WHAT IS INTERNET ?

- A NETWORK OF NETWORKS BASED ON TCP/IP PROTOCOLS

- A COMMUNITY OF PEOPLE WHO USE AND DEVELOP THOSE NETWORKS

- A COLLECTION OF RESOURCES THAT CAN BE REACHED FROM THOSE NETWORKS

INTERNET PHILOSOPHY

WORK GLOBALLY

DIAL LOCALLY

GRID COMPUTING

GRID computing is een techniek voor het verwerken van zeer

grote hoeveelheden gegevens door het wereldwijd koppelen

van computers (toepassingen in b.v. hoge energiefysica,

medische beeldvorming, ...)

Benodigdheden voor Internet

- Computer (PC)

- Modem (analoge of breedbandmodem)

- Telefoonlijn(gewone, GSM, GPRS, UMTS, ISDN, TELENET, ADSL, ...)

- Internettoegang (via 'service provider' cfr. Belnet, Skynet, ...)

DEBIET

(10 Mbyte file)

V34+ modem 33600 50

Snellere modems 56000 30

ISDN 128000 13

Satellite 400000 4

Cable 1500000 1

ADSL 9000000 0.13

bps sec

BELNET

- Het nieuw netwerk van Belnet anno 2008 met verhoogde capaciteit laat communicatie toe via een enorme bandbreedte

vroeger: 1 treinspoor x intercitytrein nu: 42 treinsporen x TGV

42 x 10 Gigabit = 420 Gbps

-Alles verloopt via glasvezelbekabeling

-Belnet levert ook SSL certificaten af

- GEANT2 netwerk

HISTORY of the INTERNET

1960s: Department of Defense (DOD)Advanced Research Projects Agency (DARPA)

• Vooral electronic mail (e-mail), vooral gebruikt door wetenschappers en overheid Usenet Netnews (een bulletin board system, mailing lists voor discussiegroepen)

1970s: Het Transmission Control Protocol - Internetwork Protocol (TCP-IP)wordt het dominante communicatieprotocol Internet

1980s: De National Science Foundation (NSF)zet de subsidiëring van de ontwikkelingen verder en maakt fondsen vrijvoor de backbone NSF net

1990s: National Library of Medicine and Vice President Al Gore (US)promoten de ontwikkeling van een 1gbs backboneGebruikte netwerken , n gebruikers , traffiek- Van Wetenschappelijk commercieel gebruik- Van Computer naar menselijke - communicatie

2000s: Commerciële ventures supporteren de Internet expansie

ARPAnet

ENKELE INTERNET-DIENSTEN

E-MAIL V-MAIL

(vrije tekst via elektronische post)(ook bestanden in attachment)(ook mailinglists, discussiefora, nieuwsgroepen)vb. Georges.Demoor@UGent.be

TELNET (terminalemulatie / user account)vb. telnet://lib.kbr.be

FILE TRANSFER PROTOC. FTP

(bestanden overbrengen)vb. ftp://ftp.ripe.net/ripe(paswoord = mail adres)

WORLD WIDE WEB-SITES of WWW

(een "site" is een verzameling van webpagina's met tekst, geluid, beeld, animatie)

INTERNET RELAY CHAT of IRC

("chatten" is praten met iemand in real-time via het toetsenbord)

VIDEOCONFERENCING

(communiceren met spraak en beeld, incl. whiteboard)

ADRESSERING (1)

E-Mail

users

georges.demoor @ UGent .be

user “at” host. domain

webmaster @ ehto be.

ADRESSERING (2) ONTLEDING VAN EEN URL

http:// www UGent be . .

URL

http-prompt

hypertext-applicatie-acroniem

Subdomein[-aanduiding(en)]

Hoofddomein(-aanduiding)

algemeen

specifiek

IP-naam IP-adres

Domein(naam)

ADRESSERING (3) HOOFDDOMEIN-AANDUIDINGEN

com Commercieel, commerciële organisaties

gov Government, overheidsinstanties en ministeries

int International, internationale organisaties

mil Military, militaire locaties

net Network, netwerkorganisaties

org Organisation, overige organisaties

edu Education, onderwijsinstellingen

at Oostenrijk es Spanje

au Australië fr Frankrijk

be België it Italië

ca Canada nl Nederland

de Duitsland uk Groot-Brittannië

dk Denemarken eu Europa

COMMERCIAL or NOT ?

! URLs

+ .EDU

+ .ORG

+ .GOV

? .COUNTRY ABBREVIATION

- .COM

.INFO

.BIZ

URL : cave !

www.lycos.com

www.lycos.co.uk

www.lycos.be

In the past, many of the services on the Internet were not 'user-friendly' enough. Now, the World Wide Web (WWW) is available as easy to use interface. On Web servers the information is organised in documents containing hypermedia links to other documents on the Web.

Tim Berners-Lee (nu W3C) en Robert Cailliau “Inventors of the WWW”

The HyperText Transfer Protocol (HTTP) supports a universalnaming scheme for information on all computers accessiblethrough the Internet.

The HyperText Markup Language (HTML) allows the displayof formatted and / or multimedia documents to beindependent of the device.

Repositories of Standard Concepts and Objects (cfr. ‘context-’ versus ‘not context-free’)

The Standard Generalized Markup Language (SGML)

(ISO 8879 - 1986):

A Syntax with: - procedural labels

- Elements, attributes & values (rules!)- Granularity through the nesting of elements- Document Type Definitions (DTDs)

- descriptive labels (semantics based structure)

The Hypertext Markup Language (HTML)

W3C - WG

(application)

Standardised DTDs for Healthcare?

Extensible Markup Language (XML)(subset)

- element nodes, document nodes, instruction nodes, comment nodes, pseudo-element nodes

[ Extensible Style Language (XSL) presentation ]

WWW - BROWSERS

NETSCAPE NAVIGATOR / COMMUNICATOR

MOZILLA/FIREFOX

MICROSOFT INTERNET EXPLORER

2008 IE 7 IE 6 FireFox Moz Chrome Safari Opera

Sept 26.3% 22.3% 42.6% 0.5% 3.1% 2.7% 2.0%

Source: http://www.w3schools.com/browsers/browsers_stats.asp

WWW - BROWSERS

NETSCAPE NAVIGATOR / COMMUNICATORMOZILLA/FIREFOX

MICROSOFT INTERNET EXPLORER

Major changes in popular Internet Browsers are nowoccurring every three months.

Frequent updating becomes a must as new productsreally have an increased functionality!

HYPERMEDIA =HYPERTEXT + MULTIMEDIA

HOST 1 HOST 2

HOST 3

HYP

ERLI

NK

ANCHOR

HISTORY of the WWW

BROWSERS

Gopher

Archie

Mosaic

Netscape

Internet Explorer(Microsoft, cf. Windows)

LANGUAGES

SGML

HTML

XML

CONTENT

Text

Images

Sound

Multimedia(incl. video)(WML)

INTRANET is an institutional network based on TCP/IP that usestechnology developed for the Internet (such as the World Wide Weband electronic mail).

Unlike access to the Internet, access to Intranets and their functionis restricted to those using the institutional (eg. Hospital-) data.

Most of hospital’s information is considered confidential (sensitive patient or corporate issues).

ICT in Healthcare: TENSIONS

- A free market in information versus finite resources for healthcare

“Frustration caused by unability to provide new (expensive)

therapies”

- Information rich versus information poor

“The ‘have’s and the ‘have not’s, the information underclass …”

- Changing role of and relationships between doctors and patients

“Patients ‘armed’ with information from the Web …”

“Doctors becoming an endangered species …”

“Virtual doctors & cyberconsultations …”

Information Management in Healthcare : IMPLICATIONS

- Need for other kinds of education

“Core role of medical profession is not that of a ‘walking

encyclopaedia’”

“Information & Knowledge management training in Medicine”

“Less memorization, more searching, thinking, choosing, deciding”

- Need for new information and data policy in healthcare

- Need for more communication skills:

“Co-operative assessment of risks and benefits between the doctor

and the patient”

HEALTH INFORMATION / COMMUNICATION

Goals?

Issues?

Dimension?

Research, Care, Quality Assessment,Budgetting, Education, Marketing?

Prevention, Care and Cure (Diagnosis, Therapy),Follow-up, Revalidation, Palliation?

Disease, Patient, Drug, Echelon, Time?

“There is a need for new tools (filters)…”

INTERNET EVOLUTION

1. Net Wizards http://www.isc.org/ds/

2. NUA Internet Surveys http://www.nua.ie/surveys/how_many_online/index.html

Communication Media and Education

JOURNALs

VIDEOFILMs

CD-ROMs, DVDs, HD-ROMs

CD-Is

NARROW CASTING TV

ELECTRONIC DATA INTERCHANGE (EDI)

INTERNET / WORLD WIDE WEB (WWW)

1999 2.5 miljard webpages

Toename 7 miljoen webpages per dag

Hoeveelheid informatie

(E-mail info 500x > dan webpagina's)

(Jaarlijks wereldwijde info = 1.5 miljoen Terabyte)

8 bits = 1 byte

210 bytes = Kilobyte = 1024 Bytes220 bytes = Megabyte= 1024 Kilobytes230 bytes = Gigabyte = 1024 Megabytes240 bytes = Terabyte = 1024 Gigabytes250 bytes = Petabyte = 1024 Terabytes260 bytes = Exabyte = 1024 Petabytes270 bytes = Zettabyte= 1024 Exabytes280 bytes = Yottabyte= 1024 Zettabytes

BITS en BYTES

REASONS for USING Internet - WWW

“Instant publishing”“Instant retrieving”

“More information available” (cfr. MEDLINE)

“Inexpensive” (only local phone call)

“Easy” (cfr. World Wide Web, WWW)

“Convenient” (eg. from home)

“Communication with peers”(cfr. e-mail, discussion-lists, newsgroups)

UP TO DATE (cfr. CD-ROM)

Publishers switch to Internet … but competition is now ‘global’ (international)

Before InternetAfter Internet

Finding Information on the WWW

Altavista

Google

Webcrawler

KartOO

”HOW DO I FIND INFORMATION RELEVANT TO MY NEEDS?”

Free-text SEARCH ENGINE

Subject DIRECTORIES (directory based search engine)

Evaluated SUBJECT CATALOGUES

(Hybrid SYSTEMS)

SEARCH ENGINES versus DIRECTORIES

SEARCH ENGINES

“make use of large databases of information and present selected documents based on certain search terms, phrases, etc.”

SUBJECT CATALOG OR DIRECTORY

“a collection of maintained links organized by content”

Websites

ROBOT (spider, crawler)

“bi-directional”

Database

Search engine

+

“indexed”

“graphical interface”

Queries

(and)

Newsgroups

SEARCH ENGINES: CHARACTERISTICS

? How many webpages indexed

? Search syntax (+, -, …)

? Refine features (language filters, date filters)

? Sort features

? Number of hits and/or perfect matches

? Way of ranking (relevance, irrelevance)

? User friendliness

? Fast connection speed, server-characteristics

? Intelligent content extraction (spelling, synonyms)

? Updating (rate of)

SYNTAX

- Double quote (“ “) for phrase searching

- Signs (+,-) before term

- Modifiers (AND, OR, NEAR, AND NOT …)

- Wild Card Search (*) for word-stemming (truncation)

- Locating pages which link (LINK: URL) (1)

- Locating images (IMAGE: name) (2)

- Narrowing down (title:, text:, domain: )

eg. (1) LINK: www.vrt.be

(2) IMAGE: gene

Different Search Engines

Different hitsDifferent ranking

Robots gather different SAMPLES of webpages

- Some robots can successfully access more than others: image maps, frame links, applets, password protected pages

“no Internet search engine is able to index the data within the MEDLINE database”

RANKING

- Term in title section

- Term in page body

Meta - Search - Engine

)2(.E.S )n(.E.S)1(.E.S

Query

eg. DogPile (interfaces with different Databases including: Google, Yahoo, Overture …)

+appropriate for highly specific search terms

http://www.searchengineshowdown.com/features/

Music & Audiowww.musicsearch.com

Video & Audiohttp://www.singingfish.com/

Camerawww.camcentral.com

Pictures & Imageshttp://persia.ee.columbia.edu:8008/

Peoplehttp://www.whowhere.lycos.com/www.bigfoot.net

BELGISCHE en/of VLAAMSE ZOEKMACHINES

Ad Valvas http://www.advalvas.be/

MediMediaNet http://www.medimedianet.be/

Scoot http://www.scoot.be/

Web Watch http://www.webwatch.be/

( ! Nederlandstalige zoekstrings gebruiken …)

SUBJECT DIRECTORIES / CATALOGUES

eg.: Yahoo ! - Health Section (http://dir.yahoo.com/health)

+ Hierarchical structure logical “From the broader … to the narrower concept”

- Human Input less up-to-datenot always systematic

EVALUATED SUBJECT CATALOGUES

1. Medical Matrixhttp://www.medmatrix.org/(links to >5.000 quality-assessed Internet Sites) (AMIA)betalend

2. OMNI (Organising Medical Networked Information)http://omni.ac.uk(browsing by alphabetic classified topic, MeSH)

3. Health on the Net (HON)http://www.hon.ch(the Foundation has developed a Code of Conduct)

EVALUATED SUBJECT CATALOGUES

Strenght: evaluated highly relevant and qualitative

Weakness: compiled by individuals incomplete *

* ( ! MEDLINE has indexed over the last 5 years > 2 million documents)

http://www.sofweb.vic.edu.au/internet/research.htm

The TOP TEN MEDICAL RESOURCES

(alphabetical list)

1. Centers for Disease Control and Prevention (CDC)http://www.cdc.gov/

2. Internet Mental Healthhttp://www.mentalhealth.com/

3. National Institutes of Health (NIH)http://www.nih.gov/

4. Oncolinkhttp://www.oncolink.com/

5. PubMed - MEDLINE on the Webhttp://pubmed.gov/

6. Reuters Healthhttp://www.reutershealth.com/

7. RxListhttp://www.rxlist.com/

8. TRIP - Turning Research into Practice http://www.tripdatabase.com/ (betalend, nu 5 gratis zoekopdrachten per week)

9. OVIDhttp://www.ovid.com/site/

10. World Health Organisationhttp://www.who.int/

Finding what you want: CONCLUSION

- High quality evaluated subject catalogues

- Broad perspective general subject catalogues

- High specificity free text (meta-) search engines

(or combination)

Does the resource meet a defined quality threshold?

(1)

1. Accountability

Authorship (author, affiliation, credentials, e-mail)

Attribution (references or sources must be stated)

Disclosure (owner, sponsor, advertiser should be displayed)

Currency (indication of date of creation and last update)

2. Badge of approval (quality label)?

More based on Web design, innovation / freshness inappropriate

Exception: Health on the Net Foundation

http://www.hon.ch/Conduct.html

Does the resource meet a defined quality threshold?

(2)

3. Rating Tools (checklists)(quality scores)

1. “Website Evaluation Rating Checklist” (Richard Waller)

http://www.waller.co.uk/eval.htm

Cave: ‘this assessment is not sufficient to guarantee SAFETY’

2. QUality Information ChecKlisthttp://www.quick.org.uk/index2.htm

Does the resource meet a defined quality threshold?

(3)

4. Web Filtering

Configure your web-browser in order to deny access to pages.

PICS (Platform for Internet Content Selection) labeling scheme.

Authors embed tags into a page indicating features such as (nudity, violence, …): med PICS tags.

Internet Explorer: load a file with extension .rathttp://dermis.multimedica.de/

check page + inquiry to label bureau

Does the resource meet a defined quality threshold?

(4)

Frauds and Quackery

CAVE “miracle cures”

1. Websites and Newsgroups that promote products/services to cure through a credible-looking Web-site:

CANCERAIDS (aloe vera)ARTHRITIS (see cucumber)MULTIPLE SCLEROSISBALDNESS

“aimed at patients willing to try anything!”

false hope, delaying proper treatment …

2. Facts based on personal experience and anecdotes rather than on rigorous medical research and evidence

The Quality Issue

- Cure-all remedies (“get rich quick” agenda)

- Inaccurate information (good faith)

- Biased information (pharmaceutical sponsorship)

Monitoring Health Frauds and Quackery

Quackwatchhttp://www.quackwatch.com/

National Council Against Health Fraudhttp://www.ncahf.org/

American Council on Science and Healthhttp://www.acsh.org/

PubMed (Medline on the Web)

Other websites also offer FREE access to Medlinebut PubMed is the best version:

- data from the ‘PubMed in Process’ file incorporated citations appear more quickly than in other versions eg. NEJM: within 1 week, Lancet, BMJ: within a fortnight

- powerful searching (via pull down menus)

!

Synergy between different systems to support complementary services in medicine

Internet for access to Literature (education) for e-mail

Extranetfor Patient Related Data Exchangefor access to Health Professional Services

Intranet for WWW based Electronic Medical Record Systems

Legacy EMR System

Safety Security

- Confidentiality- Integrity- Availability- Authentication

NETiquette

SECURITY

InternetSecure Extranet = Virtual Private Network

Public Domain

! Confidentiality, Integrity, Availability

! Masquerade

! Interception, misrouting

! Destruction

Closed Usergroup

Security Threats in Communications

- Interception of identity

- Masquerade

- Replay

- Manipulation: - replacement - insertion - deletion - misordening - destruction

- Repudiation

- Denial of service

- Misrouting

- Traffic analysis(Passive: Active intruder)

THE INTERNET-WWW IS A VERY HELPFUL

COMMUNICATION CHANNEL

THE INTERNET-WWW DOES NOT

CREATE INFORMATION OR KNOWLEDGE

The Internet will influence not only the way we

communicate with colleagues and patients, but

the way we store clinical data,

the way we pursue education,

the way we publish our work.

(J. Zellingher, M.D. M.D. Computing, Vol 13, no 4, 1996)

Medi Media Net

- Indications & Contra-indications

- Druginteractions

- Side effects, adverse drug reactions, risks

Cfr :

The passive Medical records of today’smedical information systems have tochange into active objects that remind,suggest or even seek out advice.

ELECTRONISCHPATIENTENDOSSIER (multimediaal)

SPRAAKHERKENNING(Lernout & Hauspie)

N.L.P. (Language & Computing)

E.D.I. (MediBridge, ...)

B.O.S. enEXPERTSYSTEMEN

(Standaarden)

INTERNET - WWW(Interactieve webapplicaties)

S.I.S. - KAART

SMART CARDS

VOORSCHRIFTENGENEESMIDDELEN

M.K.G.'s(Ziekenhuizen)

INTEGRATIE enORDERCOMMUNICATIE(Ziekenhuizen)

AFSPRAKENBEHEERTARIFERINGSTATISTIEKEN, ...

DE AANTREKKELIJKHEID VAN HETELEKTRONISCH MEDISCH DOSSIER

E.H.R. / Multimedia

ELEKTRONISCH PATIENT DOSSIER

BRON-GEORIENTEERD

TIJD -GEORIENTEERD

PROBLEEM -GEORIENTEERD

OPLOSSING -GEORIENTEERD

DX PlainPERFORMANCE OF FOUR COMPUTER-BASED

DIAGNOSTIC SYSTEMS

The New England Journal of Medicine(June 23, 1994)

DXPLAIN (version 4.5)

ILIAD (version 4.0)

MEDITEL (version 2.0)

QMR (version 2.03)

PROPORTION OF CORRECT ANSWERS0.52 - 0.71

DECISION THEORY

Probabilities (Bayes)Decision Trees “Quantitative,Utilities Formal”...

Heuristics “Extensible,Production rules, Frames Pragmatic”For- & Backward Reasoning

EXPERTSYSTEMS

In- and Output PatternsUnits and Layers “Pattern Recognition,Parallel Processing Self-Learning”Connection Strenghts

NEURAL NETWORKS

PROBABILISTICAPPROACH

HEURISTICAPPROACH

NEURALNETWORKS

PATTERNRECOGNITION

HYBRIDSYSTEMS

EXPERTSYSTEMEN

Vooral gespecialiseerd:

- elektrolieten stoornissen

- schildklierlijden

- diabetes

- infarct

- leverstoornissen

- ...

VALIDATIE INTERPRETATIE

“KNOWLEDGE-EXTRACTION is the most difficult step”

Quality ofDecision Support

System

Effortsto

Formalize

Information Systems Human Beings

ACCESS TO WHICH HEALTHCARE INFORMATION?FOR WHOM?

WHAT:

ACTORS:

PURPOSE:

DATA INFORMATION KNOWLEDGE

CITIZENS HEALTHCARE PROFESSIONALS(eg. patients) (eg. Medical doctors)

CARE RESEARCH EDUCATION PROMOTION SALES

(*)

(*) (DATA : Anonymous Data Identifiable Patient Data

Subjective Data Objective Data

“Passive reception of data” “Active search for data”

INTEGRATION

Centralisation

but

Interoperability + Communication

! - Standardisation - Confidence / Trust - Quality, safety, security, ethical & legal issues - International and global dimension

COMMUNICATION

Co-ordination Problem:

- Who will ‘organise’ communication in Healthcare?

- Who will ‘benefit’ from communication?

- Who has the authority, who is responsible?