A freshly graduated German doctor claims to never have used the Internet and leaves an enthusiastic Web addict like Dr. Tuomo Kauranne from the University of Joensuu in Finland stunned. If this young physician doesn't have any experience with the Web, then how should the mature and older generation of general practitioners (GPs)? This little anecdote shows we cannot take the general characteristics and medical advantages of the Internet for granted. Sounds like an excellent occasion to dot the i's and cross the t's, our Finnish speaker at the ITIS'98 Conference must have thought. His concise lecture constituted a conscious return to the basics of Internet technology.
Initially, we have to realise ourselves that the Internet opens a new perspective of splendid opportunities to the common as well as the professional user. A worldwide accessibility to both public and private communication networks is being offered by means of a flexible client software compatibility. The browser represents a powerful user metaphor and little training is required to use it. The future promises an increasing specialisation through the geographical boost of expertise centres. The Web enables the user to dynamically generate information from data bases. The interactive quality allows for mass-tailoring of end products and the easy way of communication facilitates the process of remote consultation.
Recent developments in the field of medical images access and transmission are a blessing to researchers and medical staff. The proliferation of DICOM PACS, Digital Imaging and Communications in Medicine via a Picture Archival Computer System, enhances the use of tele- and even voice-consultation over the Internet Protocol (IP). By means of global mobile access to services, surgeons, specialists and physicians are invited to discuss specific cases via desktop videoconferencing with the relevant medical images directly at hand. For reasons of security and identification, smart cards will soon be introduced.
The ideal solution to introduce Internet into the hospitals is the way of smooth integration. Dr. Kauranne considers the choice for electronic patient records as a good start. From this point, automatic on-line documentation on patient examination, treatment and surgery could be built up to finally arrive at a universal access to the patient status quo throughout the entire hospital. This just-on-time availability of patient data and medical resources enhances the efficiency, reduces the paper work and minimises the chance for mistakes. For the GP, this system of intelligent referral offers all necessary links to the patient documentation. In order to help his patient in a matter of "treatment complex", such as a backache, the GP has access to real time booking of all specialist resources. On-line follow-up of the patient's progress after his discharge from the hospital, evidently is part of the procedure.
Geographical distance no longer forms a barrier to patient data access thanks to the mobile Web device. Any browser will suffice to retrieve any arbitrary patient documentation on his medical past and to tele-analyse the data while the browser is supervising the process. The tele-consultation is performed over mobile telephone or through videoconferencing. Present concerns include the urgent need for security guarantees as well as affordable bandwidth facilities. Access to the Internet should still be extended as well as the image analysis techniques through use of Java applications.
Nevertheless, we are witnessing a growing liberation of the medical imaging market thanks to DICOM and the upcoming universal broadband services, enabling hospitals to transfer their images to supercomputing sites. These high performance platforms dispose of the required potential to compute intensive analyses and have acquired specialised expertise on imaging techniques. At the University of Joensuu, a DICOM PACS site currently is accessible over the Web. The team of Dr. Kauranne has been setting it up to try out novel imaging algorithms within the frame of the Euromed-project. Several basic methods have been incorporated for matching the image corpus. VMW Magazine has reported on this prototype in the April-issue of this year.