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Information processing is a major element of hospital risk management programs. A microcomputer-based information system has been designed and implemented in a medium-size university hospital. The design principles and the functional capabilities of the system are described here, followed by an evaluation based on the first year of operation.
This paper will address how a hospital was able to utilize a microcomputer to determine weighting criteria to allocate Medicaid patient days to certain physicians when the State reduced the allowable days by 59 percent. The allocation basis had to address the following: the hospital's mission, financial viability, the impact on its teaching programs and university affiliations and antitrust and anticompetition laws and regulations.
The following criteria were used to document program enhancement after the implementation of a microcomputer laboratory: faculty and student attitudes toward computer-assisted instruction (CAI); student anxiety scores toward state board examinations; increased visibility of the college (number of authored CAI modules, CAI grants, computer committee memberships, faculty attendance at computer courses); and relationship involving learning style, attitude, and student learning. Ninety-two of 112 students and 39 of 55 faculty responded to the request for data collection. Postimplementation, both faculty and students showed mean increases in their attitude toward CAI, although not statistically significant. Senior students had significantly decreased anxiety scores toward the state RN licensure examination after using Mosby's NURSESTAR for review (p less than .001). Increased visibility was also documented, but data collection continues regarding the relationship involving learning style, attitude, and student learning. It was concluded that the innovation of computers in an established nursing curriculum served to enhance program excellence.
This paper will address the complex issues of effective cost management and declining inpatient volume. Utilizing a microcomputer-based physician incentive compensation program, it will show how a hospital developed a plan to increase inpatient hospital utilization and improve cost management. It will discuss the Internal Revenue, HCFA, and legal implications of the plan.
The accelerating pace of improvement and innovation in today's microprocessors offers a real challenge to the software industry. MUMPS, a language well suited to take advantage of this technology, has already been introduced on 8-bit microcomputers, and 16-bit versions are under development. The long-term results of the availability of MUMPS on new generations of microprocessors will have an impact on the visibility of the language, its evolution, and its use on existing minicomputers. These implications are discussed in depth in this paper.
The Texas Department of Health expanded its newborn screening program to include four disorders in February of 1980. Because of the large volume of specimens being processed (approximately 2500 daily), it was essential that laboratory aspects of this program be computerized. Currently, both laboratory and follow-up activities are linked by computer. The modular, microcomputer approach employed has provided the necessary capabilities to ensure accurate and efficient tracking of newborns from specimen submission through diagnosis and treatment. Continual program evaluations are also possible through statistical tabulations of various types of data collected and maintained in the system.
An electronic interface for a Research Machines 380Z microcomputer and a Vickers M85/6 integrating microdensitometer is described, together with outlines of the control software. A typical applications programme, which may be written in several high-level languages, is outlined for the determination of a time course plot for enzyme activity in a tissue section. This system facilitates rapid accurate measurement and analysis of experimental data.
We evaluated two representative microcomputer-based programs for organizing a biomedical literature filing system. With a bibliography of 100 anesthetic references, a series of benchmark tests was developed to measure the speed and accuracy of typical searching, sorting, and formatting tasks. Each program performed the searching tasks accurately and at about the same speed. One program performed sorting without errors, provided the field order of the template used to enter references was unchanged. Both programs used "punctuation files," that is, templates for controlling author presentation; punctuation to suit style requirements of individual journals; and order of particular fields, such as publisher and year of publication. Each program was able to format journal, book, and chapter references correctly, but the resulting output required some refining in a word processor. Both require a major time commitment to learn and to create custom punctuation files for journals not included in the predesigned punctuation files. Once mastered, both programs are quite competent at organizing reprints and formatting journal references.
Approximately 50% of the pharmacy man-hours committed to providing a parenteral nutrition service at the Children's Hospital, Birmingham were spent in calculations, form filling and record keeping. An increasing demand for the service, with no extra staff available, meant that the service had to be made more efficient. A 90% time saving was achieved by using a microcomputer to free the pharmacy staff from many of the laborious mathematical and clerical chores. The program was developed by a member of the nutritional care team; this meant that it was designed with the specific needs of the service in mind. In addition the detail and accuracy of patient data recording have been greatly improved.
Hypertension after cardiac surgery is common and is associated with increased morbidity. It is usually managed by the infusion of short acting vasodilators. The use of a closed-loop computer system to control the infusion of a vasodilator has been shown to compare favourably with manual control. We have developed a closed-loop system for the ATARI 1040ST microcomputer to control arterial pressure by the simultaneous infusion of two vasodilators. The control program is based on a proportional-integral-derivative algorithm which has been adapted to allow control of two IMED 929 infusion pumps from one RS-232 port. All communication between the user and computer is carried out with a 'mouse', thus increasing acceptability of the system to ward staff. Cardiovascular data are collected on-line from the patient monitor via a custom-built analogue to digital convertor. This system was used to study glyceryl trinitrate and sodium nitroprusside in 24 patients requiring vasodilators after cardiopulmonary bypass. The study showed that in 14 of the patients hypertension was controlled by GTN alone and 10 required supplementary SNP. We have demonstrated that this dual-pump automatic arterial pressure control system is a satisfactory and safe method of administering two vasodilators simultaneously. It is suitable for both routine clinical and research uses.
Feedback control is widely used in applications which range from simple control of room temperature to very sophisticated control of space flight. This paper describes some fundamentals of feedback control as they apply specifically to microcomputer based medical devices. A classical controller is described in its analog and digital implementations. Reference is made to methods for adjusting or tuning the controller for specific applications. Successful applications of adaptive or self-tuning control are discussed. Examples of feedback control include systems to control arterial blood pressure by the infusion of sodium nitroprusside, systems to control arterial carbon dioxide concentration by mechanical ventilation and systems to control depth of anesthesia by controlled anesthesia delivery.
A system for the on-line production of anaesthetic records with a microcomputer is described. The requirements of the system are a keyboard, a video display unit and a colour plotter. The system requires no programming expertise from anaesthetists and nurses. The records have improved information display, patient care and reduced time spent in administration effort. Disadvantages are the relatively high cost and requirement of preprocessing of haemodynamic and respiratory parameters.
As a contribution to the structure-activity relationship of silver sulfanilamide complexes, the pKa-values of thirteen sulfanilamides and the log K-values of their related silver compounds were determined using a microcomputer-controlled titrator which determines the silver ion concentration and hydrogen ion concentration in a combined measurement. Predictions on antibacterial effectiveness and the risk of sensitization reactions of some of the investigated silver sulfanilamides are made on the basis of the conditional stability constants computed from the pKa- and log K-values at pH = 7.4.
Microcomputers may be conveniently and effectively used to manage personal medical literature collections. A bibliographic data base consisting of the author, title, and source for each reference is entered and stored on magnetic tapes or disks. Document categorization and keyword assignment prior to entry is optional, thus allowing clerical personnel to maintain both the literature collection and the bibliographic data base. Subject searches using an array of search terms formulated by the medical user permit retrieval of relevant bibliographic citations. Current alphabetical and keyword-in-context listings of the documents in the the collection may also be produced. The programming approach uses string processing and is within the capability of programmers with limited experience.
A system for computer-assisted instruction in performing ophthalmic visual field examinations is presented. The system is implemented on a microcomputer making use of specially developed algorithms to summarize the information contained in a visual field in a very compact, efficient manner and to determine cursor position relative to stored visual field landmarks. The computer program presents a challenging testing situation by using visual fields, based on those of actual patients, of differing degrees of complexity. It is particularly well suited for trainees as well as for the physicians and ophthalmic technicians who frequently perform this examination.
A microcomputer program written in BASIC for the IBM-PC and compatibles has been developed to analyze the effects of many parameters on the gas exchange and transport phenomena in the lungs and the tissues. The program is designed for use by medical students and residents concerned with gas exchange (anesthesiology, pulmonary diseases, critical care, etc.) to study the steady state effects on blood and tissue oxygen and carbon dioxide levels. The present program consists of two main subroutines: Pulmonary Gas Exchange and Tissue Gas Exchange. Steady state gas exchange at the lungs can be studied using either a three-compartment model or V/Q relationships. The V/Q subroutine uses single or multiple populations of V/Q distributions to determine gas exchange using a log-normal distribution of V/Q ratios. Other variables can be adjusted which determine the arterial and mixed-venous blood gases. These values are then fed into the second part of the program to analyze factors which determine tissue O2 tension. The Tissue Oxygen Tension subroutine is also subdivided into a modified Krogh-Erlang model, which provides a three-dimensional plot of theoretical capillary and tissue O2 tensions, and a Piiper model which includes the effect of diffusion shunt on O2 tensions and treats the tissue as a well-stirred compartment. Minimal and maximal tissue O2 tensions are calculated using the Piiper model since the intercapillary distance is allowed to vary depending on the O2 delivery by diffusion. Estimates of blood and tissue O2 tensions, diffusion/perfusion coefficients, amount of O2 delivered and the size of the active capillary bed are summarized in a table.
A microcomputer based control system has been developed to automatically induce and maintain neuromuscular block during surgery. The system repeatedly adjusts the infusion rate of a muscle relaxant, succinylcholine, based on the evoked, rectified, and integrated electromyogram (EMG). The system was tested in 12 patients for a 30-min infusion period with a setpoint of 80% depression of the evoked, rectified, and integrated thenar EMG. The mean time to reach the setpoint for 10 of the patients was 5.5 (+/- 1.87 SD) min and the mean time for 95% recovery after infusion was stopped was 5.4 (+/- 0.83 SD) min. Average overshoot was 9.9% of the baseline (+/- 3.1% SD), and the average time within +/- 10% of the setpoint was 22.1 min (+/- 7.26 SD). The total dose of succinylcholine for these 10 patients ranged from 1.21 to 3.77 mg/kg with a mean of 1.92 mg/kg. The other two patients were relatively insensitive to the drug and the controller was unable to bring the response to the setpoint due to a ceiling placed on infusion rate by the control algorithm.
RI Manager is a microcomputer program for storage and analysis of genetic mapping data from recombinant inbred strains. The program rapidly identifies statistically significant linkage between known loci and a newly described locus, and it facilitates rapid evaluation of alternative map orders for linked loci.