Biomedical subjects
Publications and source records attributed to T A Pryor.
This article assesses the potential value of an integrated medical/ hospital information system (IMIS) for the members of the Eastern Mediterranean Region of the World Health Organization, and describes the preliminary results of a feasibility study questionnaire done in December 1989 at Salmaniya Medical Center (SMC) in the state of Bahrain.
Methods for optimizing coded data entry in clinical systems are a frequent topic of system design. We have developed a new mechanism for this type of data entry that we call "Pick From Thousands" (PFT). It combines several known methods, including menu selection, keyword entry, and initial character matching, but adds a new string matching algorithm. The PFT method is more selective than initial character matching for a given number of keystrokes if entries in the coded list have more than one word. Collaborative processing between a PC workstation and the central HELP system computer is used to optimize ease of maintenance and increase the flexibility and performance of the system.
Information management is central to modern patient care. Computerization of information management has resulted in both departmental systems which serve information needs in locations such as the Radiology Department and in hospital-wide information systems which seek to integrate management of clinical data from many departments. For each of these systems to achieve the goal of maximizing both the effectiveness of health care workers and the quality of patient care, they need to share the data that they capture. Below we discuss a variety of applications, both currently available and in the realm of research protocols, that depend on a high level of communication between Radiology Information Systems and Hospital Information Systems. These examples suggest the benefits of integrating the medically relevant data collected by all of the computer-based information systems in the hospital setting.
Intracerebral hemorrhage is an important concern after thrombolytic therapy for acute myocardial infarction, but risk factors are controversial. Accordingly, we assessed risk factors in 107 treated patients of whom 4 had intracerebral hemorrhage. Intracerebral hemorrhage occurred at a mean of 25 hours (range 3.5 to 48) after therapy and was fatal in 2 patients. Significant differences were found between patients with and without intracerebral hemorrhage for age (77 +/- 7 vs 62 +/- 11 years, p less than or equal to 0.01), and initial (161 +/- 23 vs 135 +/- 23 mm Hg, p less than or equal to 0.03) and maximal (171 +/- 30 vs 146 +/- 20, p less than or equal to 0.02) systolic blood pressures. Initial and maximal diastolic blood pressures also tended to be higher (101 +/- 25 vs 86 +/- 16, p less than or equal to 0.07; 104 +/- 24 vs 90 +/- 13, p less than or equal to 0.06). Differences did not achieve significance for comparisons of gender, height, weight, site of infarction, time to therapy, specific thrombolytic agent used, concomitant therapy, interventions and partial thromboplastin time. It is concluded that age (greater than or equal to 70 years) and elevated blood pressure (greater than or equal to 150/95 mm Hg) are important risk factors for intracerebral hemorrhage. The overall balance of benefit and risk of thrombolysis should continue to be assessed by large mortality trials.
We tested a new model of the HELP patient database that makes use of relational tables to store patient data and provides access to data using SQL (Structured Query Language). The SQL database required more storage space and had many more physical records than the HELP database, but it was faster and more efficient in storing data than the standard HELP utilities. The HELP utilities used disk space more efficiently and were faster than the SQL tools when retrieving data for typical clinical reports. However, the SQL model provides networking capabilities, general report writing tools, detailed user documentation, and an ability for creating secondary indexes that offset its poorer performance.
Manual graphing of the progress of labor is considered useful but is not often done. The early detection of some deviations requires special graphics aids. Our objective was to develop an easy-to-use computer program for the integrated visual presentation of information characterizing the progress of labor. Through the use of inexpensive personal computers equipped with graphics monitors, the program provides a combined graphics display of timed progressive cervical dilatation, fetal station, and stimulation of uterine activity (oxytocin infusion). For the early detection of abnormalities, phase-specific normal ranges (reference areas) are displayed. In addition, protraction/arrest as well as precipitate labor disorders are highlighted and computer messages are displayed. The program was evaluated through the assessment of 405 labors entered into a local area network of computers. On average, the program identified 1.5 abnormalities per recorded labor (2.0 for labors resulting in vaginal delivery). The graphic presentation of the labor curve, produced within 3 seconds, displayed 27% more information than the tabular format on the same screen area and provided a single-screen display of the labor curve even for patients with excessive data. The computer-generated display of labor curves facilitates visual presentation and interpretation of labor progress and can also help to translate quality assurance criteria into clinical practice.
Use of hospital information systems (HIS) are no longer limited to administrative functions. The addition to these systems of decision support capability is now a necessity. Development of the decision support modules requires a different software architecture than that employed by most HIS systems today. This paper describes the generic uses of decision support throughout the many hospital applications. Several levels of decision support are outlined with examples to illustrate the many areas where decision support is useful. At LDS Hospital in Salt Lake City, Utah we have developed an HIS using a new software architecture which supports the creation of decision support applications. This system uses a frame structure to represent knowledge. Examples of the frames and their syntax is presented. Using the frame tools which are provided, an application developer can easily develop and test decision support modules which interact directly with the clinical user and the patient database.
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A prospective study of a computerized arrhythmia alarm system was carried out in the coronary care unit during 200 patient hours of monitoring. The computer system was designed to activate an alarm on the development of rhythm and conduction disorders including asystole, ventricular tachycardia, atrial tachycardia, sinus tachtcardia, bradycardia, frequent premature ventricular beats, atrial fibrillation and bundle branch block. Study patients were simultaneously monitored by the computer system and a conventional analog heart rate alarm system. All alarms generated by the two systems were evaluated. Of 79 computer alarms, 42 (53 percent) were true positive alarms; during the same period there were 167 analog alarms of which only 13 (8 percent) were true positive alarms. In both systems, false positive alarms were primarily due to patient movement, but they occurred only 25 percent as often with the computer system as with the analog system. These results indicate that computerized arrhythmia monitoring systems offer significant advantages over conventional monitoring techniques.
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