Dear Biomch-L readers,

The following item was received today via the RESEARCH list; I should think
that it is highly relevant in our field, too.

Regards -- HJW.
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Date: Fri, 10 May 91 14:59:51 EDT
Sender: Hospital Computer Network Discussion Group and Data Base

From: "Donald F. Parsons MD"
MARCH 1992
To: Marty Hoag

D. Parsons MD, Wadsworth Center, Room C273, New York State
Department of Health,
Empire State Plaza, Albany, NY 12201-0509. Tel: (518)474-7047;
Fax: (518)474-8590. E-mail to moderator: BITNET dfp10@albnyvm1;
Internet; UseNet;
Compuserve 71777,212
Date: May 10, 1991
File: hspinvit.asp

The New York Academy of Sciences Sponsored:

Moderators and Editors: Donald Parsons MD and;
Carl Fleischer Robert A. Greenes MD, PhD
Dir., Consulting Services Assoc. Prof. Radiology
FMS Telecommunications Dir., Decisions System Gp
314 Walnut St. Brigham & Women's Hospital
Wellesley, MA 02181 75 Francis St.
617 235-2245; fax 617 235-9337 Boston, MA 02115
617 732-6281; fax 617 732-6317
NYAS Sub-Committee Chair:
Morris Shamos PhD
M.H. Shamos & Associates
6 East 43rd St.
New York, NY 10017
212 573-6030w; 212 884-9030h; fax 212 263-713


Dear Subscriber,

The purpose of this letter is to invite you or a
representative to participate in the upcoming New York Academy of
Sciences sponsored meeting: "A CONFERENCE ON EXTENDED CLINICAL
on Monday, March 23 through Wednesday, March 25, 1992 at the
Marriott Hotel, Copley Square (across from the Prudential),
Boston. I believe that this is the first national and
international conference bringing together those interested in
sharing consulting resources between large medical centers and
rural hospitals and groups of physicians. As you know, the
crisis in rural health care is worsening and telecommunications
may well assist in restoring acute or emergency care to some
rural areas.
However, the Conference has a wider scope: it covers also
the LANs, WANs and national networks involved in intra-hospital,
inter-hospital, national and international consultation (or
medical disaster management). Apart from the technical aspects;
the personal, social, educational, economic and legal aspects of
such communications will be considered. Emphasis will be placed
on the medical informatics involved, and on training physicians,
nurses, public health and social workers, and hospital
administrators to give them a basic understanding of the new
computer methods of assembling and distributing patient and
hospital administration information.
Having received full endorsement by the NYAS, we are in the
process of putting together a preliminary program (enclosed).
In some cases we have suggested a title and place for you in the
program. If not, please examine the program and suggest your own
place and topic. At this time all names of speakers and titles
are preliminary only. Please give us your own title(s). We will
be flexible about restructuring the arrangement of topics and the
program itself. Your comments about the program and about
additional speakers, will be most valuable. Let us know if some
important areas have been omitted or underemphasized. At the
same time we would like to keep the number of parallel sessions
at a minimum. We hope that all chairpersons and co-chairs will
also give a paper.
A call for poster abstracts will be issued later. Please
also let us have any suggestions about choice of commercial
The papers of this conference will be published as a single-
topic volume of the Annals of the New York Academy of Sciences.
This serial publication is distributed throughout the world to
virtually every major science library. It reaches a wide
audience of basic, biomedical and clinical scientists. For the
near future, this issue should become the major reference for
clinical networking information. To achieve this status, rapid
publication is necessary. The NYAS will publish our issue 6-9
months after the conference. Authors are expected to submit
papers 2 weeks before the conference, or at the very latest, at
the time of the conference. A booklet of abstracts will be
available to the attendees.
At this stage, we are actively involved in fund raising. We
hope to support those who indicate a need for travel and per diem
expenses. Meanwhile, we hope you can commit yourself to
participate regardless of financial assistance. The enclosed
form is to indicate your needs.
We sincerely hope that you will be able to participate. To
confirm this, please complete the form and return immediately to
Ms. Busacco by mail or fax as indicated on the form. Kindly send
a copy to me (Donald Parsons) by mail, fax or e-mail, also.
If you have further questions, please call me at (518) 474-
7047 (it has an answering machine).


Donald Parsons
Professor, Albany School of Public Health
Af.Professor of Biology, SUNY Albany
Research Physician III, NY State Dept of Health


In recent years there has been a serious and continuing
decline in the number of operating rural health facilities and in
the availability of acute care in rural hospitals. This
situation has contributed significantly to rural economic decline
and the rising cost of health care in USA. Increasingly,
patients have the extra expense of travelling to distant large
medical centers for treatment.
A partial reparation of the situation can be achieved by
computer networking between consultants at large medical centers
and rural hospitals and physicians. Xrays or other medical
images necessary for the consultation can be transmitted over
ordinary phone lines in a few minutes, using new data compression
algorithms and error-correcting modems. A diagnosis, or patient-
stabilization information can be phoned, faxed or e-mailed back
to the rural center in a short time. Chronic treatments that
require repeated consultant control (such as chemotherapy) can be
handled in the same way. The patient is able to stay at the home
site for such treatment. Phone/fax consultant-access systems
using dedicated switchboards, are already working well in several
states (e.g., Alabama, Tennessee and Georgia). These states are
attempting enhancement by addition of digital text and image
transmission capability.
The identification of preferred technical approaches to such
computerized networking is a main objective of this Conference.
We will review medical computer networks already operating, both
in USA and elsewhere, and discuss new possibilities. This
Conference is the first comprehensive discussion of this
question. It is badly needed since communication between
experimenting groups has been at a minimum, and the need for such
systems has received little attention by granting agencies and
legislators. Only recently, has a BITNET discussion group
(HSPNET-L@albnydh2) on this subject become available.
Apart from the technology and design of such hospital
computer networks (including the place of local bulletin boards,
landlines, satellite and packet-radio links), we will address
many related issues: medical staff attitudes and training in use
of computers, types of patient data packages, confidentiality of
data, legal issues, etc. We will also address a variety of
applications: high-definition TV, teleradiology, telepathology,
fetal monitoring, accreditation/ education programs, access to
literature searches in rural areas, improvement of disease
notification, exchange of state and federal medical advisories,
and disaster and trauma management.
Hopefully, this Conference will serve to focus and catalyze
the use of modern medical informatics principles for the
improvement of the quality of health-care delivery.

Scientific rationale for the conference.
The economic and structural crisis in health delivery in USA
today make a search for technical assistance an urgent matter.
The possibility that computer assisted telecommunications and
principles of medical informatics can provide a relatively
inexpensive easement of the problem is important in these days of
huge deficits.
Recent major advances in several scientific fields have
provided optimism that this approach will be rewarding. In image
processing, data compression algorithms have switched attention
from very expensive satellite communication to the use of
ordinary land lines. Evolution of error-correcting modems have
improved the outlook further for use of landlines.
Very recently, there has been considerable legislative
interest in developing a higher speed (T1,T3) national network
(e.g. CREN) which might stimulate US industry. There is growing
commercial interest towards making ISDN voice/data lines the
national standard. If such developments occur, the improved
hardware and expertise developed will help this kind of health-
delivery task.
Fortuitously, there have been many Defence grants recently
awarded to medical-center radiology departments for the purpose
of improving the digitization, storage and transmission of
digitized medical images (PACS - picture archiving and
communication systems). This funding has accelerated image
processing and development of digitization and transmission
methods. Many medical-center radiology departments now have
personnel, equipment and expertise that make them a natural
center for controlling the exchange of digitized patient data.
Eventually it is hoped that the science of medical
teleinformatics will develop to the point that national systems
can be interlinked in a world-wide exchange of medical
experience. This should be of particular benefit to developing
countries and countries struck by large-scale disaster


Speakers may choose 30 m. or 20 m. (which includes 5 m. for
discussion). On-line computer sessions and videos will run
during the 25 m. coffee breaks which will be held in the Poster
Viewing Area, adjacent to the Commercial Exhibit Area. Press
Conferences will be held at 5 pm on Day 2 and at noon on Day 3.
All chairpersons will be expected to present papers. CME credit
will be available.

First Day:
COMPUTER NETWORKS. Chair: D.F. Parsons, NYS Dept of Health,
Albany, NY
8.30-8.40. Welcome and Announcements: D.F. Parsons
1. Opening Address: John S. Quarterman. "The Matrix:
Computer Networks and Conferencing Systems Worldwide. What They
Have to Offer for Medical Consulting."
2. "The French Communicable Disease Network and Other
European Networks," Philippe Garnerin DVM, PhD; Chief of Computer
Operations, FCDN, Universite Paris, France (with live video
3. "The DIV Netherlands Hospital and General Practice
Network" P.G. Arnou, Stichting Dienst Informatie Verwerking,
Hilvarenbeekseweg 60, 4460 BB Goes, Netherlands.
4. "Medical Networks in Sweden," Eng-leong Foo, Director,
UNEP/UNESCO/ICRO Microbiological Resources Center, Dept of
Bacteriology, Karolinska Institute, S 104 01 Stockholm, Sweden.
5. "Medical Networks in Canada," Lewis S. Carey MD,
Department of Diagnostic Radiology and Nuclear Medicine,
University Hospital, University of Western Ontario, Canada.


Oeffinger, President Texas Hospital Education and Research
Foundation, Co-Project Director of Texas Rural Hospital
Electronic Exchange -TRHEX, Austin, TX
1. "The State of Healthcare In Rural America." --------
2. "Telecommunications Technology for Rural Healthcare."
A.M. Bennet, National Center for Health Services Research,
3. "Several Medical Networks in Texas (KARENET, MEDNET and
Others)." John C. Oeffinger
4. "Rural Networking In North Dakota." Marty Hoag, Manager
System Services, Computer Center, North Dakota State University,
PO Box 5164, Fargo ND 58105. (701)237-8639; fax (701)237-8541.

B. MEDICAL INFORMATICS. Chair: Edward H. Shortliffe MD,
PhD, Chief, Division of Internal Medicine, Stanford University
Medical Center, Stanford, CA.
1. "Teaching Informatics to Medical Personnel." E.H.
2. "Improved Notification, Reporting and Exchange of State
and Federal Advisories." -------
3. "The WONDER System for On-line Epidemiological Data
Analysis." CDC MAINlink, Sarah L. Lyle, PRI Inc, 18 Executive
Park Drive, Atlanta, GA 30329.
4. "Telecommunications in Medicine: The 3I Project." A.
Hasman, Foundation 3I, Dept. Medical Informatics and Statistics,
Univ. Limburg, PO Box 616, 6200 MD Maastricht, Netherlands.
1.30 pm. Start of Poster Session. Start of Commercial Exhibits
5. "Maintaining Confidentiality in Electronic Patient Data."
6. "IEEE and Other Standards for Medical Data Interchange."
T.E. Rutt, AT&T Bell Labs, Holmdel, NJ 07733.

Evening: Free. Independently arranged Subgroup Meetings will be

++++++++++++++++++++++++++++++++++++++++++++++++++ ++++++
Second Day:

Problems of Digital data transfer.
3a. Teleradiology Chair: Steve Pizer PhD, Dept. of
Computer Science, Univ. North Carolina, Chapel Hill, NC 27599-
3175. (919)962-1785.
i. "Teleradiology as an Important Consulting Tool." Steve
ii. "Recent Image Data Compression Techniques." Joseph
Caresio, University of Kansas, Medical Center, Kansas City,
iii. "Teleradiology for the Emergency Room." Nolan J.
Kagetsu MD, Dept of Radiology, St.Lukes/Roosevelt Hospital
Center, Amsterdam Ave at 114th St, New York, NY 10025-1723.
iv. "Ultra-high-speed Teleradiology with ISDN Technology."
James L Lear MD, Dept Radiology, Box A034, University of
Colorado, Health Sciences Center, 4200 E. Ninth Ave, Denver, CO
v. "TAMRI - Rapid Reporting in Miami on Phone-line
Transmitted Radiographs and Slides From Latin America."
Mario A. Mendez, Director, Trans-American Medical Referrals,
Inc., 5200 Blue Lagoon Drive, Suite 640, Miami, FL 33126.

3b. Telepathology, Miscellaneous Telemedicine
Applications. Chair: Ronald S. Weinstein MD,
Chairman, Dept. Pathology, Rush-Presbyterian-St.Luke's Medical
Center, 1653 W. Congress Parkway, Chicago, IL 60612.
i. "Telepathology Consulting." R.S. Weinstein.
ii."Fetal Heart Rate Monitoring in Rural Areas." Steven l.
Clark MD, Utah Valley Regional Prenatal Center, 1034 North
500 West, Provo, UT 84604.
3c. Interhospital linkages. Chair: John P. Glaser
PhD, Brigham and Women's Hospital, Boston.
i. "The Longwood Medical Area Network" John P. Glaser PhD,
Brigham and Women's Hospital, Boston.
ii. "Data Communications Within a Health Authoritory," J.
Moseley, Hammersmith Hospital, London.

3d. Bulletin Boards and FidoNet. Chair: David Dodell
DMD,10250 North 92nd Street, Suite 210,
Scottsdale, AZ 85258-4599. (602)860-1121
i. "FidoNet for Medical Consulting." David Dodell
ii. "Medical Bulletin Boards Around the World" John
Beasley, Family Medicine, Univ. Wisconsin Medical

3e. Disaster and Trauma Center Networking. Chair:
Dr. Andrew Bern, Head Disaster Medicine Section, American College
of Emergency Physicians, 9846 NW 18th St., Coral Springs, FL
33071. (305)755-7083.
i. "Telecommunication Needs for Disaster Medicine in USA."
Andrew Bern MD.
ii. "Current Disaster Networking in USA." David Butler,
Natural Hazards Research and Applications Information Center,
Inst. Behavioral Science #6, Campus Box 482, Un. Colorado,
Boulder, CO 80309-0482. (303)492-6818; fax (303)492-6924.

3f. Special Compact Patient Data Packages. Chair:
i. "SmartCards in Health Care." Nancy Mann, Health and
Consumer Industries, Arthur D. Little, Acorn Park,
Cambridge, MA 02140.
ii. "Storage of Medical Data on Optical Discs." A. Hasman,
Dept. of Medical Informatics and Statistics, University of
Limburg, 6200 MD Maastricht, Netherlands.

3g. Consulting via Satellite. High Definition TV
Consulting. Chair: Charles Clements
i. "Global Hospital Networking." Charles Clements,
SatelLife, 225 Fifth Street, Cambridge, MA 02142.
ii."Cost Containment in Satellite Medical Consulting."
iii."The Satellite System at the University of
iv. "The HDTV Consulting System in Texas." Cliff Eason,
Vice President Southwestern Bell and the Texas Children


Problems and Non-digital Consulting.

4a. Problems for Medical Personnel in Using
Computers, Confidentiality, Finance and Legal Problems.

Chair: Benjamin Wright, Attorney, 3420 Granada, Suite
400, Dallas, TX 75205. (214)526-5254.
i. "Electronic Data Interchange and American Law." Ben
ii. "Problems for Medical Personnel in Adapting to Use of
iii."Third-party Reimbursement for Telecommunications
Patient Care." A.M. Bennet.

4b. Phone/Fax Consultant Services. Chair:
i. "GaIN: Network of Physicians and Hospitals in Georgia"
Jocelyn A. Rankin
ii. "MIST - Medical Information by Telephone" Lynn Watson,
MIST Coordinator, University of Alabama Medical School, UAB
Station, Birmingham, AL 35294. (205)934-5957; fax (205)975-
iii. "The Tennessee Consultation Center." Garlena
Davenport, Director.
iv. "West Virginia CONSULT Statewide Medical Information
System." Linda Jacknowitz, Project Director, WV Univ.
Health Sciences Center, Morgantown, WV 26506. (304)293-4996;
fax (304)293-2901.


4c. Packet Radio Medical Communication. Chair: Phil
Karn, Bellcore Corp., (201)829-4299.
i. "The Potential of Packet Radio for Medical Consulting."
Phil Karn.
ii. "Examples of International Medical Consulting by Packet
Radio." Len Traubman DDS, 1448 Cedarwood Drive, San Mateo,
CA 94403. (415)333-6812; fax (415)573-1217.


Evening: Subscription Dinner (tables can be selected according
to sub-interest), Cash Bar (both assisted by

Guest speaker at dinner: Daniel R. Masys MD. FACP. Director
Lister Hill National Center for Biomedical Communications,
National Library of Medicine, NIH. "U.S. Federal Plans for
Expansion of National Computer Networks and for Network Aid to
Rural Medical Centers" Q. & A.
++++++++++++++++++++++++++++++++++++++++++++++++++ +++++++

Third Day:

AM. Session 5. PANEL DISCUSSION "What is the Best Approach to
Restoring Acute-Care Consulting to Rural Hospitals and Physician
Topics: Increasing discussion in trials of networks, increased
and more goal-orientated federal funding for network
Panelists: Chair: D. F. Parsons;
PM. End of Poster Session and Commercial Exhibits. Departure.