HELP:
`A Dynamic
`Hospital
`Information
`System
`
`I
`
`Springer-Verlag
`
`FITBIT EXHIBIT 1016
`
`Page 1 of 6
`
`FITBIT EXHIBIT 1016
`
`

`
`Gilad J. Kuperman Reed M. Gardner
`T. Allan Pryor
`
`HELP: A Dynamic Hospital
`Information System
`
`With 110 Illustrations
`
`Springer-Verlag
`New York Berlin Heidelberg London Paris
`Tokyo Hong Kong Barcelona Budapest
`
`Page 2 of 6
`
`

`
`To Dr. Homer R. W
`
`Gilad J. Kuperman, M.D.
`National Library of Medicine Fellow in
`Medical Informatics
`LDS Hospital/University of Utah
`Salt Lake City, UT 84143, USA
`
`TI Allan Pryor
`Professor, Department of Medical
`Informatics
`University of Utah;
`Co-chairman, Department of Medical
`Informatics LDS Hospital;
`Salt Lake City, UT 84143, USA
`
`Reed M. Gardner, P1-1.1).
`Professor, Department of Medical
`Informatics
`University of Utah;
`Co-chairman, Department of Medical
`
`Informatics LDS Hospital;
`salt Lake clty’ UT 84143’ USA
`
`Series Editor:
`Helmuth F. Orthner
`Professor of Computer Medicine
`The George Washington University Medical Center
`Washington, DC 20037, USA
`
`Library of Congress Cataloging-imPublication Data
`Kuperman, Gilad J.
`HELP: A dynamic hospital information system/ Gilad J. Kuperman,
`Reed M. Gardner, T. Allan Pryor.
`p.
`cm. — (Computers and medicine)
`Includes bibliographical references.
`ISBN 0-387-97431-8 (alk. paper). — ISBN 3-540-97431-8 (alk.
`D3133?)
`2. Medical care—Data
`1. HELP (Information retrieval system)
`processing.
`3. Hospital care—Data processing.
`4. Hospitals-
`Administration-—Data processing.
`1. Gardner, Reed M.
`II. Pryor,
`T. Allan (Thomas Allan)
`III. Title.
`IV. Series: Computers and
`medicine (New York, N.Y.)
`2. Hospital
`[DNLM:
`1. Decision Making, Computers-Assisted.
`Information Systems.
`3. Medical Records. WX 26.5 K96h]
`R858.K86
`1991
`610’ .285 —dc2O
`DNLM/DLC
`for Library of Congress
`
`Printed on acid—free paper.
`
`© 1991 Springer-Verlag New York Inc.
`All rights reserved. This work may not be translated or copied in whole or in part without the written
`permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010,
`USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with
`any form of information storage and retrieval, electronic, adaptation, computer software, or by similar or
`dissimilar methodology now known or hereafter developed is forbidden.
`The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former
`are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks
`and Merchandise Act, may accordingly be used freely by anyone.
`While the advice and information in this book is believed to be true and accurate at the date of going to
`press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors
`or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the
`material contained herein.
`
`Typeset by Bytheway Typesetting Services, Norwich, NY.
`Printed and bound by Edwards Brothers, Inc., Ann Arbor, MI.
`Printed in the United States of America.
`
`9 8 7 6 5 4 3 2 1
`
`ISBN 0-387-97431-8 Springer-Verlag New York Berlin Heidelberg
`ISBN 3-540-97431-8 Springer-Verlag Berlin Heidelberg New York
`
`Page 3 of 6
`
`

`
`1. History of the HELP System
`
`The Cardiovascular Period: 1954 to 1967
`
`I
`
`in cardiovascular physiology at
`c
`. before coming to Utah.
`In
`using computers in medicine,
`o
`-
`« study the propagation of pulse
`powerful digital computers were
`through the liver, kidney, and
`-
`- n--- This work was successful
`
`published work of computers in
`
`" » Computers
`
`—« was an object of study in the
`an - « ‘ tion and new surgical tech-
`-n t of these diseases practicable.
`- _' on clinical grounds. There now
`- based purely on clinical findings
`~ -- on the catheterization results.
`- Dr. Alan F. Toronto and Dr.
`
`- 've diagnoses of the physicians
`‘-
`. was often incorrect when com-
`. These observations, along with
`-
`Lusted [2] who had theorized that
`-- by applying a statistical (Baye-
`- his colleagues to see how well the
`diagnoses based on clinical find-
`- patient findings and conditional
`- -« — that could account for the
`
`1 elihood. The program performed
`- --
`' y the actual diagnosis (based
`as likely was equal to, or better
`_..- who were asked to predict the
`The computer also generated a
`catheterizations became a rou-
`
`«
`
`computerized diagnostic methods
`-o- . However, the statistical tech-
`'
`ed important in the realm of
`
`Ira used and data entry was per-
`- . Programs were written in For-
`on punched cards as “memory.”
`
`..-- [0 LDS Hospital. Throughout this
`»
`». Hospital man be used.
`
`These punched cards were run through the card reader, which generated
`machine-executable code. The output was then generated and printed. Data
`entry required days to do what could be done in seconds on a modern
`personal computer. The IBM computer had a memory capacity of 8000 to
`12,000 bytes. Random access memory and disk drives became available
`only in the early 1960s. The first disk drive used in the laboratory was half
`the size of a home refrigerator and stored a grand total of 5 megabytes of
`data.
`
`1.1.3 1963: Digital Signal Processing
`
`Experiments in the catheterization laboratory produced a variety of physio-
`logical signals (blood pressures from the heart chambers and vessels, dye
`dilution curves, the ECG, and nerve potentials) from experimental animals.
`Drs. Homer R. Warner, W. Sanford Topham, and one of the authors
`(RMG)2 were interested in processing these signals to aid their understand-
`ing of physiological control systems. At first the signals were processed
`manually but the laboratory staff soon realized the computer could be used
`to acquire, process, and report the signals. The signals were being digitized
`by hand sampling and the results keypunched into the computer. When
`analog-to-digital converters became available, the signals could be automat-
`ically captured by the computer and converted into digital form for further
`processing and reporting. The first analog—digital converter (or ADC) filled
`a 6-foot high rack, cost $80,000, and had a (what was at the time thought
`to be very fast) sampling rate of 50,000 samples per second. A modern
`ADC with a sampling rate of more than 1 million samples per second can
`be purchased for $200 to $300. Much of the important early research in the
`field of physiological data acquisition and processing took place at LDS
`Hospital and contributed greatly to the field of what is now called patient
`monitoring. Patient monitoring has played an important role in medical
`care since the 19605 permitting, to a great extent, the advent of critical care
`medicine and intensive care units.
`In 1964, the computer hardware was changed from an IBM 1620 to a
`Control Data Corporation 3200 (CDC 3200) computer. The CDC 3200 had
`serial number 3! This machine had a stupendous amount of main mem-
`ory—32K bytes. Each clinical program was designed to run in a 2000-byte
`partition, tiny by today’s standards. A time-sharing system was developed
`
`2Dr. Reed M. Gardner first came to LDS Hospital during the winter of 1960 as a National
`Science Foundation research fellow in Electrical Engineering doing work on analog computer
`simulations. He returned to the Laboratory in the fall of 1962 as a graduate student in
`Electrical Engineering doing work on acquisition and analog—digital conversion of physiologi-
`cal signals. He received a Ph.D. in Biophysics and Bioengineering from the University of Utah
`in 1968.
`
`Page 4 of 6
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`Page 5 of 6
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`Page 5 of 6
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`
`l. History of the HELP System
`
`Expansion of the Database: 1967 to 1972
`
`simultaneously and would time
`‘c_‘
`
`.|
`
`yfics and Bioengineering was es-
`Unjversity of Utah. The depart-
`cu - 11 as the Department of Medi-
`- chairman and Drs. Topham and
`Students were first graduated in
`have received doctorates and
`
`from the department.
`
`Computerization
`
`- physiological signals (i.e.,
`'
`_', it was decided to try to obtain
`- heart catheterization. Drs. War-
`- Clinton Day were involved in the
`
`nu laboratory required develop-
`storage cathode-ray tubes (CRTs)
`CRTs write the information only
`constant refresh technology used
`custom-built and cost about
`- -- to permit physicians to operate
`
`erization data became part of
`. The system was more accurate
`rsults, and allowed physicians to
`minutes of finishing the case. At
`.- were caused by rheumatic fever
`the physiological data was crucial
`
`the computer could help them to
`the surgical process as well. The
`laboratory were extended to two
`- --
`intensive care unit for post-
`
`»
`
`at the Cardiovascular Laboratory. He
`Cape Canaveral, Florida programming a
`- ' --
`involved in the early space program.
`- a Ph.D. in Computer Science from the
`
`open-heart surgical patients. The computer installed in the open-heart unit
`used vacuum tube and analog computer technology since it was impractical
`to have huge digital devices in a clinical setting. Connecting the computers
`to the bedside monitors required special integrated circuits, switching cir-
`cuits, and digital multiplexors, all of which had to be custom-built.
`
`1.1.6 1967: Regional Medical Program Outreach
`
`In 1967 the Regional Medical Outreach Program granted LDS Hospital $2
`million to be used over 3 years to study the feasibility of using computers
`to communicate with geographically distant hospitals. The purpose of the
`program was to develop techniques for bringing state of the art medical
`techniques and medical knowledge to rural hospitals. The grant allowed-
`for expansion of the LDS Hospital computer system (this included an up-
`grade to a CDC 3300) and for the development of communications tech-
`niques. Four other hospitals were all equipped to be able to perform com-
`puterized intensive care unit (ICU) monitoring, electrocardiography (ECG),
`pulmonary function testing, and cardiac catheterization. Signals would be
`transmitted to the LDS Hospital computer system that would provide inter-
`pretation functions. Communications were via analog modems over tele-
`phone lines. With the help of AT&T, special analog modems were devel-
`oped that allowed the storage tube CRTs to be used remotely. Although
`the concepts and their operation were a success, problems such as noise on
`the communications lines and repeated failures of the devices pointed out
`the importance of reliability in a system’s routine clinical functioning.
`Computers and Biomedical Research was established in 1967, with Dr.
`Warner as editor, to provide a forum for researchers in computers and
`biomedicine. The journal continues to be one of the leading publications in
`medical informatics.
`
`1.2 Expansion of the Database: 1967 to 1972
`
`In 1965 the sequential multichannel chemistry analyzer became available.
`This system (the Technicon SMA-12) could analyze 12 chemical values
`from a single serum sample. John D. Morgan was assigned to interface the
`SMA-12 to the computer system so that laboratory data could be reviewed
`in the catheterization laboratory and ICUs along with the hemodynamic
`data. The benefits of having many forms of clinical data available concur-
`rently quickly became evident and projects that captured other types of
`patient data were soon begun.
`Drs. Warner, Gardner, and Pryor determined that the best way to store
`and retrieve clinical information required some kind of medical terminol-
`ogy coding scheme. Work began on the coding scheme known as pointer-
`to-text, or PTXT (pronounced “P-text”). This scheme is still used and is
`
`Page 6 of 6