Proceedings of the 28th Annual Hawaii International Conference on System Sciences - I995

An Intelligent Multimedia Patients Information System:

Design Problems and Solutions
Dr. Grace Aul, Dr. Ching Kwong Kwokz and Heung Wing h e 1
'Department of Information and Systems Management, The Hong Kong University of Science and
Technology, Hong Kong
2Department of Neurosurgery, Kwong Wah Hospital, Hong Kong

Abstract developed over the past few years [ 11, 14, 181. Another
This paper reports the research findings in the design type of imaging systems which can be used in maintaining
of an intelligent multimedia patients information systems paper records for patients - document processing systems,
(IMPIS). The system is aimed to be used by medical are also being investigated [3,7,101.
professionals at different organizational levels within a
hospital, as well as hospital administrative executives for Integration of these high-end imaging systems with
management support purposes. The data transmitted could existing hospital information systems became one of the
be in the form of text, graphics such as electronic technology challenges faced by today's health care and
diagnostic images, sound such as voice annotation notes, information technology professionals [ 5 ] . The On-line
or video such as critical moments during an operative Medical Record project 1131 was aimed to unify the
procedure. These data are used for helping practitioners in structured clinical database, the point-of-care data
the diagnostic process, conducting research in medical collection and diagnostic image management. However,
areas, and archiving of medical information for future little has been reported on how other types of multimedia
references and medical legal purposes. In addition, data such as graphics, video and audio information can be
statistical results can be generated for facilitating used and integrated into these systems.
resources planning in hospitals. This paper presents an
integrated object-interface-scenario modeling approach to This paper summarizes the preliminary results of the
designing such a system. The problems found, with the IMPIS project conducted by the Department of
illustration of a prototype, and the proposed solution to Information and Systems Management at the Hong Kong
the identified problems are discussed. University of Science and Technology in collaboration
with the Department of Neurosurgery at Kwong Wah
1: Introduction Hospital in Hong Kong. The focus of this research is to
design a patients information system which provides
Multimedia can be defined as the input, assimilation meaningful multimedia data about the medical history of a
and output of any combination of text, graphics, patient. This information can be used for medical
animation, video and audio data through one or more practitioners in diagnosis as well as in handling medical
communication media. It has opened up a new dimension legal cases where a more vivid description of the patient's
for people to expand the use of database management condition is required.
systems by including the storage and manipulation of
audio-visual data other than traditional text. The need for Since the system has to be integrated with the temtory-
multimedia in computerization of patients' medical wide hospital information systems, the existing hospital
records were studied because of its diverse requirements information systems development is described in section
on the variety of data types to be archived. Patients two. Section three presents an integrated object-interface
information system is a potential multimedia application -scenario modeling framework which is used for
which if properly implemented, could improve efficiency, obtaining user requirements during the design phase. As
completion of documentation, and quality of patients care. the concept of multimedia is rather new to the hospital
staff, detailed sessions of discussions and interviews were
The use of multimedia in the medical industry begins conducted with selective medical practitioners and
with electronic diagnostic imaging systems [4, 161. The hospital administrators. A prototype of the system, when
concept of PACS (picture archiving and communication applied in the Department of Neurosurgery of Kwong
systems) which link all diagnostics imaging devices in a Wah Hospital, is described in section four. The design
hospital for storing electronic images such as X-rays, problems and proposed solutions are discussed in sections
computed tomography (CT), magnetic resonance imaging five and six respectively. Conclusions and future work are
(MRI), ultrasound and computed radiography (CR), has given in section seven in the paper.

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 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 1995

2: Development of hospital information human resources and payroll system, financial system,
systems in Hong K m g assets management and materials management systems,
staff roistering system, library management and text
Hong Kong's Hospital Authority (HA) officially took delivery system, electronic mail and office automation
over the management of all 39 hospitals and 56 specialist systems are also under investigation.
out-patient clinics in Hong Kong in December 1991 from
the Government Hospital Services Department and Before the temtory-wide hospital information systems
subverted Health Organization. Erom an organization with can support permanent archival of electronic diagnostic
almost no co-ordinated computerizationimplementation,a images of patients, most of the diagnosis are still based
three-stage IT strategy formed in 1992 will take the HA upon verbal description of the symptoms from the patient
into the year 2000 [ 111. or some medical examination results that are generated
from other sources. The P A S data only include patients'
Stage I of the strategy begins in 1992 with the "Hong admission and discharge infomation, but does not contain
Kong Health Information Highway" project. The goal of any information about the diagnosis or operation that a
the project was to attain "seamless health care delivery" patient has at the hospital. The IMPIS project attempts to
by linking up 39 general hospitals, 56 specialist outpatient go beyond the traditional approach by expanding the
clinics and two HA offices via high-speed networks. Four patient's medical history to include graphics, audio and
fundamental databases - Patients, Staff, Finance and video data. These data may be crucial to the physicians
Assets were established. An integrated patient when images and video clips showing critical treatment
administration system (IPAS) which enabled the that a patient has received previously are important in
centralization of territory-wide patients admission and giving a more informed and efficient diagnosis.
discharge records were implemented. Other systems Inappropriate application of drugs on patients due to the
systems such as the out-patient appointment system and lack of detailed patient's medical history, especially in
the drug dispensing labeling system were also emergency cases, can be reduced. Some of the
implemented. Stage I1 recently begins with the examinations required can be automated so as to support
development of clinical information systems. Stage 111 the medical practitioners in the diagnostic process. By
will be focusing on the integration of applications in the entering the results of the examination on-line, instant
hospital and clinical environment. The development of analysis on the patient's condition can be obtained.
management support systems to help hospital
administrative in monitoring the existing operation and Currently, the patients admission and discharge data
planning for future services will also be included. generated by IPAS are downloaded to Kwong Wah
Hospital as a ".DBF" file in a real-time mode. This file is
An electronic medical card which contains personal stored at a local hospital server where authorized users
particulars of the patient and some vital data on medical with the appropriate level of security access are able to
precautions such as the patient's drug history is currently log onto the database through a desktop personal
being evaluated in two hospitals. The objective of the computer. Nevertheless, one of the design challenges of
medical card is to enable first-hand information about a IMPIS was to integrate the inEormation of the patients
patient to be retrieved quickly and easily in case of collected at the hospital with the data stored in IPAS.
emergency, during patient registration and processing of After studying the data structure of IPAS, an object-
patient bills. If proved to be successful, the patient card interface-scenario approach as described in the following
will be rolled out to all public hospitals. It is also section, was used to investigate the user requirements of
anticipated that the next version of the electronic card will multimedia system.
be able to carry the medical case summary of the patients
in the form of text and image using the optical media. 3: The object-interface-scenarioframework
Other applications that are under investigation include Allen and Frieder [2] described PACS and the
in-patient and out-patient management systems, patient complications of database design and communications
records management system, and patient billing and constraints with an examination on both the relational and
revenue collection system. Clinical support applications object-oriented database approaches, as well as the
under development or outsourced by Hospital Authority centralized and distributed approaches. These approaches
include radiology information management system, ward are generally "database table-focus'' or "relationship-
order entry and resuIts reporting systems, specialty focus" modeling methodologies. As the design of IMPIS
clinical information systems, operating theater is centered around "patients" and "medical practitioners"
management system, computer-based pharmaceutical as end-users, it is more appropriate to use a user-oriented
procurement and supplies management system, diagnostic approach focusing on how data are being manipulated by
imaging system, laboratory management system and users An integrated object-interface-scenario modeling
nursing management information system. Business framework is therefore applied so as to capture the
support applications such as clinical management system, complex and uncertain requirements of the system.

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 Proceedings of the 28th Annual Hawaii Iniemational Conference on System Sciences - 1995

Several joint application design sessions were held There are two types of objects in the object-interface-
between systems designers and selective medical staff in scenario analysis. Physical objects are objects such as
order to explore the user requirements. A prototype was patients, doctors, clinics, hospital administrators and
built during these sessions for helping the users to examination reports, which retain their own identity either
visualize how the system will work in reality so that they outside or inside the computerized system. Logical objects
are able to specify the requirements in more depth. are objects that are created artificially such as
computerized records.
The objective of the IMPIS system is to have
"complete" medical data on each patient. This include all As there are many events that could happen to a patient
the possible incidents that could happen to a "patient", for through time, possible scenarios were then identified and
example, being diagnosed by a doctor, taking a medical studied (see figure 1). The two main parameters in
examination or taking an X-ray, etc., with recording of the formulating a scenario is the purpose of the patient's visit
time, date, place, persons involved and outcome of the and the clinic involved. An example of a scenario is
event. As different from a text-based transaction "when a patient visits the cardio-pulmonary surgery unit
processing system, the scope of the data in Ih4PIS include for a post-operation medical check.
diagnostic images, graphics, voice and video clips.

Figwe 1. The Concept of A Scenario

Patient Patient
leaves or
discharged

collect druas on .
The scope of this research involves a detailed study As the scope of study is too wide to be covered in the
based on the scenario matrix as shown in figure 2. All initial investigation, the requirements of the Department
possible events that could happen to a patient in either an of Neurosurgery was selected to be a pilot site for the
in-patient or out-patient case are required to be further study to be undertaken.
broken down for all different types of clinics. For
example, a medical examination recommended by a The "interface" between different objects for example,
physician or an operation being performed by a surgeon. patient, doctors, nurses, etc., in each scenario event are
examined. The modeling of the interface involves the
Figure 2. The Scenario Matrix following tasks :
identify the role of different objects involved in the event
identify the means of communication between different
HOSPITAL CLINICS
Internal Medicine .
In- Patient
...
Out-Patient
objects
examine what type of information is being generated and in
Neurology
Nephrology ..
0

.. what format
describe how the information is being used by different
Cardiology
Endocrinology .. .. objects and identify the flow of information between these
Geriatric
Urology .. ..
objects
identify how the information is being stored and retrieved by
General Surgery
Other Specialties
Cardio-pulmonary Surgery e
. e
different objects

Two types of data are being classified in the modeling

Gastro-enterology
Neurosurgery
Ophthalmology
e
. ..
0
process. Global data refers to patient data which are
shared between different departments in the hospital, and
0
local data which are mainly generated and used within the
Ear-Nose-Throat ENT
Obstetrics and Gynecology
e
e .. department. The global data contains a further subset of
patients' demographic data which has the same data
Pediatrics
Radiology .
0

. structure mapping as that of the IPAS database at Hospital

Authority. Hence, whenever there is a change of data
Anesthesiology
Pathology
Orthopedics
..
0 e

e
. structure of IPAS, only this portion of the data file and the
associated program will need to be updated.

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 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 199s

4: A prototype system for IMPIS Angiogram (see figure 8 ) contains graphical

information such as X-ray images of blood vessels for the
A prototype based on the above design methodology patient under examination. It allows users to record the
when applied in the Department of Neurosurgery at pathological findings of the blood vessels by annotating
Kwong Wah Hospital was built for users to evaluate. The on a standard anatomical diagram of the organ concerned.
scenario selectcd was "when a patient was admitted as an
in-patient to the department until he or she is discharged Admission Diagnosis is designed to record the clinical
from the hospital". The conceptual structure of the IMPIS findings of the patient on admission to the ward. In
prototype and its associated entity-relationshipdiagram is addition, the external injuries such as bruising and
shown in figures 3 and 4 respectively. laceration can be malced on a graphical representation of
the human body on the computer s c m (see figure 9).
There are two components in the prototype - the patient This type of graphics recordings are extremely useful at a
case record and the medical library. According to figure 4, later date when there is a medical legal implication such
each component is made up of a group of entities. The as health insurance claim.
case summary entity forms the focal point of the patient
case record component. Each case summary record W a r d contains a physical layout of the beds in the
belongs to one patient and may contain one or more ward with the occupation details of beds (see figure 10).
operation records. Each operation note may have one or With the trigger of a button on the selected bed in the
many operation codes and angiogram. Detail description diagram, the data of the patient assigned to the bed will be
of each entity type is given in the following subsections. instantly retrieved from the IPAS database. A report can
In addition, the patient record comporlent integrates with be printed out to show the utilization rate of the beds in
IPAS. It contains a data mapping of IPAS together with the ward over a period of time so that better arrangement
other clinical information such as medical officer in of beds can be made.
charge, diagnostic examination results and operations
record. The medical library acts as a supporting unit and Prescription module is integrated with the drug
data source for the patient case record. An interface of the formulary database so that data about the drug can be
IMPIS prototype system for the Department of retrieved automatically. The prescription form generated
Neurosurgery is shown in figure 5. is used in issuing to the patients and transferring to the
pharmacy division.
4.1: The patient w e record component
Electromyelogram ( E M G ) Record keeps the
The Case summary entity (see figure 6) contains electromagnetic diagnostic information of a patient with
summary information on each patient who is admitted to an image of the waveform such as electroencephalogram
the hospital. A case will be closed when the patient is (EEG) and the doctor's opinion of the diagnosis.
discharged. All information such as history, progress,
disease, operation and outcome are condensed on a case 4.2: The medical library component
summary form. This is particularly useful in getting all the
admission information at a glance during out-patient Disease Code holds a full set of ICD90 standard
follow-up. With such means, continuous care of the disease description and codes. The information inside is
patient can be ensured. Moreover, this module is called by many patient case record modules such as case
integrated with IPAS so that the personal details of the summary, operation record, etc. Operation Code is
patient are not required to be re-entered in the system. By similar to the disease code and also follows the ICD90
using the unique "hospital number" assigned by IPAS standard. It is used in a similar manner to disease code.
during patient admission, the corresponding data about a Drug Formulary contains brief information and coding
particular patient can be retrieved instantly. about all the drugs available in the hospital. The
information is well classified and organized so that users
Operation Notes record the details about every can easily access the data. Drug formulary is integrated
operation that is being performed daily. Photos of the with the prescription module.
injured patient prior to and after the operation are stored
(see figure 7). Such records also incorporated the key 4.3: Other functionality
medical images such as CT scan and video clippings of
the critical moments during an actual operation (see figure The prototype generates two types of reports - the
8). Surgeons can annotate voice recording notes on admission statistics report that shows the number of
important findings for that record. This integration and patients that are admitted to the hospital within a selected
amalgamation of all these forms of multimedia data are date range and the work load statistics report that shows a
extremely valuable in giving a more informed and vivid summary of work load status of different surgeons within
description of the operative procedures which cannot be a certain period. These reports are used by hospital
achieved otherwise by using pure text. executives for supporting management decisions.
Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 1995

Figure 3. A Conceptual Structure of the IMPIS Prototype

Medical Library A Patient Case Reocrd

Drug formulary Case summary
Operation code Operation notes
Disease code Admission diagnosis record
EMG record
Angiogram
Prescription
Ward record

PATIENTS INFORMATION SYSTEMS

Figure 4. Entity-relationship Diagram of IMPIS Prototype

Admission
Diagnosis Record

EMG Record
Patient Case Record
Medical Librarv

Operation Code Disease Code

I : 1 relationship
d I :M relationship

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 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 1995

Summary Formulary Statmtiu

Figure 7. The Operation Note Module (2)

. ... ...

............................................

Figure 10. The Ward Module

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 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - I595

5: Design problem onto IMPIS. Medical data is as sensitive as criminal

records, and should not be accessed by all levels of
An evaluation on the prototype was done by showing medical staff. It is a,c"mon practice that all medical data
the system to a wider group of potential users including generated from the hospital are considered properties of
doctors, surgeons, nursus and other medical officers in the the hospital and will not be released without consent.
Department of Neurosurgery. Users were asked to try out Also, another matter noticed by the users were what if the
the system individually and feedback was collected from patients refuse for any video to be taken in an operation.
the users. The results were further supplement by the
observations made during the evaluation process. The A major problem raised by the surgeons was the use of
type of problems encountered can be categorized into two these computerized records in medical legal cases. In
groups - technical and non-technical problems. Hong Kong, there is no written law in accepting computer
digitized data as legal documents. At the moment, only
5.1: Non-technical problems microfiche and microfilm are accepted in court as medical
evidence. Although the use of WORM (write-once-read-
The non-technical problems can be discussed with many) disks for permanent archive of original data seems
respect to users, operational and social perspectives. to be one possible solution in proving the originality of
the document, the legal procedures involved in certifying
5.1.1: User-relatedproblems a WORM diskette as a "true" has to be established.

During the evaluation process, we discovered that most 5.2: Technical problems
medical professionals generally have a low level of
computer literacy. Many do not even know how to type. The prototype system was implemented using
The learning curve of users are generally very slow. FileMaker h-o running on Microsoft Chinese Windows
Intensive training and a long period of hands-on support over a period of two months during the joint application
was required to help the users to use the system. design sessions. A small ethemet network running for two
to three users was set up for the testing purpose. There are
Surgeons, are generally found to resist the use of five main technical concerns discovered throughout the
computer systems in their work firstly because they found design and prototype evaluation process.
it difficult to learn a new technology at their age, and
secondly, rejected the additional work load on their job 5.2.1: Integration with P A S
duties, Although they are convinced about the potential
benefits of being able to retrieve medical history of a Since IPAS is managed by Hospital Authority, the
patient very easily, they do not want to get involved with interface program written for retrieving IPAS data from
the actual input process of the data. IMPIS has to be updated whenever there is a change in
the IPAS data structure. It is anticipated that more and
5.1.2: Operational and cost problems more of this type of maintainance problems will arise as
the territory-wide hospital information systems are being
The input logistics of the data required in the system increasingly centralized.
was addressed seriously by the users. Since there is no
computerized radiology system installed in the hospital, 5.2.2: Availability of software developmenttools
these images have to be manually input into the
computers system. A scanning or digitizing input The ideal database management system development
workstation is required to capture these electronic environment for developing this type of system should be
diagnostic images onto the computer. This is a tedious able to handle multimedia data types, SQL and client-
process and it is evident that it would not be appropriate server processing functions. Such pre-requisites limit the
for surgeons to input these data into the system. Similarly choice of database software. On the PC, Filemaker Pro,
for video data. Since only critical moments were required and FoxPro for Windows for example, are popular
to be stored, it means that the video has to be edited database software development tools which can be
before digitized into the computer. At the moment, not all adopted for such purposes. However, the database engine
the surgical operations are recorded onto video tapes. The of these systems are not powerful enough for supporting
cost of implementing such a system hence became a multimedia applications in a multi-user environment. It
critical issue to hospital executives interviewed. was impossible to transfer a video clip of one minute and
display the video without crashing the system.
5.1.3: Sacial problems
A system that supports both Chinese and English data
The security of patients' data was a major social entry and output is needed for IMPIS. Data such as the
concern, especially when a user cam easily get access to patient name is necessary to be stored in both languages in
the territory-wide patients data bank once they are log Hong Kong. The commonly used Chinese characters set

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 Proceedings of the 28th Annual Hawaii Intematwnal Conference on System Sciences - I995

for computer is Big 5 code. However, software which can 6: Soiutions

support Big 5 code and co-exists with both a networking
software and a database program is very limited. Under For the non-technical problems discussed above, one
the Microsoft Chinese Windows, only Novel1 network of the solutions in helping the users in using the system is
system is compatible. to adopt a consistent interface in thc design.This principle
was enforced by using common background buttons
5.2.3: Capacity af data storage required between screens, clear field labels and standard typeface.
User-friendliness and simplicity is the most critical
It is estimated that a huge capacity of data storage is principle in designing the user interface. A long education
required. There is about 20,000patients admitted each process in convincing the users of the benefits and
year in a general hospital. If the average of each patient teaching the users in using the system cannot be avoided.
case file is 20 megabytes, a total of 400 gigabits of storage Also, it is found that features such as the automated
space will be required per year. Even if the files are admission diagnosis module which enabled instant results
compressed to 1:4 of the size, 100 gigabits are still to be generated helped to attract users' interests. More of
required. With the fastest CPU,the delay in retrieval time this type of features that is closely related to their routine
is inevitably slow. Allowance has also to be made for tasks will help to better utilize the system. We have also
decompression of the file. found that most medical practitioners liked the idea of
using voice annotation in recording the case notes instead
There is also a data retention problem of the data of typing in the text manually. Users indicated that the
downloading from the IPAS database. The database is concept could be applied to other tasks where they have to
growing at a rate of 40 megabytes per month. With the make notes while carrying out their daily duties.
current mode of downloading, a detailed capacity plan is
required in order to accommodate the data expansion. The only solution to the data input problem is to have
one or more dedicated operators to cany out the digitizing
5.2.4: Hardware ConfSguration for user workstation process. In order to store critical moments of an operation,
a new procedure has to be implemented in the hospital
The minimum configuration for supporting multimedia and supporting staff have to be appointed to manage the
output on a Windows-based PC for a user demands a video shootinlg process. There will also be a need for the
computer such as a 486DX2 66MHz with at least 16 surgeon in charge to select the required video clippings.
megabytes of RAM, a high resolution VGA graphic
acceleration card and monitor, a pair of speakers with a On the social issues concerned by the medical
16-bit sound card a video compression and display card, a professionals, solutions have yet to be determined. The
decompression card for images, a SCSI card for a CD- inclusion of multimedia data has provoked the need for
ROM drive or additional hard disk and a network card. re-thinking about the responsibilities of medical staff in
With these armamentarium, the slots in the PC are maintaining patients record within a hospital. It is likely
completely filled, even for the most up-to-date hardware that new procedures and policies have to be formulated in
architecture design. Moreover, it will be difficult to utilize order to facilitate the implementation so that all the
fully the computer for other purposes other than medical required data are properly archived into the system.
records. The cost of such a machine is inevitable high. Consensus have to be obtained from the patients if this
type of data were to be stored as part of a patient's case
5.2.5: Networking support record in the hospital. In addition, patient's right in
accessing the archived information will have to be stated
Electronic medical record has to be stored and clearly on a signed agreement between the patient
retrieved on a reliable hospital network system. Such a involved and the hospital. Data security policies within
system might be required to link 50 workstations in a the hospital have to be carefully established in order to
small hospital to as much as 200 workstations in a large avoid misuse of any sensitive patients data.
general hospital. Heavy traffic within the network is
expected during the office hours. Delivery of a large file Most of the technical problems found in the evaluation
including images, sound and video clips requires process were mainly due to the hardware limitations,
significant traffic time. When more than 50 users are networking support and software incompatibility
retrieving or printing data, undue delay is bound to problems. These technological problems will be sorted out
happen when the network is based on the exist in time. Research work in handling these problems have
technology. The ethernet system with coaxial wiring been conducted by others [l, 8, 121. However, what is
system is doom to halt the whole system. More wide band missing is a conceptual design for illustrating the role of
cabling, such as optical fiber, is required. However, such various components, how they could be arranged in such
cable is expensive and not economically feasible in the an environment so as to work together cost-effectively. A
public hospital system with a skeleton budget. proposed system architecture design for IMPIS based on
the lessons learn from this research is shown in figure 11.

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 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 1995

DWAM'UEWAL LOCALAREA NEWORK

I
II
P
A
S

High-speed network (e.g. FDD/)

5. mulUmedia 3.
data 2. results 1. query

- t t
High-end U w retrievrl user mtrleval
L worllltrtion workstation

IHOSPITAL NETWORK

A "true" multimedia information system requires the and the electronic data management system is established
marriage of both a powerful client-server architecture by using a database table maintaining the relationship
database management system and an efficient electronic between the record in the database management system
multimedia data management system. As the requirements and the associated identification key@) of the multimedia
of diagnosis examination support increase in the system, a data. When a user executes a query on a patient, the query
dedicated medical diagnosis server is recommended. will be sent to the database management system for
processing. A list of results which fits into the criteria of
Database management systems which can handle the user will be returned and displayed on the computer
multimedia data in a multi-user environment are still terminal. The user can continue the query process until an
limited. Most vendors claim that their database systems option for retrieving further multimedia data is selected.
are able to support multimedia simply because the The command will then be sent to the database
systems are able to handle one gigabit of data per field management system where the associated identification
and user can define data types such as "picture", "movie", key(s) of the multimedia data is retrieved. The database
"sound", etc. There is usually no other functionality to management system then sends a message to the
facilitate the input, processing and output of multimedia electronic multimedia data management system and the
data in these systems. The system architecture of these selected data file is located. The electronic multimedia
database management systems are often maximized for data management system then takes over the user request
on-line text-based data transaction processing instead of and send the multimedia data file to the user over the
geared towards an effective archival and retrieval of high-speed network. In this way, the database
multimedia data. An electronic data management system, management system can continue to serve the usual
which is designed specially to archive and retrieve transaction processing for other users while the electronic
multimedia data, will help to improve the system multimedia data management system will concentrate on
performance. Input, processing, output and other facilities managing the transfer of multimedia data.
such as conpressionldecompressiontechniques are often
built into these systems in order to maximize the quality In order to reduce the cost of hardware and networking
of the data stored and speed of retrieval, but at the same devices, a hybrid model of network design can be used by
time minimize the storage cost of the multimedia data. partitioning the hospital network into high speed network
such as FDDE to serve high-end users and an ethernet
The design proposed to utilize the on-line transaction network to serve normal users. Each department should
processing power of a client-server database by putting all install a decentralized LAN system linked to a high-speed
the database tables in the hospital-wide server. Each data hospital-wide networking backbone with their own
file in the electronic multimedia data management system departmental medical diagnostic server and electronic
is labeled with a unique identification number. The link data management system. This will help to reduce the
between the client-server database management server traffic of transmitting multimedia data across the hospital

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 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 1995

network. Only inter-departmental exchange of data is Conference on Multimedia Computing and Systems,
transported through the backbone. Data such as laboratory Boston USA, p. 76-85.
results which are mostly text-based can be distributed Allen L. and Frieder 0. (1992) "Exploiting Database
through the ethernet channel. Although the database Technology in the Medical Arena", IEEE Engineering in
Medicine and Bwlogy Magazine, vol. 1 1 no. 1, p. 4249.
structure is different for each department, the data inside Au G. (1992) "Using Document Image Processing in the
IPAS are shared by various departments. Data generated Health Care Industry", Proceeding of the Second Asia-
from different departmental LAN can be filtered and Pacific Medical Informatics Conference, Hong Kong,
extracted before exporting back to the central Hospital Nov 1992.
Authority data bank for generating statistical reports. Dayhoff R.E. (1988) "A Medical Image Database",
Optical InformationSystems, vol. 9 no. 12, p. 39-40,42.
With the advent of CD-ROM, bulky multimedia data Dayhoff R.E., Maloney D.L.. Kuzmak P.M., Shepard
storage at departmental level is feasible and economical. B.M., Kenney T.J., Sadan A., Fletcher R.D., and Lu D.
When the hard disk in the departmental server is full, the (1991) "Experience with MUMPS-based Hospital
data can be spilled over to a CD-ROM. As most of the Information System with Images", MUG Quarterly, vol.
21 no.3, p. 53-56.
hospital record is not going to be changed after all the Gmsky W.I. (1994) "Multimedia Information Systems",
data is verified, it can be stored on a CD-ROM. Sequential IEEE Multimedia, vol. 1 no. 1, p. 12-24.
CD-ROMs can be loaded onto a jukebox or stack CD Kaebnick G.E. (1990) "Burbank Hospital Eases into Full
players. Many years of record can be read and retrieved Document Automation", Inform, vol. 4 no.8 p. 27-79.
simultaneously by this method. Khayat S.H. and Bovopoulos S.H.(1994) "A Proposed
Bus Arbitration Scheme for Multimedia Workstations",
7: Conclusions and future work Proceeding of the International Conference on
Multimedia Computing and Systems, Boston USA, p. 415-
The research presented in this paper has demonstrated 424.
Kleinholz L. and Ohly M. (1994) "Multimedia Medical
how multimedia data can be used in real-life applications. Conferencing: Design and Experience in the BERMED
However, we have discovered that the inclusion of Project", Proceeding of the Intematiowl Conference on
multimedia data does not simply means installation of an Mdtimdia Computing and Systems, Boston USA, p. 255-
optical fiber network or having powerful multimedia 264.
computers. Rather, it often requires more involvement and Kohn D. (1991) "Current and Future Applications of
co-operations with users of the systems in the input stage Optical Storage Technology in the Health Care Industry",
than traditional text-based database systems. The cost of Document Image Automation, May-June 1991, p. 143-
implementation of this type of system is high and the 148.
value of the return has yet to be determined. The success 111. Masudo Y. and Yohro T. (1990) "An Introduction to
of implementing a system like W I S also rely heavily on Anatomical Image Digitizing System", Computer
Methods and Programs in Biomdicine, vol. 31 no. 2, p.
organization intervention in pursuing these systems to be 115-123.
used effectively. Nevertheless, the advancement in 121. Okon C. (1994) "Promoting Interoperability for
information technologies has given rise to the birth of a Networked Multimedia", Advanced Imaging, March
new generation of computerized patients records in a 1994, p. 52 and 70.
format that was not possible ten or twenty years ago. 131. Lee R. (1989) "The Online Medical Record", Federation
However, the development of this new generation of of American Health Systems Review, vol. 22 no. 2, p.50-
computerized patients record will not rely only on the 52.
continuous growth in technologies, but also on the way 141. Lieber H., Buchsteiner W., Offenmuller W.(1991) "RIS -
how this type of information is accepted in our society. A Radiology Information System, Introduction and
Benefits in the X-ray Department of the Straubing
Hosipital", Electromedica, vol. 59 no. 3, p. 89-97.
In spite of the problems which cannot be solved by 151. Ruszowski J., Kim Y., Spelman F.A. (1989) "Clinical
technologies alone, we will continue the development of Decision Making Based on Expert Knowledge Relational
another generation of IMPIS based on our proposed Rules: an Information-Theoretical Approach",
design and explore how users response to other new Proceedings of the Annual International Conference of
technologies. The scope of study shall include features IEEE Engineering in Medicine and Biology Society,
such as artificial intelligence [151, content-based retrieval Seattle USA.
techniques on multimedia data, video-conferencing in 161. Spilker C. (1987) "Medica1 Imaging: Merging Picture
supporting collaboration diagnosis [9] and voice Archives and Communications", Inform, vol. 1 no. 3, p.
recognition systems [TI. 24-27.
171. Tan H. (1994) "Taking Hong Kong's healthcare into Year
2000", The ITMaga&e, inagrual issue, p. 98-110.
References Treves S.T., Hashem E.S., Majmudar B.A., Mitchell K.,
and Michaud D.J. (1992) "Multimedia Communications
[l]. Adam J.F., Houh H. H., Ismert M.. Tennenhouse D.L. in Medical Imaging", 1EEE Joumal on Selected Areas in
(1994) "A Network Architecture for Distributed Communications, vol. 10 no. 7, p. 1121-1132.
Multimedia Systems", Proceeding of the International

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