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Showing papers in "Journal of Medical Systems in 1977"


Journal ArticleDOI
Shannon Brunjes1
TL;DR: This article will attempt to explain in very simple terms what a computer is, what it does, and how it works.
Abstract: In less than 40 years computers have become essential in almost every facet of life, including hospital administration and medical care. As a small contribution to the effort of promoting a general understanding of these wonderful machines that have so affected our existence (often, but not always, for the better), this article wilt attempt to explain in very simple terms what a computer is, what it does, and how it works. The word \"computer\" is not a new one. It used to mean \"a person who computes,\" just as the word \"typewriter\" once referred to a person who types. Eventually, of course, a \"typewriter\" came to mean a machine used for typing, but a similar extension of the word \"computer\" to mean simply \"a machine used for computation\" would be insufficient, for computers do far more than compute as we shall see.

64 citations


Journal ArticleDOI
TL;DR: A system has been developed to generate hospital budgets based on the types of patients served according to clinical attributes such as diagnoses and surgical procedures, and for each class a profile of resources consumed is determined.
Abstract: A system has been developed to generate hospital budgets based on the types of patients served. Several hundred classes of patients are defined according to clinical attributes such as diagnoses and surgical procedures, and for each class a profile of resources consumed is determined. The class definitions are based both on homogeneity of patient care processes as well as resource consumption. These profiles are expressed as revenues generated by charging departments and as costs both direct and indirect for all services. A methodology has been developed to associate all indirect costs with their source for each service included in the profile. From a forecast of patient load by class, budgets can be computed from the cost profiles and revenues determined from the charging profiles. Further analysisthus can included the effect of changes in case mix as well as changes in patient care processes. The effect on revenues of different reimbursement mechanisms can also be projected as a function of the case mix. The system is currently being implemented for demonstration and evaluation at the Yale-New Haven Hospital.

39 citations


Journal ArticleDOI
TL;DR: An overview of El Camino Hospital's computerized medical information system from installation to the present tells of the vast information available to hospital professionals through simple lightpen selections on a CRT screen, how it handles most manual activities,How it reduces errors, and how it replaces the nurses' Kardex files.
Abstract: Success is the word used most often to describe El Camino Hospital's computerized medical information system Operational since 1972, the system has gained total support from virtually all hospital personnel Physicians, nurses, and administrative people use the system routinely as part of their day-to-day activities HEW-sponsored studies have heralded the system for its impact on improving patient care and containing costs The following paper is an overview of the system from installation to the present It tells of the vast information available to hospital professionals through simple lightpen selections on a CRT screen, how it handles most manual activities, how it reduces errors, and how it replaces the nurses' Kardex files Automated systems technology is vital to the future of health care, and it is a valuable tool for enhancing the quality of patient care and improving the use of labor resources This paper further gives an important insight into other benefits offered to all hospitals by the advent of systems such as the one at El Camino

16 citations


Journal ArticleDOI
TL;DR: Hospitals and vendors are encouraged to consider this issue urgently and to evaluate their equipment so that adequate data can be obtained by prospective customers when they plan to purchase peripheral and main frame equipment.
Abstract: Unfortunately, the paucity of literature and enlightened concern regarding destructive noise within the hospital environment has masked the inherent danger to patient care and personnel. With the introduction of noise-making devices such as computers, it is almost easy to become acclimated to this intrusion of privacy. There are a number of studies indicating that the increase of noise causes a decrease in performance and mental stability of individuals, and we feel that this should be a very serious consideration before the installation of any communication system.3,4,5 We would also like to encourage the establishment of a set of specifications which the vendors would agree to abide by when placing equipment in the hospital. Our own attempts to create vendor interest in this area have not produced significant results up to this time. Without a direct economic demand for a type of device enclusure or containment as described in this paper, we will continue to be offered the standard operational production model, which we will eventually have to retrofit and modify to make acceptable to the hospital. This is both an expensive and hazardous procedure because the vendor at that point can void warranty for a number of reasons. We would encourage hospitals and vendors to consider this issue urgently and to evaluate their equipment so that adequate data can be obtained by prospective customers when they plan to purchase peripheral and main frame equipment.

6 citations


Journal ArticleDOI
TL;DR: A microcomputer-based voice-response system has been implemented that permits clinic staff to easily randomize patients in clinical trials despite the complexity of the algorithm.
Abstract: Simple randomization of patients to treatment regimens in clinical trials can result in inbalance among stratum categories. Procedures that produce balance may lack randomness. Systems that are not deterministic yet produce balance are often extremely complex and are not easily performed by randomization clerks. A microcomputer-based voice-response system has been implemented that permits clinic staff to easily randomize patients in clinical trials despite the complexity of the algorithm. Data entry is accomplished by the use of Touch-Tone® keys.§ Input prompts and regimen assignment are spoken by a commercially available voice synthesizer.

5 citations


Journal ArticleDOI
TL;DR: In 1970, computers were already commonplace in hospitals; they were used mainly in accounting offices for routine business functions such as billing and inventory as mentioned in this paper, and it was learned that the nature of the data n in this case the patient record was crucial.
Abstract: By 1970, computers were already commonplace in hospitals; they were used mainly in accounting offices for routine business functions n billing and inventory. Patientoriented applications were tried frequently but were often trivial, and infrequently successful. 1 The organizational and operational complexities of health care institutions were soon recognized by most information-system designers as far more formidable than originally anticipated. This recognition gave impetus to what we now call the \"bottom-up\" approach to system construction, best exemplified by Octo Barnett's modular approach? In addition, it was learned that the nature of the data n in this case the patient record was crucial. Although attempts to formalize patient records had been undertaken before, the advent of the computer provided impetus to this task. The computer's capability for analysis and classification was confounded by the virtually unbounded extent of the medical vocabulary, and by the complexity and ambiguity of the grammar by which medical relationships are conventionally expressed. Out of these problems there grew research in medical linguistics 3.' and attempts at automatic translation and encoding of free text. 5.6 Others, namely Weed, I worked at restructuring the organization of the record itself from time orientation to problem orientation. Looking at the early 1970s, one is struck by the divergence between the global nature of the projects undertaken and the limited scope of the results. This is due partly to the excess of enthusiasm of early researchers; certainly no field elicited so

4 citations


Journal ArticleDOI
TL;DR: A microprocessor is the decision-making/data-manipulating portion of a microcomputer system just as is the central processing unit (CPU) of a minior macrocomputer system (macro is a convenient term used to refer to large-scale mainframes).
Abstract: A microprocessor is the decision-making/data-manipulating portion of a microcomputer system just as is the central processing unit (CPU) of a minior macrocomputer system (macro is a convenient term used to refer to large-scale mainframes). The distinction is somewhat blurred with respect to the classifications between minicomputers and large-scale computers. This is even more so between minicomputers and microcomputers. The main distinctions have to do with size, speed, and cost factors. In point of fact, a microprocessor may be defined as a oneor few-chip integrated circuit (IC) realization of a general purpose CPU. (The term IC refers to the electronic fabrication technology involved in manufacturing the microprocessor. This term will be explained in more detail later.) The microprocessor contains registers (temporary, or working storage), control circuitry, and data paths for interpretation and execution of instructions? The primary difference between the larger CPUs and the microprocessor is size. This stems from the fact that the larger CPUs are made up of many individual physical components and the microprocessor is a single physical device. Figure 1 shows this relationship between the CPU of a NOVA 820 minicomputer and an INTEL 8080 microprocessor. The microprocessor is a single programmable logic device, which may act as the heart of a computer system (i.e., be a CPU) or may find use in a myriad of other devices (i.e., be a controller). In particular, microprocessors today are found in automobile ignition systems, washing machines, microwave ovens, and intelligent laboratory instruments. The extreme versatility, low cost, and high reliability of these devices have brought about a revolution in the electronics industry as well as in every other field that utilizes devices to control or monitor situations through electronic means.

4 citations


Journal ArticleDOI
TL;DR: The most significant management development of the 20th Century—the computer—is not being used effectively by hospital management in their hour of greatest need.
Abstract: The most significant management development of the 20th Century—the computer—is not being used effectively by hospital management in their hour of greatest need. Why? What can be done?

4 citations


Journal ArticleDOI
TL;DR: Optimization of laboratory information must precede successful utilization of this extensive and expensive wealth of data in order to produce a large number of test results in a relatively short time with a high degree of accuracy.
Abstract: In an era severely affected by the advanced stages of technocracy, it should not astound anyone that highly sophisticated technologies have metastasized throughout our hospital system. While simplifying many complex problems, the advantages of modern technology also create many interesting conflicts. One such dilemma surfaces as a consequence of clinical laboratories being able to produce a large number of test results in a relatively short time with a high degree of accuracy. Optimization of laboratory information must precede successful utilization of this extensive and expensive wealth of data.

3 citations


Journal ArticleDOI
TL;DR: An on-line, practice-oriented library system now exists in prototype form which can act as a central repository of medical information and is expected to expand in the future to include a medical problem-oriented indexing system, a diseaseoriented library, and a page-associated file of references.
Abstract: An on-line, practice-oriented library system now exists in prototype form which can act as a central repository of medical information. The source data are gathered by the residents at Shands Teaching Hospital and Clinics at the University of Florida as part of their rotation through clinical pathology. The information is continually updated and reviewed every 3 months by new residents and area specialists. Plans are under way to make this pool of information accessible to all levels of the health care team in an instantaneously addressable fashion via CRT (cathode ray tube). After many months of resource development, we have major sections of an on-line dictionary of clinical and surgical pathology and expect to expand this in the future to include a medical problem-oriented indexing system, a diseaseoriented library, and a page-associated file of references.

3 citations


Journal ArticleDOI
TL;DR: The attempt to move toward a systematization of approach has led to a closer cooperatioin with computer scientists and the definition of a teaching and training basis for professionals in the field.
Abstract: It has to be understood that the selected description of some installations and their main research or work areas is not intended to give a comprehensive picture of the developoment of medical informatics in the Federal Republic of Germany. Some of the characteristics of this development are (1) integrative approach to hospital information systems; combination of medical and administrative tasks; (2) systematic development of an academic basis; (3) governmental support for projects of data processing in health care; (4) growing interest for applied systems analysis oif health care delivery; (5) increasing concern for the cost development in health care and a general interest for the development of control mechanisms. The attempt to move toward a systematization of approach21 has led to a closer cooperatioin with computer scientists and the definition of a teaching and training basis for professionals in the field. It is feld that such a basis is necessry for the development of effective solutions and further advancement in this field.

Journal ArticleDOI
TL;DR: This paper documents the steps that led to the system the authors are currently data, creates a microform archive and an on-line index, and serves as the data base for research inquiries.
Abstract: The vast flood of information resulting from medical record keeping in a clinical laboratory must be cataloged and archived. To deal with this problem we designed an approach employing automated report generation by a laboratory computer, data base management of patient laboratory results, and automated microform generation via computer output microform (COM). This paper documents the steps that led to the system we are currently data, creates a microform archive and an on-line index, and serves as the data base for research inquiries. In addition, we have experienced a cost savings over manual procedures and now possess the capability of expansion without the costly addition of personnel.

Journal ArticleDOI
TL;DR: The cost of building, installing and maintaining a full hospital laboratory communication system is expensive, and the actual cost per test for full service vapability is somewhere between 13 and 17 cents.
Abstract: The cost of building, installing, and maintaining a full hospital laboratory communication system is expensive. Using an outside accountant, our books were audited to determine the expenses in each of our major cost centers. These data are tabulated along with services provided. Although the initial expenditures are high, the actual cost per test for full service capability is somewhere between 13 and 17 cents. If viewed as a cost per patient day, the price ranges between 59 and 85 cents.

Journal ArticleDOI
TL;DR: The standardized disease classification system is used by ARCH (a regional health planning agency) to obtain a measure of acute hospital utilization and regional health status, and aids in the formulation and monitoring of health problems.
Abstract: This paper deals with the development of the standardized disease classification system, which generates usable statistics for comprehensive health care planning. It is used by ARCH (a regional health planning agency) to obtain a measure of acute hospital utilization and regional health status. A sample of 35.000 patients discharged from 39 acute-care facilities in the St. Louis bistate region was examined and tested. The existing disease classification systems (three versions of ICD and SNDO) were converted into the standardized system. Its application results in a better conceptualization of current health problems. It aids in the formulation and monitoring of health problems.


Journal ArticleDOI
TL;DR: In this article, a communications model of the consult process is presented and examined using the diagnostic radiologists as the example, and some future possibilities for using computers to enhance the consultant's ability to meet medical objectives are suggested.
Abstract: The term ‘state of the art” applied to medical technology should stimulate consideration of medical objectives as well as comparison of similar equipment. A communications model of the consult process is presented and examined using the diagnostic radiologists as the example. Examples of computer applications relating to the model are discussed, and some future possibilities for using computers to enhance the consultant's ability to meet medical objectives are suggested.

Journal ArticleDOI
TL;DR: Hardware configuration, physical plant, libraries, diagnostic algorithms, system usage and surveillance, and manpower and human engineering are now significant operational features and essential for LIS acceptance by a department of pathology as well as the practicing medical staff.
Abstract: A Laboratory Information System (LIS) is a convenient organization of programs and hardware designed to meet the health care delivery needs of a department of pathology. A full service LIS is now a commercially viable product and after 2 years of experience, certain desirable design features are evident for a second generation system. Such variables as hardware configuration, physical plant, libraries, diagnostic algorithms, system usage and surveillance, and manpower and human engineering are now significant operational features and essential for LIS acceptance by a department of pathology as well as the practicing medical staff.

Journal ArticleDOI
TL;DR: In Sweden, the first applications of computers within health care started 20 years ago and the pure clinical computer applications can be said to be designed primarily for the needs of the patient.
Abstract: In Sweden, the first applications of computers within health care started 20 years ago. The medical computer systems of today can be separated into three different groups: 1. Administrative and/or financial applications, which include payroll, financial and cost accounting, budgetary control, preventive maintenance plans, stock control and stores accounting, personnel information, inventory control. 2. Paraclinical (laboratory) systems, which include laboratory systems (test request, work schedules, instrument control, result calculation, report preparation, quality control), pharmaceutical systems (drug prescription, drug ordering, drug records and stock control, drug administration recording), radiology and radiotherapy systems (examination reports, record retrieval, radiation dose calculation, staff safety, treatment monitoring), and physiological signal analysis and miscellaneous systems (blood transfusion, organ matching, drug reaction monitoring, nuclear medicine, ultrasonics, etc.). 3. Patient care (clinical) computer applications can be divided into subgroups. (a) medicoadministrative, including admissions, registration, patient scheduling, menu and diet planning, work lists, hospital appointment/booking, bed state, statistical systems (hospital activity analysis, cancer registration, etc.), waiting lists, discharge, nurse's and doctor's orders; (b) the clinical (patient care) process, including an \"automated\" medical record for patient monitoring, multiphasic screening, inand/or outpatients. The pure clinical computer applications can be said to be designed primarily for the needs of the patient. The paraclinical or the medicoadministrative systems can be looked upon as a basic structure or a skeleton in which the \"automated\" record is the vital key for medical decision making. The information for patient care is stored in the

Journal ArticleDOI
TL;DR: There is little historical precedent or factual material on which to base decisions regarding hospital noise levels in relationship to work stations and areas such as the clinical laboratory, so the following proposal is made.
Abstract: There is little historical precedent or factual material on which to base decisions regarding hospital noise levels in relationship to work stations and areas such as the clinical laboratory. The problems we experienced in our own developmental period provided convincing evidence that detailed written specifications for vendors and designers regarding acceptable noise levels in selected areas of the hospital are imperative. It is within this context that the following proposal is made.

Journal ArticleDOI
TL;DR: A commercial time-sharing program for identification of the Enterobacteriaceae was modified to operate on a small computer, and system performance has been satisfactory.
Abstract: A commercial time-sharing program for identification of the Enterobacteriaceae was modified to operate on a small computer. Program modification was straightforward, and system performance has been satisfactory. Computer-assisted identification of enteric organisms has been a useful instrument in quality control within the laboratory and has yielded an unexpected benefit as an educational tool. Since many hospital laboratories have access to one or more computers capable of running such a program, these benefits of computer-assisted identification can become more generally available at an attractively low cost.


Journal ArticleDOI
TL;DR: Techniques are described which provide immediate physician feedback for education which do decrease health care costs and optimize professional interaction through proper system designs.
Abstract: A PSRO audit of laboratory performance can be achieved without additional manpower if tied into the communication and laboratory system of the hospital. Techniques are described which provide immediate physician feedback for education. Cumulative statistics are recorded for internal laboratory review and for validation of technical performance. Through proper system designs, significant improvements can be achieved which do decrease health care costs and optimize professional interaction.

Journal ArticleDOI
TL;DR: An evaluation model was developed and used to monitor the impact of a new mode for entering patients into an existing health care delivery system, and it compared the new mode to two alternate entry methods.
Abstract: An evaluation model was developed and used to monitor the impact of a new mode for entering patients into an existing health care delivery system, and it compared the new mode to two alternate entry methods. In accordance with specified eligibility criteria, 6285 patients were selected and then randomly assigned to the three entry modes. The model employed a health status classification which divided patients into four groups depending upon the concurrence of medical care provider and patient as to whether the patient was well or sick. It then measured the utilization of care resources for each patient health status group. All data were then age-sex-adjusted and analyzed for each of the three entry modes for a standard mix of health status groups.


Journal ArticleDOI
TL;DR: With the continuous development of new applications, MARS is now essential to the function of the department and has again proven the point that physicians and computers can function symbiotically in the medical environment.
Abstract: Missouri Automated Radiology System has functioned in full support of the Department of Radiology for more than 7 years. For the past 5 years, MARS has functioned as a minicomputer system on a DEC (Digital Equipment Corporation) PDP-15 computer. While continuing to effectively support the department, in daily use by 20 staff and 15 resident physicians, MARS has continued to function in a research and development mode. With the continuous development of new applications, MARS is now essential to the function of the department and has again proven the point that physicians and computers can function symbiotically in the medical environment.


Journal ArticleDOI
TL;DR: It is the hope that, thanks to individual efforts, medical informatics will prove to be indispensable and feel like a “fish in the water,” according to Mao's advice.
Abstract: It appears that in a very centralized country like France there is no definite governmental policy for medical data processing. This lack of policy given to medical informatics is obvous if one considers the number of professors and researchers recruited, the amount of research and development contracts granted: They are close to being ridiculously small. Despite this unfavorable situation, thanks to individual efforts, a substantial numbre of projects have been implemented and have proved to be useful and acceped by the medical community. Our hope is that, thanks to these tactics, medical informatics will prove to be indispensable and feel like a “fish in the water,” according to Mao's advice.

Journal ArticleDOI
TL;DR: An analysis of the findings from a national health survey conducted in Chile to obtain information on both met and unmet demand proved feasible and highly informative, and exceptions to this general finding revealed patterns that should improve insights for health planning.
Abstract: Consideration of unmet need as well as effective demand for health services is desirable for planning but frequently ignored. This paper reports an analysis of the findings from a national health survey conducted in Chile to obtain information on both met and unmet demand. The joint analysis proved feasible and highly informative. Total felt need tended to be relatively constant among population groups in comparison with differences in actual services utilization. Moreover, exceptions to this general finding revealed patterns that should improve our insights for health planning.

Journal ArticleDOI
TL;DR: A filing system of cumulative patient record cards is described for use by large or active blood banks, which contains 40,000 complete patient records on line, can easily be expanded, may be linked to off-line files or a computer, and is simple to operate.
Abstract: A filing system of cumulative patient record cards is described for use by large or active blood banks. Cards are retrieved for review of patient identification, past transfusion history, and legally necessary documentation of test results. Information on the cards is handwritten (as is required in most blood banks) onlyonce, reducing transcription error. Card acquisition depends on an electromechanical delivery system, which is selectively activated by a programmed key-stroke sequence. Cards are filed and accessed randomly so that records cannot be lost. A backup system for delivery permits certainty of retrieval of records. The system contains 40,000 complete patient records on line, can easily be expanded, may be linked to off-line files or a computer, and is simple to operate.

Journal ArticleDOI
TL;DR: This work has devised a computer-generated laboratory record system that provides continuous access, yet ensures record security, and is possible to configure a remote record facility that is convenient for physician use and yet operates with alow original capital investment and utilizes no additional personnel.
Abstract: One of the by-products of computerizing a clinical laboratory is the resultant increase in paper production and its associated manual system overloads. In an attempt to resolve this problem, we have devised a computer-generated laboratory record system that provides continuous access, yet ensures record security. By the use of closed-circuit television, intercom, and a microfilm reader/printer, it is possible to configure a remote record facility that is convenient for physician use and yet operates with alow original capital investment and utilizes no additional personnel.