Database management systems into the 1980s: a review.
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This article summed up 4 years experiences in the creation and working with software package for collection, processing and storage of data in the form of standard database. Software package--PATHOLOGIST--can be implemented on microcomputer compatible with IBM PC. This package manages 92 relative databases in the order to gather all possible information about performed histological, cytological, immunological examinations as well as autopsy.
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We designed and built an application called MD Assist that compiles data from several hospital databases to create reports used for daily house officer rounding in the medical intensive care unit (MICU). After rounding, the report becomes the objective portion of the daily "SOAP" MICU progress note. All data used in the automated note was available in digital format residing in an institution wide Sybase data repository which had been built to fulfill data needs of the parent enterprise. From initial design of target output through actual creation and implementation in the MICU, MD Assist was created by physicians with only consultative help from information systems (IS). This project demonstrated a method for rapidly developing time saving, clinically useful applications using a comprehensive clinical data repository.
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We describe the design and implementation of QBISM (Query By Interactive, Spatial Multimedia), a prototype for querying and visualizing 3D spatial data. Our medical image application is focused on the brain mapping requirements for multimodality relationships across multiple subjects. It incorporates data describing both structure and function. It includes data structures that describe anatomy, physiology, coordinates using rendered imagery and statistical output. The system is built on top of the Starburst DBMS extended to handle spatial data types, specially, scalar fields and arbitrary regions or space within such fields. In this paper we list the requirements of the application, discuss the logical and physical database design issues, and present timing results from our prototype. We observed that the DBMS' early spatial filtering results in significant performance savings because the system response time is dominated by the amount of data retrieved, transmitted, and rendered.
The Loyola Open-Heart Registry is a fully operational database that has hundreds of programs designed to input, modify, verify, maintain, update and analyze its raw data. It contains retrospectively collected data on approximately 4000 patients who underwent coronary bypass (CABG) or cardiac valve replacement (CVR) from January 1970 to May 1981. Since 1981 we have collected detailed information on approximately 1300 patients per year. The system is described in clinical and technical terms. The means of data acquisition and input are described and a flow chart for the collection of data is provided. The system's hardware is described briefly, and the nature and limitations of the software are discussed. Specific datasheets are described, and examples of output retrievals are provided. A few comments are made regarding the administrative aspects of database management. The entire paper is summarized, and our future plans and areas of development are described.
An automated system for recording information pertaining to applicants to the Internal Medicine Residency Program at Temple University Hospital was developed in 1983. Major objectives were to improve recordkeeping, filing, communication with applicants, and efficiency of the review committee's process. Reports generated have permitted tracking of the applicant pool throughout the recruiting season and collection of statistics which may be compared with prior years. The capacity of the Residency Office to market the Internal Medicine Residency Program through prompt, accurate, and personal communication with each applicant has been facilitated.
The Department of Veterans Affairs (VA) Decentralized Hospital Computer Program (DHCP) contains data modules derived from separate ancillary services (e.g., Lab, Pharmacy and Radiology). It is currently difficult to integrate information between the modules. A prototype is being developed aimed at integrating ancillary data by storing clinical data oriented to the patient so that there is easy interaction of data from multiple services. A set of program utilities provides for user-defined functions of decision support, queries, and reports. Information can be used to monitor quality of care by providing feedback in the form of reports, and reminders. Initial testing has indicated the prototype's design and implementation are feasible (in terms of space requirements, speed, and ease of use) in outpatient and inpatient settings. The design, development, and clinical use of this prototype are described.
A computer system for the generation of printed operation records based in the operating suite and used by the surgeon is described. The time necessary for producing such a record is in the order of 4-6 minutes for the majority of cases and does not interfere with the conduct of an operating list. The advantages include a printed legible operative record, automatic OPCS coding and automatic grading, the storage of data in a form that allows later analysis for audit and research and the production of an operating log for trainees. The use of mandatory fields forced individuals to follow a structured format complying with the guidelines on medical records and notes from The Royal College of Surgeons of England reissued in 1994. The potential value of using the same data for the production of discharge documentation suggests an opportunity for improving the efficiency in the production of such documentation.
During the 1970s, the Army health hazard assessment (HHA) process developed as a medical program to minimize hazards in military materiel during the development process. The HHA Program characterizes health hazards that soldiers and civilians may encounter as they interact with military weapons and equipment. Thus, it is a resource for medical planners and advisors to use that can identify and estimate potential hazards that soldiers may encounter as they train and conduct missions. The U.S. Army Center for Health Promotion and Preventive Medicine administers the program, which is integrated with the Army's Manpower and Personnel Integration program. As the HHA Program has matured, an electronic database has been developed to record and monitor the health hazards associated with military equipment and systems. The current database tracks the results of HHAs and provides reporting designed to assist the HHA Program manager in daily activities.
A management system for a magnetic resonance imaging facility was developed to store pertinent patient data and to maintain a teaching file. The system was developed on a Digital PRO-350 microcomputer using a commercially available database software package. The cost of the system was about $7000. The patient data are entered at a terminal by a clerk typist. Input data are condensed or abbreviated to accommodate the limited data storage on the microcomputer. Cases can be rapidly retrieved and sorted on the basis of any of the 42 data fields available or any combination of these fields. The system has been successfully used for 18 months to create directories for a teaching file, for presentations, and for clinical research. Census-type data can be compiled, and the system can be used for word processing.
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AIM: To present our experience with integrating digital information on Intensive Care Unit patients (clinical data, laboratory findings, imaging, etc) to create electronic patient records. MATERIAL AND METHODS: Using the hospital Intranet, a connection was established between the Local area Network (LAN) of the Intensive Care Unit (ICU) and the Digital Imaging and Communications in Medicine (DICOM(R)) network of the Radiology Department allowing to receive, process and archive digital images locally at the ICU. Using the software RADclient-RADimage, the information received was managed by an electronic patient record system (DIGISTAT by UMS-Unterberger Medical Software, Florence). All the above software runs on Microsoft WindowsNT 4.0 platforms. RESULTS: Images of various kinds and formats (CT, MRI, etc.) pertaining to the ICU patients were semi-automatically handled and filed on a local server acting as a central databank. The images were then included in the electronic patient record and made available to the end user who could view them using either web technologies (hypertexts were automatically generated that could be viewed through the widely available World Wide Web browsers) or specific viewing utilities supplied with DIGISTAT . DISCUSSION AND CONCLUSIONS: For the intensivist, the handling and filing of data on hospitalised or discharged patients for treatment or research purposes involves having to process large amounts of information. Furthermore, in the event of patients being re-admitted to the unit, it is crucial to have ready access to all the information regarding previous hospital stays, including diagnostic images, to avoid the need for time-consuming searches through the hospital s paper-based archives. The possibility to access clinical information and diagnostic images using a single computer programme proved to be useful both for evaluating the patient s conditions immediately after the imaging procedure and for monitoring the patient s progress over time by comparing the different diagnostic images and imaging procedures. This pilot experience could be seen to provide the basic know-how for applying the method in the future Emergency Department of the A. Gemelli Hospital in Rome.
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