Showing papers in "Journal of Medical Systems in 1979"

Statistical forecasting in a hospital clinical laboratory.

Abstract: Three forecasting methodologies were applied to monthly laboratory test count data in order to arrive at a best procedure for forecasting ahead to cover the next fiscal year. The purpose of the forecasting was, first, to aid in reimbursement and income decisions and, second, to assist in operations management decisions within the laboratory itself. The Box-Jenkins ARIMA models were found to be superior in all cases, and forecasts for individual test counts (as opposed to packages of tests billed as a unit) were improved if forecasts for inpatients and outpatients were done separately and then aggregated. With 2 years of experience to go on, the annual forecast error stands at around 4.5%.

Automated nerve fiber counting using an array processor in a multi-minicomputer system.

Abstract: It has been suggested that recovery of motor and sensory function in the site distal to a peripheral nerve lesion should be improved if the nerve bundles (fasciculi) are matched and individually sutured. Three parameters are proposed to provide quantitative data: the count of the nerve fibers that regenerate, the number of functional regenerated nerve fibers, and a measurement of end organ reinnervation. A thin cross section of a transected and repaired sciatic nerve of a mongrel cat is fixed, stained, photographed, and digitized through a microscope 6 months following nerve repair. The data arrays are then subjected to four basic processing routines: edge enhancing, thresholding, template matching, and peak detection. Finally, the peaks are counted and provide an estimate of the number of nerve fibers in the nerve under study. Comparing counts of nerve fibers proximal and distal to the transection site of the nerve provide data on the proportion of regeneration present at various times. The content of this paper is, to a large extent, describing the implementation of the needed image-processing algorithms for automated counting on the Multi-MiniComputer System (MMCS). Optimal use of the AP-120B array processor and the pipeline processing provided by using the Eclipse 200s and the Nova 3 make a marked improvement in overall throughput.

Psychological systems questionnaire: a decision-relevant patient screening test designed for on-line administration.

Abstract: Developments in the field of computerized psychological assessment are reviewed. It is pointed out that the on-line computer medium differs radically from the traditional paper-and-pencil medium for psychological testing. This new medium calls for new types of instruments that are psychometrically well designed. The construction of one such instrument. the Psychological Systems Questionnaire, is described. The advantages of this approach are discussed.

Determining clinical significance in repeated laboratory measurements. The "Clinical Delta Range".

Abstract: A study of healthy subjects was conducted at the University of Florida wherein 52 routine clinical laboratory procedures were measured during normal operation of the clinical laboratories. The goal of the study was to quantify nonsignificant personal variation for a number of laboratory procedures referred to as a “Clinical Delta Range.” which results from taking several samples per day, several days during the week. Results of the statistical test of hypotheses are given together with summary statistics for the 52 different laboratory procedures. A discussion of the model and testing methods are provided. Further, examples are given to illustrate the methodology and certain limitations associated with the concept of a Clinical Delta Range.

Medical applications in the TANDEM-16 multiple computer system environment.

Abstract: This paper addresses the question of reliability and the TANDEM-16 approach to facilitate reliable computers. Specifically, the use of the TANDEM-16 within the medical environment is described. Three current applications within the Medical Computing Resources Center at The University of Texas Health Science Center at Dallas are developed, each characterized by different reliability considerations.

A proposal for laboratory data reporting.

Abstract: Changes are proposed regarding the presentation of laboratory information. More definitive statements are required for reference limits, sampling variance (the Clinical Delta Range), and multivariate group analysis of large test batteries. To make this transition possible, laboratory reports should be classed so that the practicing physician has some measure of confidence in the product and its compatability with other sources. The proposal extends to the range of financial reimbursement and suggests that class standing be issued by an accrediting agency and support a structured level of payment.

Introduction to the Medical Information Processing Track at the 12th Hawaii International conference on System Sciences (1979)

Abstract: For each of the past 12 years, Honolulu has been the site of a unique conference. Originally emphasizing electrical engineering and data communication, the Hawaii International Conference on System Sciences, HICSS, has evolved over the years into a meeting that brings together practitioners and academicians in several computerrelated disciplines. In recent years, it has provided a forum for the interchange of ideas among professionals from the fields of computer hardwarel software, and advanced applications areas. Throughout its history, HICSS has also provided a mechanism for examining special current topics from the system sciences in the form of a major track of \"subconference.\" It was in this tradition that H4/CSS12, held in early January 1979, contained a major track on medical information-processing systems chaired by Prof. Bruce D. Shriver of the University of Southwestern Louisiana. The justification for focusing on this area is strong. The use of computer-based information-processing systems has permeated every aspect of the health care industry. The advances of technology that have brought about a significant decrease in the cost of these systems over the last decade have allowed them to be employed in the administration, management, and application of health care. The issue that faces us, as either suppliers or users of medical information systems, is to develop highly reliable, usable, maintainable, serviceable, and growth-oriented systems that are costeffective. Such goals are difficult to obtain in a reasonably stable area, let alone in an area where the use of computers is rapidly undergoing change. In addition, the regulation and standardization that must eventually accompany the use of computers in several medically related areas is not yet well defined. Furthermore, it is not obvious what impact such regulation will have because it is not clear what form such regulation will assume. Meanwhile, medical information processing is spawning its own group of experts, journals, and meetings, which are all trying to identify what is unique and important to their particular use of information-processing systems. The objective of the sessions assembled in the Medical Information Processing Track of HICSS-12 was to represent a cross section of several key areas of interest and concern in this field. Ralph Grams, editor of the Journal of Medical Systems, set the stage for the

A note on computer graph plots of physician practice locations.

Abstract: This note examines the distribution of a medical school's physician graduates among states. Computer graph plots of this distribution are shown to be an alternative way of providing information to health care administration decision-makers concerned with physician practice location.

On-line computer management of cardiac surgical data.

Abstract: The surgeon (or one of his assistants) enters, in a computer file, information on open-heart surgical procedures through a remote terminal located in the recovery room. Clinical and historical findings, complications occurring during the immediate postoperative period, and postmortem data when applicable are entered in the course of the hospital stay or after discharge. Relevant information entering the computer system in other hospital departments is automatically incorporated in the open-heart surgery file. A final multicopy operative report is printed in the recovery room shortly after the surgical procedure is completed. All information on patients in the file constitutes a permanent and dynamic data base that is accessible at any time from any remote terminal in the hospital computer system. This data base contains an average of 500 items of information per surgical procedure and is available via an on-line retrieval program for both quality control purposes and extrapolation of prognostic data on new patients.

A description of the DAVID interactive instructional television system and its application to post-high school education of the deaf.

Abstract: This paper describes the unique DAVID instructional system, which merges motion, color, and audio capacities from instructional television with individualized student interaction, answer analysis, immediate reinforcement, individualized lesson content, branching, and data gathering from computer-assisted instruction. DAVID (Digital And Video Interactive Device) instruction includes drill and practice, tutorial, and dialogue strategies based on existing and new TV lessons. The system was created for the National Technical Institute for the Deaf by Dr. vonFeldt and was operational in November 1977. This paper includes (1) a description of deaf student needs, which were the basis for system development; (2) description of the completed prototype (DAVID); and (3) results of preliminary testing of the system with deaf students.

Evaluation--a word for all seasons.

Abstract: When one looks back over the past 20 years of scientific accomplishment and its impact on American life, the initial impression is one of awe and amazement. In spite of this rapid technologic growth, one is subconsciously aware of a growing cautiousness about the prospects for the future and the potential expression of man's ingenuity. Since the euphoria of the space program, we have suffered a lethargy of imagination that now places the study of economics and the conservation of the sacred dollar above all variables. Perhaps this is the zenith of the intellectual high that surrounded the incredible feats of space travel. Perhaps this is the natural evolutionary force following a series of\"future shock\" experiences, or perhaps this is a direct result of the world energy/inflation crisis. Whatever the cause, we all must deal with two relevant questions: \"What do we do today?\" and \"Where do we go from here?\" Our \"today\" is the day of electronic wizardry. Economists many years hence will have to consider this era the antithesis of inflation. While all studies indicate that major commodities such as food, energy, and natural resources continue to shrink and to lead the inflationary spiral, the electronic sciences and technologies are actually progressing in the opposite direction by delivering more for less. This countercurrent force is not evident to the average consumer since his major expenditures are made for inflated items. The implications of this electronic deflation and scientific expansion are extremely important for those who work in the medical systems field. While electrical engineering technology is rapidly advancing, our medical systems appear stagnant and depressed. At national medical systems meetings, groups are talking about issues that were present 4 and 5 years ago, with no substantial research or improvement over this period of time. The same speakers are back with their early papers extolling the virtues of new systems, if they could be built. Let's look at some of the factors for this disparity of progress and see if the issues aren't understandable and malleable. For industry, the past 5 years of developing hospital and medical information systems has been painfur, expensive, and very minimally rewarding. Recently, major medical systems corporations have succumbed to the economic and political pressures and gone out of business. The ability to sell a medical system at this time is a challenge even to an optimist. Tremendous hurdles stand between the decision to acquire a system and the actual installation and utilization. The complications of weaving a

An analogue echogram range gate tracker for clinical echocardiography.

Abstract: The fundamental purpose of this paper is to present the results of a feasibility study for an online, real-time automatic range gate tracker (ARGT) for clinical echocardiography, specifically for the purpose of determining cardiac output noninvasively and in real time. The basic ARGT design represents an implementation of specific algorithms and a system controller that permit user interaction and interpretation of clinical echocardiograms. In its analytical mode, the ARGT automatically tracks cardiac echoes as visually perceived and selected by the user. While tracking specific cardiac echoes, the ARGT converts the complex ultrasonic echogram into a pair of meaningful analogue signals (corresponding to the motion of the anterior and posterior left ventricular walls) from which dimensional information corresponding to dynamic geometric changes of the heart are derived. From this information, the cardiac output is computed in real time.

Uninterruptible power systems and other power protection equipment for electronic health care systems

Abstract: The increasing usage of electronic instruments in health care systems invariably leads to some level of dependence on them. In order to maximize the utility of these tools a high degree of reliability is essential. Many of the failures being experienced in systems where electronic instruments are being utilized may be attributed not to a failure of the instrument itself but rather to the poor quality of the commercial power to which they are attached. In order to reduce the effects of power fluctuations and outages, some type of power protection equipment must be installed between the commercial power system and the instrument. This article discusses the types of electronic “noise” present on commercial power lines and the various types of equipment used to reduce its effect on electronic instrumentation. In general, the Uninterruptible Power System (UPS) is shown to be the most effective power buffering element for a health care environment. General terminology associated with specifications of a UPS is defined in the article and attached appendix.

Design history of a cell kinetics simulation language.

Abstract: The field of cell kinetics relates to the movement and proliferation of cells through their generative cycle and to how this cycle is affected by chemotherapy treatment. CELLSIM is a discrete, digital simulation language for modeling this process. The language is interpretive, with the interpreter written in FORTRAN. It has been implemented on a wide variety of computer systems. The language features dynamic memory allocation, arithmetic string manipulation, and the capability of generating random variates from a number of probability distributions. The language has continued to evolve as the needs and desires of cancer researchers have been discovered. Its early use was only in experimental environments, but it is now being used to prescribe actual chemotherapy treatments.

Impact of government regulations on two management and clinical information systems in a medical school environment

Abstract: Administrative and legal requirements and, in particular, federal and state government health care assistance and social services program regulations all combine to add complexity to the management and operation of ambulatory and inpatient health programs. This paper describes how constantly changing government regulations and differences in interpretations and definitions have been expensive, time-consuming and sometimes detrimental to health care delivery for two large management and clinical computer-based information systems.

A predictive and descriptive model of interns' hospital selections

Abstract: This paper examines the differences among medical students who have chosen different types of hospitals for internship training. The criterion variable of a medical student electing to take internship training in a government, private, public, or university hospital is analyzed using admissions, medical training, and practice data as independent variables. Multiple discriminant analysis is employed to evaluate the profiles of physicians who have taken internship training in the different types of hospitals. Classification rates were found to be somewhat accurate. Computer graph plots of discriminant analysis mappings are used to depict differences among the hospital-based internship groups. The results of applying these techniques and methods are of value for more efficient hospital administration.

Government regulations and other influences on the medical use of computers

Abstract: This paper presents points brought out in a panel discussion held at the 12th Hawaiian International Conference on System Sciences, January 1979. The session was attended by approximately two dozen interested parties from various segments of the academic, government, and health care communities. The broad categories covered include the specific problems of government regulations and their impact on specific clinical information systems installed at The University of Texas Health Science Center at Dallas, opportunities in a regulated environment, problems in a regulated environment, vendor-related issues in the marketing and manufacture of computer-based information systems, rational approaches to government control, and specific issues related to medical computer science.

A hospital medication monitoring system

Abstract: Hospitals need to process large quantities of scattered information to properly screen medication orders. The data includes complex relationships involving drugs, diseases, and other drugs that determine whether a particular drug is contraindicated for a patient. Hospitals would therefore benefit from a flexible system for storing complex medical data relationships. We have used GPLAN, a CODASYL-like data management system, to construct a functioning model of a hospital pharmacy medication monitoring system. The patients' histories, drug-drug contraindications, disease-drug contraindications, and recommended dosages are stored in the data base in a network structure defined by the Data Description Language. Each drug order is checked for dose, allergies, current diseases, and current medications.