The project is aimed at designing and implementing a prototype system (MILORD) able to handle in an effective way multimedia medical records, which represent an integrated view of patient's data. MILORD will act as a "glue", binding together the different information sources (administrative vs clinical data, pictorial and textual vs structured data etc.) in order to improve the quality of medical diagnosis in the real clinical environment. It will support a departmental environment, in which the medical staff can manage directly all the information involved in a specific department, as well as access the information provided from other departments. Typically, MILORD will support a federation of autonomous subsystems, each of which is composed of a multiprocessor server, a number of workstations and interfaces to information sources and medical equipment. MILORD users will be allowed to co-operate and share the same patient data in a real-time co-operative work mode supported by a teleconferencing module.
The multimedia interaction with large object oriented radiological and clinical databases (MILORD) project concerns the storage, retrieval, communication and processing of heterogeneous multimedia clinical information in an integrated environment. Advanced technologies are exploited, such as: new knowledge representation tools, advanced human computer interaction, 3-dimensional graphical processing of medical images, high performance parallel architecture and algorithms, large scale distributed data storage, cooperative environment for clinical applications. Since considerable attention is given to the large health care European market, the project will develop precompetitive prototypes of industrial products. The close link with real working environments makes it possible to derive from the MILORD system a turn key product with a relatively amount of additional work; in fact, from its first version, the system is going to be installed and evaluated in large hospitals in different European countries.
Since AIM is an application-driven program, it is exploiting the most advanced technology achievements. Consequently, the MILORD system is being implemented by exploiting the KIWIS (ESPRIT Project 2424) system as follows: firstly, the advanced graphical user interface design system is being customised and enriched for taking into account the multimedia interaction requirements specific for the medical application; secondly, the knowledge representation and manipulation language (LOCO) is being enriched in several directions in order to manage multimedia objects and also to meet the requirements of medical applications; thirdly, the Cooperation manager is being extended to support a MILORD federation, which also includes teleconferencing facilities; lastly, the main-memory resident DBMS is being substantially modified to become an efficient multimedia object manipulation and storage server. Summarising, the major technological extensions to KIWIS that are being carried out in MILORD are: multimedia capabilities, management of large and heterogeneous storage devices, interactive 2D/3D graphics, adoption of a server-clients architecture, exploitation of parallel computing equipment. The project has a planned duration of three years and eleven organisations from five European countries are working on seven work packages ranging from medical requirement definition to technical development and clinical testing.
The project concerns the electronic support of diagnostic and therapeutic processes in clinical daily routine. In particular, the MILORD environment is expected to give an answer to the rising demand for:
- storing, retrieving and manipulating, in an integrated and quick way, a large amount of clinical information which is, by its nature, heterogeneous (text, voice, images, biosignals, sounds) but that physicians want to consider as an integrated whole;
- communicating and cooperating between medical experts in real-time, sharing the same clinical data;
- using user-friendly information tools with advanced interfaces, including 3D graphics and the use of the voice as input medium.
Because of the type of work in a medical department, it is expected that MILORD will really help in: increasing effectiveness, saving time and cooperating effectively with the staff or other departments. The close link that will be carried on with working environments makes it possible to plan to derive from MILORD a turn-key system with a relatively limited amount of work.
Relationship to other Projects and Actions
MILORD is mainly cooperating in the context of the AIM Project Line AMICI on Multimedia, Workstations and Images) in particular, with the projects COVIRA, EURIPACS, HELIOS-2, and SAMMIE. other AIM projects related to MILORD are: GALEN and GEHR for the modelling and representation of medical data and the general architecture of medical records; SEISMED for security and authorisation; MARGOT due to the common interest in object-oriented techniques. MILORD is also going to contribute to the Accompanying Measures "Assessment of Information Technology in Medicine" (ATIM) and "Consensus formation and Standardisation promotion" (ACOSTA).
Testbed and Verification
From its first version (planned in June 1993), MILORD will be installed for testing in Radiological and Surgical departments of large hospitals of different European countries. The evaluation will be carried out during the routine use in diagnostic and therapeutic activity. The clinical data processed at the multimedia workstation will involve several different types of patients and diseases in order to test the prototype in multiple ways. All the staff working with the system will be repeatedly asked to answer questionnaires concerning the functionality and the efficacity of the system.