A distributed health information network for consultative services in surgical pathology

While the threat of federal health care reform in the USA appears to have vanished, financial pressures from insurance companies and health maintenance organizations (HMO) are causing increasing numbers of hospitals to merge in order to survive. As a result, many institutions will encounter the myriad of difficulties associated with sharing information among clinical, laboratory and research sites. Digital computer networks help transcend geographical barriers, but incompatibilities among architectures, operating systems and GUIs persist as formidable obstacles. We present a network of heterogeneous computer platforms which has been established to assist physicians and scientists to generate and manage electronic patient records dynamically and to share digital images and clinical reports among disparate sites. During the course of a pilot project, diagnoses determined by surgical pathologists using interactive digital consultation were consistent with the original diagnosis which had been rendered 1-2 years earlier using conventional light microscopy techniques in 98% of the cases studied. A set of anonymous patient records and several interactive quizzes including histopathology, clinical histories and microscopic diagnosis have been established and made accessible to medical students training in basic pathology via campus-wide computers and throughout the Internet using Gopher and Mosaic. The databases have been accessed at a rate of 800 queries/day. The network is being evaluated by a consortium of research and clinical sites to explore its potential role in a broader range of consultation and educational applications.