M.H. Baljon

Secure and cost-effective exchange of cardiac images over the electronic highway in the Netherlands

Today, in many catheterization labs the images are processed and stored in digital format. This creates the possibility to transfer the images electronically between an university cardiology centre and referring cardiology centres. Electronic exchange of images will reduce waiting time and costs involved with physically sending cine films or CD-ROMs to other centres. However, the electronic exchange of images poses two big challenges: 1) the safeguarding of the privacy of the patient-related information; 2) the handling of large amounts of data. These challenges can be met by using encryption algorithms and efficient data reduction methods.

Application of handheld computers for mobile access to a cardiology information system

Patient care in a coronary care unit (CCU) can be greatly improved by direct access to a specially-tailored electronic patient record (EPR) system. Current systems are based on large, non-portable workstations or PCs; the present information systems are global applications, not specifically designed for registration and data retrieval at the bedside. As part of the on-going development of CARIS (CARdiology Information System), we have developed dedicated modules to support the clinical care process in the CCU. The user interface has been specifically designed to make the necessary typing effort as small as possible. Instead of on standard PCs, the applications run on so-called Web tablets (Siemens SIMpad/sup /spl copy//). The SIMpad solution was preferred above keyboardless notebook computers (e.g. the Fujitsu Stylistic/sup /spl copy//) or palm-sized organizers (Palm/sup /spl copy//).

The Maastricht medication module

Currently the ICT departments working together in the Interuniversity Institute of Cardiology of the Netherlands are conducting a research project to conceive and build an Electronic Patient Record for CARdiology (EPD-CAR) In this paper one part of this project, MMM the module designed to archive all (cardiac) medication prescribed to a patient is discussed. This module not only forms a electronic patient medication file but also can be used to create new prescriptions, edit old ones and to generate all kind of overviews, like given medication, stopped medication, etc. to support optimal medical treatment. Apart from the features of the actual medication module, the integration of the module in Hospital or Departmental Information Systems is illustrated. Finally new options for research enabled by the use of such a uniform module to document prescribed medication are discussed.

A testbed project for DICOM images and waveforms integration

Today, in many catheterization labs, angiographic images are stored in DICOM format on CD, and reviewed from this DICOM CD. However, in clinical practice it would be very, advantageous to be able to store and display the images together with the waveforms (ECG, pressure) recorded simultaneously in the cathlab. To this end, a new supplement will be added to the DICOM standard (supplement 30). To gain experience with this DICOM-WV supplement, and to get comments from prospective users, we have initiated a project to create combined DICOM data-sets and to develop a viewer for times-synchronized display of images and waveforms, based on a draft version of the new DICOM-WV supplement. The initial results show that conversion of the waveform signals to DICOM-WV format can be easily performed and that time-synchronous display of images and waveforms opens new and exciting possibilities towards a fully integrated digital cathlab laboratory. Future plans include include a more generic solution to the time-synchronization problem, inclusion of other image modalities such as echo, inclusion of annotations and events and integration with DICOM supplement 23 (structured reporting).

A patient planning and tracking system for a cardiac surgery department

Patients undergoing cardiac surgery occupy a cascade of beds during their stay in hospital. The length of stay at each sub-department depends on many factors such as the condition of the patient, the performed therapeutic procedure and the attending staff. The patient throughput therefore may be hampered in many ways and is subject to vast communication processes in which copying of information is a substantial component. In order to optimize this throughput a software package has been developed based on a computer model predicting the average stay of a patient on each sub-department, given the surgical procedure and his clinical condition. This way the overall flow of patients can be predicted and potential problems in patient logistics can be foreseen. Furthermore sharing of information will reduce the workload and the number of misinterpretations.

Patient 98: a component-based multimedia workstation for cardiac care and research

A component-based medical workstation is under development. This workstation should provide to physicians, nurses and others access to all patient data including administrative data, summaries of studies, lab reports, signals and moving images. The main characteristics of this system are. 1. Integration of all patient information through one interface. The system comprises general medical information modules and dedicated cardiology and cardiac surgery modules. 2. Component-based. The framework of the system contains different patient selection modules in which individual components can be plugged in. Every component presents medical data of one patient (e.g.: a report or a sequence of images). The user can customize the workstation to every required circumstance.

Integrated access to function test results from within a cardiology information system

A dedicated cardiology information system (CARIS) has been developed in our department to record all information pertaining to studies performed in the cathlab and pacemaker lab. However, information stored in other systems in the cardiac function lab was not available in CARIS. This includes ECGs (rest ECGs, stress ECGs and Holter ECGs), and reports from echo studies and stress ECG studies. Data obtained from these functional studies are stored in various database systems. For each of these systems a different, dedicated interface was developed to allow the cardiologist to obtain access to the data from within CARIS. These results show that integration of all information available in the cardiology department is feasible. Presently, we are developing a completely new version of CARIS that will allow optimal integration of cardiology based information (as well as in the CARIS database, as in separate systems) with data in the hospital information system.

A diagnostic component for the EPD-Car project

This paper describes a diagnostic module which is a part of the EPD-CAR (Electronic Patient Dossier for Cardiology) project of the Interuniversity Cardiology Institute of the Netherlands. It consists of 13 coding trees, each containing between 3 and 20 subitems. The scheme evolved from daily practice where standard coding schemes proved insufficient. It consists of one main diagnosis and up to 10 optional subdiagnoses. Back-end integration is achieved through conversion tables to ICD-9 and ICD-10. The current system is in use now,for over 1.5 years and contains diagnoses of over 11000 patients. The system is written in Visual Foxpro 6.0 and is an ActiveX-component.

The choice of a commercial broadband communication system for ABC4CarE

In order to inquire the hard- and software possibilities for broadband communication applications, an inventory was made of specific solutions for the three main goals of the ABC4CarE project: teleconsulting, teleguiding and teleteaching. As the project plans for ABC4CarE are maturing, three of these telecommunication applications have been chosen, and a thorough survey was made on the usefulness of the application in each specific situation. For the Groningen-Leeuwarden X-ray cathlab teleconsulting connection the Philips VISU solution will be used because of the low cost. For the Amsterdam-Alkmaar X-ray cathlab teleconsulting and teleguiding connection, the Lucent MediaBuilder solution was chosen because of the broad spectrum of possibilities. The Rotterdam-Rotterdam echocardiographic teleguiding connection uses a home built application using a toolkit from Berkeley University.

An enhanced DTC component for the EPD-CAR project

This paper describes a module which is a part of the EPD-CAR (Electronic Patient Dossier for Cardiology) project of the Interuniversity Cardiology Institute of the Netherlands. It uses general guidelines to advise on the functional tests that have to be performed depending on the diagnoses. The model differentiates between the diverse conditions under which the patient enters the medical circuit. The model converts the detailed information into a crude code the is becoming the basis of financial compensation for medical treatment, starting January 1st 2003. The system is written in Visual Foxpro 7.0 and is an ActiveX-component.