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Clinical dietitians' time and expertise have been allocated much more efficiently at Fairview General Hospital through computer analysis of information that is readily available in existing mainframe programs. Other health care institutions may be able to achieve similar results by examining information about patient populations and diet orders stored in their computers.
A highly automated laboratory data processing environment for use with Coulter STKS haematology analysers is described. This in-house system is based on a network of personal computers running Novell Network software and communicating with an IBM mainframe. The system captures the leucocyte scatterplot graphic and numeric parameters from the blood analysers, integrating this with patient demographic and request data held on the host computer. This composite picture is then reviewed on the network by laboratory personnel before generating printed reports. The system has provided greater data integrity, reduced paper flow and improved efficiency in the laboratory's operations and lays the foundations for dealing effectively with the next generation of advanced haematology analysers.
A survey was conducted to determine if user characteristics affected respondents' expectations of computer systems and to identify the most and least desirable features hospital pharmacists want in computer systems. A questionnaire was mailed to 200 hospital pharmacists selected randomly. The survey was designed to gather demographic data, general systems information, and information on system features in 10 major categories. A total of 111 surveys were returned. Of the respondents, 55% had some type of computer system. The leading type of system used by the respondents was a mainframe-shared system. The majority of respondents (87.4%) indicated that they had a "moderate" amount of experience with computer systems. The most commonly preferred hardware was the minicomputer. It appeared that user characteristics did not influence the pharmacists' expectations of computer systems. In ranking the categories, the hospital pharmacists indicated that the i.v. admixture area, inpatient drug distribution, and clinical functions were the most important for computer applications.
Clinical trials for anti-gingivitis and anti-plaque agents commonly use the mean of Silness and Löe plaque indices and Löe and Silness gingival indices as response variables. The aim of this report is to determine if data from anti-plaque and anti-gingivitis clinical trials using Silness and Löe plaque indices and Löe and Silness gingival indices satisfy conditions necessary for the use of the univariate or multivariate approach to repeated measures. These conditions are multivariate normality, homogeneity of variance-covariance matrices, and for the univariate approach, a type-H variance-covariance matrix. Data from 5 separate clinical trials representing a wide range in sample size, pretreatment mean gingival and plaque indices and treatment effects were used to test these conditions. Either the univariate or multivariate approach to repeated measures was found to be appropriate for both responses of the 5 clinical trials. Thus, means of Silness & Löe and Löe and Silness gingival indices meet the necessary conditions for use of either the univariate and/or multivariate approach to repeated measures. However, significant time-treatment interactions are a common occurrence in these types of clinical trials and must be evaluated carefully. The analyses in this study were carried out using SAS. Other mainframe statistical software packages and many micro-computer statistical software packages have routines to analyze repeated measures experiments with analysis of variance methods. However, some of the packages may omit the multivariate approach to repeated measures or may not include interactions between within-subject and between-subject effects. These packages should be used with caution.
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To evaluate the feasibility of analyzing large perinatal datasets on smaller computers, the 1980 National Natality Survey was downloaded first to a minicomputer and then to a microcomputer. Operating system utilities were used to minimize programming and storage requirements. Accuracy was confirmed by comparing descriptive statistics with published values derived on mainframes. Based on a typical analytic problem, implementation on the microcomputer compared favorably to implementation on the minicomputer. Our results suggest that the microcomputer may be a practical alternative to the mainframe for perinatal epidemiological analysis.
Presently, software architects face the challenge of integrating and linking different application software packages built on different computer platforms. Often they inherit various systems, ranging from mainframe to PDA-based applications. The first stage before programming different interfaces is to identify the means of communications most suitable for particular systems. The experience of the Mount Sinai Medical Center in New York, which combines a hospital, a healthcare network, a research center and a medical school, illustrates common problems faced by a number of medical institutions. This paper will discuss the various options, including the Internet, software architects have, and how they can use them during the development of an infrastructure for health care systems.
UNLABELLED: In many institutions information systems are used to process off-line anaesthesia data for invoices, statistical purposes, and quality assurance. Information systems are also increasingly being used to improve process control in order to reduce costs. Most of today's systems were created when information technology and working processes in anaesthesia were very different from those in use today. Thus, many institutions must now replace their computer systems but are probably not aware of how complex this change will be. Modern information systems mostly use client-server architecture and relational data bases. Substituting an old system with a new one is frequently a greater task than designing a system from scratch. This article gives the conclusions drawn from the experience obtained when a large departmental computer system is redesigned in an university hospital. METHODS: The new system was based on a client-server architecture and was developed by an external company without preceding conceptual analysis. Modules for patient, anaesthesia, surgical, and pain-service data were included. Data were analysed using a separate statistical package (RS/1 from Bolt Beranek), taking advantage of its powerful precompiled procedures. RESULTS: Development and introduction of the new system took much more time and effort than expected despite the use of modern software tools. Introduction of the new program required intensive user training despite the choice of modem graphic screen layouts. Automatic data-reading systems could not be used, as too many faults occurred and the effort for the user was too high. However, after the initial problems were solved the system turned out to be a powerful tool for quality control (both process and outcome quality), billing, and scheduling. The statistical analysis of the data resulted in meaningful and relevant conclusions. CONCLUSIONS: Before creating a new information system, the working processes have to be analysed and, if possible, made more efficient; a detailed programme specification must then be made. A servicing and maintenance contract should be drawn up before the order is given to a company. Time periods of equal duration have to be scheduled for defining, writing, testing and introducing the program. Modern client-server systems with relational data bases are by no means simpler to establish and maintain than previous mainframe systems with hierarchical data bases, and thus, experienced computer specialists need to be close at hand. We recommend collecting data only once for both statistics and quality control. To verify data quality, a system of random spot-sampling has to be established. Despite the large investments needed to build up such a system, we consider it a powerful tool for helping to solve the difficult daily problems of managing a surgical and anaesthesia unit.
This paper describes the design and evolution of the data management systems developed in support of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. These systems span platforms from stand-alone computers to distributed systems on local area networks to mainframes. Allowing all of these systems to share appropriate information electronically introduces integration, synchronization, testing, and support challenges. For each platform, applications were developed to handle data entry, editing, trial management, reporting, telecommunications, and data sharing. Approaches to issues such as level of data access, integration with other, existing applications, and handling the expansion of the protocol are discussed.
Industrial fitness and regular screening examinations as called for by vocational disease regulations in the GDR yield large amounts of data relating to places of work and to those members of the work force whose fitness must be verified prior to employment and at regular intervals thereafter. These data must be available to the work's doctor in the various combinations he needs to ensure the medical well-being of the employees and to act as an adviser on matters of industrial hygiene. Several programs have been developed for implementation on distributed ESER computers to solve this problem. The primary records "Arbeitshygienische Komplexanalyse--Dokumentationsbeleg" (industrial hygiene record) and "Grunduntersuchungsbogen--Datanerfassungsbeleg" (medical data record based on fitness checks) are recorded and checked by desk-top computer and subsequently linked to the wage file record by mainframe for analysis. Examples encountered at a shipyard are used to describe the different programs and some of the ways in which they can be linked. The ability to select any combination of data concerning industrial medical, hygiene and income related matters is a major advantage for the work's doctor.
An image capture and communication system for emergency computed tomography (CT) is presented. The system, named ICCS, integrates CT scanners, personal computers (PC), network systems, an IBM API gateway and an IBM mainframe platform. The ICCS was implemented in the emergency unit in the Taichung Veterans General Hospital (TCVGH) and has received considerable support from the doctors, nurses and staff of the TCVGH emergency unit who have shown great interest in ICCS. This is because ICCS allows physicians in the emergency unit to examine patients' images on image viewing stations immediately after the patients are CT scanned. It also makes remote consultation possible for doctors who can stay where they are and consult with radiologists through the system and a hot line without leaving the emergency unit. This advantage greatly reduces the consultation time and saves many unnecessary trips between the emergency unit and the Department of Radiology.
An epidemiological investigation may be designed to collect data and analyse associations between many risk factors and/or many disease groups. A FORTRAN program has been developed to calculate point and interval estimates of odds ratios and attributable risks from stratified, unmatched case-control data for any number of disease/risk-factor combinations. For each disease/risk-factor association, this program can be used to estimate odds ratios by level of exposure and by latency. All output is time- and date-stamped with labels and titles to increase readability and provide useful documentation of study results. All data management is performed using the SPSS package, giving the program a great deal of flexibility, at the same time making it easy to implement and to use. The program has been installed on several mainframes.
Because of increased vertical and horizontal integration of health care businesses, integration of health care data is more crucial than ever. One hospital's first steps in this direction consisted of development of an online physician's office billing system through which users could access the hospital mainframe and data programs.
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The research is to establish nursing E-truck, provide immediately information to nurses, patient's bedside-service. Each nursing work, through computer wireless LAN card, optic fiber network in hospital to the mainframe, to open an activated medical treatment work. Nurses can key in the patient's condition or nursing notes after take care of the patient at the patient's unit, reduce repeated copy, produce working efficiency and working satisfaction.
University College Hospital, a teaching hospital situated in Central London, has been using computers since 1964. Development of an integrated on-line hospital administration computer system was started in 1974. By mid 1977, the components of the system which had been implemented included a patient Master Index, Registration of new patients, Waiting Lists, Bed State, Out-patient Appointments, X-ray, Microbiology and Disease Index. The system was implemented using the Rank Xerox Data Systems (CODASYL based data-base management software, with the majority of applications running on a terminal network supported by transaction processing programs. The experience gained during three years of using such a system is reviewed, with particular emphasis on the ways in which the system matched up in practice to the expected benefits of data-base management facilities. In early 1977, it was decided to replace the Rank Xerox mainframe with a minicomputer which was considered to be a more cost-effective solution to the hospital's computing requirements. The machine selected a PDP 11-70, is running the Digital Equipment Corporation's implementation of Standard MUMPS, an interpretive language developed in a hospital environment, with its own file management software. The decisions which were made in redesigning the existing computer systems for the new machine are discussed. The progress made to date in the transfer of applications from the mainframe to the mini is reviewed, and some of the features of the software available on each machine and its suitability for the implementation of on-line data management and retrieval systems are compared.
Research into the physiology of exercise and kinanthropometry is intended to improve our understanding of how the body responds and adapts to exercise. If such studies are to be meaningful, they have to be well designed and analysed. Advances in personal computing have made available statistical analyses that were previously the preserve of elaborate mainframe systems and have increased opportunities for investigation. However, the ease with which analyses can be performed can mask underlying philosophical and epistemological shortcomings. The aim of this review is to examine the use of four techniques that are especially relevant to physiological studies: (1) bivariate correlation and linear and non-linear regression, (2) multiple regression, (3) repeated-measures analysis of variance and (4) multi-level modelling. The importance of adhering to underlying statistical assumptions is emphasized and ways to accommodate violations of these assumptions are identified.
This paper describes the planning and implementation of a Local Area Network (LAN) for the nursing service of a 504-bed urban teaching hospital. The major goals of the network were: support for nurse executives, nurse managers, and the departmental assistants assigned to administrative offices; increased efficiency and effectiveness of the nursing administrative areas; and improved communication systems. Collaboration between the nursing service and the Computer Information Center (CIC) resulted in a network of over 70 workstations, spanning 11 buildings. The network provides access to multiple programs that support clinical, managerial, and research activities. Gateways provide access to the hospital's two mainframes.