Multimedia Workstations

P. Degoulett, F-C. Jean\ Review Paper C. Safran2 Multimedia Workstations: 1Broussais University Hospital and Paris VI University, Paris, France Electronic Assistants for Health 2Harvard Medical School, Center for Clinical Computing, Boston MA, USA Care Professionals Abstract: The increasing costs of health care and the economic reality has produced an interesting paradox for the health professional to perform more clinical work with fewer support personnel. Moreover, an explosion of the knowledge-base that underlies sound clinical care not only makes effective time management critical, but also knowledge management compelling. A multimedia workstation is an electronic assistant for the busy health professional that can help with administrative tasks and give access to clinical information and knowledge networks. The multimedia nature of processed information reflects an evolution of medical technologies that involve more and more complex objects such as video sequences or digitized signals. Analysis of the 445 Medline-indexed publications for the January 1991 to December 1994 period, that included the word "workstation" either in their title or in their abstract, helps in refining objectives and challenges both for health professionals and decision makers. From an engineering perspective, development of a workstation requires the integration into the same environments of tools to localize, access, manipulate and communicate the required information. The long-term goal is to establish an easy access in a collaborative working environment that gives the end-user the feeling of a single virtual health enterprise, driven by an integrated computer system when the information system relies on a set of heterogeneous and geographically distributed components. Consequences in terms of migration from traditional client/server architectures to more client/network architectures are considered. Keywords: Health-care Professional Workstation, Software Engineering, Integration, Internet, Intranet 1. Introduction cilities are still not in a position to (physician, nurse, etc.), the worksta provide their professionals with trans tion can be more than a dataandknowl Health-care professionals depend parent access to distributed patient data, edge integrator. Through evolution on accurate and timely access to infor knowledge sources, and processing ary steps, the workstation will first mation about the patients under their services. The workstation for the serve the information needs for patient care, information contained in the bio health-care professional provides both care, support professional and per medical literature, and information a short-term solution to the problem of sonal communications, provide deci accumulating in databases around the inadequate information infrastructures sion support, and facilitate professional world. However, the promise of the and an evolutionary path toward an and personal task management [4-8]. information age has not been realized integrated information environment [1- The workstation needs to evolve from in health-care because of the technical 3]. The development of such a work an information display device into a short-sightedness of closed· systems station involves consideration from work-facilitating device with the goal and sociopolitical boundaries that in the viewpoints of the end-user, the of becoming an intelligent electronic hibit collaboration and data sharing. engineer, and the health administra assistant. Because of continued purchasing of tor. From the engineer's perspective, closed-end solutions, health-care fa- From the end-user's perspective the workstation is the unique mediator Yearbook of Medical Informatics 1996 65 between the health-care professional cilitate the collection of the data previous generations. Comments on a and the health network that conceals necessary for executive decision sup prototype are different from experi the complexity of the underlying in port. ments in a real situation. Such experi formation system. It is a hardware and ments require mature and secure prod software framework that needs to ad ucts, and it becomes more difficult at dress interface management, secure 2. Functional Requirements this stage to make drastic changes. communication, processing and con Economic pressures impose the need trol, and eventually local storage. 2.1. The Expression of End-users' for a large market to balance the Physically, these processes can be Needs high cost of development. End-us combined within the same box or dis ers' expectations are likely to be tributed over a network.Their devel It is traditional in health care to tempered by the constraint of mini opment should benefit from a careful assume thatthe functions of a comput mal consensual functions and the evaluation of end-user needs and ap erized system should be patient-cen need, at the institution level, to fa propriate software-engineering tech tered and the developments user-en cilitate transitions. niques [2,9,10]. tered. Interfaces and accessible func Finally, from the health adminis tions need to be tailored to the ex 2.2. Organizational and trator's perspective, the workstation is pressed needs of individual users or Technological Trends a new technology that needs to be categories of users (e.g., general prac integrated into the organization and titioners, radiologists, nurses). Indeed, Requirements must also be based have proved cost/effectiveness [11]. the participati()n of end-users in the on the prospective understanding of This technology, however, is nothing development process and in evalua the changes in the delivery of care and less than a radical structural agent of tion teams with designers and external in the technology. Table 1 illustrates, change. The device can enhance pro evaluators minimizes the risk of inap through the analysis of Medline in ductivity, change communication pat propriate design and provides the nec dexed publications from January 1st, terns and, hence, the ways in which essary feedback on the viability of the 1991 to December 31st, 1994, the professionals and support staff col first prototypes [12-15]. growing interest for workstations. A laborate in the care process, provide But end-users' reactions are often total of 445 publications included the the technical ingredients for true con conflicting and biased by their per term "workstation", either in their title tinuous quality improvement, and fa- sonal experiences with products of or in their abstract. The number of Period 1991-1992 1993-1994 Total (100%) Nature of the publication (%) (%) (%) Analysis and design, review papers 15,6 23,7 20,2 Development, derscriptive papers 65,1 57,7 60,9 Evaluation papers 19,3 18,6 18,9 Total no (1) 192 253 445 Main application domain covered Generic 10,4 5,5 7,6 Health-care units 18,8 31,6 26,1 Radiology, PACS, radiotherapy 35,9 31,6 33,5 Biology, genetics, molecular biology 8,9 12,6 11,0 Anatomopathology 8,9 5,1 6,7 Surgical processing 3,1 4,0 3,6 Signal processing . 3,1 2,4 2,7 Education 4,2 1,6 2,7 Access to data and knowledge banks 4,7 0,8 2,5 Table 1. Epidemiology, clinical research 0,5 3,6 2,2 Nature and domain of Workstations for disabled people 1,6 1,2 1,3 publications covered by the 445 Total no (I) 192 253 445 Total number of publications publications from 1991 to 1994, in Medline (2) 752,528 759,666 1,512,194 indexed in Medline and including Ratio (1)/(2) 0,026% 0,033% 0,029% in their title or their summary the term "workstation". 66 Yearbook of Medical Informatics 1996 publications has increased by 32% Table 2. Selected functional requirements. from the period 1991-1992 to the pe riod 1993-1994. Application domains 1. Ability to help the medical practice (direct patient care support) cover all medical fields and mainly Computerized patient record update and consultation health-care units, radiology, biology and - data recording (administrative, medical, nursing, investigations) pathology. The number of true evalua -multimedia object management (e.g., text, graphics, images, sounds) -data presentation (e.g., summaries, flow sheets, graphics) tion papers is low by comparison with - simultaneous record consultation (group work, staff discussions) design papers, descriptive papers and Decision support literature reviews. -clinical calculations (e.g., drug doses, predictive value of a sign or symptom) However, the recent development - search for similar patient cases of community health-information net - access to contextual knowledge (intelligent agents) works (CHIN) and the current explo - diagnostic and therapeutic suggestions sion of Internet- and Intranet-based - prognosis evaluation experiences will significantly change - strategy selection support for the years to come the vision of the -follow-up support (e.g., monitoring and alerts, follow-up reminders, functionalities and architecture of a compliance evaluation) workstation [ 16, 17]. 2. Support to the management of the health care professional environment - health-care unit management (resources, planning) . 2.3. A Typology of Functionalities -access to reference information (e.g., protocols, consensus reports) -evaluation of medical prbcedures (e.g., outcome measures) 3. Teaching and research Table 2, derived from the literature -access to literature and the personal experience of the -access to external data and knowledge banks (e.g., drugs, clinical trials) authors, summarizes some key func -end user assistance (e.g., on-line help, tutorials) tional requirements

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