Digital Imaging and Communication in Medicine (DICOM) is a communication protocol that imaging devices use to communicate. The universal acceptance of the DICOM standard by the major medical vendors means that the digital transition in veterinary medicine should be relatively smooth provided DICOM is used. DICOM service objects, roles, service classes, and conformance standards are discussed. The authors strongly encourage the use of image acquisition software and image archive systems that support the DICOM standard. Veterinary

The elements of a digital imaging system are bound together by the network, so careful attention must be paid to this essential component. Networking hardware and cable choice will affect the speed of image transmission between devices within a network. Wireless networking offers convenience at the expense of speed and potentially, security. If a facility allows its network to connect to the Internet, security precautions are essential. Firewalls prevent unauthorized and destructive access to the network; virtual private networks allow encrypted communication with the network; and email and web browser encryption allow data transmitted from the network to other users on the Internet safely. This article presents an overview of this broad array of technologies. Readers are encouraged to seek additional depth as needed to address individual networking needs.

I n veterinary medicine a complete electronic medical record (EMR) should contain all information (eg, demographic, financial, medical/surgical, diagnostic, and pharmaceutical) related to all visits of a patient as well as owner contact and billing information. It is clear that such a complete EMR and the ability to retrieve and use the information it contains in an integrated manner would provide operational economies, improve patient care, and enhance teaching. We embarked on a project to develop such a record in an academic institution. This article describes our approach and how the EMR is currently being used in academic medicine. Development of the Hospital Information SystemThe effort to develop a computerized patient record system for the veterinary medical teaching hospital (VMTH) began about 20 years ago but progressed with difficulty, largely because of a lack of human resources. The event that triggered the commitment of substantial resources toward development of the EMR was the need for the VMTH to become autonomous from the services of an outside accounting firm. The firm was unable to provide the level of detail and flexibility required for the fiscal management of the VMTH. The decision was made to hire programming staff to write a hospital information system (HIS) specifically designed to combine the objectives of clinical information management with those of hospital administration and patient billing in a single integrated system. The existing medical record system served as the foundation for this effort. The computing platform chosen was the Massachusetts General Hospital Utility Multiprogramming System (MUMPS), because it had a proven record of success in medical computing, provided a flexible programming environment and strong retrieval capabilities, and did not require a mainframe computer. 1,2 A decision was also made that the primary force guiding EMR development would be to meet the needs of the users it was designed to serve: the VMTH faculty, students, and staff.In the old accounting system all financial entries were made centrally in cashiering. At that time a copy of each completed procedure request was hand routed to cashiering, where it was manually posted. As an initial step toward facilitating diagnostic reporting, VMTH staff in the various services who already had responsibility for entering billing information onto the routing slips were assigned responsibility for entering that information directly into the HIS. This point-ofservice entry concept was adopted as an objective for development for all components of the EMR. Point-ofservice entry was defined as assigning responsibility for information entry to the individual closest to the source of the information. Software tools were designed that enabled these individuals to make the entries directly into the electronic record instead of the paper record. For example, admissions staff entered demographic information as they acquired information necessary to make an appointment, usually during a telephone conversation with t...

The lossless capture of the entire range of optical densities encountered in a radiograph can require up to 4000 individual shades of gray. Most inexpensive computer displays, and most grayscale image formats contain only 256 gray shades. To use these systems, a look up table must be generated to display the scanned image, which maps the approximately 4000 gray shades in the digitized radiograph to the 256 gray shades on the monitor. However, if this conversion is inappropriately performed, much of the information contained in the original image could be lost. This study was undertaken to develop an histogram equalization algorithm that would automatically convert the 4000 gray shade digitized radiograph into a 256 gray shade image file, without perceptable loss of diagnostic information or image quality.