Logo of jamiaAlertsAuthor InstructionsSubmitAboutJAMIA - The Journal of the American Medical Informatics Association
J Am Med Inform Assoc. 1996 May-Jun; 3(3): 191–207.
PMCID: PMC116301
PMID: 8723610

Building national electronic medical record systems via the World Wide Web.

I S Kohane, P Greenspun, J Fackler, C Cimino, and P Szolovits
Author information ► Copyright and License information ► Disclaimer

Abstract

Electronic medical record systems (EMRSs) currently do not lend themselves easily to cross-institutional clinical care and research. Unique system designs coupled with a lack of standards have led to this difficulty. The authors have designed a preliminary EMRS architecture (W3-EMRS) that exploits the multiplatform, multiprotocol, client-server technology of the World Wide Web. The architecture abstracts the clinical information model and the visual presentation away from the underlying EMRS. As a result, computation upon data elements of the EMRS and their presentation are no longer tied to the underlying EMRS structures. The architecture is intended to enable implementation of programs that provide uniform access to multiple, heterogeneous legacy EMRSs. The authors have implemented an initial prototype of W3-EMRS that accesses the database of the Boston Children's Hospital Clinician's Workstation.

Full Text

The Full Text of this article is available as a PDF (2.0M).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Dorenfest S. Creating a "Top 100" HIS firm: the lessons of history. Healthc Inform. 1994 Jun;11(6):49–passim. [PubMed]
  • Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA. 1993 Jan 20;269(3):379–383. [PubMed]
  • Ornstein SM, Garr DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. J Fam Pract. 1991 Jan;32(1):82–90. [PubMed]
  • Bleich HL, Beckley RF, Horowitz GL, Jackson JD, Moody ES, Franklin C, Goodman SR, McKay MW, Pope RA, Walden T, et al. Clinical computing in a teaching hospital. N Engl J Med. 1985 Mar 21;312(12):756–764. [PubMed]
  • Pryor TA, Gardner RM, Clayton PD, Warner HR. The HELP system. J Med Syst. 1983 Apr;7(2):87–102. [PubMed]
  • McDonald CJ, Tierney WM, Overhage JM, Martin DK, Wilson GA. The Regenstrief Medical Record System: 20 years of experience in hospitals, clinics, and neighborhood health centers. MD Comput. 1992 Jul-Aug;9(4):206–217. [PubMed]
  • Stead WW, Hammond WE. Computer-based medical records: the centerpiece of TMR. MD Comput. 1988 Sep-Oct;5(5):48–62. [PubMed]
  • Dayhoff RE, Maloney DL. Exchange of Veterans Affairs medical data using national and local networks. Ann N Y Acad Sci. 1992 Dec 17;670:50–66. [PubMed]
  • Zielstorff RD. Capturing and using clinical outcome data: implications for information systems design. J Am Med Inform Assoc. 1995 May-Jun;2(3):191–196. [PMC free article] [PubMed]
  • Frawley SJ. Building a Database of Data Sets for Health Services Research. Proc Annu Symp Comput Appl Med Care. 1994:377–381. [PMC free article] [PubMed]
  • Sujansky W, Altman R. Towards a standard query model for sharing decision-support applications. Proc Annu Symp Comput Appl Med Care. 1994:325–331. [PMC free article] [PubMed]
  • Salton G. Developments in automatic text retrieval. Science. 1991 Aug 30;253(5023):974–980. [PubMed]
  • Hersh WR. Evaluation of Meta-1 for a concept-based approach to the automated indexing and retrieval of bibliographic and full-text databases. Med Decis Making. 1991 Oct-Dec;11(4 Suppl):S120–S124. [PubMed]
  • McCarn DB. MEDLINE: an introduction to on-line searching. J Am Soc Inf Sci. 1980 May;31(3):181–192. [PubMed]
  • Côté RA, Robboy S. Progress in medical information management. Systematized nomenclature of medicine (SNOMED). JAMA. 1980 Feb 22;243(8):756–762. [PubMed]
  • Gabrieli ER. A new electronic medical nomenclature. J Med Syst. 1989 Dec;13(6):355–373. [PubMed]
  • Campbell JR, Payne TH. A comparison of four schemes for codification of problem lists. Proc Annu Symp Comput Appl Med Care. 1994:201–205. [PMC free article] [PubMed]
  • Lamiell JM, Wojcik ZM, Isaacks J. Computer auditing of surgical operative reports written in English. Proc Annu Symp Comput Appl Med Care. 1993:269–273. [PMC free article] [PubMed]
  • Miller PL, Frawley SJ, Wright L, Roderer NK, Powsner SM. Lessons learned from a pilot implementation of the UMLS information sources map. J Am Med Inform Assoc. 1995 Mar-Apr;2(2):102–115. [PMC free article] [PubMed]
  • Rosenberg KM, Coultas DB. Acceptability of Unified Medical Language System terms as substitute for natural language general medicine clinic diagnoses. Proc Annu Symp Comput Appl Med Care. 1994:193–197. [PMC free article] [PubMed]
  • Zielstorff RD, Cimino C, Barnett GO, Hassan L, Blewett DR. Representation of nursing terminology in the UMLS Metathesaurus: a pilot study. Proc Annu Symp Comput Appl Med Care. 1992:392–396. [PMC free article] [PubMed]
  • Campbell JR, Kallenberg GA, Sherrick RC. The clinical utility of META: an analysis for hypertension. Proc Annu Symp Comput Appl Med Care. 1992:397–401. [PMC free article] [PubMed]
  • Cimino C, Barnett GO, Hassan L, Blewett DR, Piggins JL. Interactive Query Workstation: standardizing access to computer-based medical resources. Comput Methods Programs Biomed. 1991 Aug;35(4):293–299. [PubMed]
  • Cimino JJ. Representation of clinical laboratory terminology in the Unified Medical Language System. Proc Annu Symp Comput Appl Med Care. 1991:199–203. [PMC free article] [PubMed]
  • Cimino JJ, Aguirre A, Johnson SB, Peng P. Generic queries for meeting clinical information needs. Bull Med Libr Assoc. 1993 Apr;81(2):195–206. [PMC free article] [PubMed]
  • Peng P, Aguirre A, Johnson SB, Cimino JJ. Generating MEDLINE search strategies using a librarian knowledge-based system. Proc Annu Symp Comput Appl Med Care. 1993:596–600. [PMC free article] [PubMed]
  • Sperzel WD, Abarbanel RM, Nelson SJ, Erlbaum MS, Sherertz DD, Tuttle MS, Olson NE, Fuller LF. Biomedical database inter-connectivity: an experiment linking MIM, GENBANK, and META-1 via MEDLINE. Proc Annu Symp Comput Appl Med Care. 1991:190–193. [PMC free article] [PubMed]
  • Reddy R, Jagannathan V, Srinivas K, Karinthi R, Reddy SM, Gollapudy C, Friedman S. ARTEMIS: a collaborative framework for health care. Proc Annu Symp Comput Appl Med Care. 1993:559–563. [PMC free article] [PubMed]
  • Lowe HJ, Walker WK, Vries JK. Using agent-based technology to create a cost effective, integrated, multimedia view of the electronic medical record. Proc Annu Symp Comput Appl Med Care. 1995:441–444. [PMC free article] [PubMed]
  • Hammond WE, Stead WW. Adopting TMR for physician/nurse use. Proc Annu Symp Comput Appl Med Care. 1991:833–837. [PMC free article] [PubMed]
  • Forsythe DE. Using ethnography to build a working system: rethinking basic design assumptions. Proc Annu Symp Comput Appl Med Care. 1992:505–509. [PMC free article] [PubMed]
  • Wilton R. User-specific interfaces for clinical data-management systems: an object-based approach. Proc Annu Symp Comput Appl Med Care. 1992:265–269. [PMC free article] [PubMed]
  • Shaw DJ, Czaja RF. User interactions with the PDQ cancer information system. Bull Med Libr Assoc. 1992 Jan;80(1):29–35. [PMC free article] [PubMed]
  • Green CA, Gilhooly KJ, Logie R, Ross DG. Human factors and computerisation in intensive care units: a review. Int J Clin Monit Comput. 1991;8(3):167–178. [PubMed]
  • Beaudouin-Lafon M. An overview of human-computer interaction. Biochimie. 1993;75(5):321–329. [PubMed]
  • Payne TH, Martin DR. How useful is the UMLS metathesaurus in developing a controlled vocabulary for an automated problem list? Proc Annu Symp Comput Appl Med Care. 1993:705–709. [PMC free article] [PubMed]
  • Cimino JJ. Data storage and knowledge representation for clinical workstations. Int J Biomed Comput. 1994 Jan;34(1-4):185–194. [PubMed]
  • Burgun A, Delamarre D, Botti G, Lukacs B, Mayeux D, Bremond M, Kohler F, Fieschi M, Le Beux P. Designing a sub-set of the UMLS knowledge base applied to a clinical domain: methods and evaluation. Proc Annu Symp Comput Appl Med Care. 1994:968–968. [PMC free article] [PubMed]
  • Cimino JJ, Johnson SB, Peng P, Aguirre A. From ICD9-CM to MeSH using the UMLS: a how-to guide. Proc Annu Symp Comput Appl Med Care. 1993:730–734. [PMC free article] [PubMed]
  • Cimino JJ. Controlled medical vocabulary construction: methods from the Canon Group. J Am Med Inform Assoc. 1994 May-Jun;1(3):296–297. [PMC free article] [PubMed]
  • Hersh WR, Hickam DH, Haynes RB, McKibbon KA. A performance and failure analysis of SAPHIRE with a MEDLINE test collection. J Am Med Inform Assoc. 1994 Jan-Feb;1(1):51–60. [PMC free article] [PubMed]
  • Huff SM, Rocha RA, Bray BE, Warner HR, Haug PJ. An event model of medical information representation. J Am Med Inform Assoc. 1995 Mar-Apr;2(2):116–134. [PMC free article] [PubMed]
  • Rocha RA, Huff SM, Haug PJ, Warner HR. Designing a controlled medical vocabulary server: the VOSER project. Comput Biomed Res. 1994 Dec;27(6):472–507. [PubMed]
  • Sager N, Lyman M, Bucknall C, Nhan N, Tick LJ. Natural language processing and the representation of clinical data. J Am Med Inform Assoc. 1994 Mar-Apr;1(2):142–160. [PMC free article] [PubMed]
  • Schuyler PL, Hole WT, Tuttle MS, Sherertz DD. The UMLS Metathesaurus: representing different views of biomedical concepts. Bull Med Libr Assoc. 1993 Apr;81(2):217–222. [PMC free article] [PubMed]
  • Pearson P, Francomano C, Foster P, Bocchini C, Li P, McKusick V. The status of online Mendelian inheritance in man (OMIM) medio 1994. Nucleic Acids Res. 1994 Sep;22(17):3470–3473. [PMC free article] [PubMed]
  • Hinds A, Greenspun P, Kohane IS. WHAM!: a forms constructor for medical record access via the World Wide Web. Proc Annu Symp Comput Appl Med Care. 1995:116–120. [PMC free article] [PubMed]
  • Kohane IS. Getting the data in: three year experience with a pediatric electronic medical record system. Proc Annu Symp Comput Appl Med Care. 1994:457–461. [PMC free article] [PubMed]
  • Cimino JJ, Socratous SA, Clayton PD. Internet as clinical information system: application development using the World Wide Web. J Am Med Inform Assoc. 1995 Sep-Oct;2(5):273–284. [PMC free article] [PubMed]
  • Willard KE, Hallgren JH, Sielaff B, Connelly DP. The deployment of a World Wide Web (W3) based medical information system. Proc Annu Symp Comput Appl Med Care. 1995:771–775. [PMC free article] [PubMed]
  • Cimino JJ, Socratous SA, Grewal R. The informatics superhighway: prototyping on the World Wide Web. Proc Annu Symp Comput Appl Med Care. 1995:111–115. [PMC free article] [PubMed]
  • Lowe HJ, Lomax EC, Polonkey SE. The World Wide Web: a review of an emerging internet-based technology for the distribution of biomedical information. J Am Med Inform Assoc. 1996 Jan-Feb;3(1):1–14. [PMC free article] [PubMed]
Articles from Journal of the American Medical Informatics Association : JAMIA are provided here courtesy of American Medical Informatics Association