Computers: New Dimension in
Patient Care
By WALTER S. ROSS
The doors of the
intensive-care unit (ICU) at the University of Alabama Hospital in Birmingham
swing wide and a new patient—male, 42—is rushed in. He has just spent 67 minutes “on the pump” (heart-lung machine)
while surgeons replaced a section of damaged coronary artery.
In a kind of controlled
frenzy, eight doctors, nurses and technicians join in a flashing ballet of
arms, reaching across one another in a seemingly aimless tangle, attaching electrical
leads, placing tubes and bottles, pushing buttons. In five minutes, the patient is hooked up to instruments that
will monitor, second by second, four vital blood pressures via catheters placed
inside his heart and arteries during surgery.
Tubes from his chest lead to a bottle on an automatic scale that weighs
blood drainage; a similar device measure urine output.
All these data are fed into
a computer that has been programmed to continuously monitor and compare key
factors in the patient’s condition, and measure them against a program of
symptoms selected by the surgeon. To do
this, it must make 50 to 100 complex computations every 120 seconds. The results are displayed on a television
screen. A nurse or doctor can “ask the
machine by means of buttons below the screen how the patient is doing, and get
a visual report of any of his vital signs, calculated at five-minute of
half-hour intervals since he entered the ICU.
The computer, however, does
much more than merely monitors the patient’s condition. It can recommend treatment and even actually
treat the patient. If he isn’t putting
out enough urine, the screen signals, “Give a dose of 15-percent mannitol.” And when detects an internal blood loss, a
pump infuses precisely measured amounts into a vein. This infusion is repeated every two minutes whenever is
necessary. Should the machine’s supply
he used up, it flashes: “need more blood.”
Since the system was
started, in 1966, it has been used for about 14,000 open-heart-surgery
patients. Dr. john W. Kirklin, the
surgical chief who created the computer programs our of his experiences at that
time with some 8000 open-heart operations, estimates that the computer has
helped to save the lives of countless critically ill patients. It can do this because it monitors every
sign that the surgeon orders, forgets nothing, never get tired and makes no
mistakes.
The computerized ‘nurse” was
developed to meet a specific need.
University Hospital serfes as the open-heart-surgery referral center for
the Southeast states, a region with a perennial shortage of skilled nurses and
technicians. To meet the rising demand
for open-heart operation, the hospital would have needed additional personnel
and intensive-care spares that were simply not available.
The computer had relieved
the problem. With a new ICU, the
hospital has increased its heart operations from 150 a year to over 1800. Under manual care, patients spend three to
five days recovering from surgery. With
the computer’s help, the average adult open-heart patient usually is out of
intensive care in 16 to 24 hours.
“Before we had the
computer,” says nurse Sharon Shaw, “we would barely finish one set of exams
before having to start the next. There
was no time to talk to frightened and disoriented patients coming out of
surgery. Now we can claim and measure
them; it helps them get better so much faster.”
Of course, nurses watch the
computer’s TV screen constantly, for there are, deliberately, no warning bells
of lights. If anything happens to the
computer, nurses must be alert to take over, even though it has a 99 percent
success rate. And while computerized
ICU care costs perhaps $40 extra per day per patient, it eliminates about two
days of intensive care—than saving about $450 per patient.
Computers have thus far
moved slowly into medicine, braked by the profession’s conservatism, by a fear
of malpractice wits that might result from handling over life-and-death
decisions to machinery and, perhaps, by some resentment toward an automated
challenge to doctors’ expertise. But
the climate is changing as computers prove just how helpful they can be.
For example, computers are
now used routinely to select from among perhaps 20,000 different patterns of
radiation treatment the handful likely to produce the best results for a
particular patient, an almost impossibly tedious task for a human. They can “read” electrocardiograms
(EKGs)—ordinarily a time consuming job—in only a minute to determine whether
they are normal or not. Since about 40
million EKGs had to be read in 1973 alone, the potential time saving is
enormous.
Some computer programs are
phenomenally accurate. A heart program
developed by IBM was tested on 1435 EKGs, 1008 of which were abnormal. The computer was correct 97 percent of the
time in classifying cases as normal of abnormal, and it analyzed with great
precision the reasons for the abnormalities.
Another computer, at the University of Missouri Medical Center, has been
programmed to scan X rays and diagnose rheumatic heart disease. In one test, the machine was matched against
a team of ten radiologists. The
computer was 73-percent accurate against the radiologists’ combined score of 62
percent.
Theoretically at least,
there is no limit to the number and complexity of problems a computer can
handle. For example, a group of
pediatric specialists has programmed a computer to assist in diagnosing more
than 3000 significant childhood alignments.
The idea is not to replace the doctor, but to jog his memory, reassure
him that he hasn’t overlooked anything and, if necessary, furnish him with
leads to information about disease that he may never have seen or studied.
Any physician can consult
the computer by dialing the hospital neatest him that has a
teletypewriter. The program can be
particularly useful to isolated doctors and hospitals without access to expert
consultants.
Computers are providing to
be the means to meet another growing public demand: that medicine prevent, not
merely cure, disease. People are
beginning to see health as a basic right, like education. This means regular physical checkups for
every man, woman and child. Yet there
simply aren’t enough doctors or nurses to accomplish this. The answer?
Computers, linked to automated, foolproof testing equipment. There are already hundreds of major
Automated Multiphase (handling a verity of different examinations) Health
Testing Units at work in this country, giving complete physical exams in one to
two hours.
I visited three clinics
where the units are in use. At one, in
Philadelphia, the physical begins with a typist checking you into the computer
with such basic information as name, address, sex and age. Then the machine takes over. I put or earphones and listened to a man’s
voice asking me tape-recorded questions about my heath (the tapes are available
in foreign languages, too), and then pressed one of several buttons: a yellow
for “Don’t Know Answer: beige, “Sometimes”; red “No”; green, “Yes”; a pure
white for “Don’t Understand Question”; a blue for “Repeat Last Question”; and
an orange for “Next Question Phase.”
At the French-polyclinic
health Evolution Center in New York, similar queries are flashed on a
television screen. This system employs
“branching logic.” If the machine asks
if you get headaches, and you punch “no,” it will skip more headache questions
and to on to others—usually about 250 in all.
Most doctors do not have time to take an oral history as complete as
this. And patients like the system—the
machine does not hurry them and they can take time to think, or revise their
answers.
After your history is taken,
you move on to the actual examination.
In the nearing test, for instance, you are put on earphones, press a
button when you hear a sound and release the button when you stop hearing it. The results are recorded by the computer and
stored in its memory. Blood pressure
and EKG are taken automatically.
Technicians take blood samples and send them to an automated laboratory,
where machines can check as many as 20 different body chemistries on as many as
300 samples per hour—at a cost of about one-quarter that of manual
analysis. When all the tests, including
X rays, are completed and the computer has digested the results, it prints out
a chart with your abnormalities flagged for a physician.
At IBM, where to date
185,000 employees have received such voluntary health examinations, Dr. John C.
Duffy, medical director, says, ‘in about a third of the cases we discover some
medical condition previously unknown to employee.” Some two and half percent of all examinations detect conditions
that are really serious: diabetes and silent heart attacks are the most
frequent.
One man had a normal
printout from his first checkup in 1969, when he had just turned 40. Four years later, although he felt fine, his
second exam reveled serious heart abnormalities. Cardiologist verified the computer analysis, and the employee was
told to see his own doctor. He
underwent open-heart surgery to replace a damaged aortal valve and clean out
blocked arteries, and is now backing at work.
The staff doctor believes that if the checkup hadn’t uncovered his heart
condition, the man would not be alive today.
Employees’ health records
remain in the computers’ memory bank for instant printout and comparison with
subsequent examinations, so that trends can me spotted. This may become the most important part of
the service. As Gerald Hillman, manager
of the IBM medical-system department, says, “Many doctors now believe that each
of us is programmed to get some disease.
It’s like and intercontinental ballistic missile—if you can spot the
trajectory, you may be able to shoot it down before it his the target.”
