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Wiring a medical school and teaching hospital for telemedicine
International Journal of Medical Informatics 65 (2002) 161– 166 www.elsevier.com/locate/ijmedinf
Erratum
Wiring a medical school and teaching hospital for telemedicine N.M. Hjelm *, J.C.K. Lee, D. Cheng, C. Chui Area of Excellence in Telemedicine, Chinese Uni6ersity of Hong Kong, Shatin, N.T., Hong Kong, People’s Republic of China
Abstract The planning and installation of a telemedicine system for communication within a teaching hospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching, especially problem-based learning, and all aspects of postgraduate teaching. © 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Telemedicine; Medical teaching; Audio visual communication
1. Introduction The technical infrastructure for audio-visual communication has improved dramatically in the 1990s with the advent of the Integrated Synchronised Digital Network (ISDN) technique. As a result, intracontinental and intercontinental teleconferences with multi-point connections are now common events. Within a country, video-consultations are increasingly used to provide ‘health care at a distance’, especially to patients living in remote areas. It was appreciated that the critical distance in telemedicine and tele-education is related PII of original article: S 1 3 8 6 - 5 0 5 6 ( 0 1 ) 0 0 1 4 5 - 9. * Corresponding author. E-mail address: magnus – [email protected] (N.M. Hjelm).
to needs and that this distance can be short. Therefore, the Committee on Telemedicine in the Chinese University of Hong Kong (CUHK) decided to explore the benefits of installing a system for audio-visual communication in its teaching hospital, the Prince of Wales Hospital (PWH) and the medical school, comprising the Clinical Science Building on the hospital site and the Basic Science Building on the university campus itself, about 4 miles apart. When the project started in 1997, prototype video systems were already installed in the main lecture theatre on the hospital site for external conferences and demonstrations of endoscopic surgery (ISDN lines) and internal conferences with the university campus (asynchronous transfer modes (ATM)). These
1386-5056/02/$ - see front matter © 2002 Elsevier Science Ireland Ltd. All rights reserved. PII: S 1 3 8 6 - 5 0 5 6 ( 0 2 ) 0 0 0 1 0 - 2
162
Erratum
systems had been successfully tested at local and overseas conferences starting in 1994. In addition, a Gigabit Ethernet developed by the Hospital Authority in Hong Kong (HA) was installed in 1996. This system works as a local area network (LAN) and supports the transfer of patient information between the PWH and a large number of hospitals in the Special Administrative Region.
2. General specifications for the extended video-communications system As a first step in implementing the project, general specifications for the video-communications system were defined. It was envisaged that the system should support the following activities. Internal consultations. Health professionals spend much unproductive walking time in carrying out their daily duties and are often unavailable for ad hoc consultations because they cannot leave their working area, e.g. the operating theatre or the outpatient clinic. It was predicted that many of these shortcomings could be overcome by a video-communication system that could be accessed at many locations in the combined hospital and university sites. External consultations. The need for teleconsultations with overseas health professionals about patients admitted to the PWH was considered limited. However, such consultations could be more frequent with hospitals in mainland China for the provision of a second opinion to patients with complicated diseases. Education and training. The traditional format for undergraduate training where one teacher is lecturing to a group of students has been criticised for not being sufficiently ‘problem-oriented’. Therefore, many medical schools have introduced a
system where more than one teacher is present at lectures and tutorials to cover different aspects of a clinical problem. The implementation of such a curriculum is complex and requires that teachers give absolute priority to attending scheduled lectures. It was realised that an internal, multi-point video-system could overcome many of the practical problems involved in organising problem-based learning as teachers and instructors contributed to a lecture from their offices or the video-station on the floor they happened to be on at the time of the lecture. Alternatively, a group of students could be placed in a departmental seminar room with their tutor and patients on selected wards could be demonstrated by video-link. Meetings. Meetings are important means of running any organisation efficiently. In hospitals, meetings play an important role in maintaining the quality of care. In the present hospital system, much time is spent on finding a convenient time and venue for arranging meetings with members of established committees, and on an ad hoc basis in case of administrative and professional emergencies. It was considered that a multi-point video-system would represent the optimal solution to many of these problems and provide a platform for increased interaction internally and externally between health professionals and health administrators. Conferences. It was accepted that conferences with overseas centres on selected topics should be encouraged as an important part of undergraduate training and postgraduate education. Therefore, the planned video-system should enable wards, operating theatres, lecture theatres and seminar rooms to be connected with external centres (locally and overseas) for
Erratum
interactive demonstrations and interventions. Multi-point connecti6ity. A facility for multi-point connections would be required for optimal use of the video-system. It was foreseen that commercial bridges would become available for use in an internal/external environment before the completion of the project, simultaneously linking different types of video stations (e.g. PictureTel, Polycom, Vcon, Cu SeeMe) and communicating over different types of network (e.g. ISDN, ATM, Ethernet, Internet, LAN). This prediction has been vindicated as recently released commercial products (e.g. www.accord.com) can achieve these goals. These systems have the capability of connecting up to 100 different types of internal and external audio-visual stations, and are easy to operate by well-designed menus from a central point or peripheral points. Settings and connections can be changed instantaneously from any video-station connected to the LAN. Video-stations. The system should be able to accommodate different types of peripheral audio-visual stations. This would allow the flexible use of a range of video-stations differing in degree of sophistication (and therefore price) to be selected according to intended use. For example, person-to-person conferences could be expected to require less sophisticated video-stations than the transmission of radiological and microscopic images. It was acknowledged that the present range of video-systems was limited and not always compatible in terms of connectivity. However, it was also predicted that the range of products would expand substantially during the life-time of the network to be installed and that the problem of connectivity would improve as manufacturers adapted their products to international standards.
163
2.1. Technical specifications for the 6ideo-communication system As several subsystems for video-communications were already installed in the medical school and its teaching hospital at the start of this project, it was decided to incorporate these elements into the overall design of the system as specified in the following. To install additional cable (fibre optics) only to sites not already linked to the Gigabit Ethernet. To use the combined high-bandwidth Ethernet and ATM systems as a LAN. To provide health professionals with passwords according to staff grade and clinical needs, allowing them passage to Ethernet from the ATM LAN through the Ethernet firewall, established to protect patient confidentiality. To ensure that the ATM backbone can be used in clinical situations where stable connectivity is required, e.g. during supervision of surgical procedures.
3. Monitoring installation work It was appreciated that the technical infrastructure for the extended system had to be installed in a working environment, that (minor) structural alterations needed to be carried out in the buildings involved, and that the work could potentially cause a nuisance to patients and staff. Therefore, an ad hoc project group was established consisting of representatives from the CUHK Area of Excellence in Telemedicine, the CUHK & HA Information Technology Units, Architecture Units and the Administrative Units. The project group was charged with the task to inform hospital and university staff about the timetable for the work to be carried out and appoint officers to monitor the work with regard to quality and safety.
Fig. 1. Diagram outlining the integrated LAN (ATM and Ethernet backbone) in the CUHK Medical School and its teaching hospital, the Prince of Wales Hospital. The LAN connects two 11-floor ward blocks (Wards A –F), the Endoscopy Centre, the Clinical Science Wing, the Cancer Centre, the Clinical Education Unit (in previous staff quarters), the A&E department and the future Trauma Centre, two outpatient blocks (L.K.S. North & South Wings) and CUHK Main Campus. Three ATM switches have been installed. In all, more than 50 floors are connected for audio-visual communication. There is one Master Central Point for the running of the integrated LAN. A more detailed scheme is available on request by the corresponding author.
164 Erratum
165
Erratum
4. Outcome
4.1. Planning experience Two planning documents turned out to be essential for the planning of the project: (i) the layout of the network (Fig. 1), drawn in such a way that both layman and specialists could understand its extent and function; and (ii) a list of components in the extended network, detailing the components to be installed on each floor. These documents served as the basis for preparing tenders, follow-up meetings with members of the project group and contractors, and information issued to staff in the PWH and the CUHK. Frequent brief meetings were found to be more efficient than memos in order to establish a good understanding of the objectives of the project and to clarify the meaning of many medical and technical terms. The total time spent by the project team until completion of the project was about 300 manhours.
4.2. The installation of the network and its capacity The whole project lasted 24 months from its conception to completion. Once the installation work started, it was completed in 6 months or in about 25% of the total project period. About 50 floors in the CUHK medical school and the PWH (with two outpatient departments) and the adjacent Hong Kong Cancer Centre were connected to the Ethernet/ATM LAN (Fig. 1). In theory, the initial bandwidth of 155 mbps will allow up to 400 video-stations to be connected simultaneously to the system. In practice, it is unlikely that more than 40 video-stations will be used simultaneously during the first triennium of the system. This will make bandwidth available for the transmission of telemedicine applications requiring higher bandwidths, e.g. live demonstrations of microscopic images of frozen sections to surgeons in the operating theatre. The installation of addi-
Table 1 Direct costs for installing the integrated ATM/Ethernet LAN and a minimum number of audio-visual stations (ten) assuming a 5-year life span of the networka Cost (HK$) Networking Trunking Telecom equipment ATM link Subtotal
1 000 000 1 700 000 600 000 3 000 000
Basic workstations Audio-visual units (10 units)
600 000
Total a
3 600 000
All figures have been rounded off.
tional ATM switches can further increase the bandwidth. Multi-point bridges, still to be added to the system, will greatly facilitate the use of audio-visual communication in both the local and extended health care environment. Table 2 Some cost ratios, using the installation costs of the integrated ATM/Ethernet LAN in Table 1 and key indicators describing the health service in the Prince of Wales Hospitala Hospital statistics Beds Cost/bed (HK$)
1350 1600
Non-hospitalised patients/year Accident&Emergency 210 000 Out-patient clinics 520 000 Allied health 220 000 (total, 950 000) Hospitalised patients/year Patient days/year
100 000 460 000
Cost ratios for a 5-year period Per patient Hospitalised (HK$) Non-hospitalised (HK$) All (HK$)
9.00 0.75 0.70
Per patient day (HK$)
1.60
a
All figures have been rounded off.
166
Erratum
4.3. Staff reaction University and hospital staff were informed about progress with the project at regular intervals and are generally looking forward to start using the system.
4.4. Costs The direct costs for the project amounted to HK$ 3.6 million, as outlined in Table 1. The expenses are comparable with conventional improvements to the infrastructure in a major hospital, e.g. improved lighting and new elevator systems. As the ratios presented in Table 2 show, the cost per patient over a 5-year period is similar to that of a first-class stamp. Therefore, the value of the increased quality of care and the potential for rationalising the provision of health care in the hospital that will be the result of using the integrated ATM/Ethernet LAN will no doubt turn out to be substantially larger that the initial investments.
4.5. Testing the performance of the network Initial tests of the network performance have been successfully carried out and have covered the following aspects of video-communication. Testing the ATM-LAN. Testing the Ethernet LAN. Testing the combined ATM/Ethernet LAN. These test have indicated that the performance of the system is satisfactory with regard to connectivity (handshake), stability and at internal and external coferences. 5. Discussion The modern version of telemedicine involving not only the transmission of audio signals, but also visual signals was introduced as a means of providing patients in remote areas with improved access to health care. So far,
little attention has been paid to the use of audio-visual communication within a smaller setting such as a hospital. However, as this paper demonstrates, there are many applications of audio-visual communication in such an environment. Audio-visual communication between patients and health professionals, and between health professionals themselves, should improve the quality of health and of undergraduate and postgraduate teaching to all categories of health professionals. Interestingly, the costs for a hospital-based audio-visual LAN are surprisingly low compared with overall costs for patient care. Therefore, telemedicine in a hospital environment could well be the main application of this form of information technology in the longer term. There is little information available with regard to telemedicine applications in the local setting and, to the best of our knowledge, the system described in this paper is the first of its kind. Acknowledgements This paper was written on behalf of the members of the CUHK Telemedicine Committee. During the period of installing the integrated ATM/Ethernet LAN, the committee consisted of H. Chan (Dermatology), J. Cheng (Orthopaedic Surgery), Christine Choi (PWH Data Centre), S. Chung (Endoscopic Surgery), C.B. Hazlett (Office of Educational Services), N.M. Hjelm (Chemical Pathology, Chairman/ Co-ordinator until November 1999; present Chairman/co-ordinator: HKNg), R. Jones (Pharmacology), A.H.Y. Lau (Pharmacology), J.C.K. Lee (Anatomical & Cellular pathology), S.H. Lee (Community and Family medicine), F. Tong (Information Engineering), J. Tse (Hospital Authority), and H.T. Tsui (Electronic Engineering). The generous grants from the Vice Chancellor’s one-time support fund and the Hospital Authority in Hong Kong are gratefully acknowledged.
Erratum
Wiring a medical school and teaching hospital for telemedicine N.M. Hjelm *, J.C.K. Lee, D. Cheng, C. Chui Area of Excellence in Telemedicine, Chinese Uni6ersity of Hong Kong, Shatin, N.T., Hong Kong, People’s Republic of China
Abstract The planning and installation of a telemedicine system for communication within a teaching hospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching, especially problem-based learning, and all aspects of postgraduate teaching. © 2002 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Telemedicine; Medical teaching; Audio visual communication
1. Introduction The technical infrastructure for audio-visual communication has improved dramatically in the 1990s with the advent of the Integrated Synchronised Digital Network (ISDN) technique. As a result, intracontinental and intercontinental teleconferences with multi-point connections are now common events. Within a country, video-consultations are increasingly used to provide ‘health care at a distance’, especially to patients living in remote areas. It was appreciated that the critical distance in telemedicine and tele-education is related PII of original article: S 1 3 8 6 - 5 0 5 6 ( 0 1 ) 0 0 1 4 5 - 9. * Corresponding author. E-mail address: magnus – [email protected] (N.M. Hjelm).
to needs and that this distance can be short. Therefore, the Committee on Telemedicine in the Chinese University of Hong Kong (CUHK) decided to explore the benefits of installing a system for audio-visual communication in its teaching hospital, the Prince of Wales Hospital (PWH) and the medical school, comprising the Clinical Science Building on the hospital site and the Basic Science Building on the university campus itself, about 4 miles apart. When the project started in 1997, prototype video systems were already installed in the main lecture theatre on the hospital site for external conferences and demonstrations of endoscopic surgery (ISDN lines) and internal conferences with the university campus (asynchronous transfer modes (ATM)). These
1386-5056/02/$ - see front matter © 2002 Elsevier Science Ireland Ltd. All rights reserved. PII: S 1 3 8 6 - 5 0 5 6 ( 0 2 ) 0 0 0 1 0 - 2
162
Erratum
systems had been successfully tested at local and overseas conferences starting in 1994. In addition, a Gigabit Ethernet developed by the Hospital Authority in Hong Kong (HA) was installed in 1996. This system works as a local area network (LAN) and supports the transfer of patient information between the PWH and a large number of hospitals in the Special Administrative Region.
2. General specifications for the extended video-communications system As a first step in implementing the project, general specifications for the video-communications system were defined. It was envisaged that the system should support the following activities. Internal consultations. Health professionals spend much unproductive walking time in carrying out their daily duties and are often unavailable for ad hoc consultations because they cannot leave their working area, e.g. the operating theatre or the outpatient clinic. It was predicted that many of these shortcomings could be overcome by a video-communication system that could be accessed at many locations in the combined hospital and university sites. External consultations. The need for teleconsultations with overseas health professionals about patients admitted to the PWH was considered limited. However, such consultations could be more frequent with hospitals in mainland China for the provision of a second opinion to patients with complicated diseases. Education and training. The traditional format for undergraduate training where one teacher is lecturing to a group of students has been criticised for not being sufficiently ‘problem-oriented’. Therefore, many medical schools have introduced a
system where more than one teacher is present at lectures and tutorials to cover different aspects of a clinical problem. The implementation of such a curriculum is complex and requires that teachers give absolute priority to attending scheduled lectures. It was realised that an internal, multi-point video-system could overcome many of the practical problems involved in organising problem-based learning as teachers and instructors contributed to a lecture from their offices or the video-station on the floor they happened to be on at the time of the lecture. Alternatively, a group of students could be placed in a departmental seminar room with their tutor and patients on selected wards could be demonstrated by video-link. Meetings. Meetings are important means of running any organisation efficiently. In hospitals, meetings play an important role in maintaining the quality of care. In the present hospital system, much time is spent on finding a convenient time and venue for arranging meetings with members of established committees, and on an ad hoc basis in case of administrative and professional emergencies. It was considered that a multi-point video-system would represent the optimal solution to many of these problems and provide a platform for increased interaction internally and externally between health professionals and health administrators. Conferences. It was accepted that conferences with overseas centres on selected topics should be encouraged as an important part of undergraduate training and postgraduate education. Therefore, the planned video-system should enable wards, operating theatres, lecture theatres and seminar rooms to be connected with external centres (locally and overseas) for
Erratum
interactive demonstrations and interventions. Multi-point connecti6ity. A facility for multi-point connections would be required for optimal use of the video-system. It was foreseen that commercial bridges would become available for use in an internal/external environment before the completion of the project, simultaneously linking different types of video stations (e.g. PictureTel, Polycom, Vcon, Cu SeeMe) and communicating over different types of network (e.g. ISDN, ATM, Ethernet, Internet, LAN). This prediction has been vindicated as recently released commercial products (e.g. www.accord.com) can achieve these goals. These systems have the capability of connecting up to 100 different types of internal and external audio-visual stations, and are easy to operate by well-designed menus from a central point or peripheral points. Settings and connections can be changed instantaneously from any video-station connected to the LAN. Video-stations. The system should be able to accommodate different types of peripheral audio-visual stations. This would allow the flexible use of a range of video-stations differing in degree of sophistication (and therefore price) to be selected according to intended use. For example, person-to-person conferences could be expected to require less sophisticated video-stations than the transmission of radiological and microscopic images. It was acknowledged that the present range of video-systems was limited and not always compatible in terms of connectivity. However, it was also predicted that the range of products would expand substantially during the life-time of the network to be installed and that the problem of connectivity would improve as manufacturers adapted their products to international standards.
163
2.1. Technical specifications for the 6ideo-communication system As several subsystems for video-communications were already installed in the medical school and its teaching hospital at the start of this project, it was decided to incorporate these elements into the overall design of the system as specified in the following. To install additional cable (fibre optics) only to sites not already linked to the Gigabit Ethernet. To use the combined high-bandwidth Ethernet and ATM systems as a LAN. To provide health professionals with passwords according to staff grade and clinical needs, allowing them passage to Ethernet from the ATM LAN through the Ethernet firewall, established to protect patient confidentiality. To ensure that the ATM backbone can be used in clinical situations where stable connectivity is required, e.g. during supervision of surgical procedures.
3. Monitoring installation work It was appreciated that the technical infrastructure for the extended system had to be installed in a working environment, that (minor) structural alterations needed to be carried out in the buildings involved, and that the work could potentially cause a nuisance to patients and staff. Therefore, an ad hoc project group was established consisting of representatives from the CUHK Area of Excellence in Telemedicine, the CUHK & HA Information Technology Units, Architecture Units and the Administrative Units. The project group was charged with the task to inform hospital and university staff about the timetable for the work to be carried out and appoint officers to monitor the work with regard to quality and safety.
Fig. 1. Diagram outlining the integrated LAN (ATM and Ethernet backbone) in the CUHK Medical School and its teaching hospital, the Prince of Wales Hospital. The LAN connects two 11-floor ward blocks (Wards A –F), the Endoscopy Centre, the Clinical Science Wing, the Cancer Centre, the Clinical Education Unit (in previous staff quarters), the A&E department and the future Trauma Centre, two outpatient blocks (L.K.S. North & South Wings) and CUHK Main Campus. Three ATM switches have been installed. In all, more than 50 floors are connected for audio-visual communication. There is one Master Central Point for the running of the integrated LAN. A more detailed scheme is available on request by the corresponding author.
164 Erratum
165
Erratum
4. Outcome
4.1. Planning experience Two planning documents turned out to be essential for the planning of the project: (i) the layout of the network (Fig. 1), drawn in such a way that both layman and specialists could understand its extent and function; and (ii) a list of components in the extended network, detailing the components to be installed on each floor. These documents served as the basis for preparing tenders, follow-up meetings with members of the project group and contractors, and information issued to staff in the PWH and the CUHK. Frequent brief meetings were found to be more efficient than memos in order to establish a good understanding of the objectives of the project and to clarify the meaning of many medical and technical terms. The total time spent by the project team until completion of the project was about 300 manhours.
4.2. The installation of the network and its capacity The whole project lasted 24 months from its conception to completion. Once the installation work started, it was completed in 6 months or in about 25% of the total project period. About 50 floors in the CUHK medical school and the PWH (with two outpatient departments) and the adjacent Hong Kong Cancer Centre were connected to the Ethernet/ATM LAN (Fig. 1). In theory, the initial bandwidth of 155 mbps will allow up to 400 video-stations to be connected simultaneously to the system. In practice, it is unlikely that more than 40 video-stations will be used simultaneously during the first triennium of the system. This will make bandwidth available for the transmission of telemedicine applications requiring higher bandwidths, e.g. live demonstrations of microscopic images of frozen sections to surgeons in the operating theatre. The installation of addi-
Table 1 Direct costs for installing the integrated ATM/Ethernet LAN and a minimum number of audio-visual stations (ten) assuming a 5-year life span of the networka Cost (HK$) Networking Trunking Telecom equipment ATM link Subtotal
1 000 000 1 700 000 600 000 3 000 000
Basic workstations Audio-visual units (10 units)
600 000
Total a
3 600 000
All figures have been rounded off.
tional ATM switches can further increase the bandwidth. Multi-point bridges, still to be added to the system, will greatly facilitate the use of audio-visual communication in both the local and extended health care environment. Table 2 Some cost ratios, using the installation costs of the integrated ATM/Ethernet LAN in Table 1 and key indicators describing the health service in the Prince of Wales Hospitala Hospital statistics Beds Cost/bed (HK$)
1350 1600
Non-hospitalised patients/year Accident&Emergency 210 000 Out-patient clinics 520 000 Allied health 220 000 (total, 950 000) Hospitalised patients/year Patient days/year
100 000 460 000
Cost ratios for a 5-year period Per patient Hospitalised (HK$) Non-hospitalised (HK$) All (HK$)
9.00 0.75 0.70
Per patient day (HK$)
1.60
a
All figures have been rounded off.
166
Erratum
4.3. Staff reaction University and hospital staff were informed about progress with the project at regular intervals and are generally looking forward to start using the system.
4.4. Costs The direct costs for the project amounted to HK$ 3.6 million, as outlined in Table 1. The expenses are comparable with conventional improvements to the infrastructure in a major hospital, e.g. improved lighting and new elevator systems. As the ratios presented in Table 2 show, the cost per patient over a 5-year period is similar to that of a first-class stamp. Therefore, the value of the increased quality of care and the potential for rationalising the provision of health care in the hospital that will be the result of using the integrated ATM/Ethernet LAN will no doubt turn out to be substantially larger that the initial investments.
4.5. Testing the performance of the network Initial tests of the network performance have been successfully carried out and have covered the following aspects of video-communication. Testing the ATM-LAN. Testing the Ethernet LAN. Testing the combined ATM/Ethernet LAN. These test have indicated that the performance of the system is satisfactory with regard to connectivity (handshake), stability and at internal and external coferences. 5. Discussion The modern version of telemedicine involving not only the transmission of audio signals, but also visual signals was introduced as a means of providing patients in remote areas with improved access to health care. So far,
little attention has been paid to the use of audio-visual communication within a smaller setting such as a hospital. However, as this paper demonstrates, there are many applications of audio-visual communication in such an environment. Audio-visual communication between patients and health professionals, and between health professionals themselves, should improve the quality of health and of undergraduate and postgraduate teaching to all categories of health professionals. Interestingly, the costs for a hospital-based audio-visual LAN are surprisingly low compared with overall costs for patient care. Therefore, telemedicine in a hospital environment could well be the main application of this form of information technology in the longer term. There is little information available with regard to telemedicine applications in the local setting and, to the best of our knowledge, the system described in this paper is the first of its kind. Acknowledgements This paper was written on behalf of the members of the CUHK Telemedicine Committee. During the period of installing the integrated ATM/Ethernet LAN, the committee consisted of H. Chan (Dermatology), J. Cheng (Orthopaedic Surgery), Christine Choi (PWH Data Centre), S. Chung (Endoscopic Surgery), C.B. Hazlett (Office of Educational Services), N.M. Hjelm (Chemical Pathology, Chairman/ Co-ordinator until November 1999; present Chairman/co-ordinator: HKNg), R. Jones (Pharmacology), A.H.Y. Lau (Pharmacology), J.C.K. Lee (Anatomical & Cellular pathology), S.H. Lee (Community and Family medicine), F. Tong (Information Engineering), J. Tse (Hospital Authority), and H.T. Tsui (Electronic Engineering). The generous grants from the Vice Chancellor’s one-time support fund and the Hospital Authority in Hong Kong are gratefully acknowledged.