Diabetes and the computer: Part 2 Centres using micro-computers in the field of diabetes care

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  • Report of the working party of the British Diabetic Association set up to look into com- puting systems used by doctors caring for diabetics in the UK

    Diabetes and the computer: Part 2 Centres using micro-computers in the field of R D Hill FRCP Consultant Physician Poole General Hospital, Longfleet Road, Dorset, BH15 2JB

    diabetes care

    (a) Staffordshire General Infirm- ary Diabetic Micro-Computer (1) System facilities: (i) Patient record system; (ii) Patient management system; (iii) Research.

    (2) Hardware required: Computer Apple 2E, cost approximately f1,200, hard disc cost approximately f1,500, printer, DMP Apple printer, cost approximately f620, no maintenance contract available. Cost of repairs approximately f80 per annum.

    (3) Software required: Standard commer- cial database management formated by Dr. Daggett. Cost approximately f140, no maintenance available.

    (4) Zjpe of input: Batch processing, data collected in clinics entered into computer remote from clinic by Dr Daggett and secretaries.

    (5) Zjpe of output: Print-out.

    (6) Notes: This system was purchased primarily for monitoring the diabetic clinic but it is also used for thyroid follow up and other metabolic disorders. It is kept in Dr Daggetts office away from the clinic area. New records are entered by Dr Daggett but the updates are entered by secretaries. At present the database can- not be interfaced with word processing packages. However, the system is being modified to allow the printing of labels. It will then be possible to correspond directly with patients using the database as the basis. The system will allow recall of patients for review and ophthalmic assessment, and general access to patients who have been discharged to mini clinics.

    (7) Where installed: The system is install- ed in Staffordshire General Infirmary, Stafford.

    (8) Contact: The system may be seen up and running in the Department of Medicine, Staffordshire General Infirm- ary, Stafford, ST16 2PA (Dr Peter Dag- gett, tel 0785 58251).

    (b) Oxford Paediafric Diabetes Micro-Computing System (1) System facilities: (i) Patient record system; (ii) Research; (iii) Word process- ing; (iv) Statistics.

    (2) Hardware required: IBM XT with 360K floppy discs and 10M hard disc,


    RAM upgraded to 256K, cost approx- imately f4,445, no maintenance contract. Epson FX-80 printer, cost approximately f425. Note. This equipment can now be obtain- ed much more cheaply by shopping around.

    (3) Software required: Compsoft DMS text database, cost approximately f400. Also software supplied by Ames Division, Miles Laboratories Inc, for use in conjunc- tion with the Memory Glucometer (Ames Diabetes Patient Management System).

    (4) Zjpe of input: Data collected on forms, input remote from clinic, single-user.

    (5) Zjpe of output: Print-out

    (6) Notes: This system is basically for use with the Ames Patient Data Management System. However, there is a wide range of software, including word processing and data management available for IBM systems and IBM look-alikes. The system has therefore been used for storing infor- mation about children attending the Paediatric Diabetes Clinic in Oxford, par- ticularly with reference to current research projects. It is used to store demographic data on patients.

    There is only an initial patient record. Follow-up records and cumulative time- related data have not been stored. The system does not assist in clinic manage- ment. The statistics package has been pro- duced locally and is not generally available. It is possible to link the IBM micro to a main frame.

    (7) Where installed. System installed at the University Department of Paediatrics, John Radcliffe Hospital, Headington, Ox- ford, OX3 9DL

    (8) Contact: System may be seen up and running. Contact Dr I Jefferson, address as above (tel 0865 817432).

    (c) Diabeta (1) System facilities: (i) Patient record system; (ii) Patient management system; (iii) Research. The patient records system consists of an initial patient record con- taining 200 variables. The follow-up record contains 20 variables and in addi- tion time-related data. The diabetic clinic management system allows listings as

    required. Enquiry and reporting systems enable those at risk or for review to be listed. There is a full enquiry, reporting and statistical system for research pur- poses. A patient report summary for in- itial visit and GP letter generation for follow-up visits is available.

    (2) Hardware required: Computer - Spec- trum, manufactured by Micro Apple with 1536K RAM, tape cartridge 17M and hard disc 36M. A very basic package, ie the minimal system would cost f6,000 com- pared with a multi-user 5-terminal system costing f16,000. Each terminal may cost from f400-E1,400 and a printer f1,500. Maintenance is at 15% of capital cost by manufacturer although at St Thomas Hospital maintenance of both hardware and software is done on site.

    (3) Software required: The basic package - APL programmes covering data entry, storage, indexing, retrieval, and reporting summaries - is included in the total cost above. The main software package was written within the department at St Thomas Hospital.

    (4) Zjpe of input: Forms completed in clinic by doctor or by a fully interactive direct data entry via VDU by doctor in clinic, clerks, secretaries and nurses.

    (5) Zjpe of output: Fully interactive data entry and retrieval by doctor at VDU in clinic. Print-out.

    (6) Notes: This is a very ambitious and complex system. It provides more facilities and more detail than any other micro system available. It provides a patient report summary for the initial visit and generates GP letters for follow-up visits. These have been shown to be acceptable from the GP point of view. There is no limit to the questions which may be ask- ed in simple English in the enquiry system. It is intended to expand the system to in- clude clinic appointments and an expert system rule base to improve patient care and screening and provide GPs with guide lines for patient management. If this system were to be transplanted to other hospitals, would the department at St. Thomas Hospital be prepared to service their software and act as a trouble shooting centre?

    (7) Where installed: The system has only been installed in St. Thomas Hospital.

    Practical DIABETES NovIDec 1986 Vol 3 No 6

  • TteuiQw- Diabetes & the computer, part 2. Micros

    Blood Diet glucose details 75 750g CHO mmol/l

    (8) Contact: The system may be seen up and running in the Department of Medicine, St Thomas Hospital, London, SE1 7EH (Contact Sebastian Till, tel 01-928 9292 extension 2415).

    (d) Ealing Hospital Diabetic Micro- Computer System (I) System facilities: (i) Patient record system; (ii) Research.

    (2) Hardware required: Apple 2E with 130K floppy disc and 10M hard disc. Printer. Total cost approximately 4,000.

    (3) Software required: DBASE 11. 300. No maintenance or back-up facilities.

    (4) Dpe of input: Single-user, batch pro- cessing only.

    (5) O p e of output: Print-out.

    (6) Notes: This system provides an initial patient record system storing 60 variables. There is as yet no follow-up record. No cumulative time-related data is recorded. The output provides listings, and the en- quiry and reporting system is capable of listing those patients at risk or who require review. The system has a full enquiry, reporting and statistics capability. The system may be configured by the user to his own needs. Data is collected on forms by diabetic liaison sister and the data is entered into the computer in batches by secretary. This system is used simply to provide a card index type record of pa- tients and to provide suitable documen- tation for research purposes. It is intend- ed to update all data at intervals (?3 years).

    (7) Where installed: System installed at the diabetic clinic, Ealing Hospital, Southall, Middlesex.

    (8) Contact: The system may be seen up and running at the above hospital, con- tact Dr H M Mather MD MRCP (tel

    (e) St lames Hospital Diabetic Computer System (1) System facilities: (i) Patient record system, including an initial record (80 items), a follow-up record (30 items), mean clinic blood glucose and weight range (maximum and minimum); (ii) Diabetic clinic management, including listings, outpatient appointments, and an enquiry and reporting system for those at risk or review; (iii) Research enquiry and reporting and statistics (not yet used).

    (2) Hardware required: BBC Micro Torch 280 (2 x 5$ floppy disc drives), Epson RX80/FT printer, green screen monitor, total cost approximately f1,500. At pre- sent, a single interactive terminal is in use but software has now been written for multiple-user operation. The cost of the system for 3 terminals, 21 Mbyte Win- chester storage and 3 printers will be

    Practical DIABETES Nov/Dec 1986 Vol 3 No 6

    01-574 2444).

    Treatment prescribed morning:- glib 5 mg lunchtime:-

    5,500 (inclusive of TORCHNET linear bus networking and VAT).

    (3) Software required: dBASE I1 (Ashton Tate) commercial files, configured by Dr Oakley. Basic cost 300-f400. Configured version (DATA RUN) shortly available for 100.

    (4) Tjpe of input: Data collected by doc- tor in clinics, clerks, secretaries and medical students. On line data entry in clinic (only 1 VDU at present). On or off line data entry of history and examination findings. Batch processing and appoint- ments management by secretary.

    (5) Dpe of output: On line in clinic or print-out (see notes below).

    (6) Notes: If a statistical package is to be used, more storage (Winchester disc) will be required. Print-out includes a clinic summary visit printed on self-adhesive labels, which can be st