Progress and Problems of Interhospital Consulting by Computer Networking

In recent years we have seen a steady deterioration in rural health delivery both in the United States and also in developing countries.' More than 28 million Americans live in rural communities that are underserved by the health care system. Loss of acute care and specialist consultation can be partly restored by the development of efficient telecommunication patient-data links to main medical centers.2 Larger hospitals in North Amcrica often have a multitude of computers (from PCs and workstations to mainframes). They have been mostly used for hospital administration (e.g., scheduling of procedures and financing). Some states have networked all their hospitals because they require weekly bed-occupancy and insurance information by electronic mail (e-mail). Many access their computerized clinical pathology results and other reports via local area networks (LANs). A few make archiving and image processing of digitized x-rays available to departments outside of the radiology department. Intensive care units (and emergency rooms) are sometimes islands of intensely computerized, automated monitoring. They often successfully assist staff in watching over many simultaneous critical-care situations. Isolated efforts are under way to facilitate record kccping by using text or voiceactivated computer entry directly from the bedside to standardized patient-data forms. Underlying all these efforts is the need to deal with masses of nonstandardized hospital administration and patient data. This overwhelming problem has revived interest in the study and teaching of the long-established science of medical informatics.' The general picture of Hospital Information Systems (HIS) is, all too often, one of multiple types of poorly integrated computer systems and local networks. Much of this confusion can be traced to a lack of accepted hardware and software standards for commercial suppliers; also, to a deficiency of network engineering expertise for choosing and coordinating the multitude of available commercial systems. Western countries with national health systems have the advantage of being able to standardize countrywide. They are also stimulated by the requirement to centralize the reporting and analysis of patient and administrative data. But what o f smaller hospitals in rural areas or developing countries? There may be a PC or two, but no funds or expertise to d o much more than keep patient records