Extensions to the HISA standard--the SynEx computing environment.

OBJECTIVES: This paper reports on the integration work required to support the delivery of healthcare. Specifically, four elements are included being: the DHE (a standards based distributed healthcare environment), Synapses which is a patient record server, XML as a technology to deliver records, and finally two client applications that facilitate structured data entry (SDE) and the remote booking of specialist services. METHODS: A general motivation for the work is presented and augmented on hand of a clinical scenario. Additionally, the adoption of a middleware approach is reviewed. The role of computerised patient records is described followed by an account of a federated record server. The approach favoured by standards bodies in utilising XML is covered and the tailoring to suit the needs of the integration is explained. The main practical challenges in achieving integration are presented, one of these being the mapping between the DHE data model and the Synapses server record architecture. RESULTS: The described environment has been demonstrated to provide the functionality that is required and in addition it has been shown that the engineering challenges can be met in a controlled and orderly manner. CONCLUSIONS: The role of the DHE middleware component acting as an 'anchor' has been shown to be a valid one onto which other specialised components can be added to provide a richer service environment. Additionally, it has been demonstrated that XML is a good candidate technology that facilitates connectivity to client applications over an extranet. The demands inherent in both the clinical scenario and the computerised patient record can be met by the computing environment described in the paper.

A laboratory test request protocol system.

This paper describes the design, implementation and assessment of a computer-based protocol application to support requests by clinicians for laboratory investigations. As part of the motivation for the work a rigorous engineering software approach was adopted not just for purely technical reasons but also as a means of maximising the role of the user.

[Diagnosis of isolated hypereosinophilia in parasitology (378 cases)]. / Diagnostic des hyperéosinophilies isolées en parasitologie (378 cas).

378 cases of isolated hypereosinophilia (eosinophils greater than 500 by mm3 of blood) are presented. The diagnosis was done for 189 cases: 184 parasitic diseases and 5 non parasitic diagnosis (3 neoplastic syndromes). The diagnosis was done more often if patients came back from a tropical area, if hypereosinophilia was observed on two samples of blood, if hypereosinophilia was major (greater than 2,500 eosinophils). The diagnosis was not done for 189 cases, but 49 patients have had an allergic disease. Drug etiologies are certainly underestimated.