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The early stages of MUMPS demonstrated the language's reliability and functionality, yet it was limited to operating on standalone mainframe and minicomputer architectures. Slowly, as technology progressed and client-server networks became a reality, the speed and performance of MUMPS has brought new dimensions to healthcare.
We describe a microcomputer program (KMSURV) for exploratory univariate statistical analysis of survival data which is directly applicable to the evaluation of clinical trials and to retrospective epidemiological studies of hospital registry-based data. The program calculates life-table-like information based on Kaplan-Meier's product-limit estimators of the survivorship function S(t) and provides summary measures of average survival times. In addition, two non-parametric tests for the comparison of survival distributions are performed. A report-quality, high resolution plot of the S(t) estimates for all groups being compared complements each set of analyses. KMSURV is not a simple adaptation of a mainframe statistical analysis package and, thus, it utilizes efficiently the interactive environment which is inherent in microcomputing.
This paper is intended to give you an overview about the migration process of the Hospital Information System (HIS) at the University Hospital of Giessen towards an open client server based architecture. It describes the software architecture of the existing mainframe applications and the network interfaces involved in opening the centralized software architecture to a wide variety of remote applications.
Florida Hospital, a 1,462-bed organization in five locations in the central Florida area, wanted to implement an EDI system that would take redundancies, paper and FTEs out of their system. They hired a consultant to educate them about EDI and help them put together an EDI business plan. They decided to implement three initial transaction sets for a price catalog, purchase orders, and PO acknowledgments. Requesting departments will be able to order routine items directly from vendors via EDI. Future transaction sets will include advance ship notice with price (857) that will generate a receipt off of which the hospital will pay, and electronic funds transfer. Translation and communication software for their mainframe system was chosen to accommodate both the most and least electronically sophisticated trading partners, and negotiations/education on doing business with the hospital via EDI are ongoing.
Analog/Digital conversion of up to 16 channels can be set up and executed interactively with sampling rates individually adjusted for each channel. Additionally, asynchron and parallel digital I/0 is provided, including the possibility of triggering the beginning and the end of data acquisition on an external TTL signal. For non-experienced personnel the package can be run fully interactively with help-menus. Conversely, the experienced user can skip the menu level and directly access the A/D conversion card at the programmers' level in FORTRAN, BASIC or PASCAL. This two level approach considerably enhances the versatility of the package. Data structures in memory and on disk are the same for both levels. Thus, data acquired in menu mode can be compatibly accessed and evaluated from the menu--as well as the programmers' level. Furthermore, a concept is presented for a most efficient and convenient transfer of pre-processed data onto an IBM-mainframe for further analysis in SAS. This transfer scheme allows for continued transparency of the data files, should--for technical reasons or due to changes in the type of data acquired--changes or upgradings of the A/D conversion software become necessary. The package is available for IBM-XT/AT personal computers.
A systems analysis has been done to determine how computer technology can provide an information system to improve the care of the mother and her baby. A minimum data base was established complying with the recommendations of the Körner Committee and designed to meet the needs of the health personnel looking after the mother and baby. An ICL DRS 20/50 network of four microcomputers has been installed in the obstetric unit of a district teaching hospital with a link to the regional mainframe. There have been no significant software or hardware faults since the system became fully operational in January 1984. All women are registered on the system at their first visit allowing the pregnancy to be followed prospectively. Subsequently midwives enter data on line at delivery and at discharge. The on line validation and range checks improves the accuracy of the data allowing a reliable perinatal audit to be obtained routinely. The system has been accepted by the staff since much of the routine pregnancy documentation is produced automatically. This includes booking letters and summaries for general practitioners, admission slips, birth notification forms, registers and forms for the community midwives and health visitors. Immediate production of reports for community health staff allows better communication and improved patient care. No additional staff are needed in the obstetric unit and one job which was mainly of a clerical nature has been saved and the salary transferred to provide one more midwife for the postnatal wards.(ABSTRACT TRUNCATED AT 250 WORDS)
SMS, an international corporation headquartered in Malvern, PA, is a leading provider of information systems and services to the healthcare industry. Although best known for its acute care hospital information systems, SMS expanded its market focus in 1980 with the establishment of its Physician Services Division. Its emergence as a leader in the physician information marketplace has resulted in an increase in contract signings of 24 percent in the past six months. The division employs 640 people in 28 offices nationwide. Products of the division include SIGNATURE, an on-line mainframe-based financial, patient and clinical management information system that operates in-house or remotely; the Physician Office System, a PC-based business office system; and Practice Management, SMS' business office/accounts receivable management service.
Order processing and parts issuing are within the scope of an inventory management system and, as such, it was logical to incorporate the Purchase Order Management Menu into the biomedical engineering inventory management system. The Purchase Order Management function was implemented using the services of a biomedical engineering technician who is a staff member. Software development time (two months) was the only resource that was necessary to incorporate this function into the inventory system. This function, implemented on a PC, provided locally functions that had not been available on the mainframe-based hospital purchasing system. These functions directly addressed the needs of the users, who in this case are the staff members of the department of biomedical engineering at University Hospital, Stony Brook, New York.
SMILE (St. Luke's Medical Center Information Linkage Environment) is a HIS which is a client/server system using a UNIX workstation under an open network, LAN(FDDI&10BASE-T). It provides a multivendor environment, high performance with low cost and a user-friendly GUI. However, the client/server architecture with a UNIX workstation does not have the same OLTP environment (ex. TP monor) as the mainframe. So, our system problems and the steps used to solve them were reviewed. Several points that are necessary for a client/server system with a UNIX workstation in the future are presented.
A new simulation system of diagnostic and therapeutic processes is developed. The aim is to train medical students for the practical use of their knowledge, utilizing patient data in a total hospital information system. The knowledge in the system is presented by the specialists for every case. In medical school there are many specialists in various fields. With their cooperation the system can grow up to a comprehensive CAI system for clinical education. The system is designed to work on the mainframe for easiness of development, maintenance and extensions of the system. The present framework has been applied to the simulation of diagnostic process. The usefulness of the present system has been confirmed by specialists and students.
The article describes the design of a user-defined multipurpose system based on the Zilog Z-80, 8-bit microprocessor. The basic concept comprises a mainframe with a keyboard/display interface for communication between user and system. Different types of instrumentation equipment can be obtained using the same mainframe; only the contents of the program memory have to be changed. Up to seven programmable input/output boards can be installed. Some special-purpose boards are constructed to improve the versatility of the system. The major advantage of the presented system is that it can be applied at any time in the laboratory in an experiment or in the hospital for diagnostic or therapeutic purposes, without the engagement of existing computer memory.
The area under the ROC curve interests us as a method for analyzing discrimination or detectability. One can assess a diagnostic test or probability assessor with respect to its degree of discrimination. The area under the ROC curve gives us the probability of correctly identifying abnormal from normal in a forced-choice, two-alternative problem. Previous methods used for calculating the area involved maximum likelihood estimation on a mainframe or minicomputer. This paper demonstrates an adaptation of a recently published nonparametric method for estimating the area. This adaptation takes advantage of electronic spreadsheet software and may be used on most (if not all) microcomputers. The paper develops the construction of the program needed for the necessary calculations.
A non-sequential Bayesian program for diagnosing acute abdominal pain was developed using an Amdahl mainframe accessed by a Texas Instrument remote terminal. Transferring the program to a MacIntosh SE/30 using hypercard was attended by increased utilisation from 15 to 44%.
When Hurricane Opal slammed Florida's gulf coast last October, Baptist Healthcare in Pensacola was in danger of a direct hit, putting the hospital's mainframe, minicomputers and telecommunications network--not to mention its patients--in peril. But Baptist had planned for just such a danger and, in the end, no harm was done. How would your hospital have fared? Here's what you can do now to make sure your hospital will keep running after disaster strikes.
An emergency department (ED) clinical system was developed by in-house personnel, with ED physician, nursing, registration and clerical staff input. The utilization of existing hardware and customization of the hospital's mainframe hospital information system (HIS) facilitated the implementation of a cost-effective system that meets the information access needs of a busy, state-of-the-art academic ED. The transition to automation of the ED was facilitated through the use of a comprehensive training plan and change strategies.
Hospitals and other health care organizations historically have been slow to adopt new managerial techniques. The same holds true for the acceptance of information and information technology as true strategic resources. With so much emphasis being placed on lowering operating costs and increasing the quality of care combined with the information revolution in today's society, the current complacent attitude often displayed toward health information management poses glaring organizational dilemmas for today's health care organizations. As many health care organizations begin to grapple with technical tasks such as developing the electronic patient medical record, they realize that there are many organizational implications to be dealt with as well. Issues such as who has the proper authority and responsibility not only to manage the mainframe and networks but also to correlate the information that all the hardware and technology provide with the strategic goals of the organization present significant hurdles. If these hurdles are not successfully cleared, any attempts at improving organizational strategy and performance via improved management of information resources are inhibited.
This paper explores aspects of the need for clinical database management systems that permit ongoing service management, measurement of the quality and appropriateness of care, databased administration of consultation liaison (C-L) services, teaching/educational observations, and research. It describes an OPTICAL SCAN databased management system that permits flexible form generation, desktop publishing, and linking of observations in multiple files. This enhanced MICRO-CARES software system--Medical Application Platform (MAP)--permits direct transfer of the data to ASCII and SAS format for mainframe manipulation of the clinical information. The director of a C-L service may now develop his or her own forms, incorporate structured instruments, or develop "branch chains" of essential data to add to the core data set without the effort and expense to reprint forms or consult with commercial vendors.
This is a 1999 update of an original article based on 1989-90 data published in the Journal of Hospital Marketing. The adoption of hospital information technologies shows that most of these technologies were no longer in the innovator or early adopter stages. Infrastructure building technologies such as clinical information links, PC networking with the mainframe, MD links between doctors and hospital and E-mail showed the highest percentage of increase. Bar coding for inventory (transactional) also made great increases. Opinions on barriers to the adoption of hospital information technology are ranked and are studied by age of respondent, public vs. private hospitals, and job function.