Limitations of computers in medicine.
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The economy of automated multiphasic health testing (amht) activities patterned after the high-volume Kaiser program can be realized in low-volume settings. amht units have been operated at daily volumes of 20 patients in three separate clinical environments. These programs have displayed economics entirely compatible with cost figures published by the established high-volume centers. This experience, plus the expanding capability of small, general purpose, digital computers (minicomputers) indicates that a group of six or more physicians generating 20 laboratory appraisals per day can economically justify a completely automated multiphasic health testing facility. This system would reside in the clinic or hospital where it is used and can be configured to do analyses such as electrocardiography and generate laboratory reports, and communicate with large computer systems in university medical centers. Experience indicates that the most effective means of implementing these benefits of automation is to make them directly available to the medical community with the physician playing the central role.Economic justification of a dedicated computer through low-volume health testing then allows, as a side benefit, automation of administrative as well as other diagnostic activities-for example, patient billing, computer-aided diagnosis, and computer-aided therapeutics.
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The application of the binomial distribution for determining the number of "falsely positive values" is not suitable because of the partly strong correlations between the clinical chemical parameters. We have therefore tried to obtain more precise estimations for the number of falsely positive values by using a generalisation from Sylvester's formula and taking into account the correlations. We use multivariate statistics for testing a patient's value" when several laboratory parameters are simultaneously considered. The multivariate technique leads firstly to a significant reduction of the erroneously interpreted "falsely positive values" and secondly allows the detection of hidden implausible constellations of values.
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