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                   PC-LAN BASED HOSPITAL INFORMATION SYSTEM FOR
                      MEDICINE: HOW FAR HAVE WE COME?

            Setting up the  Hospital  Information  Systems  (HIS)  at
         large  medical centres has become a pressing issue of today.
         The Research and Technology Center "Eye  Microsurgery", (RTC
         EM),  Moscow, Russia, is  responsible for management 540,000
         patients and performs over 60,000 surgeries within  a  year.
         Such an information flow cannot be processed without the use
         of the state-of-art computerized information technologies.
            Not long  ago  the  hardware  basis of HIS were large and
         minicomputers  [1,2,3],  which   reduced   reliability   and
         "viability"  of  a  computing  system  due to data had to be
         processed and stored inside a central unit.  Some  hospitals
         use  the  multiprocessor configuration to obtain the desired
         'viability',  but such an approach inevitably  increase  the
         system`s   cost.   However,  the  problem  of  providing  an
         information support for medical applications can be resolved
         at  a  new  level  with the introduction of high performance
         personal/professional computers with  high-speed  hard  disc
         drives  of  large  capacity,  inexpensive  computer  network
         adapters and  operating  systems  for  local  area  networks
         (LAN).  And  now  we  can  find  a  successful  use of LANs,
         designed for HIS and Patient Care Systems  and  applied  for
         large  hospitals  and particular at Ophthalmological Centres
         [4,5,6].  Furthermore,   the   strategy   in   the   medical
         information systems design in the 1990's will be oriented at
         the comprising computer networks [7].
            In 1988  the Computer Department of the RTC EM had worked
         out a project [8],  which comprised the  LAN  based  complex
         hardware  and  software  design  for  the typical ophthalmic
         medical centre  as  that  the  Moscow  RTC  EM  is.  It  was
         implemented  at october 1990 with the 24 LANs interconnected
         and over 300 workstations involved, and embraced practically
         all medical services and departments of RTC EM (Fig.1). Each
         LAN consists of 20-25 personal computers  based workstations
         (PC-WS) and about 10 printers. The PC-WS have been placed in
         the reception office,  diagnostic lines,  certain diagnostic
         rooms,   for   ophthalmologists,   at   the  in-patient  and
         out-patient  admission  department,  hospital   departments,
         operating  units (non-sterile zone),  for administration and
         at  the  Computer   Department.   We   have   utilised   the
         ETHERNET-CHEAPERNET   and   line/star  ArcNET  LAN  adapters
         depending upon an actual disposition of medical departments.
         Furthermore, we have also used the ETHERNET fiber-optic (FO)
         communication (FO star couplers and FO  repeaters)  for  the
         fileservers  interconnection  in three main buildings of RTC
         EM:  primary  building  (incorporating  the  administration,
         research   departments,  hospital  and  operating  theater),
         automated polyclinic and  aftercare  block.  Uninterraptible
         power  supplies  are  used  for  all computers to ensure the
         powerline safety.  Each computer is supplied with  both  the
         specific  medical  programs and with standard software (text
         editors,  statistic   evaluations,   slides   and   graphics
         handling,  ect.).  The  advantage  of the IBM PC workstation
         application is obvious.
            The user  is  expected  only  to  be  a proficient in his
         domain and have  some  skill  in  using  the  keyboard.  The
         "RECEPTION"  workstation  is  designed  to  enter  patient's
         personal details,  a preliminary  diagnosis,  residence  and
         region  of  the  patient  and  to manage the patient flow to
         diagnostic lines.  The "DIAGNOSTIC  DEVICE"  workstation  is
         purposed  to  enter  the  data  provided  by  the diagnostic
         devices.  At present we are in a position to carry  out  the
         following :to enter the data as per 35 diagnostic forms with
         rapid retargeting the software for the  concrete  diagnostic
         device;  to  perform  automatic  data  entry for the devices
         having  the  corresponding  communication  RS232C   channels
         (autorefractometers,       autokeratometers,      biometers,
         pachymeters manufactured by "Humphrey"  (USA)  and  "Topcon"
         (Japan); to arrange the conveyer-type passage of patients by
         using  the  "Daisy"  diagnostic  line  ,and  to  transfer  a
         patient's  identifier  to  each successive diagnostic device
         ;to enter a medical conclusion containing  detailed dialogue
         on certain information forms; to accumulate statistical data
         regarding  the  passage   of   patients.   The   workstation
         "DOCTOR-OPHTHALMOLOGIST" can provide the following:  to find
         patient's  data  according  to  his  unique   identification
         number;  scan  the  information  entered  at  the diagnostic
         lines; schedule the days when surgeries are to be performed;
         calculate  a  parameters of the certain opticoreconstructive
         operation;  prescribe the treatment  procedures;  arrange  a
         sick-list; order an additional examination. While describing
         the eye status,the dialogue with a computer is  conducted in
         accordance  with  the  developed "tree",  describing the eye
         status  before  and  after  surgery.  Using  the  "HEAD   OF
         OPERATING  UNIT"  workstation one can control the scedule of
         surgeries in operating units,  check up the  preparation  of
         operational  lists,  give  grant permission for a surgeon to
         carry out certain types of ocular operations, set a limit as
         to the number of surgeries  to  be  performed  in  different
         operating theatres etc.
            In  summary,  the  essential  advantages  of the computer
         networks application for the HIS management in RTC EM are as
         the following:
            1) The information safety and integrity is  significantly
         increased,  and  the  desired  information  can be retrieved
         almost without delay.
            2) The computer programs realize the statistical data  in
         a  most  objective,  rapid  and  adequate  manner,  which is
         essential in monitoring the clinical  work.  The  doctor  is
         supplied with intellectual prompts, since certain algorithms
         are  based  on  the  experience  gained  by  the leading RTC
         ophthalmologists.
            3) The unique diagnostical and surgical experience of the
         RTC EM is accumulated and systemised to be used further  for
         the expert systems design.
            4)  The  powerful  support for the financial relations of
         the  patient  treatment  (billing,  accountings,  etc.)   is
         provided.
            The software discribed above and the network itself were
         designed for ophthalmological clinics and that's why they
         have some specific features. The main idea of our's next
         step was to create an universial HIS environment that could be
         implemented in any domain of medicine. At the end of 1991
         we launched out Medical  Patient  Health  Care  System
         "MedWork".
            "MedWork" makes it possible now (exept common features):

         - To update and to add new blanks in the library of  medical
         forms, that describes the state of a patient in any domain
         of medicine. It can be done by medical staff interactively,
         without  programmers help.
         - In easy mode one can create and use any kind of abstracts
           from  patients  file.
           While  creating  an  abstract  you  may
           determine  needed  forms  or  parts  of forms you want to
           handle. Doctor can determine position and arrangements of
           each data at the screen.

         - In easy mode you may create various lists of patients  for
           directing  patients  to  specialists.  Creating  lists  of
           patients allowed you to plan the work  of  specialists  or
           diagnostic cabinets.

         -  To  direct  the  patient to needed specialist and fix the
           date and time.

         - To find the patient by the name or by the number of his file.

         - To record patient in list and can take from the list. With
           the help of the list you may count developed patinents.

         -  To  make  an  account for patient and to keep a financial
            statistics.

         - You may  get  statictics  about  deseases,  about  doctors
           medical work financial statistics.

         -  You  may  update  and  add  references  for  any  kind of
           information. For example you may organize Order  board  or
           Bullitene board etc.

         - To send and receive messages from users of the system even
           if  they are not working in current time. With the help of
           this mail system you may plan your working time and create
           dayly or weekly plan.

         -  You  may  use  hierarchical   descriptor   intended   for
           decreasing of text input from keyboard.

         -  To  record sequences of keyboard typing and then play the
           script that alows  you  to  configure  working  place  for
           various specialists.

         System supports network access for any types of networks for
         PC-XT,AT  or compatible. All patient information is strongly
         compressed .That's why the  information  about  one  patient
         during  5 years is about 2-3 Kb. Accessing time for any kind
         of patient information doesn't depend from patients  number.
         In  real  system you can develope more than 100.000 patients
         in a year.

         In next versions it will be supported working with  graphics
         objects,  automatic  input from medical units through RS-232
         port, functions of archiving for supporting great streems of
         patients (more than 100.000 in a year).



                     With warm regards,
                               Albert Akmalov MedWork Project Manager
                               Beskudnikovsky Blvd. 59 a
                               Moscow Russia 127486
                               Tel (095) 905-46-98
                               Fax (095) 485-59-54
                               E-mail alik@irtc.msk.su