1. Intranet Technology in Hospital Information Systems James J. Cimino, M.D. Department of Medical Informatics Columbia University

2. Accessing Clinical Information over the Internet and World Wide Web James J. Cimino, M.D. Department of Medical Informatics Columbia University

3. Web Access to the EMR at Columbia-Presbyterian Medical Center James J. Cimino, M.D. Department of Medical Informatics Columbia University

4. CPMC in 1988 - preTCP/IP IBM Mainframe Data Repository Data Monitor Vocabulary Server Results Review Clinicians Ancillary Systems

5. CPMC in 1991 - TCP/IP Minicomputer IBM Mainframe Data Monitor Vocabulary Server Clinicians Ancillary Systems Upload Engine Vocabulary Server Minicomputer Data Repository Intranet Clinical Application Vocabulary Server Results Review

6. CPMC in 1994 - WWW Clinicians Knowledge Resources Minicomputer Vocabulary Server IBM Mainframe Data Monitor Intranet Internet Web Server Data Repository Internet

7. Clinical Database Row-oriented relational database (DB2) Flexible and extensible Clinical data coded with MED Multiple time stamps

8. Data Monitor - Input and Alerts Stores all data in repository Checks data for triggers Executes Medical Logic Modules Stores alerts in database

9. Clinical Database Server - Output Dynamic queries (SQL) Canned queries –Time span –Last "n" results Class-based retrievals ("get all positive culture results")

10. Medical Entities Dictionary (MED) 56,000 medical concepts 82,000 synonyms Multiple hierarchy (72,000 links) Semantic network (43,000 links) Calcium Preparations Calcium Intravascular Calcium Tests Abnormalities of Calcium HypercalcemiaHypocalcemiaSerum CalciumPlasma Calcium

11. MED Server Lexical searching Concept attributes Classes Ancestors

12. Web Server Clinical database queries Vocabulary server queries –Class queries –Translation HTML document generation Applets Web links

13. CPMC’s Web EMRs Elpis - single patient view PolyMed - service view WebCIS - multiple views

14. Web EMR Features Frame-based interface Summary reporting Graphical displays Multimedia displays Cross-patient displays Order entry Integration of on-line resources Security and confidentiality

15. screen shots patient list departmental screen headers - lab details - lab lab summary lab graph radiology - detail dop - detail alerts cardiology - detail ecg multi-patient summary lab order entry pharmacy list pharmacy rx time view

16. Integration of On-line Resources Lab to Medline Lab to PDR Lab to disease description (DXplain) Lab to differential diagnosis (DXplain) Lab to guideline (cholesterol) Drug to dietary restriction information Drug to PDR X-ray to Medline X-ray to Web information sources

17. screen shots of integration Lab to disease description (DXplain) Lab to differential diagnosis (DXplain) Lab to guideline (cholesterol) Drug to dietary restriction information Drug to PDR X-ray to Medline X-ray to Web information sources

18. Security and Confidentiality User logon name and password Encryption (SSL) Logon screen ID (single use) Session screen ID (expires)

19. Current Challenges Application development Navigation of hypertext No control over client machines Resource integration Hospital mergers

20. parting shot - carmen sandiego lab