Electric Differential Multimedia Laboratory Bibliography
Jeffrey R. Galvin, MD
William E. Erkonen, MD
Michael D'Alessandro, MD
Peer Review Status: Externally Peer Reviewed
Dr. Galvin is associate professor, Dr. Erkonen is assistant professor, Dr. D'Alessandro is resident, the Electric Differential Multimedia Laboratory, Department of Radiology, The University of Iowa College of Medicine, Iowa City, IA. 52242
Correspondence and requests for reprints should be addressed to Dr. Galvin, Department of Radiology, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA. 52242, Telephone: 319/356-7980, FAX: 319/356-2220
Abstract
To extend quality medical care to a greater number of
individuals, a more efficient strategy is needed to distribute
information to primary care physicians. We therefore developed a
concept called the Virtual Hospital, which combines a wide-area
computer network with a medical multimedia database. This creates an
on-line link between academia and primary care physicians. This
system should enhance the delivery of medical care by the primary
care physician and broaden the educational scope of academic centers.
The citizens of our country rightfully demand a health care delivery system that provides equal access to efficient, quality medical care. As a first step toward this goal, the population will require an adequate number of well-trained primary care physicians. Unfortunately, primary care physicians are often required to work in isolation without adequate information resources.1 If primary care physicians are to provide quality medical care and survive the rigors of their profession, they will require a powerful and convenient source of current information. Optimal diagnosis and therapy are predicated on timely access to information. This information has been available within academic centers; however, a cost-effective link to primary care physicians has not been possible until now. Emerging wide-area computer networks and inexpensive multimedia computers will allow the efficient transmission of this information, thereby forging a partnership between academic centers and the primary physician.
This combination of networks and computers will be the building blocks of a "Virtual Hospital." A Virtual Hospital is a continuously updated medical multimedia database stored on computers and accessed through high-speed computer networks. This information will be available to primary care physicians 24 hours a day. Virtual Hospitals will be created by medical centers and will provide invaluable support to primary practitioners as well as laying the groundwork for our future involvement in "distance learning".2 Metsemakers and colleagues3 contend that "current medical curricula generally do not sufficiently reflect the knowledge, skills, and attitudes required for physicians who will work in the 21st century." As a self-directed continuing medical education (CME) program, a Virtual Hospital will be relevant to the current concerns of practicing physicians. We think that delivering CME to physicians in their offices or homes is the future of CME, and this will be a very popular service of a Virtual Hospital.
The concept of "distance learning" is not new, and a number of innovative states have developed health care networks that rely on current phone systems and a combination of mainframe and minicomputers.4-10 Most report rapid growth and a high level of acceptance by the primary practitioner. This has occurred despite the relatively primitive computer technology and the lack of a broad-band network connection. The MIST system (Medical Information Service via telephone) provides health professionals with continuous access to the Medical Center of the University of Alabama at Birmingham. In the first year of operation (1969-1970), this system handled 2,413 calls. In 1992, the system logged 85,000 requests from Alabama, surrounding states, and other countries around the world.9 There is a growing movement of academic thought that recognizes the importance of distance learning.10 The combination of affordable mulitmedia microcomputers and available broad-band networks will accelerate this trend.
Implementing a Virtual Hospital
A Virtual Hospital may contain the following:
In 1992, our laboratory (Electric Differential Multimedia Laboratory) developed a hardware independent approach to multimedia learning that creates totally digital medical media that is stored in industry standard file formats.11, 12 Our Virtual Hospital's medical media is stored in a multimedia database on a computer file server (storage computer) that is linked to a high-speed computer network. This medical media is organized into medical multimedia textbooks (MMTBs). An MMTB is a multimedia computer program that patterns its user interface after a printed textbook but incorporates functions beyond those of a printed textbook such as the ability to play video and audio clips. MMTBs can also display an almost unlimited number of high-resolution images, and they can be quickly and rapidly searched and updated. The multimedia files comprising each MMTB are stored in the Multipurpose Internet Mail Extension (MIME) multimedia file format, an Internet standard for storing multimedia information. (Lacey DL, D'Alessandro MP, Galvin JR. NetMMTB: The future of medical publishing via Internet accessible multimedia textbooks - in preparation). The multimedia database is organized using the Gopher software technology. Gopher facilitates the acquisition of information stored on the Internet. Gopher servers are file servers that organize information into a coherent knowledge structure or "Gopherspace." Gopher clients are graphic user interfaces that run on personal computers and allow intuitive access to Gopherspace.
The Virtual Hospital's MMTBs are shipped across high-speed computer networks to physicians in their offices or homes where they can be viewed using standard personal computers (Macintosh, Windows, and NeXT) equipped with public domain Gopher clients. The United States government has funded the creation of high-speed data superhighways in the form of the National Research and Education Network (NREN). This computer network will be available throughout the country and is based on high-speed fiber optic technology; it serves as our transmission medium.
A Virtual Hospital will be of great use to all practicing physicians as well as residents and medical students. In particular, a Virtual Hospital can provide meaningful medical information support to primary care physicians when they require subspecialty consultation and opinions. In the near future, high-speed computer networks will allow any physician within this country or around the world to access this information. Primary physicians will also have the ability to request remote consultations and add to the database by sending digitized representations of their patients. Current patient data that could be transmitted in this fashion would include live video of the patient (for example, a skin rash or abnormal gait), heart sounds, lung sounds, radiographic images and pathology images. This capability will make "electronic consultation" more meaningful.
Medical information for our Virtual Hospital is being gathered from sources within our College of Medicine as well as other health science colleges. This information is currently being obtained from lectures, teaching conferences, grand rounds, and emeritus professors, who have a wealth of teaching material. An unexpected benefit relates to medical student teaching. We are using first-year medical students to gather media and create patient simulations. They have found this to be a worthwhile experience. The students are required to follow patients from the initial workup through therapy and discharge. Thus, this process involves the medical student in clinical medicine much earlier in his or her career.
Conclusion
The time for the Virtual Hospital is now. Through the combination
of wide-area computer networks and the Virtual Hospital, academic
medical centers can share current information with primary
physicians. This link is a step toward the efficient delivery of
quality medical care.
Acknowledgments
The authors wish to thank Nola Riley for typing and Phyllis
Bergman for editing this manuscript.
References
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