Medical and Clinical Chemistry Networks and Bulletin Boards in Argentina ADOLFO M. GALANTERN1Ka.h AND ALAN D. MARCHC aHospital de Clinicas Universidad de Buenos Aires Buenos Aires, Argentina CInstitutode Investigaciones Neurologicas Raul Carea Buenos Aires, Argentina Beginning in April 1989, a telephonically accesible UNIX-based system has been operating in the city of Buenos Aires under the auspices of the Department of Clinical Chemistry of the University of Buenos Aires School of Medicine. D A C N B , an acronym from the Spanish for the Department of Clinical Chemistry of the Faculty of Pharmacy and Biochemistry, is an electronic mail (e-mail) server and bulletin board system (BBS) mainly involved with medical and biochemical topics. DACFYB also coordinates a nationwide BBS network with bases in local biochemical associations of Argentine provinces. Each of these associations runs a dial-up system serving individual users throughout the provinces and represents a node in the nationwide network. Their BBSs work under a special computer protocol which emulates various UNIX functions on DOS-based machines. At present, the most active areas of interest in the network are AIDS, toxicology, and a radioimrnunoassay (RIA) quality-control collaborative program. MEDICAL INFORMATICS AND THE HEALTH NETWORKS IN ARGENTINA
The Argentine Republic has a population of 36 million people distributed over an area just above one million square miles. The economic crisis that affects health care worldwide affects Argentina in a particularly severe manner because the health system has been experiencing budgetary problems during the last two decades. In this context, computer applications to medicine are viewed as a luxury, except probably for administrative applications. There are two main areas of computer applications to medicine. First is the administrative or management area, which involves the processing of information related to the administrative support of medical activity. This involves financial and inventory control, quite generalized in both the public and private settings, and some simple administrative commercial software that slowly is finding its way into private offices, etc. The second area of application is strictly medical and scientific but generally restricted to institutions involved in research, of which there are few in number. Remote and local access to medical and biological databases and statistical analysis of scientific data are main application areas. Some image-processing work has also been done. bemail: [email protected] 301
302
ANNALS NEW YORK ACADEMY OF SCIENCES
Hardware devoted to medical applications relies almost exclusively on personal computers, mainly PC compatibles, both as stand-alone units or integrated into local area networks (LANs). Minicomputers are the exception, and mainframes, to the best of our knowledge, have not been used in the medical setting. An important fact that deserves mention is the scarce sharing of resources between the administrative and medical areas. The generalized use of PCs became the first element we took into account when designing our network. As far as medically oriented wide area networks are concerned, three highly integrated systems, which we shall later describe, are nowadays operative in Argentina in the context of the so-called Red Acadtmica Nacional (RAN) [Spanish for National Academic Network]. A short description of how these networks originated and developed is necessary for an adequate understanding of their present conformation. The origin of medical networks in Argentina can be traced back to the activities of two different groups whose work went on in complete ignorance of each other’s. One of the groups was strictly medical and had been formed by health professionals (medical doctors, biological chemists, etc.) with an interest in computer applications to medicine and communications, who set the foundations of a medically oriented network. The other group was composed of computer scientists who slowly built a small network for internal communications, which later expanded to a national level that exceeded the original scope of the computer science specialists by allowing access to users outside the computer science community. The medical side of the story begins when Delphi, an international commercial organization providing on-line computer services, opened offices in Argentina. In what was probably a publicity scheme aimed at gaining new members, a group of health professionals known to be involved in computer applications to medicine was offered the company’s service for free. A related-interest group was thus established and announced, and, to Delphi’s advantage, a great number of health professionals took on the service and began connecting regularly. This system was particularly attractive to health professionals throughout the country because of its use of an X25-based national packet network called ARPAC, which enables transmission of information at a national level at very low cost. Likewise, Delphi obtained a gateway into NASA’s SPAN network, which provided the Argentine computer-communications community its first possibility of connecting with international networks such as Internet and BITNET. Activity in the computer science area began when, taking advantage of the multiuser-multitasking capabilities of their UNIX-based platforms, computer science departments of different Argentine universities established a small network across telephone lines using the UNIX-to-UNIX computer communications protocol (UUCP). This small UNIX-based network soon expanded into other departments and institutions with neighboring interests. One of the first groups not directly related to computer science to become integrated was the Department of Astronomy of the Faculty of Exact Sciences of the University of Buenos Aires, which made heavy use of resources provided by the computer science department of that same university. One interesting aspect to note regarding the exponential growth this network was soon to experience is that Argentine universities are not usually established on geographically integrated spaces as is the case with campuses in the United States. Rather, each school and sometimes different departments of the same school are located in buildings widely spread apart throughout the city. This poses communication problems that make networks very attractive to staff.
GALANTERNIK & MARCH: CHEMISTRY NETWORKS IN ARGENTINA
303
Further steps in improving the UNIX network came about when an international gateway became active through a state-supported hotline that allowed access to the UUCP intcrnational network. A problem that initially barred network access to many potential users was the generalized use of DOS-based personal computers in the majority of Argentine academic centers. This roadblock was soon overcome as the UUPC communication package-a software which emulates a UNIX terminal on DOS-based machines-was made widely available, that is, shortly after a sudden increase of nodes and users occurred. The de facto network that was thus established called itself, as already mentioned, Red Academica Nacional, and continued to be administered by its original designers at the Department of Computer Science of the University of Buenos Aires. The integration of medical related-interest groups into the UNIX network took place as three active participants in the Delphi network migrated their systems to UNIX platforms. Our Department was the first to take this step during the first months of 1989 and was shortly followed by the Buenos A r e s Children’s Hospital group and by the group operating at the Buenos A r e s headquarters of the Pan American Health Organization. In our own case, being aware of the National Academic Network’s existence, we requested and soon gained access to it as a node. Shortly thereafter, we set up a dial-up system devoted to medicine and related areas which was offered to the community free of charge. Both the Buenos Aires Children’s Hospital and the Pan American Health Organization soon followed in our steps, thus giving way to the three major medical networks presently operating in Argent ina.
TECHNICAL CHARACTERISTICS OF PUBLIC MEDICAL NETWORKS PRESENTLY ACTIVE IN ARGENTINA
OPSARG, an acronym of Organizacion Panamericana para la Salud, Argentina, is operated by computer scientist Fernando Lopez Guerra. OPSARG presently serves approximately 72 nodes with a mean of three users per node. GUTI is named after Ricardo Gutierrez Children’s Hospital, one of the three major pediatric hospitals in Buenos Aires. It is operated by Dr. Albert0 Barengols, a nuclear medicine specialist. GUTI serves about 22 nodes, 14 of which operate inside the Hospital. Each node has a mean of three users per node. DACFYB is an acronym for the Department of Clinical Chemistry of Buenos Aires University’s School of Pharmacy and Biochemistry [Departamento de Analisis Clinicos, Facultad de Farmacia y Bioquimica], which is affiliated with the main teaching hospital of the University of Buenos Ares. Although originally aimed at biochemists, many medical doctors often sign in in order to gain access to the National Academic Network. DACFYB is slightly different from the abovementioned networks in that it favors fewer nodes with a greater number of users per node. Presently DACFYB has nine nodes with an estimated 55 users per node. Services provided by all groups operating in the health area are basically similar. All networks offer e-mail facilities. All of them distribute two locally produced lists. The first is “salud,” a general-interest list moderated by OPSARG. The second is “brolis,” a list of Argentine medical libraries which also reproduces MEDLIB-L and is moderated by GUTI. Finally, many international lists are redistributed by numerous groups (i.e., MEDNEWS, HSPNET, BIONET group, MEDNETS, NUCMED, etc.).
304
ANNALS NEW YORK ACADEMY OF SCIENCES
SHORT HISTORY AND OPERATING CHARACTERISTICS OF DACFYB The purpose of presenting the DACFYB network is to offer an example of a very low-cost network which can serve its users in an adequate and useful way. As previously described, DACFYB established itself independently as a UNIXbased node at the beginning of 1989. At that time it operated on an AT compatible running under UNIX/286, with two terminals, a 1200-baud modem, and a 40-MB hard disk. In June 1989 a dial-up menu-driven system written in UNIX shell was established. In September of that same year a bulletin board system (BBS) running under Unaxcess, a public-domain UNIX node package was begun. Shortly thereafter, in October, the system was changed to a 386-compatible with four terminals, a 2400-baud modem, and a 180-MB hard disk. By then, the services offered were bulletin areas, both national and international. National areas included bulletins on research grants, scientific meetings, and medical education. Strictly medical bulletins included clinical medicine, infectious diseases, AIDS, toxicology, etc. Computeroriented areas were also available, such as UNIX information, well-known SIMTEL20, and general information on networks. International bulletin areas enabled redistribution of lists produced outside Argentina, such as MEDNEWS, HSPNET, MEDLIB, BIONET, etc. A file area was likewise available, including an extensive library of medically oriented DOS software, MEDNEWS, UUCPmap, etc. Finally, as recently as August 1991, a high-speed 9600-baud modem was introduced, and a major change was effected. A problem that began to appear increasingly was saturation of our only dedicated telephone line; this was a consequence of the great increase in the number of users and the long periods which many of them remained logged in. By using the WAFFLE package, a series of remote BBSs was established and many direct DACFYB users were reassigned to them. The WAFFLE package is a BBS software running under DOS which allows communication via UUCP with UNIX nodes and offers e-mail services, as well as bulletin and file areas. These remote BBSs were developed on DOS platforms and mainly in the provinces. Given the absolute absence of funding of any kind, these BBSs were installed on PC compatibles used by provincial biochemical associations. Because these computers were generally engaged in administrative duties during most of the day, and also as a consequence of no multitasking capabilities, these BBSs became active during the night. Thanks to this form of “distributed processing” scheme, the above-mentioned bottleneck disappeared. Also, through this system many clinical chemistry laboratories in the provinces obtained access to the Latin American external quality control program for radioimmunoassay, which was being run by our department under the sponsorship of the World Health Organization. The establishment of remote BBSs represented a major improvement in the efficiency of our network. Before their implementation, the volume of information accumulated by DACFYBs main server, as well as its growth rate, made adequate classification of information increasingly difficult to manage. Users had to go through extensive searches in order to locate their items of interest. At present, all DACFYB services are distributed by its remote BBSs, which allow for a better classification of information. Each remote BBS has three levels of bulletin areas. The first level includes bulletins that are only accessible by users of that particular node. Every time a potential user requests subscription to DACFYB, we try to assign him to the remote node most related to his interests. If his interests are more general, he is assigned to the geographically closest remote BBS, in order to keep his communication costs low.
GALANTERNIK & MARCH CHEMISTRY NETWORKS IN ARGENTINA
305
Each of these nodes is, of course, not an isolated unit. All of them share information at precisely a second level, represented by a common base of bulletins that is available to all nodes depending on DACFYB at a national level. These bulletins are periodically distributed throughout the whole of the DACFYB network. Finally, at a third level are bulletin and file areas that may be accessed by non-DACFYB users via e-mail. Of course, these areas are also available to DACFYB users. Another important operational characteristic of the DACFYB network is compression of all bulletin information prior to distribution to remote BBSs, in a manner similar to USENET-NEWS. This implementation resulted in an overall reduction of communication times because remote BBSs usually employ low-speed modems. CONCLUSION
Efficient communications are an imperative in the biomedical world of today. These communications must be fast, error-free and of low cost, the latter a specially relevant matter in developing countries. Throughout this paper we have presented a low-cost, efficient network which serves some basic communication needs of health professionals in a developing country such as Argentina. Special emphasis was made on the low cost involved in establishing such a network, the majority of its hardware components based on nondedicated PC-compatible machines, and using publicdomain (free) software. Such a network may be easily reproduced in most developing countries without significant cost.
The Argentine Republic has a population of 36 million people distributed over an area just above one million square miles. The economic crisis that affects health care worldwide affects Argentina in a particularly severe manner because the health system has been experiencing budgetary problems during the last two decades. In this context, computer applications to medicine are viewed as a luxury, except probably for administrative applications. There are two main areas of computer applications to medicine. First is the administrative or management area, which involves the processing of information related to the administrative support of medical activity. This involves financial and inventory control, quite generalized in both the public and private settings, and some simple administrative commercial software that slowly is finding its way into private offices, etc. The second area of application is strictly medical and scientific but generally restricted to institutions involved in research, of which there are few in number. Remote and local access to medical and biological databases and statistical analysis of scientific data are main application areas. Some image-processing work has also been done. bemail: [email protected] 301
302
ANNALS NEW YORK ACADEMY OF SCIENCES
Hardware devoted to medical applications relies almost exclusively on personal computers, mainly PC compatibles, both as stand-alone units or integrated into local area networks (LANs). Minicomputers are the exception, and mainframes, to the best of our knowledge, have not been used in the medical setting. An important fact that deserves mention is the scarce sharing of resources between the administrative and medical areas. The generalized use of PCs became the first element we took into account when designing our network. As far as medically oriented wide area networks are concerned, three highly integrated systems, which we shall later describe, are nowadays operative in Argentina in the context of the so-called Red Acadtmica Nacional (RAN) [Spanish for National Academic Network]. A short description of how these networks originated and developed is necessary for an adequate understanding of their present conformation. The origin of medical networks in Argentina can be traced back to the activities of two different groups whose work went on in complete ignorance of each other’s. One of the groups was strictly medical and had been formed by health professionals (medical doctors, biological chemists, etc.) with an interest in computer applications to medicine and communications, who set the foundations of a medically oriented network. The other group was composed of computer scientists who slowly built a small network for internal communications, which later expanded to a national level that exceeded the original scope of the computer science specialists by allowing access to users outside the computer science community. The medical side of the story begins when Delphi, an international commercial organization providing on-line computer services, opened offices in Argentina. In what was probably a publicity scheme aimed at gaining new members, a group of health professionals known to be involved in computer applications to medicine was offered the company’s service for free. A related-interest group was thus established and announced, and, to Delphi’s advantage, a great number of health professionals took on the service and began connecting regularly. This system was particularly attractive to health professionals throughout the country because of its use of an X25-based national packet network called ARPAC, which enables transmission of information at a national level at very low cost. Likewise, Delphi obtained a gateway into NASA’s SPAN network, which provided the Argentine computer-communications community its first possibility of connecting with international networks such as Internet and BITNET. Activity in the computer science area began when, taking advantage of the multiuser-multitasking capabilities of their UNIX-based platforms, computer science departments of different Argentine universities established a small network across telephone lines using the UNIX-to-UNIX computer communications protocol (UUCP). This small UNIX-based network soon expanded into other departments and institutions with neighboring interests. One of the first groups not directly related to computer science to become integrated was the Department of Astronomy of the Faculty of Exact Sciences of the University of Buenos Aires, which made heavy use of resources provided by the computer science department of that same university. One interesting aspect to note regarding the exponential growth this network was soon to experience is that Argentine universities are not usually established on geographically integrated spaces as is the case with campuses in the United States. Rather, each school and sometimes different departments of the same school are located in buildings widely spread apart throughout the city. This poses communication problems that make networks very attractive to staff.
GALANTERNIK & MARCH: CHEMISTRY NETWORKS IN ARGENTINA
303
Further steps in improving the UNIX network came about when an international gateway became active through a state-supported hotline that allowed access to the UUCP intcrnational network. A problem that initially barred network access to many potential users was the generalized use of DOS-based personal computers in the majority of Argentine academic centers. This roadblock was soon overcome as the UUPC communication package-a software which emulates a UNIX terminal on DOS-based machines-was made widely available, that is, shortly after a sudden increase of nodes and users occurred. The de facto network that was thus established called itself, as already mentioned, Red Academica Nacional, and continued to be administered by its original designers at the Department of Computer Science of the University of Buenos Aires. The integration of medical related-interest groups into the UNIX network took place as three active participants in the Delphi network migrated their systems to UNIX platforms. Our Department was the first to take this step during the first months of 1989 and was shortly followed by the Buenos A r e s Children’s Hospital group and by the group operating at the Buenos A r e s headquarters of the Pan American Health Organization. In our own case, being aware of the National Academic Network’s existence, we requested and soon gained access to it as a node. Shortly thereafter, we set up a dial-up system devoted to medicine and related areas which was offered to the community free of charge. Both the Buenos Aires Children’s Hospital and the Pan American Health Organization soon followed in our steps, thus giving way to the three major medical networks presently operating in Argent ina.
TECHNICAL CHARACTERISTICS OF PUBLIC MEDICAL NETWORKS PRESENTLY ACTIVE IN ARGENTINA
OPSARG, an acronym of Organizacion Panamericana para la Salud, Argentina, is operated by computer scientist Fernando Lopez Guerra. OPSARG presently serves approximately 72 nodes with a mean of three users per node. GUTI is named after Ricardo Gutierrez Children’s Hospital, one of the three major pediatric hospitals in Buenos Aires. It is operated by Dr. Albert0 Barengols, a nuclear medicine specialist. GUTI serves about 22 nodes, 14 of which operate inside the Hospital. Each node has a mean of three users per node. DACFYB is an acronym for the Department of Clinical Chemistry of Buenos Aires University’s School of Pharmacy and Biochemistry [Departamento de Analisis Clinicos, Facultad de Farmacia y Bioquimica], which is affiliated with the main teaching hospital of the University of Buenos Ares. Although originally aimed at biochemists, many medical doctors often sign in in order to gain access to the National Academic Network. DACFYB is slightly different from the abovementioned networks in that it favors fewer nodes with a greater number of users per node. Presently DACFYB has nine nodes with an estimated 55 users per node. Services provided by all groups operating in the health area are basically similar. All networks offer e-mail facilities. All of them distribute two locally produced lists. The first is “salud,” a general-interest list moderated by OPSARG. The second is “brolis,” a list of Argentine medical libraries which also reproduces MEDLIB-L and is moderated by GUTI. Finally, many international lists are redistributed by numerous groups (i.e., MEDNEWS, HSPNET, BIONET group, MEDNETS, NUCMED, etc.).
304
ANNALS NEW YORK ACADEMY OF SCIENCES
SHORT HISTORY AND OPERATING CHARACTERISTICS OF DACFYB The purpose of presenting the DACFYB network is to offer an example of a very low-cost network which can serve its users in an adequate and useful way. As previously described, DACFYB established itself independently as a UNIXbased node at the beginning of 1989. At that time it operated on an AT compatible running under UNIX/286, with two terminals, a 1200-baud modem, and a 40-MB hard disk. In June 1989 a dial-up menu-driven system written in UNIX shell was established. In September of that same year a bulletin board system (BBS) running under Unaxcess, a public-domain UNIX node package was begun. Shortly thereafter, in October, the system was changed to a 386-compatible with four terminals, a 2400-baud modem, and a 180-MB hard disk. By then, the services offered were bulletin areas, both national and international. National areas included bulletins on research grants, scientific meetings, and medical education. Strictly medical bulletins included clinical medicine, infectious diseases, AIDS, toxicology, etc. Computeroriented areas were also available, such as UNIX information, well-known SIMTEL20, and general information on networks. International bulletin areas enabled redistribution of lists produced outside Argentina, such as MEDNEWS, HSPNET, MEDLIB, BIONET, etc. A file area was likewise available, including an extensive library of medically oriented DOS software, MEDNEWS, UUCPmap, etc. Finally, as recently as August 1991, a high-speed 9600-baud modem was introduced, and a major change was effected. A problem that began to appear increasingly was saturation of our only dedicated telephone line; this was a consequence of the great increase in the number of users and the long periods which many of them remained logged in. By using the WAFFLE package, a series of remote BBSs was established and many direct DACFYB users were reassigned to them. The WAFFLE package is a BBS software running under DOS which allows communication via UUCP with UNIX nodes and offers e-mail services, as well as bulletin and file areas. These remote BBSs were developed on DOS platforms and mainly in the provinces. Given the absolute absence of funding of any kind, these BBSs were installed on PC compatibles used by provincial biochemical associations. Because these computers were generally engaged in administrative duties during most of the day, and also as a consequence of no multitasking capabilities, these BBSs became active during the night. Thanks to this form of “distributed processing” scheme, the above-mentioned bottleneck disappeared. Also, through this system many clinical chemistry laboratories in the provinces obtained access to the Latin American external quality control program for radioimmunoassay, which was being run by our department under the sponsorship of the World Health Organization. The establishment of remote BBSs represented a major improvement in the efficiency of our network. Before their implementation, the volume of information accumulated by DACFYBs main server, as well as its growth rate, made adequate classification of information increasingly difficult to manage. Users had to go through extensive searches in order to locate their items of interest. At present, all DACFYB services are distributed by its remote BBSs, which allow for a better classification of information. Each remote BBS has three levels of bulletin areas. The first level includes bulletins that are only accessible by users of that particular node. Every time a potential user requests subscription to DACFYB, we try to assign him to the remote node most related to his interests. If his interests are more general, he is assigned to the geographically closest remote BBS, in order to keep his communication costs low.
GALANTERNIK & MARCH CHEMISTRY NETWORKS IN ARGENTINA
305
Each of these nodes is, of course, not an isolated unit. All of them share information at precisely a second level, represented by a common base of bulletins that is available to all nodes depending on DACFYB at a national level. These bulletins are periodically distributed throughout the whole of the DACFYB network. Finally, at a third level are bulletin and file areas that may be accessed by non-DACFYB users via e-mail. Of course, these areas are also available to DACFYB users. Another important operational characteristic of the DACFYB network is compression of all bulletin information prior to distribution to remote BBSs, in a manner similar to USENET-NEWS. This implementation resulted in an overall reduction of communication times because remote BBSs usually employ low-speed modems. CONCLUSION
Efficient communications are an imperative in the biomedical world of today. These communications must be fast, error-free and of low cost, the latter a specially relevant matter in developing countries. Throughout this paper we have presented a low-cost, efficient network which serves some basic communication needs of health professionals in a developing country such as Argentina. Special emphasis was made on the low cost involved in establishing such a network, the majority of its hardware components based on nondedicated PC-compatible machines, and using publicdomain (free) software. Such a network may be easily reproduced in most developing countries without significant cost.
