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\title {Developments of computational methods and networking
in medical institutions in Hungary}
\author
{ISTV=8FN GY=A7RI \\
Department of Mathematics, \\
 University of Veszpr=82m, \\
Hungary, \\ \\
J=8FNOS KARSAI \\
Department of Medical Informatics,\\ A. Szent-Gy=94rgyi
Medical University,\\ Kor=A0nyi fasor 9, Szeged 6720, Hungary, \\ \\
ATTILA PETH=A7\\ Medical University, Debrecen, \\ \\
ATTILA SALI \\ I. Semmelweis Medical University, Budapest}


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\begin{document}
\baselineskip 0.3in
\maketitle
\date{}
\begin{abstract}

In this paper we are dealing with the applications of computers in the
Hungarian medical education, research, and medical informatics.
We give a review of the educational programs, of the main areas of
applications, emphasizing the problems, milestones and the remarkable
development of medical informatics in Hungary during the last years.
 \bigskip

{\em Keywords:} computer based education, health care systems, networking=
,
medical informatics, integrated information systems.
\end{abstract}

\section{Introduction}

Medicine and medical education are very important in computing
applications all over the world.
This is also the case in Hungary. Especially, the whole spectre of
applications, from health care systems to scientific modelling,  can
be followed at the medical universities.

The interactions and variations of technical possibilities, user's
expectations, the tasks and their solutions, and the huge work of
dedicated experts led to the present state, where informatics became
an organic part
of the everyday life of the Hungarian medical universities. There are
introduced new information systems based on top-level
hardware-software devices. This concerns the research, education and
clinical work, too.
In the paper we present the progress and the results of developments.

Above we suggested, that all the areas of medical computer
applications can be found at the Hungarian medical universities.
The reason is the special structure, that is not usual in some
countries.

In addition to the theoretical departments, the  clinical departments als=
o
belong to the universities, mainly doing the practical education. The
tipical structure is shown on Figure 1.

\begin{center}

Figure 1
\end{center}

It's consequence is that the computer services must support not only the
education and research, but also the routine health care and the financial
management.
These areas are unseparable, they only mark the main directions. See
Figure 2.

\begin{center}

Figure 2
\end{center}


We note, that the presence of clinical and diagnostic departments has
a key role in improvements, because of the demands of everyday work
and of the business relations to the Health Insurance Company, which
are the main motivators of the developments and immediately improves
even the educational program of theoretical subjects.

Next, after some words about the history, we discuss the cases of
applications in health care, economic work, graduate and postgraduate
education, research and the information infrastructure.

\section{The history}
The history of medical informatics in Hungary is longer than 20
years, when the
Computing Centers at SOTE in Budapest and at SZOTE in Szeged were
founded.
The other universities recognized the importance of informatics some
years later.
The  Laboratory of Informatics at DOTE in Debrecen was established for
example only in 1992.

At the beginning, because of the restricted capabilities of the hardware,
the main
applications were the evaluation of handly-collected data.
There were also experiments to develope clinical administration
systems, but their success \, were restricted.

The main reasons are the following:

- the potential users were not prepared for the new technic.

- the hardware could not satisfy the functional and speed expectiations

- the lack of experience of the developers in developing complex
systems

About ten years later the ideas were realized with success.

With the apparance of desktop computing devices and local area
networks a new age started. They meant an explosion in applications. 
The PC-s were at once introduced in all areas. The interest of the doctors
and the requirement of the management increased. 
In consequence, the education of computer
technics was started in the middle of 80-s.
Local, and later networked, in-and outpatient systems,
laboratory systems etc. were developed for the clinical departments.
E-mail functions helped the local
communications. The researchers could start to use scientific
packages.

These applications were very successful. The most important success
factors are:

- close cooperations with the users,

- restructuring the working environment to the new possibilities,

- structural problem-solving, step-by-step introduction,

- responsible help of the university leaderships,

- central coordination and management,

- decreasing the prices, weakening of COCOM,

- good examples,

- Hungary-wide coordination of medical informatics,

- the introduction of cost-sensible insurance system,

- central support of the development of the infrastructure of the universities.

\bigskip

The success of developments generated new demands, requirements. The
most important of them are the necessity of

- international network connection,

- central databank services,

- integrated clinical information system,

- use of the "live"  systems in education,

- central high powered processor capacity for scientific calculations,

- central resource management.

To realize these requirements comprehensive informatical investments
started at
every university in Hungary.
In the following sections we summerize the present state of results
and
applications.

\section{The infrastructure}

In the 90-s complete university-wide networks are developed. All the
departments are
networked. The university networks have connection to the world-wide
Internet.
The networks have optical (FDDI, Token-Ring) backbone and mostly
coaxial
wings (Ethernet, Token-Ring). The following parameters illustrate the
sizes:
of $ \sim 20 $ bridges, $ \sim 40 $ multiport repeaters, 1-2 routers,
length of
cableing approx. 50 km, 25 subnetworks (example of SZOTE-SZEGED).

The used network softwares are Novell-Netware, TCP/IP, DECNET.
The departmental servers are mostly Novell PC-servers, serving the
$ \sim 500-1000 $ PC-s in the departments (10-50 in each).
For some services (Email, Internet connection, CD, etc.) central
servers are
installed and managed by the computing centers.
The mailers are VAX-VMS or UNIX machines. There are "Charon" mail-
gateways to Novell mailing (Pegasus mail).
CD servers with Novell or IP are used for scientific databank
services (PC service!)

While the most application are PC-based, in some areas there are
necessary
high powered RISC servers and workstations as comput-servers. To
reach them
X-terminals and X-windows emulator softwares are installed.
What concerns the education, there are networked cabinets (for
example, four PC
cabinets and one X-terminal cabinet at SZOTE, two PC cabinets and one X-te=
rminal
at DOTE) for education.
In addition to the special servers for education, the students, who
want to do research, can reach other resources. The students can work ove=
r
Internet (mail, transfer, etc.).
We note that the resources work continously 24 hours a day.

Figure 3-5 show the logical structure of SZOTENET, DOTENET and SOTENET,
respectively. In details see
(\cite{KJ-Gy}, \cite{petho1},\cite{sali1}).

\begin{center}
Figure 3
\end{center}

\bigskip
\begin{center}
Figure 4
\end{center}

\bigskip
\begin{center}
Figure 5
\end{center}

\bigskip

\section{Education of Informatics and Mathematics}

As we have seen above, the technical condition (resources, cabinets)
make possible to realize
the most modern educational programs in the frame of both the
graduate and postgraduate
courses and of courses for the teaching and research staff.

We summerize the main course programs. As example, Figure 6 shows the
schedule.


\begin{center}
Figure 6
\end{center}

\bigskip
{\em Mathematics for pharmacy students}.

The course is computer illustrated
from 1994 at SZOTE. The Mathematica package is used for this purpose.
(\cite{KJ1}). The main topics are: biomedical processes and
functions,
exponential, logaritmic functions, differential and integral
calculus,
differential equations, functions of several variables, applications
in pharmacy.

\bigskip

{\em Biostatistics for pharmacy and for Ph.D students}

The practicals are computer-based. Packages SAS, SPSS and
Statgraphics are
used. The main topics are: elements of probility, distritutions,
normal
distribution, data analysis, tests, regression analysis, variance
analysis.

\bigskip
In the informatics courses the students use the "sharp" resources,
programs,
that they can meet in their clinical work or research.

\bigskip

{\em Basics of Informatics for all graduate and Ph.D. students}

The topics are: basics of personal computing (DOS, utilities, etc.),
Windows,
documents-editing, spread-sheet programs; Email, network services
scientific
databanks. Since the preliminary knowledge level of  the students can
be very different, there are basic and advanced groups organized.

\bigskip

{\em Fundamentals of Medical Informatics}

This course is not
technical, the applications illustrate the learned ideas.
The main topics: the main areas of medical informatics; informatics
of research; information structures, information flow; clinical
information systems;
informatics of social health care; special areas.

\bigskip

In addition to the above considered ones, there are organized special
courses, like

- advanced applications,

- networks in medicine,

- signal processing,

- courses on program packages,

- multimedia,

- graphic workstation applications, etc.,

\bigskip
Moreover, there are subjects, which are also computer based, like

- biopharmacy,

- pharmacy information systems,

- chemical modelling.

\bigskip

We note that the interest from the students is huge. The PC cabinets
are full
between the lessons. This is the reason, that one cabinet in Szeged  is
established only for
for the students.

\bigskip

\section{General services, Applications for research}

Nowadays, some services are so organic in the scientific work that
can be considered as parts of the
informatical infrastructure.

\bigskip

{\em Networking} For local connection for PC-s, mainly Novell Netware
is
used, since the main services are file and print services and
mailing. Decnet and Internet are for international connection and for
connection to the
processing servers (VMS, UNIX servers, station).
International electronic mail through Internet is available. The
domains
are (szote.u-szeged.hu, sote.hu, dote.hu).
The international connection is quite new (3-5 years) and satisfies a
very old demand from the research.

\bigskip

{\em Local databanks, Information services.}
In addition to library informations and news, the medical CD-databanks
like
MedLine, Current Contents, Science Citation Index, Excerpta Medica are
available from any networked stations.

\bigskip

{\em Scientific Packages}
For the widely used packages (SAS (PC, UNIX), SPSS, BMDP, Mathematica, MAPLE, 
Word for
Windows, etc. licences are bought and installed on the central resources.=

The computing centers coordinate and manage their usage.

The packages of special interest are ordered and installed locally in
the
departments, but some of them work on central servers of high speed
(for example in chemistry, pharmacokinetics, etc.).

We have to mention here the systems, running on fast graphic
workstations, which have
been available for 1-2 years. Their graphic and multimedia
capabilities
haven't been recogenized yet fully by the users. We feel, that this
is the
last moment, when the users are generally satisfied with the PC-s.

\bigskip

\section{Patient's care}
\bigskip

As we mentioned above, this area is the one, which forced first the
modernization of computing infrastructure. In 1993 a new cost-sensible 
insurance system was introduced in Hungary. The budget of the hospitals
was earlier more or less independent of their performance. The new
system requires up to date data on patients attending on the hospitals or in 
our case on the clinical departments. As our universities took part in
the preparation and development of the new insurance system, they realized
soon the necessity of the application of computing environments. 

We have to mention that our clinical departments are situated in pavilions
spread about at a large area, hence networking is fundamental for a 
unique information system. Only on this way can overcome on the duplication
of data and can be unified the departmental systems.

As results of earlier developments, at all universities and at all
clinical
departments, there work unified in-and outpatient departmental
information systems with common standards. Now the developments are
directed
to university-wide integrated clinical information systems, since the
optimization of cost-income, giving management informations and
supplying
care histories are not possible without such a complex system.

The realizations of this gool are different. At SOTE-Budapest the
integration
of the networked PC-based systems is developed. In Szeged and
Debrecen the
PC-based system are going to be changed for a centralized information
system,
which works on some high-powered central servers. This model seems to be 
easier manageble with the present technology, although it is not properly
adequate with the more or less independent management system of the 
clinical departments. With the development of the computing technology we
have to move in the future into distributed departmental systems. 

\bigskip

\section{The organizational conditions}
\bigskip

The tasks in doing medical informatics can be completed only under
well-organized conditions.
The computing centers, departments of medical informatics have basic
role. They
form the concepts, develope, adapt the systems, manage the university
network and central resources. These departments deal with
educational tasks and take part in research too. 

 At almost every clinical or theoretical department there are
computer experts working for the local developements and system
management.
The departmental informatical representative coordinates the
informatical work (not technical!).

To emphasize the importance of medical informatics, the university
leaderships
founded the informatical committes, which "politically" help the
professional work.

We believe, that these conditions, the dedicated willing and the
expert
are the main factors of the  success of computer applications in
medicine
in Hungary.


\begin{thebibliography}{xxx}

\bibitem{KJ-Gy}
Gy=93ri I., Karsai J.,{\em Results and plans of a medical information
system at A. Szent-Gy=94rgyi Medical University in Hungary}, in the
{\bf Proceedings of 5th International Conf. on System Sciences in
Health Care}, Omnipress Publishing, Prague, 1992.

\bibitem{KJ1}
Karsai J., Forczek E., {\em Computer visualization in the course of
mathematics for pharmacy students}, in the {\bf Proceedings of the
Colloquium MEDICOMP'94}, Szeged, 1994.

\bibitem{boda}
Boda K., {\em Computer assisted teaching of biostatistics at the
Medical University of Szeged}, in the {\bf Proceedings of the 4th
Intern. Conf. on Teaching Statistics}, Makkarech, 1994.

\bibitem{sali1}
Sali A., {\em cim}

\bibitem{AD1}
Ag\'ocs L., Dulane S.K. {\em Informatics in education at University 
Medical School of Debrecen}, in the {\bf Proceedings Informatika a 
Fels\H{o}oktat\'asban}, Debrecen, 1992.

\bibitem{AD2}
Ag\'ocs L., Dulane S.K. {\em A practical introduction to Informatics},
University Handbook, University Medical School of Debrecen, Debrecen, 1992.

\bibitem{SzB} 
Szekr\'enyes L., Bodroghy E. {\em A kutat\'ast \'es a napi munk\'at
seg\'{\i}t\H{o} adatb\'azis \'ep\'{\i}t\'ese laborat\'oriumi adatokb\'ol},
{\bf Proceedings of the Colloquium MEDICOMP'94}, Szeged, 1994.
\end{thebibliography}

\end{document}


-- =


-------------------------------------------------
| Janos Karsai Ph.D.  senior research associate	|      =

| Department of Medical Informatics,            |     =

| Albert Szent-Gyorgyi Medical University       |   =

| Szeged, Koranyi fasor 9., Hungary, 6720       | =

| Phone, Fax: (+36) 62 311 084                  |
| Email	  : dmikarsai@szvax1.szote.u-szeged.hu  |
|	    karsai@silver.szote.u-szeged.hu     |	=

-------------------------------------------------

--PART-BOUNDARY=.19411301042.ZM1041.szote.u-szeged.hu--




--- End of forwarded mail from MAILER-DAEMON@silver (Mail Delivery Subsystem)


-- 

-------------------------------------------------
| Janos Karsai Ph.D.  senior research associate	|      
| Department of Medical Informatics,            |     
| Albert Szent-Gyorgyi Medical University       |   
| Szeged, Koranyi fasor 9., Hungary, 6720       | 
| Phone, Fax: (+36) 62 311 084                  |
| Email	  : dmikarsai@szvax1.szote.u-szeged.hu  |
|	    karsai@silver.szote.u-szeged.hu     |	
-------------------------------------------------



