodality approaches, the one at the HUG is totally compatible with both clinical and research protocols, and efficiently addresses the multidimensional registration and visualization issues. It also smoothly integrates electrophysiology and related data as fully featured modalities.

A Multilingual Analyser ofMedical Texts

In the European Union, the need for systems which are able to accept multiple European languages is of paramount interest, because language barriers can be a strong impediment for large-scale communication in Europe. The use of analysers able to accept different European languages and convert them into a single representation common to all languages would seem to be the ideal solution. The RECIT system presented in this paper, shows an original approach for analysing sentences, understanding their meaning and storing them into a deep representation, available for future querying. The chosen approach, called proximity processing, takes advantage of the typical situation of a closed domain of knowledge (i.e. medicine) and of the structured form of medical reports (discharge summaries), using proximity rules which combine in an integrated way semantic information as well as syntactic information when needed. From the recognition of meaningful components in free text sentences, a knowledge representation is built in the form of conceptual graphs. In this article, we discuss the relevant features of both proximity processing and the subsequent transformation into a language-independent representation. In particular, we highlight the characteristics that enable our system to be easily extended to other European languages, as well as other application domains when pertinent.

Analysis of Medical Jargon: The RECIT System

Medical language constitutes a large subset of human language. However, it presents special features which have to be taken into consideration for natural language analysis. We have observed that natural language texts dealing with a specific medical area (especially discharge summaries and reports) share a common vocabulary and common habits of word usage. Facing these specificities, we describe in this paper an original system called RECIT, designed for medical text analysis and understanding. In particular, we discuss the principles which guide the analysis of medical jargon using semantic considerations, coupled with syntactic information when needed. As a result of the flexibility of the system, a medical application developed in the context of the AIM project HELIOS-2 is presented.

Using the Conceptual Graph Operations for Natural Language Generation in Medicine

Natural language generation systems for the medical domain have to take into account the specific domain vocabulary as well as the particular language style of a highly conventionalised language. This is particularily relevant for multilingual generation.

PACS and Related Research in Switzerland

A brief review of current activity in Switzerland is presented in this paper. A further description of a hospital-wide PACS project integrated with a Hospital Information System in Geneva is presented.

Distributed architecture for image archival in a hospital-wide PACS

A hospital-wide PACS project is currently under development at the University Hospital of Geneva. This system is based on an open architecture regrouping equipment from multiple vendors in a distributed topology. The image archival is organized in multiple locations geographically distributed in the hospital. These regional archives are logically linked together to provide a virtual access to all images generated from different imaging modalities. A standardized image storage format called PAPYRUS was designed based on ACR-NEMA definitions to unify the image storage and display functionalities. The PACS database is also fully integrated with the concurrent RIS and HIS. Images from different archive servers are hierarchically distributed to other temporary storage space on regional display servers. Clusters of workstations are regrouped around these local servers allowing a more efficient access to the images on local subnetworks. Special software tools were designed for the management of image distribution and maintenance of local storage space. In addition to pre- programmed and rule-based distribution of images to regional display servers, special requests can be posted by the users to initiate the transfer of additional image files from the archive servers to their local display server. The design and implementation of the system will be presented and methodological issues will be discussed. Results from preliminary simulations performed prior to the final implementation will be presented and compared to real measurements performed on the system in operation. The advantages and difficulties of implementing a distributed hierarchical storage of images will be reported.© (1992) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Evolution of PACS concepts in hospital environment

The constant improvement in computer power and performance currently offers convenient and efficient means of manipulating images, graphics and movies on off-the-shelf workstations. The trend toward integration of multimodality clinical documents from patient records follows naturally. Images and graphs are certainly the most important part of the complementary information that must accompany the text and numerical data. There is, however, a possibility to include sounds and voice messages, together with all the other modalities. In medicine this could certainly help to convey heart murmur or sounds, but could also offer a convenient way of including vocal messages and comments. These new possibilities will certainly change the way physicians use workstations for direct communication. The computer industry will soon offer means of interactive communication between remote users, through computer workstations that will open a completely new area in co-operative computing and remote consultation scenarios in medicine. More than the technology itself, it is a complete change in the behaviour and work habits that can be observed in the medical community.

HCUG Clinical Information System

The Hopital Cantonal Universitaire de Geneve (HCUG) comprises a group of primary, secondary, and tertiary care facilities, employing 8000 staff members and totaling 2200 beds. There are 50,000 admissions and 450,000 outpatient visits each year (Figure 13.1). The main hospital information system in use is the Diogene system, built over a generation by the pioneering efforts of Professor Jean-Raoul Scherrer [Borst 1999, Scherrer 1997, 1998]. Developed in the 1970s in a mainframe environment, it migrated to a farm of Unix-based servers in the early 1990s. Another locally developed system, Philos, is used in smaller facilities. Since 1997, the government has funded a major effort for the integration of these hospital information systems, and for the development of an institution-wide clinical information system (CIS).

Editorial commentary: Aims and tasks of medical informatics

The paper by Reinhold Haux [I ] presents opinions and thoughts that produce a natural incentive for further discussion and comment. Since, at the end of the paper, there is an explicit open invitation for ‘a broad public discussion on the aims and tasks of research in the field of medical informatics’, I took the liberty of adding a discussion of my own on the subject in reaction to the main sections of the paper. For convenience, I shall follow the same predefined structure as outlined in the paper with a special emphasis on the socalled ‘grand-challenges’, other worthwhile opportunities for medical informatics and the suggested position medical informatics should take in the future.