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

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
• 2 Bodenheimer T, Grumbach K. The reconfiguration of US medicine. JAMA 1995; 274: 85-90.
• 3 Frenkel M. Health financing policy after the 1994 Clinton plan experience. J Healthcare Finance 1995; 21 (03) 68-71.
• 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.
• 5 Grimes J, Potel M. Software is headed toward object-oriented components. Computer 1995; 28: 24-5.
• 6 Lewis TG. Where is client/server software headed?. Computer 1995; 28: 49-55.
• 7 Bernstein PA. Middleware: A model for distributed system services. Commun ACM 1996; 39: 86-98.
• 8 Pancake CM. The promise and the cost of object technology: A five-year forecast. Commun ACM 1995; 38: 33-49.
• 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
• 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
• 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.
• 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.
• 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
• 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
• 15 Berners-Lee T, Cailliau R, Luotonen A, Nielsen H, Secret A. The World-Wide Web. Commun ACM 1994; 37: 76-82.
• 16 Berghel H. The client’s side of the World Wide Web. Commun ACM 1996; 39: 31-40.
• 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.
• 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
• 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
• 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
• 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
• 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.
• 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.
• 24 Schwartz R. Writing Interoperable Applications with ODBC. See http:// discorp.corn/futures/8_22/interop.htm
• 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.
• 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
• 27 Ratib O. Multimedia image and data navigation workstation. RSNA’95 Scientific Program. Supplement to Radiology 1995; 197 (P) 546
• 28 Turner F. An overview of the Z39 .50 information retrieval standard. See http://www.nlc-bnc.ca/ifla/VI/5/op/udtop3.htm
• 29 Adler RM. Emerging standards for component software. Computer 1995; 28: 68-77.
• 30 Bernstein P A. Middle ware: A model for distributed system services. Commun ACM 1996; 39: 86-98.
• 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
• 32 Chueh HC, Barnett GO. Building a clinical workstation using components and a distributed object services architecture. See http://www.lcs.mgh.harvard.edu/
• 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/
• 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.
• 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.
• 36 Gosling J, McGilton H. The Java(tm) language environment: A white paper. See http:/ /java. sun.com/white Paper/javawhitepaper-1.html
• 37 Lindberg DAB, Humphreys BL, McCray AT. The Unified Medical Language System. Meth Inform Med 1993; 32: 281-91.
• 38 Cimino JJ. Vocabulary and health-care information technology: State of the art. J Am Soc Inform Sci 1995; 46: 779-82.