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
This paper reports the research findings in the design
of an intelligent multimedia patients information systems
(IMPIS). The system is aimed to be used by medical
professionals at different organizational levels within a
hospital, as well as hospital administrative executives for
management support purposes. The data transmitted could
be in the form of text, graphics such as electronic
diagnostic images, sound such as voice annotation notes,
or video such as critical moments during an operative
procedure. These data are used for helping practitioners in
the diagnostic process, conducting research in medical
areas, and archiving of medical information for future
references and medical legal purposes. In addition,
statistical results can be generated for facilitating
resources planning in hospitals. This paper presents an
integrated object-interface-scenario modeling approach to
designing such a system. The problems found, with the
illustration of a prototype, and the proposed solution to
the identified problems are discussed.
1: Introduction
Multimedia can be defined as the input, assimilation
and output of any combination of text, graphics,
animation, video and audio data through one or more
communication media. It has opened up a new dimension
for people to expand the use of database management
systems by including the storage and manipulation of
audio-visual data other than traditional text. The need for
multimedia in computerization of patients' medical
records were studied because of its diverse requirements
on the variety of data types to be archived. Patients
information system is a potential multimedia application
which if properly implemented, could improve efficiency,
completion of documentation, and quality of patients care.
The use of multimedia in the medical industry begins
with electronic diagnostic imaging systems [4, 161. The
concept of PACS (picture archiving and communication
systems) which link all diagnostics imaging devices in a
hospital for storing electronic images such as X-rays,
computed tomography (CT), magnetic resonance imaging
(MRI), ultrasound and computed radiography (CR), has
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developed over the past few years [ 11, 14, 181. Another
type of imaging systems which can be used in maintaining
paper records for patients - document processing systems,
are also being investigated [3,7,101.
Integration of these high-end imaging systems with
existing hospital information systems became one of the
technology challenges faced by today's health care and
information technology professionals [ 5 ] . The On-line
Medical Record project 1131 was aimed to unify the
structured clinical database, the point-of-care data
collection and diagnostic image management. However,
little has been reported on how other types of multimedia
data such as graphics, video and audio information can be
used and integrated into these systems.
This paper summarizes the preliminary results of the
IMPIS project conducted by the Department of
Information and Systems Management at the Hong Kong
University of Science and Technology in collaboration
with the Department of Neurosurgery at Kwong Wah
Hospital in Hong Kong. The focus of this research is to
design a patients information system which provides
meaningful multimedia data about the medical history of a
patient. This information can be used for medical
practitioners in diagnosis as well as in handling medical
legal cases where a more vivid description of the patient's
condition is required.
Since the system has to be integrated with the temtory-
wide hospital information systems, the existing hospital
information systems development is described in section
two. Section three presents an integrated object-interface
-scenario modeling framework which is used for
obtaining user requirements during the design phase. As
the concept of multimedia is rather new to the hospital
staff, detailed sessions of discussions and interviews were
conducted with selective medical practitioners and
hospital administrators. A prototype of the system, when
applied in the Department of Neurosurgery of Kwong
Wah Hospital, is described in section four. The design
problems and proposed solutions are discussed in sections
five and six respectively. Conclusions and future work are
given in section seven in the paper.
 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 1995
2: Development of hospital information
systems in Hong K m g
Hong Kong's Hospital Authority (HA) officially took
over the management of all 39 hospitals and 56 specialist
out-patient clinics in Hong Kong in December 1991 from
the Government Hospital Services Department and
subverted Health Organization. Erom an organization with
almost no co-ordinated computerizationimplementation,a
three-stage IT strategy formed in 1992 will take the HA
into the year 2000 [ 111.
Stage I of the strategy begins in 1992 with the "Hong
Kong Health Information Highway" project. The goal of
the project was to attain "seamless health care delivery"
by linking up 39 general hospitals, 56 specialist outpatient
clinics and two HA offices via high-speed networks. Four
fundamental databases - Patients, Staff, Finance and
Assets were established. An integrated patient
administration system (IPAS) which enabled the
centralization of territory-wide patients admission and
discharge records were implemented. Other systems
systems such as the out-patient appointment system and
the drug dispensing labeling system were also
implemented. Stage I1 recently begins with the
development of clinical information systems. Stage 111
will be focusing on the integration of applications in the
hospital and clinical environment. The development of
management support systems to help hospital
administrative in monitoring the existing operation and
planning for future services will also be included.
An electronic medical card which contains personal
particulars of the patient and some vital data on medical
precautions such as the patient's drug history is currently
being evaluated in two hospitals. The objective of the
medical card is to enable first-hand information about a
patient to be retrieved quickly and easily in case of
emergency, during patient registration and processing of
patient bills. If proved to be successful, the patient card
will be rolled out to all public hospitals. It is also
anticipated that the next version of the electronic card will
be able to carry the medical case summary of the patients
in the form of text and image using the optical media.
Other applications that are under investigation include
in-patient and out-patient management systems, patient
records management system, and patient billing and
revenue collection system. Clinical support applications
under development or outsourced by Hospital Authority
include radiology information management system, ward
order entry and resuIts reporting systems, specialty
clinical information systems, operating theater
management system, computer-based pharmaceutical
procurement and supplies management system, diagnostic
imaging system, laboratory management system and
nursing management information system. Business
support applications such as clinical management system,
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human resources and payroll system, financial system,
assets management and materials management systems,
staff roistering system, library management and text
delivery system, electronic mail and office automation
systems are also under investigation.
Before the temtory-wide hospital information systems
can support permanent archival of electronic diagnostic
images of patients, most of the diagnosis are still based
upon verbal description of the symptoms from the patient
or some medical examination results that are generated
from other sources. The P A S data only include patients'
admission and discharge infomation, but does not contain
any information about the diagnosis or operation that a
patient has at the hospital. The IMPIS project attempts to
go beyond the traditional approach by expanding the
patient's medical history to include graphics, audio and
video data. These data may be crucial to the physicians
when images and video clips showing critical treatment
that a patient has received previously are important in
giving a more informed and efficient diagnosis.
Inappropriate application of drugs on patients due to the
lack of detailed patient's medical history, especially in
emergency cases, can be reduced. Some of the
examinations required can be automated so as to support
the medical practitioners in the diagnostic process. By
entering the results of the examination on-line, instant
analysis on the patient's condition can be obtained.
Currently, the patients admission and discharge data
generated by IPAS are downloaded to Kwong Wah
Hospital as a ".DBF" file in a real-time mode. This file is
stored at a local hospital server where authorized users
with the appropriate level of security access are able to
log onto the database through a desktop personal
computer. Nevertheless, one of the design challenges of
IMPIS was to integrate the inEormation of the patients
collected at the hospital with the data stored in IPAS.
After studying the data structure of IPAS, an object-
interface-scenario approach as described in the following
section, was used to investigate the user requirements of
multimedia system.
3: The object-interface-scenarioframework
Allen and Frieder [2] described PACS and the
complications of database design and communications
constraints with an examination on both the relational and
object-oriented database approaches, as well as the
centralized and distributed approaches. These approaches
are generally "database table-focus'' or "relationship-
focus" modeling methodologies. As the design of IMPIS
is centered around "patients" and "medical practitioners"
as end-users, it is more appropriate to use a user-oriented
approach focusing on how data are being manipulated by
users An integrated object-interface-scenario modeling
framework is therefore applied so as to capture the
complex and uncertain requirements of the system.
 Proceedings of the 28th Annual Hawaii Iniemational Conference on System Sciences - 1995

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

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.

453
 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 199s
4: A prototype system for IMPIS
A prototype based on the above design methodology
when applied in the Department of Neurosurgery at
Kwong Wah Hospital was built for users to evaluate. The
scenario selectcd was "when a patient was admitted as an
in-patient to the department until he or she is discharged
from the hospital". The conceptual structure of the IMPIS
prototype and its associated entity-relationshipdiagram is
shown in figures 3 and 4 respectively.
There are two components in the prototype - the patient
case record and the medical library. According to figure 4,
each component is made up of a group of entities. The
case summary entity forms the focal point of the patient
case record component. Each case summary record
belongs to one patient and may contain one or more
operation records. Each operation note may have one or
many operation codes and angiogram. Detail description
of each entity type is given in the following subsections.
In addition, the patient record comporlent integrates with
IPAS. It contains a data mapping of IPAS together with
other clinical information such as medical officer in
charge, diagnostic examination results and operations
record. The medical library acts as a supporting unit and
data source for the patient case record. An interface of the
IMPIS prototype system for the Department of
Neurosurgery is shown in figure 5.
4.1: The patient w e record component
The Case summary entity (see figure 6) contains
summary information on each patient who is admitted to
the hospital. A case will be closed when the patient is
discharged. All information such as history, progress,
disease, operation and outcome are condensed on a case
summary form. This is particularly useful in getting all the
admission information at a glance during out-patient
follow-up. With such means, continuous care of the
patient can be ensured. Moreover, this module is
integrated with IPAS so that the personal details of the
patient are not required to be re-entered in the system. By
using the unique "hospital number" assigned by IPAS
during patient admission, the corresponding data about a
particular patient can be retrieved instantly.
Operation Notes record the details about every
operation that is being performed daily. Photos of the
injured patient prior to and after the operation are stored
(see figure 7). Such records also incorporated the key
medical images such as CT scan and video clippings of
the critical moments during an actual operation (see figure
8). Surgeons can annotate voice recording notes on
important findings for that record. This integration and
amalgamation of all these forms of multimedia data are
extremely valuable in giving a more informed and vivid
description of the operative procedures which cannot be
achieved otherwise by using pure text.
Angiogram (see figure 8 ) contains graphical
information such as X-ray images of blood vessels for the
patient under examination. It allows users to record the
pathological findings of the blood vessels by annotating
on a standard anatomical diagram of the organ concerned.
Admission Diagnosis is designed to record the clinical
findings of the patient on admission to the ward. In
addition, the external injuries such as bruising and
laceration can be malced on a graphical representation of
the human body on the computer s c m (see figure 9).
This type of graphics recordings are extremely useful at a
later date when there is a medical legal implication such
as health insurance claim.
W a r d contains a physical layout of the beds in the
ward with the occupation details of beds (see figure 10).
With the trigger of a button on the selected bed in the
diagram, the data of the patient assigned to the bed will be
instantly retrieved from the IPAS database. A report can
be printed out to show the utilization rate of the beds in
the ward over a period of time so that better arrangement
of beds can be made.
Prescription module is integrated with the drug
formulary database so that data about the drug can be
retrieved automatically. The prescription form generated
is used in issuing to the patients and transferring to the
pharmacy division.
Electromyelogram ( E M G ) Record keeps the
electromagnetic diagnostic information of a patient with
an image of the waveform such as electroencephalogram
(EEG) and the doctor's opinion of the diagnosis.
4.2: The medical library component
Disease Code holds a full set of ICD90 standard
disease description and codes. The information inside is
called by many patient case record modules such as case
summary, operation record, etc. Operation Code is
similar to the disease code and also follows the ICD90
standard. It is used in a similar manner to disease code.
Drug Formulary contains brief information and coding
about all the drugs available in the hospital. The
information is well classified and organized so that users
can easily access the data. Drug formulary is integrated
with the prescription module.
4.3: Other functionality
The prototype generates two types of reports - the
admission statistics report that shows the number of
patients that are admitted to the hospital within a selected
date range and the work load statistics report that shows a
summary of work load status of different surgeons within
a certain period. These reports are used by hospital
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
An evaluation on the prototype was done by showing
the system to a wider group of potential users including
doctors, surgeons, nursus and other medical officers in the
Department of Neurosurgery. Users were asked to try out
the system individually and feedback was collected from
the users. The results were further supplement by the
observations made during the evaluation process. The
type of problems encountered can be categorized into two
groups - technical and non-technical problems.
5.1: Non-technical problems
The non-technical problems can be discussed with
respect to users, operational and social perspectives.
5.1.1: User-relatedproblems
During the evaluation process, we discovered that most
medical professionals generally have a low level of
computer literacy. Many do not even know how to type.
The learning curve of users are generally very slow.
Intensive training and a long period of hands-on support
was required to help the users to use the system.
Surgeons, are generally found to resist the use of
computer systems in their work firstly because they found
it difficult to learn a new technology at their age, and
secondly, rejected the additional work load on their job
duties, Although they are convinced about the potential
benefits of being able to retrieve medical history of a
patient very easily, they do not want to get involved with
the actual input process of the data.
5.1.2: Operational and cost problems
The input logistics of the data required in the system
was addressed seriously by the users. Since there is no
computerized radiology system installed in the hospital,
these images have to be manually input into the
computers system. A scanning or digitizing input
workstation is required to capture these electronic
diagnostic images onto the computer. This is a tedious
process and it is evident that it would not be appropriate
for surgeons to input these data into the system. Similarly
for video data. Since only critical moments were required
to be stored, it means that the video has to be edited
before digitized into the computer. At the moment, not all
the surgical operations are recorded onto video tapes. The
cost of implementing such a system hence became a
critical issue to hospital executives interviewed.
5.1.3: Sacial problems
The security of patients' data was a major social
concern, especially when a user cam easily get access to
the territory-wide patients data bank once they are log
457
onto IMPIS. Medical data is as sensitive as criminal
records, and should not be accessed by all levels of
medical staff. It is a,c"mon practice that all medical data
generated from the hospital are considered properties of
the hospital and will not be released without consent.
Also, another matter noticed by the users were what if the
patients refuse for any video to be taken in an operation.
A major problem raised by the surgeons was the use of
these computerized records in medical legal cases. In
Hong Kong, there is no written law in accepting computer
digitized data as legal documents. At the moment, only
microfiche and microfilm are accepted in court as medical
evidence. Although the use of WORM (write-once-read-
many) disks for permanent archive of original data seems
to be one possible solution in proving the originality of
the document, the legal procedures involved in certifying
a WORM diskette as a "true" has to be established.
5.2: Technical problems
The prototype system was implemented using
FileMaker h-o running on Microsoft Chinese Windows
over a period of two months during the joint application
design sessions. A small ethemet network running for two
to three users was set up for the testing purpose. There are
five main technical concerns discovered throughout the
design and prototype evaluation process.
5.2.1: Integration with P A S
Since IPAS is managed by Hospital Authority, the
interface program written for retrieving IPAS data from
IMPIS has to be updated whenever there is a change in
the IPAS data structure. It is anticipated that more and
more of this type of maintainance problems will arise as
the territory-wide hospital information systems are being
increasingly centralized.
5.2.2: Availability of software developmenttools
The ideal database management system development
environment for developing this type of system should be
able to handle multimedia data types, SQL and client-
server processing functions. Such pre-requisites limit the
choice of database software. On the PC, Filemaker Pro,
and FoxPro for Windows for example, are popular
database software development tools which can be
adopted for such purposes. However, the database engine
of these systems are not powerful enough for supporting
multimedia applications in a multi-user environment. It
was impossible to transfer a video clip of one minute and
display the video without crashing the system.
A system that supports both Chinese and English data
entry and output is needed for IMPIS. Data such as the
patient name is necessary to be stored in both languages in
Hong Kong. The commonly used Chinese characters set
 Proceedings of the 28th Annual Hawaii Intematwnal Conference on System Sciences - I995
for computer is Big 5 code. However, software which can
support Big 5 code and co-exists with both a networking
software and a database program is very limited. Under
the Microsoft Chinese Windows, only Novel1 network
system is compatible.
5.2.3: Capacity af data storage required
It is estimated that a huge capacity of data storage is
required. There is about 20,000patients admitted each
year in a general hospital. If the average of each patient
case file is 20 megabytes, a total of 400 gigabits of storage
space will be required per year. Even if the files are
compressed to 1:4 of the size, 100 gigabits are still
required. With the fastest CPU,the delay in retrieval time
is inevitably slow. Allowance has also to be made for
decompression of the file.
There is also a data retention problem of the data
downloading from the IPAS database. The database is
growing at a rate of 40 megabytes per month. With the
current mode of downloading, a detailed capacity plan is
required in order to accommodate the data expansion.
5.2.4: Hardware ConfSguration for user workstation
The minimum configuration for supporting multimedia
output on a Windows-based PC for a user demands a
computer such as a 486DX2 66MHz with at least 16
megabytes of RAM, a high resolution VGA graphic
acceleration card and monitor, a pair of speakers with a
16-bit sound card a video compression and display card, a
decompression card for images, a SCSI card for a CD-
ROM drive or additional hard disk and a network card.
With these armamentarium, the slots in the PC are
completely filled, even for the most up-to-date hardware
architecture design. Moreover, it will be difficult to utilize
fully the computer for other purposes other than medical
records. The cost of such a machine is inevitable high.
5.2.5: Networking support
Electronic medical record has to be stored and
retrieved on a reliable hospital network system. Such a
system might be required to link 50 workstations in a
small hospital to as much as 200 workstations in a large
general hospital. Heavy traffic within the network is
expected during the office hours. Delivery of a large file
including images, sound and video clips requires
significant traffic time. When more than 50 users are
retrieving or printing data, undue delay is bound to
happen when the network is based on the exist
technology. The ethernet system with coaxial wiring
system is doom to halt the whole system. More wide band
cabling, such as optical fiber, is required. However, such
cable is expensive and not economically feasible in the
public hospital system with a skeleton budget.
468
6: Soiutions
For the non-technical problems discussed above, one
of the solutions in helping the users in using the system is
to adopt a consistent interface in thc design.This principle
was enforced by using common background buttons
between screens, clear field labels and standard typeface.
User-friendliness and simplicity is the most critical
principle in designing the user interface. A long education
process in convincing the users of the benefits and
teaching the users in using the system cannot be avoided.
Also, it is found that features such as the automated
admission diagnosis module which enabled instant results
to be generated helped to attract users' interests. More of
this type of features that is closely related to their routine
tasks will help to better utilize the system. We have also
found that most medical practitioners liked the idea of
using voice annotation in recording the case notes instead
of typing in the text manually. Users indicated that the
concept could be applied to other tasks where they have to
make notes while carrying out their daily duties.
The only solution to the data input problem is to have
one or more dedicated operators to cany out the digitizing
process. In order to store critical moments of an operation,
a new procedure has to be implemented in the hospital
and supporting staff have to be appointed to manage the
video shootinlg process. There will also be a need for the
surgeon in charge to select the required video clippings.
On the social issues concerned by the medical
professionals, solutions have yet to be determined. The
inclusion of multimedia data has provoked the need for
re-thinking about the responsibilities of medical staff in
maintaining patients record within a hospital. It is likely
that new procedures and policies have to be formulated in
order to facilitate the implementation so that all the
required data are properly archived into the system.
Consensus have to be obtained from the patients if this
type of data were to be stored as part of a patient's case
record in the hospital. In addition, patient's right in
accessing the archived information will have to be stated
clearly on a signed agreement between the patient
involved and the hospital. Data security policies within
the hospital have to be carefully established in order to
avoid misuse of any sensitive patients data.
Most of the technical problems found in the evaluation
process were mainly due to the hardware limitations,
networking support and software incompatibility
problems. These technological problems will be sorted out
in time. Research work in handling these problems have
been conducted by others [l, 8, 121. However, what is
missing is a conceptual design for illustrating the role of
various components, how they could be arranged in such
an environment so as to work together cost-effectively. A
proposed system architecture design for IMPIS based on
the lessons learn from this research is shown in figure 11.
 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 1995
DWAM'UEWAL LOCALAREA NEWORK
High-speed network (e.g. FDD/)
5. mulUmedia
data
- t
High-end U w retrievrl
L worllltrtion
IHOSPITAL NETWORK
A "true" multimedia information system requires the
marriage of both a powerful client-server architecture
database management system and an efficient electronic
multimedia data management system. As the requirements
of diagnosis examination support increase in the system, a
dedicated medical diagnosis server is recommended.
Database management systems which can handle
multimedia data in a multi-user environment are still
limited. Most vendors claim that their database systems
are able to support multimedia simply because the
systems are able to handle one gigabit of data per field
and user can define data types such as "picture", "movie",
"sound", etc. There is usually no other functionality to
facilitate the input, processing and output of multimedia
data in these systems. The system architecture of these
database management systems are often maximized for
on-line text-based data transaction processing instead of
geared towards an effective archival and retrieval of
multimedia data. An electronic data management system,
which is designed specially to archive and retrieve
multimedia data, will help to improve the system
performance. Input, processing, output and other facilities
such as conpressionldecompressiontechniques are often
built into these systems in order to maximize the quality
of the data stored and speed of retrieval, but at the same
time minimize the storage cost of the multimedia data.
The design proposed to utilize the on-line transaction
processing power of a client-server database by putting all
the database tables in the hospital-wide server. Each data
file in the electronic multimedia data management system
is labeled with a unique identification number. The link
between the client-server database management server
I
II
P
A
S
3.
2. results 1. query
t
user mtrleval
workstation
and the electronic data management system is established
by using a database table maintaining the relationship
between the record in the database management system
and the associated identification key@) of the multimedia
data. When a user executes a query on a patient, the query
will be sent to the database management system for
processing. A list of results which fits into the criteria of
the user will be returned and displayed on the computer
terminal. The user can continue the query process until an
option for retrieving further multimedia data is selected.
The command will then be sent to the database
management system where the associated identification
key(s) of the multimedia data is retrieved. The database
management system then sends a message to the
electronic multimedia data management system and the
selected data file is located. The electronic multimedia
data management system then takes over the user request
and send the multimedia data file to the user over the
high-speed network. In this way, the database
management system can continue to serve the usual
transaction processing for other users while the electronic
multimedia data management system will concentrate on
managing the transfer of multimedia data.
In order to reduce the cost of hardware and networking
devices, a hybrid model of network design can be used by
partitioning the hospital network into high speed network
such as FDDE to serve high-end users and an ethernet
network to serve normal users. Each department should
install a decentralized LAN system linked to a high-speed
hospital-wide networking backbone with their own
departmental medical diagnostic server and electronic
data management system. This will help to reduce the
traffic of transmitting multimedia data across the hospital
459
 Proceedings of the 28th Annual Hawaii International Conference on System Sciences - 1995
network. Only inter-departmental exchange of data is
transported through the backbone. Data such as laboratory
results which are mostly text-based can be distributed
through the ethernet channel. Although the database
structure is different for each department, the data inside
IPAS are shared by various departments. Data generated
from different departmental LAN can be filtered and
extracted before exporting back to the central Hospital
Authority data bank for generating statistical reports.
With the advent of CD-ROM, bulky multimedia data
storage at departmental level is feasible and economical.
When the hard disk in the departmental server is full, the
data can be spilled over to a CD-ROM. As most of the
hospital record is not going to be changed after all the
data is verified, it can be stored on a CD-ROM. Sequential
CD-ROMs can be loaded onto a jukebox or stack CD
players. Many years of record can be read and retrieved
simultaneously by this method.
7: Conclusions and future work
The research presented in this paper has demonstrated
how multimedia data can be used in real-life applications.
However, we have discovered that the inclusion of
multimedia data does not simply means installation of an
optical fiber network or having powerful multimedia
computers. Rather, it often requires more involvement and
co-operations with users of the systems in the input stage
than traditional text-based database systems. The cost of
implementation of this type of system is high and the
value of the return has yet to be determined. The success
of implementing a system like W I S also rely heavily on
organization intervention in pursuing these systems to be
used effectively. Nevertheless, the advancement in
information technologies has given rise to the birth of a
new generation of computerized patients records in a
format that was not possible ten or twenty years ago.
However, the development of this new generation of
computerized patients record will not rely only on the
continuous growth in technologies, but also on the way
how this type of information is accepted in our society.
In spite of the problems which cannot be solved by
technologies alone, we will continue the development of
another generation of IMPIS based on our proposed
design and explore how users response to other new
technologies. The scope of study shall include features
such as artificial intelligence [151, content-based retrieval
techniques on multimedia data, video-conferencing in
supporting collaboration diagnosis [9] and voice
recognition systems [TI.
References
[l]. Adam J.F., Houh H. H., Ismert M.. Tennenhouse D.L.
(1994) "A Network Architecture for Distributed
Multimedia Systems", Proceeding of the International
460
Conference on Multimedia Computing and Systems,
Boston USA, p. 76-85.
Allen L. and Frieder 0. (1992) "Exploiting Database
Technology in the Medical Arena", IEEE Engineering in
Medicine and Bwlogy Magazine, vol. 1 1 no. 1, p. 4249.
Au G. (1992) "Using Document Image Processing in the
Health Care Industry", Proceeding of the Second Asia-
Pacific Medical Informatics Conference, Hong Kong,
Nov 1992.
Dayhoff R.E. (1988) "A Medical Image Database",
Optical InformationSystems, vol. 9 no. 12, p. 39-40,42.
Dayhoff R.E., Maloney D.L.. Kuzmak P.M., Shepard
B.M., Kenney T.J., Sadan A., Fletcher R.D., and Lu D.
(1991) "Experience with MUMPS-based Hospital
Information System with Images", MUG Quarterly, vol.
21 no.3, p. 53-56.
Gmsky W.I. (1994) "Multimedia Information Systems",
IEEE Multimedia, vol. 1 no. 1, p. 12-24.
Kaebnick G.E. (1990) "Burbank Hospital Eases into Full
Document Automation", Inform, vol. 4 no.8 p. 27-79.
Khayat S.H. and Bovopoulos S.H.(1994) "A Proposed
Bus Arbitration Scheme for Multimedia Workstations",
Proceeding of the International Conference on
Multimedia Computing and Systems, Boston USA, p. 415-
424.
Kleinholz L. and Ohly M. (1994) "Multimedia Medical
Conferencing: Design and Experience in the BERMED
Project", Proceeding of the Intematiowl Conference on
Mdtimdia Computing and Systems, Boston USA, p. 255-
264.
Kohn D. (1991) "Current and Future Applications of
Optical Storage Technology in the Health Care Industry",
Document Image Automation, May-June 1991, p. 143-
148.
111. Masudo Y. and Yohro T. (1990) "An Introduction to
Anatomical Image Digitizing System", Computer
Methods and Programs in Biomdicine, vol. 31 no. 2, p.
115-123.
121. Okon C. (1994) "Promoting Interoperability for
Networked Multimedia", Advanced Imaging, March
1994, p. 52 and 70.
131. Lee R. (1989) "The Online Medical Record", Federation
of American Health Systems Review, vol. 22 no. 2, p.50-
52.
141. Lieber H., Buchsteiner W., Offenmuller W.(1991) "RIS -
A Radiology Information System, Introduction and
Benefits in the X-ray Department of the Straubing
Hosipital", Electromedica, vol. 59 no. 3, p. 89-97.
151. Ruszowski J., Kim Y., Spelman F.A. (1989) "Clinical
Decision Making Based on Expert Knowledge Relational
Rules: an Information-Theoretical Approach",
Proceedings of the Annual International Conference of
IEEE Engineering in Medicine and Biology Society,
Seattle USA.
161. Spilker C. (1987) "Medica1 Imaging: Merging Picture
Archives and Communications", Inform, vol. 1 no. 3, p.
24-27.
171. Tan H. (1994) "Taking Hong Kong's healthcare into Year
2000", The ITMaga&e, inagrual issue, p. 98-110.
Treves S.T., Hashem E.S., Majmudar B.A., Mitchell K.,
and Michaud D.J. (1992) "Multimedia Communications
in Medical Imaging", 1EEE Joumal on Selected Areas in
Communications, vol. 10 no. 7, p. 1121-1132.