Using Intranet Systems Technology for Endoscopy Applications

Extended Abstract Only

This paper will report on the first year’s results of a three-year research project that is concerned with the exploitation of internet/intranet technologies to produce low cost and flexible solutions for Medical Informatics applications. The project is being conducted by the CISE Group at RMCS, in collaboration with the Endoscopy Department of the Gloucestershire Royal NHS Trust, and has resulted in the development of an experimental prototype for an Endoscopy Surgery information system, with a telemedicine capability. The prototype has employed commercially-available Intranet application development tools and general-purpose personal computing hardware, to produce a Web-based application which is dynamically linked to an underlying, experimental Endoscopy database. The work, to date, has demonstrated the potential benefits of using Internet technology to support Endoscopy Surgery, as an alternative to using traditional Picture Archival and Communications Systems (PACS), and has provided a clear research direction for the remaining two years of our project.

Employing an SQL Server DBMS running on Windows NT, the prototype facilitates storage and organisation of patients' data, viewing and printing of patients' Endoscopy reports, and includes a facility for remote booking of a patient’s Endoscopy session. Local or remote authorised clients can access medically-approved knowledge in form of multimedia reports in HTML format, using a standard World Wide Web browser accessing a Web-based application which is dynamically linked to an underlying database.

The entire prototype currently includes three client machines (plus one connected remotely by modem) and two servers (one SQL and one HTTP), running on a range of diverse hardware and software platforms connected via fast Ethernet. In addition, we have experimented with the commercial Internet software technology options which are currently available. Rapid application development tools, facilitating quick development cycles, have been used in the construction of the prototype. A client/server two-tier architecture has been adopted: a browser, as a Graphical User Interface tier, and Webserver, as a second tier which links to a back-end database.

To improve the user interface, and to make the application more responsive, client-side programming using JavaScript and Java has been used. However, the functionality of this client-side programming has been deliberately restricted in order not to compromise application maintainability and security.

To implement the "business" functions, and to perform operations on the back-end database, we have used VBScript programs embedded within Active Server Pages (with ActiveX Design Time Controls), and Internet Information Server (ISAPI) extensions or plug-ins, on the server-side. The main application, supporting the business functions, is server based as much as possible, to enable client devices to emerge and evolve, while still being able to benefit from legacy core-application investment.

We are now beginning to implement the final features of the Intranet application prototype using currently existing technology. These features include:

• Voice Recognition. In view of the nature of Endoscopy Surgery, we are going to experiment with the integration of commercial Voice Recognition software, which will enable 'hands free' real-time data capture, and report entry, during an Endoscopy session.
• Touch Screen/Light Pen. This will be investigated, to facilitate the annotating of digitised images, to highlight anatomic areas of interest.
• Intranet applications security. We see this as a major area of investigation and concern.

While the prototype is being implemented, we are also carrying out a user requirements analysis, and are tackling the problem of usability by adopting a human-oriented (user-centred) approach: Hierarchical Task Analysis (HTA) analysis is being used to capture the users' tasks model, to ensure that the properties of an effective Human Computer Interface (HCI) are identified. Software Engineering (SE) techniques, such as object-oriented Use Case modelling, will then be used for specifying and building the functional aspects of the system, thus combining HCI and SE techniques into a coherent framework for product development. It is our overall research intention to formulate an Intranet Systems Engineering methodological framework, which will guide the development of medical applications, from user requirements capture, through object-oriented design, to web-based implementation using dynamic connections to underlying medical databases.

The paper will amplify the work outlined above, and discuss our future plans and aspirations for this project.