C. Nätscher 1, H. Mehammed 1, A. Horsch 1, H. Sussmann 1, H. D. Allescher 2
1 Dept. of Medical Statistics and Epidemiology, Technical University of Munich, Germany
2 II. Dept. of Internal Medicine, Klinikum Rechts der Isar, Technical University of Munich, Germany
Endoscopy is a fast developing specialty with an increasing importance in modern medicine. The most recent diagnostic and therapeutic methods are often practiced only at specialized centers of excellence such as university hospitals. For this reason, a Web-based Endoscopy Information System (EIS)  has been developed in the framework of a comprehensive telemedicine project (ENDOTEL, Endoscopy Teleservices) . ENDOTEL comprises a multimedia teleconsultation and information service in gastroenterological endoscopy and endosonography, primarily for physicians in rural areas.
The EIS (figure 1) contains numerous pictures, videos and texts from the 2nd Department of Internal Medicine at the university hospital Klinikum Rechts der Isar, Munich.
Figure 1 Screenshot of the EIS user interface
The EIS content is accessible via a systematic that has been derived from the endoscopy terminology guideline of the German society for digestion and metabolic diseases. By that it is possible for a physician to look fast and easily for reference findings and to inform himself about current diagnostics and therapy standards. Introductive texts offer a summary of relevant diseases and techniques for each organ. A large collection of commentated media gives a broad overview of the gastroenterological endoscopy. The user can sort the images and videos by origin (endoscopy, endosonograpy, x-ray etc.) and other criteria using the “search for media” function.
Figure 2 Interaction with the ColdFusion application server
A Microsoft Access database and the ColdFusion application server version 4.5 enable the sophisticated EIS functionality. The dynamic web pages are created with the ColdFusion Markup (CFM) language, which extends HTML tags by special tags, especially for database connectivity (searching and updating). Figure 2 illustrates the communication between web browser and the ColdFusion application server.
Fig. 3 Screenshot of the EIS administration interface
The following aspects have been crucial for the design of the EIS functionality:
· In a fast growing and innovative field of knowledge like gastroenterological endoscopy (as in medical sciences, in general) it is necessary to react quickly if new knowledge evolves.
That’s why in the EIS an administration tool (figure 3) has been integrated. It enables an authorized expert to add or update the content online. After login by username and password, the author can comfortably upload or delete media. Comments and texts are handled fast and simply by an editor that is also integrated in the application. The changes made by the author are taken over immediately due to the direct connection with the server. A separate file transfer tool is not necessary. The whole user and authoring interface has been developed in accordance to standards for software ergonomics.
At present (July 2002), the EIS contains 370 media: 350 still images and 20 video clips. The EIS is accessible on the Internet . On the ENDOTEL website , a detailed description of the EIS is available.
At the moment, 3 authors provide content to the EIS. Until end of 2002, Expert Guided Tours (EGT) will also be available. Furthermore, it is planned to integrate the information system into a comprehensive, document-based decision support system for physicians in gastroenterology.
 EIS Website www.eis.telemedizin.org
 ColdFusion Website