their patients. THERESA is therefore one of the few clinical systems that have successfully engaged clinicians in direct patient data entry. Grady also appears to have successfully solved the problem of ensuring system access. Although it has not installed expensive special fault-tolerant computer systems,12 for the last seven years a distributed network of standard supermini-computers has provided access to the system 99.95 percent of the time.

Health Evaluation Through Logical Processing

The Intermountain Health Care Corporation's Latter-Day Saints (LDS) Hospital provides another example of the CPR system of today.13 The LDS system, which has been under development for more than 25 years, is known as HELP (Health Evaluation through Logical Processing; Pryor et al., 1983). HELP's primary objective is to provide medical decision support, but it is also a computer-based patient record system. Much of the input to HELP comes directly from medical professionals entering data at terminals, but wherever possible HELP utilizes automated input of the patient's clinical data. Although LDS has conducted experiments using an automated patient history, currently only minimal history and physical examination data are contained in the HELP record. Consequently, at present, HELP maintains both a paper and a computer-based record for each patient.

Developers of HELP have consistently tried to focus on the use of patient data in making decisions about care rather than on merely the storage and communication of these data. To support its decision making goals, HELP contains more than 100,000 rules and statistical processes pertaining to a broad spectrum of health care; it uses these rules and processes to make decisions (including diagnoses)—just as a panel of experts might when presented with similar data. The system makes decisions in both a background monitoring mode and an interactive session with the health care

12  

Fault-tolerant computer systems have been developed by the computer industry to provide virtually uninterrupted service to users. To achieve such an objective, these systems offer a high degree of component redundancy in the hardware as well as sensors and special additional rerouting components. If embedded sensors detect that a crucial system component has failed, the system automatically switches to a redundant component to maintain continuous service. Although such systems are costly, they have in recent years become the mainstay for support of an organization's essential applications. Therefore, fault-tolerant computer systems are often of particular interest to CPR system vendors and developers.

13  

T. Allan Pryor of the University of Utah Department of Medical Informatics supplied the explanation and description of this system. Where possible, the information was checked for consistency with published articles in peer-reviewed journals.



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