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Yearb Med Inform 1996; 05(01): 76-86
DOI: 10.1055/s-0038-1638048
Review Paper
Georg Thieme Verlag KG Stuttgart

Constructing Workstation Applications: Component Integration Strategies for a Changing Health-Care System

R. A. Greenes
1   Decision Systems Group, Brigham and Women’s Hospital, Boston, MA, USA
,
S. R. A. Deibel
1   Decision Systems Group, Brigham and Women’s Hospital, Boston, MA, USA
› Author Affiliations
Further Information

Publication History

Publication Date:
05 March 2018 (online)

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Abstract

A health-care workstation is the means by which a professional interacts with the information artifacts of health care. However, a major transformation is taking place in the software architecture of health-care systems that alters significantly the role of the workstation. Health-care systems are becoming more complex in response to the need to support “extended enterprises” across regions, and provide both horizontal and vertical integration capabilities. Component-based software methodologies are being introduced that match well the needs of these large systems and the component services they must integrate. In the component-based framework, a workstation functions less as a “portal” for information transactions carried out on distant host computers, and more as the “orchestrator” for tasks involved in assembling, organizing, presenting, and manipulating information. Applications residing on workstations access distributed software components that carry out encapsulated functions for the application. Componentintegration methodologies include both formal and ad hoc approaches; the principal emerging technologies are the World Wide Web (WWW), CORBA, Java, OLE, and OpenDoc. An emerging strategy appears to be that of developing application integration environments that encompass and support all of these integration methodologies. Component-based approaches also facilitate standardization at the message level, as messages to classes of components can serve to focus such standardization.

Keywords

Workstations - Integration - WWW - Corba - Java - OLE
 

  • References

  • 1 Ball MJ, Silva JS, Douglas N, Degoulet P, Kaihara S. (eds.) The Health-care Professional Workstation. Proc of IMIA Working Conf, Washington, DC, June, 1993; Int J Biomed Comput. 1994; 34: 414
    PubMedGoogle Scholar
  • 2 Bodenheimer T, Grumbach K. The reconfiguration of US medicine. JAMA 1995; 274: 85-90.
    CrossrefPubMedGoogle Scholar
  • 3 Frenkel M. Health financing policy after the 1994 Clinton plan experience. J Healthcare Finance 1995; 21 (03) 68-71.
    PubMedGoogle Scholar
  • 4 Gold MR, Hurley R, Lake T, Ensor T, Berenson R. A national survey of the arrangements managed-care plans make with physicians. N Engl J Med 1995; 333: 1678-83.
    CrossrefPubMedGoogle Scholar
  • 5 Grimes J, Potel M. Software is headed toward object-oriented components. Computer 1995; 28: 24-5.
    PubMedGoogle Scholar
  • 6 Lewis TG. Where is client/server software headed?. Computer 1995; 28: 49-55.
    PubMedGoogle Scholar
  • 7 Bernstein PA. Middleware: A model for distributed system services. Commun ACM 1996; 39: 86-98.
    CrossrefPubMedGoogle Scholar
  • 8 Pancake CM. The promise and the cost of object technology: A five-year forecast. Commun ACM 1995; 38: 33-49.
    PubMedGoogle Scholar
  • 9 Stoufflet PE, Deibel SRA, Traum JH, Greenes RA. A state-transition method of modeling clinical encounters. In: Proc 1995 AM1A Spring meeting 1995: 81
    Google Scholar
  • 10 Starren J, Friedman C, Johnson SB. The Columbia Integrated Speech Interpretation System (CISIS). In: Gardner RM. ed. Towards Cost-Effective Clinical Computing. Proceedings of the 19th S;ymposium on Computer Applications in Medical Care Philadelphia: Hanley & ;Belfus Inc; 1995: 985
    Google Scholar
  • 11 Poon AD, Fagan LM. PEN-Ivory: The design and evaluation of a pen-based computer- system for structured data entry. In: Ozbolt JG. ed. Transforming infonnation, changing health-care. Proceedings of the 18th Symposium on Computer Applications in Medical Care Philadelphia: Hanley & Belfus Inc; 1994: 447-51.
    Google Scholar
  • 12 Bell DS, Greenes RA. Evaluation of UltraSTAR: Performance of a collaborative structured data entry system. In: Ozbolt JG. ed. Transforming information, changing health-care. Proceedings of the 18th Symposium on Computer Applications in Medical Care Philadelphia: Hanley & Belfusinc; 1994: 216-21.
    Google Scholar
  • 13 Giger M, MacMahon H. Image processing and computer-aided detection and diagnosis. Imaging and Information Management: Computer Systems for a Changing Healthcare Environment. In: Greenes RA, Bauman RA. eds. Radiol Clinics of North America 1996: 34 in press
    Google Scholar
  • 14 Goldberg MA. Teleradiology and telemedicine. Computer Systems for a Changing Health-care Environment. In: Greenes RA, Bauman RA. eds. Radiol Clinics of North America 1996: 34 in press
    Google Scholar
  • 15 Berners-Lee T, Cailliau R, Luotonen A, Nielsen H, Secret A. The World-Wide Web. Commun ACM 1994; 37: 76-82.
    PubMedGoogle Scholar
  • 16 Berghel H. The client’s side of the World Wide Web. Commun ACM 1996; 39: 31-40.
    CrossrefPubMedGoogle Scholar
  • 17 Lowe HJ, Lomax EC, Polonkey SE. The World Wide Web: A review of an emerging Internet-based technology for the dirstribution of biomedical information. J Am Med Informatics Assoc 1996; 3: 1-14.
    CrossrefPubMedGoogle Scholar
  • 18 Kohane IS, Greenspun P, Fackler J, Cimino C, Szolovits P. Building national electronic medical record systems via the World Wide Web. J Am Med Informatics Assoc 1996 3:inpress. See also http://www.emrs.org/medweb
    PubMedGoogle Scholar
  • 19 Cimino JJ, Socratous SA, Clayton PD. Internet as clinical information system: Application development using the World Wide Web. J Am Med Informatics Assoc 1995 2. 273-84. See also: http://www.cpmc. columbia.edu/cisdemo
    PubMedGoogle Scholar
  • 20 Jagannathan V, Reddy YV, Srinivas K, Karinthi R, Shank R, Reddy S, Almasi G, Davis T, Raman R, Qiu S, Friedman S, Merkin B, Kilkenny M. An overview of the CERC ARTEMIS Project. In: Gardner RM. ed. Towards Cost-Effective Clinical Computing. Proceedings of the 19th Symposium on Computer Applications in Medical Care. Philadelphia: Hanley & Belfus Inc, 1995 12-6. See also http://www.cerc. wvu.edu/nlrn/nlm.html
    PubMedGoogle Scholar
  • 21 Goldwein J, Wong M, Buhle L. A multimedia radiation oncology information resource on the internet. Proceedings of the American Society for Therapeutic Radiology and Oncology. Int J Radiat Oncol 1994; 30: 298
    PubMedGoogle Scholar
  • 22 Galvin JR, D’ Alessandro MP, Erkonen WE, Knutson T A, Lacey DL. The Virtual Hospital: A New Paradigm for Lifelong Learning in Radiology. Radiographies 1994; 14: 875-79.
    CrossrefPubMedGoogle Scholar
  • 23 Mammone GL, Holman BL, Greenes RA, Parker JA, Khorasani R. Inside Brigham RAD: Providing radiology teaching cases on the Internet. Radiographies 1995; 15: 189-98.
    PubMedGoogle Scholar
  • 24 Schwartz R. Writing Interoperable Applications with ODBC. See http:// discorp.corn/futures/8_22/interop.htm
    PubMed
  • 25 Hammond WE. The role of standards in creating a health information infrastructure. In: Ball MJ, Silva JS, Douglas JV, Degoulet P, Kaihara S. eds. Proc of 1M1A Working Conf 1993 Int J Biomed Comput 1994; 34: 29-44.
    CrossrefPubMedGoogle Scholar
  • 26 Horii SC, Prior FW, Bidgood Jr DW, Pari sot C, Claeys G. DICOM: An Introduction to the Standard. See http://www.xray.hmc. psu.edu/dicom/dicom_intro/DICOM Intro.html
    PubMed
  • 27 Ratib O. Multimedia image and data navigation workstation. RSNA’95 Scientific Program. Supplement to Radiology 1995; 197 (P) 546
    PubMedGoogle Scholar
  • 28 Turner F. An overview of the Z39 .50 information retrieval standard. See http://www.nlc-bnc.ca/ifla/VI/5/op/udtop3.htm
    PubMed
  • 29 Adler RM. Emerging standards for component software. Computer 1995; 28: 68-77.
    PubMedGoogle Scholar
  • 30 Bernstein P A. Middle ware: A model for distributed system services. Commun ACM 1996; 39: 86-98.
    CrossrefPubMedGoogle Scholar
  • 31 Greenes RA, Deibel S. Clinical image interpretation, review, and education support tool kit (lnfo Rad exhibit). RSNA’93 Scientific Program. Supplement to Radiology 1993: 449
    Google Scholar
  • 32 Chueh HC, Barnett GO. Building a clinical workstation using components and a distributed object services architecture. See http://www.lcs.mgh.harvard.edu/
    PubMed
  • 33 Deibel SRA, Greenes RA. An infrastructure for the development of health-care information systems from distributed components. J A mer Soc Inform Sci 1995 46. 765-71. See also http://dsg.harvard.edu/
    PubMedGoogle Scholar
  • 34 Ark ad K, Allfeldt H, Gao X, Shahsavar N, Wigertz O, Francois-Choristophe J, Degoulet P. Integration of data driven decisin support into the HELlOS environment. The Health-care Professional Workstation. In: Ball MJ, Silva JS, Douglas JV, Degoulet P, Kaihara S. eds. Proc of /MIA Working Conf 1993 Int J Biomed Comput 1994; 34: 195-205.
    CrossrefPubMedGoogle Scholar
  • 35 van Mulligen EM, Timmers T, Brand J, Cornet R, Van den Heuvel F, Kalshoven M, van Bemmel JH. HERMES: A healthcare workstation integration architecture. The Health-care Professional Workstation. In: Ball MJ, Silva JS, Douglas N, Degoulet P, Kaihara S. eds. Proc of /MIA Working Conf 1993 Int J Biomed Comput 1994; 34: 267-75.
    CrossrefPubMedGoogle Scholar
  • 36 Gosling J, McGilton H. The Java(tm) language environment: A white paper. See http:/ /java. sun.com/white Paper/javawhitepaper-1.html
    PubMed
  • 37 Lindberg DAB, Humphreys BL, McCray AT. The Unified Medical Language System. Meth Inform Med 1993; 32: 281-91.
    PubMedGoogle Scholar
  • 38 Cimino JJ. Vocabulary and health-care information technology: State of the art. J Am Soc Inform Sci 1995; 46: 779-82.
    PubMedGoogle Scholar