Marion C. Meissner

Building an integrated clinical and research network

At the Georgetown University Medical Center Department of Radiology we are currently involved in integrating three diverse networks into a coherent whole. We are installing a new Radiology Information System (RIS) and a new Picture Archiving and Communication System (PACS) as well as upgrading our existing research network, which provides Internet access, to add office automation tools. To accomplish this, many issues have to be resolved. Users of the different systems have different requirements and must have different levels of access to data on the various systems. For example, researchers need access to Internet resources and e-mail while data from the clinical systems must be protected from the outside world. Physicians and some other users on the non-clinical network also require fast and convenient access to the RIS and PACS for clinical uses. Parts of the network should be shielded from the heavy image traffic created by the PACS. On the other hand, because clinical data is also used for research, a connection between the networks is necessary. Our solution for providing adequate access for all users, assuring confidentiality for patient data, and managing network traffic will be described.

Hemodialysis Patient Management by Telemedicine: Design and Implementation

The authors describe the design and implementation of a personal computer based telemedicine system for managing patients by telemedicine. With three identical systems connected by high speed T1 lines, the physician (or allied healthcare giver) can interact, by videoconferencing, and by using multimedia files, with patients at two remote hemodialysis sites. The physician is able to visualize specifically the patients fistula/graft, and auscultate fistula, heart and lung sounds, and incorporate still pictures or audio sounds in the patients multimedia database folder, which also contains an electronic and paperless medical record. In addition there is the capability of downloading into this database all the machine parameters during dialysis. ASAIO Journal 1997; 43:M763-M766.

Integration of a RIS with an IMACS

The interface of radiology information systems (RIS) to image management and communications systems (IMACS), also known as picture archiving and communication systems (PACS), is necessary if they are to become clinically accepted. At Georgetown, we have started development of an interface between our MIIS based RIS and our AT&T CommView system. This interface is based on a one-way flow of information, with data transferring from the RIS to the PACS only. The interface is invisible to the user and requires no special action by the user to facilitate data transfer.

Comparing the security risks of paper-based and computerized patient record systems

How should hospital administrators compare the security risks of paper-based and computerized patient record systems. There is a general tendency to assume that because computer networks potentially provide broad access to hospital archives, computerized patient records are less secure than paper records and increase the risk of breaches of patient confidentiality. This assumption is ill-founded on two grounds. Reasons exist to say that the computerized patient record provides better access to patient information while enhancing overall information system security. A range of options with different trade-offs between access and security exist in both paper-based and computerized records management systems. The relative accessibility and security of any particular patient record management system depends, therefore, on administrative choice, not simply on the intrinsic features of paper or computerized information management systems.

Optimization of Picture Archiving and Communication Systems (PACS) Network Performance: Simulation and Validation

Network performance analysis is an important part of PACS implementation. An understanding of the operational PACS - is necessary for the development of a realistic computer model of the system. Subsequent simulations of the model will help locate under and over utilized nodes and predict the effect of changes to the network. At Georgetown, we have started a model of our AT&T PACS, by first studying the acquisition aspect of the PACS in detail and developing a computer model using PAW simulation software.

Remote management of haemodialysis patients: Design and implementation of a telemedicine network

Summary. Telemedicine applications have been implemented in many clinical specialties. Some, like teleradiology, are now established applications with specific standards. Most applications still do not have protocols or standards, including telemedicine for haemodialysis. As part of Project Phoenix, a National Library of Medicine funded project set up to look at the access, cost and quality implications of telemedicine in a renal dialysis setting, we are establishing such protocols and standards. This paper discusses the design and implementation of a multimedia telemedicine application being undertakin by the Imaging Science and Information Systems (ISIS) Center of the Department of Radiology, the Clinical Economics Research Unit and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GUMC). The Renal Care Patient Monitoring (RCPM) network links GUMC, a remote outpatient dialysis clinic, and a nephrologists home. The primary functions of the network are ...

Design of a multimedia PC-based telemedicine network for the Monitoring of Renal Dialysis Patients

This paper investigates the design and implementation of a multimedia telemedicine application being undertaken by the Imaging Science and Information Systems Center of the Department of Radiology and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GUMC). The Renal Dialysis Patient Monitoring network links GUMC, a remote outpatient dialysis clinic, and a nephrologists home. The primary functions of the network are to provide telemedicine services to renal dialysis patients, to create, manage, transfer and use electronic health data, and to provide decision support and information services for physicians, nurses and health care workers. The technical parameters for designing and implementing such a network are discussed.

Protecting clinical data in PACS, teleradiology systems, and research environments

As clinical data is more widely stored in electronic patient record management systems and transmitted over the Internet and telephone lines, it becomes more accessible and therefore more useful, but also more vulnerable. Computer systems such as PACS, telemedicine applications, and medical research networks must protect against accidental or deliberate modification, disclosure, and violation of patient confidentiality in order to be viable. Conventional wisdom in the medical field and among lawmakers legislating the use of electronic medical records suggests that, although it may improve access to information, an electronic medical record cannot be as secure as a traditional paper record. This is not the case. Information security is a well-developed field in the computer and communications industry. If medical information systems, such as PACS, telemedicine applications, and research networks, properly apply information security techniques, they can ensure the accuracy and confidentiality of their patient information and even improve the security of their data over a traditional paper record. This paper will elaborate on some of these techniques and discuss how they can be applied to medical information systems. The following systems will be used as examples for the analysis: a research laboratory at Georgetown University Medical Center, the Deployable Radiology system installed to support the US Armys peace- keeping operation in Bosnia, a kidney dialysis telemedicine system in Washington, D.C., and various experiences with implementing and integrating PACS.

Breaking the bottleneck : High speed medical image transmission through ATM network : implementation and application

In this paper, Georgetown University Medical Centers (GUMC) experience with utilizing ATM technology in a telemedicine application will be presented. This application involves 3D radiation treatment planning where radiological imaging, calculation of the treatment plan, and 3D display all take place at different sites. To do this, GUMC must exchange large amounts of radiology images and data with other institutions in real time. A high speed network consisting of an ATM infrastructure and satellite links was created to connect seamlessly the three sites, GUMC, University of Hawaii, and Ohio Supercomputing Center, which are thousands of miles apart. This paper studies the performance of the ATM network between GUMC and Goddard Space Flight Center, which provides satellite service to link partners in this project. The steps required to test and evaluate the ATM system will be presented. A performance comparison between ATM and Internet-LAN connections will be featured in the presentation. In particular, the theoretical speed of 155 Mbps is hard to reach due to the lack of ATM-native protocols in the transport level of the communication structure.