RESUMEN
Ten years after primary, secondary, and tertiary healthcare facilities in Crete were connected in HYGEIAnet, one of the first regional health information networks worldwide, the Twister project addressed the practical challenge of delivering integrated eHealth services to remote healthcare facilities in Crete and the south Aegean. A hybrid network infrastructure comprising terrestrial broadband, wireless, and satellite segments provided connectivity among distributed healthcare organizations. A fast-track methodology of continuous training and evaluation was used to encourage the wide adoption of EHR services in primary healthcare centers and their remote community offices, eTraining in prehospital emergency management, and medical collaboration. For the evaluation of Twister, health professionals using EHRs and citizens visiting the healthcare facilities provided their attitudes and perceptions on eHealth. Although eHealth is viewed differently by citizens and health professionals, both groups consider the EHR as an important part of the daily medical practice. However, continuous training, practical incentives, and awareness initiatives are necessary to increase the use of EHRs and the social embedding of eHealth in rural areas.
Asunto(s)
Servicios de Salud Comunitaria , Internet , Sistemas de Registros Médicos Computarizados , Servicios de Salud Rural , Actitud , Centros Comunitarios de Salud , Grecia , Humanos , Pacientes , Médicos , Atención Primaria de Salud , Encuestas y CuestionariosRESUMEN
A fundamental requirement for achieving continuity of care is the seamless sharing of multi-clinical information. Several different technological approaches can be followed to enable the sharing of health record segments. In all cases interoperability between systems is a prerequisite and this requires presently a major technological challenge. Inter-operability can be achieved either through messages or through a more advanced approach based on a federation of autonomous systems. Message based integration is centered mainly on the exchange of HL7 and DICOM messages for achieving the functional integration of clinical information systems (CIS) at institutional or regional level. The federated approach is principally used for facilitating the virtual view of the Integrated Electronic Health Record (I-EHR), without having to replicate unnecessary information. Within the context of HYGEIAnet, which is the regional health telematics network of Crete, both approaches have been utilized for providing end users with seamless access to clinical information. Both are based on an open architecture, which provides the framework for the reuse of standardized common components and public interfaces. This work presents the experiences related to the implementation of "messaging" and "federating" in HYGEIAnet, which are used complementary to each other. A comparison of the two parallel approaches, together with their strengths and weaknesses is described, and evaluation is given from the technological as well as the end users' perspective. Emphasis is given on the technological challenges in developing open, component-based information infra-structure to support integrated service delivery.
Asunto(s)
Redes de Comunicación de Computadores/organización & administración , Sistemas de Información/organización & administración , Programas Médicos Regionales/organización & administración , Integración de Sistemas , Redes de Comunicación de Computadores/normas , Sistemas de Computación , Grecia , Sistemas de Información/normas , Sistemas de Registros Médicos ComputarizadosRESUMEN
Image indexing, storage, and retrieval based on pictorial content is a feature of image database systems which is becoming of increasing importance in many application domains. Medical image database systems, which support the retrieval of images generated by different modalities based on their pictorial content, will provide added value to future generation picture archiving and communication systems (PACS), and can be used as a diagnostic decision support tools and as a tool for medical research and training. We present the architecture and features of I2C, a system for the indexing, storage, and retrieval of medical images by content. A unique design feature of this architecture is that it also serves as a platform for the implementation and performance evaluation of image description methods and retrieval strategies. I2C is a modular and extensible system, which has been developed based on object-oriented principles. It consists of a set of cooperating modules which facilitate the addition of new graphical tools, image description and matching algorithms. These can be incorporated into the system at the application level. The core concept of I2C is an image class hierarchy. Image classes encapsulate different segmentation and image content description algorithms. Medical images are assigned to image classes based on a set of user-defined attributes such as imaging modality, type of study, anatomical characteristics, etc. This class-based treatment of images in the I2C system achieves increased accuracy and efficiency of content-based retrievals, by limiting the search space and allowing specific algorithms to be fine-tuned for images acquired by different modalities or representing different parts of the anatomy.