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groups establish approval processes for their own regions, and local offices establish processes for local approvals. This structure balances local freedom against the need for greater structure at the highest levels of the organization. The databases are linked together through the national office's intranet Web site, which makes the information searchable and reduces duplication of effort. In addition to linking care management information, the PKC provides a centralized outlet for other information resources of interest to care providers. It contains a section for continuing medical education (CME) that allows users to look up their CME credits. It also provides access to online text books and journals and supports discussion groups with threaded discussions. Its workgroup functions enable users to post material and conduct national meetings in a virtual manner. Workgroups can be designated for members only, with membership defined by the chair.
All medical students are required to purchase a specific laptop computer, which has standard software and preconfigured ISP accounts for remote access. The staff transfers course notes from the live network environment so that students can download the previous, current, and following week's syllabus materials and use them off-network. A recent study of system use found that 136,000 pages were retrieved and videos were played 4,300 times in a month (Box A.1). Students also are required to take a medical informatics course delivered online. Before each class session, the students receive an e-mail message with HTML links to basic materials for that topic. Then a lab session is held in the five rooms in which student carrels are located; each student has a carrel with network access and power.
Technical requirements are based largely on the needs of remote radiological image archiving and display. To allow the simultaneous downloading of eight different 10-MB images within one second, the system needs bandwidth of 640 Mbps. The UW and Harborview radiology departments are all digital now, but they use computed radiography (in which an imaging plate is scanned by a laser) rather than flat-panel digital. The centers will become fully digitized once the technology comes down in price. Stewart envisions that a radiologist covering at a remote site might use the system to perform work that he or she would have done at the home site, downloading images remotely. 2b1af7f3a8