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Experience of transferring an integrated hospital-administration system from a CODASYL data-base to a standard MUMPS file structure.

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.

Computers↗

An inexpensive computer-aided system for quantitative echocardiography.

A comprehensive system has been developed to quantitatively analyze standard M-mode pediatric echocardiograms. It utilizes relatively inexpensive hardware together with a telephone coupling to a time-sharing computer. A complete patient report on the study is printed out upon completion, and all the data are digitally stored for future research computations. Initial and operating costs for this system are significantly less than for any comparable one available.

Diagnosis, Computer-Assisted↗

Features of commercial computer software systems for medical examiners and coroners.

There are many ways of automating medical examiner and coroner offices, one of which is to purchase commercial software products specifically designed for death investigation. We surveyed four companies that offer such products and requested information regarding each company and its hardware, software, operating systems, peripheral devices, applications, networking options, programming language, querying capability, coding systems, prices, customer support, and number and size of offices using the product. Although the four products (CME2, ForenCIS, InQuest, and Medical Examiner's Software System) are similar in many respects and each can be installed on personal computers, there are differences among the products with regard to cost, applications, and the other features. Death investigators interested in office automation should explore these products to determine the usefulness of each in comparison with the others and in comparison with general-purpose, off-the-shelf databases and software adaptable to death investigation needs.

Computers↗

Legal review: auto-authentication of medical records raises verification concerns.

In summary, federal and state laws require hospitals and practitioners to be accountable for the accuracy and completeness of medical records. The inevitable introduction of computer systems into the process of authenticating medical records evokes novel legal issues. Any computer system that does not require the review of reports after they are transcribed raises serious concerns regarding accountability for the accuracy and completeness of those documents. While federal and state laws have recognized that a signature on a document may be made by electronic or other means, regulatory and accrediting agencies restrict the auto-authentication of medical records. Systems have been proposed that would require the practitioner to see the report and would restrict the final signature authority to the practitioner after his or her review. These systems are likely to be closely scrutinized by regulatory authorities but may ultimately receive their approval. Currently, however, any system that does not require the physician to review and affix his or her signature to each document after reviewing the document creates serious risks for the health care facility implementing that system. Whether future changes in applicable laws will allow more flexibility for such systems is by no means certain.

Documentation↗

Pharmacist clinical intervention program.

Our efforts have helped us demonstrate the positive impact of pharmaceutical care for patients. Our experience with the Clinical Notes section of our computer system leads us to recommend that such capabilities be sought in all pharmacy computer systems. A significant advantage to avoiding paper-based systems for documenting and collecting information relevant to clinical interventions, ADRs, DUE data, and patient outcomes has been proven in our institution. Various ways to categorize intervention data have been reported in the literature. We recommend clinical intervention categories be based on the eight categories of drug misadventuring so that data from different hospitals can be tabulated or compared. The success of our system is that it is one system rather than many systems. The importance of pharmacist documentation demands that it be simple, efficient, and painless, or it will be nonexistent.

Adverse Drug Reaction Reporting Systems↗

Nuclear medicine in Europe. Considerations of present status and future trends.

A general view of nuclear medicine's present status and future trends in Europe is given. Nclear medicine procedures, radiopharmaceuticals, annual examinations, equipment, quality assurance, management, and number of installations of gamma cameras, and computer systems in Europe are considered. Market trends are given. The role of nuclear medicine computer systems, hardware and software, is discussed. The situation of nuclear medicine in Europe, especially in the Federal Republic of Germany (FRG) with regard to economic and medical factors, is investigated.

Computers↗

Computer-assisted system for a mycobacteria tuberculosis laboratory using MUMPS.

A Laboratory Information System (LIS) has been developed and the main part of LIS is an on-line system with auto analysers. In April 1976, the Biochemistry Laboratory was computerized in Osaka Prefectural Habikino Hospital. This LIS uses a PDP 11/40 minicomputer system using MUMPS language. At present a Mycobacteria Tuberculosis Laboratory (MTL) is computerized using the same computer and MUMPS. In this laboratory, there is no auto analyser, so this computerization aims at saving on labour in paper work and increasing the reliability of test results. This paper shows that the computerization of MTL with no auto analyser can be effectively achieved using MUMPS.

Computers↗

[Transfusion service of the county of Funen. Organizational and economical aspects of restructuring].

The reorganization of the transfusion service in the County of Funen during the period from 1990 to 1996 is described. The professional responsibility for the transfusion service was delegated to the county's only department with specialists in transfusion medicine. The responsibility for economy and personnel remained decentralized. Standard operation procedures for collection and production of blood components and for blood group serology were standardized resulting in higher quality. The number of collections were reduced from 47,000 to 35,000 in spite of an unchanged number of transfused units (approx. 31,000 per year). The outdating was reduced from 35 to 2%. A computer system was implemented resulting in rationalized flow of work and the introduction of a computer crossmatch. From 1997, when the computer system will have been paid for, the county and the university hospital will gain DKK 1.6 million and DKK 2.0 million per year respectively as a result of the reorganization.

Blood Banks↗

Clinical sequelae of radiographic iceball involvement of collecting system during computed tomography-guided percutaneous renal tumor cryoablation.

OBJECTIVES: Percutaneous renal tumor cryoablation is being evaluated as a treatment option for small renal tumors. However, when tumors are located centrally, involvement of the collecting system by the radiographic iceball can occur. We reviewed our series of computed tomography (CT)-guided percutaneous renal tumor cryoablation to identify those cases in which there appeared to be involvement of the collecting system by the radiographic iceball and to determine any clinical sequelae of such involvement. METHODS: Retrospective review of the medical records identified 6 patients who had undergone CT-guided percutaneous renal tumor cryoablation with evidence of collecting system involvement. Measurements of the tumor size, size of the radiographic iceball, and the size of the immediate postprocedure "cryozone" (region of apparent treatment on contrast-enhanced CT) were obtained from the preprocedure, intraprocedure, and immediate postprocedure CT scans. Follow-up imaging was obtained beginning at 3 to 6 months. RESULTS: Six patients were identified who met the inclusion criteria and had at least 3 months of documented follow-up. Despite the apparent involvement of the collecting system during the cryoablation procedure, no patient developed clinical signs or symptoms or radiographic evidence of a urine leak or fistula formation. Furthermore, no evidence of ureteral narrowing or stricture formation has been found to date, with a mean follow-up of 167.7 days (range 90 to 288). CONCLUSIONS: We observed no clinically appreciable urine leaks despite what appeared to be obvious involvement of the collecting system by the radiographic iceball. However, care should be exercised to avoid this insult when possible until additional research has confirmed its safety.

Adult↗

The Rancho EMG analyzer: a computerized system for gait analysis.

This paper describes a computer system which accurately defines the EMG patterns of the lower extremities during gait. Footswitches are used to identify the temporal relationships and determine the phases of the gait cycle. Fine wire electrodes, inserted in the desired muscles of the patient being tested, provide EMG signals for comparison with a normal database. The system is also usable with surface electrodes when an appropriate normal database for surface electrodes is incorporated. Descriptive qualifiers (such as 'premature onset', 'delayed cessation', 'no clinically significant EMG', 'continuous activity' etc.) are used to produce a clinically relevant printed (textual) report. The intensity filtered average (IFA) of the EMG is shown graphically with the representative profile of each stride. The IFAs for all muscles tested can be plotted together (up to six on a page) and the graphic representation of the 'raw' EMG can be produced. The methods of generating the normal database by creating time-adjusted mean profiles (TAMP) are enumerated. The clinical use of the system is discussed. A detailed analysis of 31 of the most recent patient tests for which the system was used provides an indication of its accuracy. For 86% of the 428 muscle tests examined, the EMG analyser was considered to have given the correct result as compared with a visual analysis of the raw EMG record by a trained expert. Recommendations for the use and future improvements of the EMG analyser are made.

Adolescent↗

Use of CD-ROM MEDLINE by medical students of the College of Medicine, University of Lagos, Nigeria.

BACKGROUND: Use of information technology in information acquisition, especially MEDLINE on CD-ROM and online, has been evaluated in several localities and regions, especially in the advanced countries. Use of MEDLINE on CD-ROM is still very poor among the medical students of the University of Lagos, Lagos, Nigeria, due to lack of awareness, insufficient personal computers, nonperiodic training, and the high cost of using the facility. Due to financial constraints, MEDLINE online and sufficiently-networked computer systems are not available. OBJECTIVE: To report on the situation in Nigeria, a developing country, so as to compare the current awareness of searching MEDLINE on CD-ROM among the medical students at the University of Lagos with the awareness of their overseas' counterparts. This is the first step toward setting up an online PubMed search as well as expanding the computer systems and network. METHODS: Essentially based on cross-sectional proportional sampling using structured questionnaires, in-depth interviews, and focus-group discussions among the medical students and library staff. The study involved the medical students in their second year to sixth (final) year of study. RESULTS: Of the 250 students interviewed, 130 (52%) were aware of MEDLINE on CD-ROM searches as a means of information retrieval. Only 60 (24%) had used MEDLINE on CD-ROM-2% had used MEDLINE on CD-ROM more than 9 times; 4%, 7 to 9 times; 8%, 4 to 6 times; and 10%, 1 to 3 times. Of the students who used MEDLINE on CD-ROM search, 22% used it in preparing for examinations, 24% in research, 6% in patient care, and 26% in preparation of assignments and clinical cases. Lack of awareness (52%) and cost of undertaking MEDLINE on CD-ROM search (46%) were identified as important factors that discouraged the use of MEDLINE on CD-ROM. CONCLUSION: Though the above factors were recognized as important, it was concluded that the reasons for the poor use of MEDLINE on CD-ROM are multifactorial. Poor use of MEDLINE on CD-ROM could be attributed to these critical underlying factors: nonavailability of networked personal computers, which should be connected to a central server; lack of mandatory assignments to the medical students that would specifically require use of MEDLINE on CD-ROM; financial constraints on the university management; and infrequent periodic orientation on use of MEDLINE on CD-ROM. It was therefore suggested that the number of personal computers should be increased and that the library staff should periodically train the preclinical and clinical medical students in searching MEDLINE on CD-ROM. These steps would enable the medical students to benefit from online PubMed searching when it becomes fully operational in the future.

Academic Medical Centers↗