MED. INFORM.
(1979), VOL. 4,NO. 3, 133-138
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
A computerized perinatal data system HARRY S. WARFORD, RAYMOND J. JENNETT, and DONALD A. GALL Division of Reproductive Medicine, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA (Received 21 November 1978) Keywords: Perinatal, Data system, Health-care delivery, Record system, Reproductive medicine. A computerized perinatal data system has been proposed and is under implementation at St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA. The concept encompasses all phases of perinatal care from pre-natal consulation through transferral of infant care to the family paediatrician. A complete record system was designed and computerized to serve both in-house and regional institutions with an on-line data system. Extensions into labour/delivery and nursery are under way and will provide augmentation of health care delivery as well as serving educational, audit, and research needs. Un systkme informatique ptrinatologique est en cours d’implementation au Centre Hospitalier de Saint Joseph a Phoenix, dans 1’Arizona. Ce systkme prend en compte toutes les &tapesperinatologiques, depuis les consultations prenatales j u s q u ’ i la prise en charge de I’enfant par le ptdiatre choisi par la famille. Un dossier complet est mis sur ordinateur; il peut itre consulti: en temps reel, aussi bien par le ptdiatre de famille que par les organismes de santt regionaux. Dans les buts d’education, de contr8le et de recherche, mais surtout pour augmenter le potentiel de soins d u sysime, il est prtvu d’ttendre ce dernier aux salles de travail et B la crkche.
1. Historical overview By 1970, St. Joseph’s Hospital and Medical Center, at Phoenix, Arizona, USA, had emerged as a highly capable institution providing comprehensive and specialized care for the newborn. Its neonatal intensive-care nursery had come to be recognized as an .outstanding unit expertly staffed with neonatologists and nurses trained in the care of the acutely ill newborn. Additionally, it had established an active education programme, including fellowships in the field of neonatology, and had participated in the design and implementation of early transport programmes for the State of Arizona. At that time, a proposal was made to establish the ‘Division of Reproductive Medicine’ (DORM) out of a recognition that further significant reduction in infant morbidity and mortality would more readily occur within a structure of health-care delivery that spanned the traditional boundaries delineating the specialities and services of obstetrics, neonatology, and paediatrics. In 1971, a common administrative and clinical division was created to accomplish these goals. Further fulfilment of the concept continued with the establishment of the Regional Perinatal Laboratory in 1972 and attainment of affiliate services of the Diagnostic Ultrasonography Laboratory in 1973. By 1974, the beginnings of what has become the Perinatal Biophysics department of the DORM began to examine the overall engineering aspects of computer augmented perinatal care. T h e remainder of this paper is primarily devoted to that section of the DORM and particularly to the accelerating developments of the past few years toward completion of the computer system and the achievement of on-line real-time assistance to perinatal health-care delivery. M.I.
0307-7640/79/0403 0133 302.00 i“ 1979 Taylor & Francis Ltd
K
H . S. U’arford et al.
134
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
2. Perinatal data system The Perinatal data system encompasses three major subsystems: ( a )the Central data system, ( b ) the Fetal surveillance system, and (c) the Newborn surveillance system. These three subsystems, fully capable of stand-alone operation within their respecti\‘e areas o f application, and a fourth subsystem of Remote Access Data Entry Xlodules ( R . W E 3 I s ) [vill be integrated to provide comprehensive on-line real-time assistance to perinatal health-care assessment and delivery from the pre-natal examination of discharge of mother and infant, including the transferral ofcare to the family paediatrician.
2.1. Record system When the Arizona Perinatal Project (APP) was funded by the Robert Wood Johnson Foundation in 1975, St. Joseph’s data system was adopted for expansion into a regional data-base for patient care, risk assessment, and quality and statistical evaluation of perinatal care in Arizona. A joint committee of APP, St. Joseph’s, and private perinatal specialists surveyed the perinatal record systems in use in Arizona hospitals of various sizes, confirming that such records and procedures had been independently developed for tightly bounded areas. T h e committee revised the existing record systems with the goal of developing a universal set of records for the region, treating the infant as the primary patient and seeking to record the genetic and ecological factors brought to bear upon the patient both as a fetus and a neonate. I he result was a collection of forms covering the episodic and chronologic categories given in table 1. T h e development of these forms paralleled that of the Central data system and provided both a paper record for conventional use and an input document for passing data into the computer system. Due to the identification of the APP with the developing data system, this phase of the overall Perinatal data system is utilized not only at St. Joseph’s, but also via telephone data links from Maricopa County Hospital (Phoenix), the Arizona Medical Center (University of Arizona, Tucson), the Whiteriver Apache Tribal Hospital, and by batch entry from several private obstetric practices and smaller hospitals. T h e goals and objectives of this regional record system are given in table 2. ?,
___
Table 1
1)ata sheets
~
~~
Clrro1ro4og1c
Episodic
prenatal
.XIaternal transport
Prenatal intake
Laboui-
Hospitdl admission Labour deli\ erv
Postpartun-
Obstetrical discharge Seonatal admission S e v horrt----
heonatal discharge
2.2. Central data systeni T h e Central data system implementation of the computerized data-base generated from the record system is a Data General S/200 Eclipse having 40k of inemory, two 45 megabyte disc drives, a magnetic tape unit, and provision for 17 Interactive terminals. Approximately 300 programs have been written in the
Perinatal data system
135
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
Meditech Interpretive Information Systems (MIIS) version of the Massa-husetts General Hospital Multiprogramming System (MUMPS), to facilitate data entry, retrieval, and report generation.
2.2.1. Data entry. Entry into the data system is controlled and guided by the use of passwords and menu structures tailored for each using institution. Selecting from the nested menus, the user arrives at the desired program for entry or correction and is then confronted with five basic types of questions requiring generalized responses o f ( a ) patient names, ( b ) dates and times, ( c ) numerical responses, ( d ) multiplechoice responses, and ( e ) free text or ‘other’ responses. A number of checks and balances have been programmed into the data-entry routines to reduce the normal errors that occur in any transcription process. Hence, an attempt to enter gestational age for gravidity or today’s date for maternal birthdate would be questioned or prevented by reasonableness checks and rejected with prompting to the user. Likewise, dates and times undergo scrutiny for chronological order. Every attempt is being made to keep the data-base as current as possible with each record being completed and entered as soon as possible following a particular episodic or chronologic event for which a separate record was developed. T o achieve this end, terminals have been placed in the Obstetric Clinic, Labour/Delivery Suite, Physicians’ Conference Room and Nursery, as well as in the computer room. 2.2.2. Data retrieval. Data retrieval programs provide three basic report types. The simplest report is a verbatim output of an individual data sheet and may be accessed by the mother’s name at any time following entry of that particular form. As with all the reports, it can be displayed on the requesting terminal or routed to a printer for hard copy. Table 2.
Perinatal record system
Goals and objectives
I. Direct patient care (A) Current (1) Patient-care information (2) Risk assessment (3) Concurrent review
11. Ex post facto analysis (A) Quality assessment (1) Medical audit (2) Morbidity-mortality (3) Malpractice surveillance
(4) Information transfer
(B)
Future (1) Infant health summary (2) Infant discharge risk assessment (3) Mother’s continuing reproductive record
(B)
Statistical
(1) Epidemiologic (2) Demographic (3) Logistic (4) Regional system effectiveness (C)
Research
(1) Clinical investigation (2) Congenital defect registry
The second type of report converts the formal, tabular data from the data sheets into a narrative summary covering a particular period of perinatal care. It is periodically updated only at selected points in the course of care such as following admission, completion of delivery, or nursery discharge. Hence, it is the primary means to provide continuity of care as responsibility passes from obstetrician to K2
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
136
H . S. Warford et al.
neonatologist to paediatrician. T h e various forms of this summary are then available to the obstetrician to cqmplete the mother’s file and to the paediatrician for nurserycare projection and ultimately as the beginning of a lifetime health-record for the newborn. T h e third type of report is the statistical summary. Short-term statistics are compiled on a monthly basis, with running statistics for the year, to serve the needs of various audit and review functions. Parametric statistics for the entire active database are also available for this purpose as well as for research or education. New retrieval programs are being developed to provide enhanced user interface for multi-parameter searches to generate management analysis data for a wide range of uses.
2 . 3 . Fetal surueillance system T h e Fetal surveillance system is the second major portion of the overall data system scheduled for implementation. T h e hardware of choice is a Digital Equipment Corporation LSI-11 with 28k of memory, an interactive terminal, hardcop?; unit, and a 10 megabyte moving head disc. Initial support will be provided for 12 fetal monitors. Previous attempts at providing such monitoring generally resulted in a bedside unit that produced metre after metre of unattended strip-chart record and perhaps transmitted short-term data to a central station capable of selecting and monitoring an individual bedside unit. Review of this procedure reveals that it is highly unwieldy and often inappropriate to evaluate more than eight minutes or so of data at bedside. I,ikewise, short-term data at a central station does little to enhance the care delivered to the patient and may actually reduce the effectiveness of the nursing staff by requiring considerable attention at the central station due to the short-term data being presented. Therefore, a new concept was proposed at St. Joseph’s that would remove the lengthy paper record from the bedside and replace it with an eight minute trend of fetal heart rate and contraction strength displayed on a non-fade cathoderay-tube (CRT) display. Each bedside unit would also transmit contraction strength to the central processor on a fetal beat-to-beat basis for reconstruction. Since a general-purpose processor was chosen for the central station, data analysis can be easily altered to include new techniques as they are defined. Statistical and pattern analysis will be applied to develop treatment protocol prompts as well as the traditional catastrophe driven alarms. I t should be noted at this point that no data has been routinely recorded on paper. On request, time ’segments of labour/delivery will be recalled from disc, annotated Ivith prompts and nursing notes then sent to the C R T or hard-copy unit. In this manner, hours of data can be presented in a much more compact form that integrates medical data from the sensors as well as other sources such as nursing entries, laboratory data, etc. ‘The physician can now quickly review this data without scanning many metres of chart paper while the patient becomes increasingly tense over the bedside activities. In addition to this normal use bf the review station, the data may be recalled for a variety of uses, such as research and resident and continuing education for nurses and practising physicians. Complete labour epochs or selected segments can be retained on the disc for this purpose and become available both for data-base generation and review. Hard-copy of the data will be available via a video copier should a permanent record of a particular segment be desired.
Perinatal data system
137
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
Early implementation of this surveillance system centred around a new monitor with no recorder but a digital memory and non-fade display. Since that time, additional factors have dictated that the system must function with a variety of commonly used fetal monitors. This has led to a simple and inexpensive generalpurpose interface that now permits the use of most commercial units as well as the new units and has provided considerable expansion capability at bedside should additional signals be desired for digitization and input to the central processor.
2.4. Remote access data entry modules (RADEM) The RADEM concept was the result of a desire to conveniently enter certain data into the various subsystems of the Perinatal data system during the time that care is being administered as opposed to off-line entry after the fact. Data such as medications, laboratory results, cervical dilitation, ventilator settings, etc. are all necessary to modify treatment protocol and must appear as part of the patient’s online record in a timely manner to be useful. This is to be accomplished in labour/delivery as well as the nursery, by small hand-held or table-top units that provide simple numeric input with enhanced alphanumeric responses on an abbreviated display. Data thus entered is then immediately available at the central processor for annotation into the labour/delivery or nursery outputs and will also provide much of the data required to produce computer-generated summaries without the need for so much tedious physician completed paperwork. With the great flexibility afforded by the LSI-11 implementation, the RADEM concept can very easily be adapted and tailored for new tasks such as recall of a previous entry for comparison.
2 . 5 . Newborn surveillance system T h e Newborn surveillance system represents a logical extension of the Fetal surveillance system and will embrace many of the same basic concepts. Obviously, the amount of data to be collected in the nursery far exceeds that of labour/delivery, hence the hardware requirements will be more extensive. However, the same idea of identifying and collecting condensed episodic data as opposed to brute force data acquisition will apply. T h e RADEM discussed earlier will provide the bulk of data input along with the basic cardiopulmonary monitoring equipment. Initial investigation indicates an excellent chance that on-line multi-plexed EEG acquisition and other neurological tasks may be technically and economically feasible.
3. Comments Development and implementation of the Perinatal data system described herein has undergone almost daily change as the various effects of time, finances, personnel, and acceptance have come to bear upon it at each phase. T h e early decision to expand the data-base to a State-wide region had the favourable effect of accelerating the attainment of a statistically significant population, but had the negative effect of placing a much heavier demand on retrieval earlier than scheduled. This demand has been met to-date but with over 8000 records on file from half-a-dozen sources, we stand at the brink of an explosive utilization demand as system users are rapidly realizing the vastness of the raw data within the record system. Inquiries for new statistics and reports are limited only by the imagination. T h e proposed generalpurpose search routines are expected to accommodate most of these requests and produce a high degree of confidence in the overall system so as to increase user compliance in the area of data-sheet completion.
138
Perinatal data system
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
Completion of the Fetal surveillance system is now anticipated by midyear with the Newborn surveillance system implementation following. Man-machine interface techniques refined in the labour-delivery environment will be fully utilized in the nursery to collect and coherently assemble for retrieval the massive number of data items required for patient management. Continued system refinement from that point will be based on neonatal outcome as measured, by yet undefined criteria, against the data-base of the Central data system.
Acknowledgement This paper was presented at the Symposium on Medical Informatics (the First Annual Conference of the World Association for Medical Informatics), which was held in Toulouse, France, from 14 March to 17 March 1978.
(1979), VOL. 4,NO. 3, 133-138
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
A computerized perinatal data system HARRY S. WARFORD, RAYMOND J. JENNETT, and DONALD A. GALL Division of Reproductive Medicine, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA (Received 21 November 1978) Keywords: Perinatal, Data system, Health-care delivery, Record system, Reproductive medicine. A computerized perinatal data system has been proposed and is under implementation at St. Joseph’s Hospital and Medical Center, Phoenix, Arizona, USA. The concept encompasses all phases of perinatal care from pre-natal consulation through transferral of infant care to the family paediatrician. A complete record system was designed and computerized to serve both in-house and regional institutions with an on-line data system. Extensions into labour/delivery and nursery are under way and will provide augmentation of health care delivery as well as serving educational, audit, and research needs. Un systkme informatique ptrinatologique est en cours d’implementation au Centre Hospitalier de Saint Joseph a Phoenix, dans 1’Arizona. Ce systkme prend en compte toutes les &tapesperinatologiques, depuis les consultations prenatales j u s q u ’ i la prise en charge de I’enfant par le ptdiatre choisi par la famille. Un dossier complet est mis sur ordinateur; il peut itre consulti: en temps reel, aussi bien par le ptdiatre de famille que par les organismes de santt regionaux. Dans les buts d’education, de contr8le et de recherche, mais surtout pour augmenter le potentiel de soins d u sysime, il est prtvu d’ttendre ce dernier aux salles de travail et B la crkche.
1. Historical overview By 1970, St. Joseph’s Hospital and Medical Center, at Phoenix, Arizona, USA, had emerged as a highly capable institution providing comprehensive and specialized care for the newborn. Its neonatal intensive-care nursery had come to be recognized as an .outstanding unit expertly staffed with neonatologists and nurses trained in the care of the acutely ill newborn. Additionally, it had established an active education programme, including fellowships in the field of neonatology, and had participated in the design and implementation of early transport programmes for the State of Arizona. At that time, a proposal was made to establish the ‘Division of Reproductive Medicine’ (DORM) out of a recognition that further significant reduction in infant morbidity and mortality would more readily occur within a structure of health-care delivery that spanned the traditional boundaries delineating the specialities and services of obstetrics, neonatology, and paediatrics. In 1971, a common administrative and clinical division was created to accomplish these goals. Further fulfilment of the concept continued with the establishment of the Regional Perinatal Laboratory in 1972 and attainment of affiliate services of the Diagnostic Ultrasonography Laboratory in 1973. By 1974, the beginnings of what has become the Perinatal Biophysics department of the DORM began to examine the overall engineering aspects of computer augmented perinatal care. T h e remainder of this paper is primarily devoted to that section of the DORM and particularly to the accelerating developments of the past few years toward completion of the computer system and the achievement of on-line real-time assistance to perinatal health-care delivery. M.I.
0307-7640/79/0403 0133 302.00 i“ 1979 Taylor & Francis Ltd
K
H . S. U’arford et al.
134
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
2. Perinatal data system The Perinatal data system encompasses three major subsystems: ( a )the Central data system, ( b ) the Fetal surveillance system, and (c) the Newborn surveillance system. These three subsystems, fully capable of stand-alone operation within their respecti\‘e areas o f application, and a fourth subsystem of Remote Access Data Entry Xlodules ( R . W E 3 I s ) [vill be integrated to provide comprehensive on-line real-time assistance to perinatal health-care assessment and delivery from the pre-natal examination of discharge of mother and infant, including the transferral ofcare to the family paediatrician.
2.1. Record system When the Arizona Perinatal Project (APP) was funded by the Robert Wood Johnson Foundation in 1975, St. Joseph’s data system was adopted for expansion into a regional data-base for patient care, risk assessment, and quality and statistical evaluation of perinatal care in Arizona. A joint committee of APP, St. Joseph’s, and private perinatal specialists surveyed the perinatal record systems in use in Arizona hospitals of various sizes, confirming that such records and procedures had been independently developed for tightly bounded areas. T h e committee revised the existing record systems with the goal of developing a universal set of records for the region, treating the infant as the primary patient and seeking to record the genetic and ecological factors brought to bear upon the patient both as a fetus and a neonate. I he result was a collection of forms covering the episodic and chronologic categories given in table 1. T h e development of these forms paralleled that of the Central data system and provided both a paper record for conventional use and an input document for passing data into the computer system. Due to the identification of the APP with the developing data system, this phase of the overall Perinatal data system is utilized not only at St. Joseph’s, but also via telephone data links from Maricopa County Hospital (Phoenix), the Arizona Medical Center (University of Arizona, Tucson), the Whiteriver Apache Tribal Hospital, and by batch entry from several private obstetric practices and smaller hospitals. T h e goals and objectives of this regional record system are given in table 2. ?,
___
Table 1
1)ata sheets
~
~~
Clrro1ro4og1c
Episodic
prenatal
.XIaternal transport
Prenatal intake
Laboui-
Hospitdl admission Labour deli\ erv
Postpartun-
Obstetrical discharge Seonatal admission S e v horrt----
heonatal discharge
2.2. Central data systeni T h e Central data system implementation of the computerized data-base generated from the record system is a Data General S/200 Eclipse having 40k of inemory, two 45 megabyte disc drives, a magnetic tape unit, and provision for 17 Interactive terminals. Approximately 300 programs have been written in the
Perinatal data system
135
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
Meditech Interpretive Information Systems (MIIS) version of the Massa-husetts General Hospital Multiprogramming System (MUMPS), to facilitate data entry, retrieval, and report generation.
2.2.1. Data entry. Entry into the data system is controlled and guided by the use of passwords and menu structures tailored for each using institution. Selecting from the nested menus, the user arrives at the desired program for entry or correction and is then confronted with five basic types of questions requiring generalized responses o f ( a ) patient names, ( b ) dates and times, ( c ) numerical responses, ( d ) multiplechoice responses, and ( e ) free text or ‘other’ responses. A number of checks and balances have been programmed into the data-entry routines to reduce the normal errors that occur in any transcription process. Hence, an attempt to enter gestational age for gravidity or today’s date for maternal birthdate would be questioned or prevented by reasonableness checks and rejected with prompting to the user. Likewise, dates and times undergo scrutiny for chronological order. Every attempt is being made to keep the data-base as current as possible with each record being completed and entered as soon as possible following a particular episodic or chronologic event for which a separate record was developed. T o achieve this end, terminals have been placed in the Obstetric Clinic, Labour/Delivery Suite, Physicians’ Conference Room and Nursery, as well as in the computer room. 2.2.2. Data retrieval. Data retrieval programs provide three basic report types. The simplest report is a verbatim output of an individual data sheet and may be accessed by the mother’s name at any time following entry of that particular form. As with all the reports, it can be displayed on the requesting terminal or routed to a printer for hard copy. Table 2.
Perinatal record system
Goals and objectives
I. Direct patient care (A) Current (1) Patient-care information (2) Risk assessment (3) Concurrent review
11. Ex post facto analysis (A) Quality assessment (1) Medical audit (2) Morbidity-mortality (3) Malpractice surveillance
(4) Information transfer
(B)
Future (1) Infant health summary (2) Infant discharge risk assessment (3) Mother’s continuing reproductive record
(B)
Statistical
(1) Epidemiologic (2) Demographic (3) Logistic (4) Regional system effectiveness (C)
Research
(1) Clinical investigation (2) Congenital defect registry
The second type of report converts the formal, tabular data from the data sheets into a narrative summary covering a particular period of perinatal care. It is periodically updated only at selected points in the course of care such as following admission, completion of delivery, or nursery discharge. Hence, it is the primary means to provide continuity of care as responsibility passes from obstetrician to K2
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
136
H . S. Warford et al.
neonatologist to paediatrician. T h e various forms of this summary are then available to the obstetrician to cqmplete the mother’s file and to the paediatrician for nurserycare projection and ultimately as the beginning of a lifetime health-record for the newborn. T h e third type of report is the statistical summary. Short-term statistics are compiled on a monthly basis, with running statistics for the year, to serve the needs of various audit and review functions. Parametric statistics for the entire active database are also available for this purpose as well as for research or education. New retrieval programs are being developed to provide enhanced user interface for multi-parameter searches to generate management analysis data for a wide range of uses.
2 . 3 . Fetal surueillance system T h e Fetal surveillance system is the second major portion of the overall data system scheduled for implementation. T h e hardware of choice is a Digital Equipment Corporation LSI-11 with 28k of memory, an interactive terminal, hardcop?; unit, and a 10 megabyte moving head disc. Initial support will be provided for 12 fetal monitors. Previous attempts at providing such monitoring generally resulted in a bedside unit that produced metre after metre of unattended strip-chart record and perhaps transmitted short-term data to a central station capable of selecting and monitoring an individual bedside unit. Review of this procedure reveals that it is highly unwieldy and often inappropriate to evaluate more than eight minutes or so of data at bedside. I,ikewise, short-term data at a central station does little to enhance the care delivered to the patient and may actually reduce the effectiveness of the nursing staff by requiring considerable attention at the central station due to the short-term data being presented. Therefore, a new concept was proposed at St. Joseph’s that would remove the lengthy paper record from the bedside and replace it with an eight minute trend of fetal heart rate and contraction strength displayed on a non-fade cathoderay-tube (CRT) display. Each bedside unit would also transmit contraction strength to the central processor on a fetal beat-to-beat basis for reconstruction. Since a general-purpose processor was chosen for the central station, data analysis can be easily altered to include new techniques as they are defined. Statistical and pattern analysis will be applied to develop treatment protocol prompts as well as the traditional catastrophe driven alarms. I t should be noted at this point that no data has been routinely recorded on paper. On request, time ’segments of labour/delivery will be recalled from disc, annotated Ivith prompts and nursing notes then sent to the C R T or hard-copy unit. In this manner, hours of data can be presented in a much more compact form that integrates medical data from the sensors as well as other sources such as nursing entries, laboratory data, etc. ‘The physician can now quickly review this data without scanning many metres of chart paper while the patient becomes increasingly tense over the bedside activities. In addition to this normal use bf the review station, the data may be recalled for a variety of uses, such as research and resident and continuing education for nurses and practising physicians. Complete labour epochs or selected segments can be retained on the disc for this purpose and become available both for data-base generation and review. Hard-copy of the data will be available via a video copier should a permanent record of a particular segment be desired.
Perinatal data system
137
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
Early implementation of this surveillance system centred around a new monitor with no recorder but a digital memory and non-fade display. Since that time, additional factors have dictated that the system must function with a variety of commonly used fetal monitors. This has led to a simple and inexpensive generalpurpose interface that now permits the use of most commercial units as well as the new units and has provided considerable expansion capability at bedside should additional signals be desired for digitization and input to the central processor.
2.4. Remote access data entry modules (RADEM) The RADEM concept was the result of a desire to conveniently enter certain data into the various subsystems of the Perinatal data system during the time that care is being administered as opposed to off-line entry after the fact. Data such as medications, laboratory results, cervical dilitation, ventilator settings, etc. are all necessary to modify treatment protocol and must appear as part of the patient’s online record in a timely manner to be useful. This is to be accomplished in labour/delivery as well as the nursery, by small hand-held or table-top units that provide simple numeric input with enhanced alphanumeric responses on an abbreviated display. Data thus entered is then immediately available at the central processor for annotation into the labour/delivery or nursery outputs and will also provide much of the data required to produce computer-generated summaries without the need for so much tedious physician completed paperwork. With the great flexibility afforded by the LSI-11 implementation, the RADEM concept can very easily be adapted and tailored for new tasks such as recall of a previous entry for comparison.
2 . 5 . Newborn surveillance system T h e Newborn surveillance system represents a logical extension of the Fetal surveillance system and will embrace many of the same basic concepts. Obviously, the amount of data to be collected in the nursery far exceeds that of labour/delivery, hence the hardware requirements will be more extensive. However, the same idea of identifying and collecting condensed episodic data as opposed to brute force data acquisition will apply. T h e RADEM discussed earlier will provide the bulk of data input along with the basic cardiopulmonary monitoring equipment. Initial investigation indicates an excellent chance that on-line multi-plexed EEG acquisition and other neurological tasks may be technically and economically feasible.
3. Comments Development and implementation of the Perinatal data system described herein has undergone almost daily change as the various effects of time, finances, personnel, and acceptance have come to bear upon it at each phase. T h e early decision to expand the data-base to a State-wide region had the favourable effect of accelerating the attainment of a statistically significant population, but had the negative effect of placing a much heavier demand on retrieval earlier than scheduled. This demand has been met to-date but with over 8000 records on file from half-a-dozen sources, we stand at the brink of an explosive utilization demand as system users are rapidly realizing the vastness of the raw data within the record system. Inquiries for new statistics and reports are limited only by the imagination. T h e proposed generalpurpose search routines are expected to accommodate most of these requests and produce a high degree of confidence in the overall system so as to increase user compliance in the area of data-sheet completion.
138
Perinatal data system
Inform Health Soc Care Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/31/14 For personal use only.
Completion of the Fetal surveillance system is now anticipated by midyear with the Newborn surveillance system implementation following. Man-machine interface techniques refined in the labour-delivery environment will be fully utilized in the nursery to collect and coherently assemble for retrieval the massive number of data items required for patient management. Continued system refinement from that point will be based on neonatal outcome as measured, by yet undefined criteria, against the data-base of the Central data system.
Acknowledgement This paper was presented at the Symposium on Medical Informatics (the First Annual Conference of the World Association for Medical Informatics), which was held in Toulouse, France, from 14 March to 17 March 1978.
