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 Daggett’s 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,

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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 stuck into the notes to give clear, detailed records of the pa- tient’s visits (Table). A GP letter is similar- ly generated.

(7) Where installed: The system is install- ed at St James’ Hospital, Sarsfeld Road, London SW12.

(8) Contact: The system may be seen up and running at the above hospital. Con- tact Dr N W Oakley (tel 01-672 1222 ex- tension 207).

(f) Wakefield General Hospital Diabetic Computer System (I) System facilities: (i) Patient manage- ment; (ii) Clinic management.

(2) Hardware required: Any micro- computer accepting dBase 11.

(3) Software required: Standard commer- cial dBase I1 (standard file management

(log portions) g B M M L T S BTn/yTO 3::O: 5:O:S:: 0:: 2:: 750

package using CP/M operating system - configured by user).

(4) Dpe of input: Data collected on forms, data entry by secretary - batch processing.

(5) Zjpe of output: Print-out.

(6) Notes: The system aims to collect limited data on a large number of patients.

(7) Where installed: The system is install- ed at Pinderfield General Hospital, Aber- ford Road, Pinderfields, West Yorks, WFl 4DG

(8) Contact: The system may be viewed up and running at Pinderfields General Hospital. Contact Dr W Burr (tel 0924 375217).

(g) Whiffingfon Hospital Diabetic Unit Computer System (I) System facilities: (i) Patient record system; (ii) Patient management system. (2) Hardware required: Fortune 32:16XP computer with 512K RAM, 76K floppy discs and 30M hard disc. Terminals (1-5 at €997 each). Printer x 2. Total cost €10,000 (minimal system) rising to €15,000 (multi-user 5 terminals). These prices are said to include software.

(3) Software required: Special software provided by London New Technology network.

(4) Dpe of input: Data collected on forms by doctors and clerks in clinic and entered by a secretary via a VDU.

(5) Dpe of output: Print-out.

(6) Note: This system is not yet up and running. It is under development. Even- tually the aim is to create a district-wide register, augmenting it from GP registers and prescription returns. A risk register function is being developed to create a risk

bedtime: -

Table. Clinic summary visit print-out (example)

SUMMARY OF CLINIC VISIT OF: J1234 OAKLEY NICE1 Diabetic Clinic A

Date Time

5/5/85 825 kg 0 9.00 hrs

-1 none CHO Distributions: suppertime:- I none

I

Other drugs: Navidrex K l/d, Orovite I/d.

24 hr clock) Blood 11.30 hrs

Investigations requested

checked:- 2/5/85 BP checked:- 2/5/85

General notes: Completely well

The mean blood glucose from the last 69 visit(s) is 9.8 mmol/l. The weight range for this patient i s from 55.6 kg to 888 kg. Next visit to clinic A by transport on 26/5/86 Nigel Oakley

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status for each patient, which will then generate prompts to patient, GP and hospital clinic doctor that certain systems reviews need to be done. (7) & (8) Where installed/Contact: Further details from Dr B Hurwitz, the Diabetic Unit, Whittington Hospital, London N19 (tel 01-272 3030 extension 4218/9).

(h) Middlesex Hospital Diabetic System (1) System facilities: (i) Patient manage- ment; (ii) Clinic management; (iii) Statistical and graphical data analysing. (2) Hardware required: IBM PC.XT. (3) Software required: IBM Text Pack IV (no graphs, text and time-related (numerical) data). Database 3, Symphony. Improved version - Database 3 with Com- mand Programme written by Spartex, word processor (Wordstar). Data Analysis - Lotus 1 -2 -3. RAM required: 512K. Disc required: 10 M.bytes. (4) l jpe of input: Filed from a report form. (5) l jpe of output: Files, reports, graphs, etc. (6) Notes: More information is required on this system. (7) Where installed: System is installed at the Middlesex Hospital. (8) Contact: For more information, please contact Dr A B Kurtz PhD FRCP, The Middlesex Hospital, Mortimer Street, London, WIN 8AA (tel 01-636 8333 ex- tension 7443).

(i) Metasa Diabetic System (1) System facilities: (i) Patient record; (ii) Clinical management; (iii) Enquiry and reporting system, research; (iv) Letters - word processing; (v) System utilities. (2) Hardware requirements: IBM PC/XT and various look-alikes- Ericson, Apricot, Comart Communicator, DEC Rainbow, Altos, Xerox, Honeywell, etc. RAM: 256K, Hard Disc: 10 M.byte. Operates under CP/M, concurrent CP/M, and MP/M. (3) Software requirements: A complete up and running system is supplied by Metasa Ltd, 61 Wimbledon Hill Road, Wimbledon, SW19 7QP. (4) l jpe of input: Direct data entry or batch.

Diabetes & the computer, part 2. Micros

(5) l jpe of output: Interaction via VDU or hard copy (print-out). (6) Notes: Designed to be used by the prac- tising clinician in his own way. The system is form-based and compatible with hospital case notes. In its standard form, Metabase can accommodate in the order of 30,000 patient records, with up to 50 different A4 forms per patient, and is able to handle 3-dimensional data. The system is password protected in order to respect patient confidentiality and eliminate the risk of unauthorised use. Single-user system and multi-user systems (5 ter- minals) available, total system prices in- cluding both hardware and software, rang- ing from f5,000-E18,000. The system is configured by Metasa Limited. They will provide a complete system ready, up and running, or will configure and alter the system according to the user’s needs. (7) Where installed: One system installed (see 8 below). (8) Contact: System may be seen up and running. Contact Dr R D Hill, 20 Martello Road, Poole, Dorset (tel 0202 708917). (j) Micro-Based System for Learn- ing and Assessment

This system uses a simple cheap micro (the Sinclair Spectrum Plus) and software produced at Charing Cross Hospital by Dr Peter Wise and his team. The software is published by Martin Dunitz, 154 Camden High Street, London, NWl ONE (tel 01-482 2202). The cost of the hardware re- quired is in the region of f1504200, and the software (cassette) in the region of f10.

The system utilizes animated colour graphics, with interposed ques- tions/answers, the patient interacting directly with the computer through the use of 9 keys. The programmes last between 30 and 40 minutes. One programme is for teaching non-insulin-dependent diabetics and another programme for insulin- dependent diabetics.

An interactive questionnaire pro- gramme has also been written. The answers to questions are keyed in by the patient, or a questionnaire can be com- pleted by the patient and read on an op- tical mark reader. A prescriptive feed-back is automatically generated by the com- puter, providing a correction of knowledge defects and giving an indication of the pa- tient’s level of knowledge in specified areas.

Details may be obtained from Dr P H

Wise MB PhD FRCP FRACP, Consultant Physician, Charing Cross Hospital (Fulham), Fulham Palace Road, London, W6 8RF (tel01-748 2040 extension 2394).

(k) Other Micro Systems Under Development (1) One-User Yersion of the Clinical Data Systems Diabetic System: DEC profes- sional micro (not expandable). ? capable of net working. Software a subset of Clinical Data System version 3, expandi- ble Cost approximately €12,500. A similar micro LSI system for small units with data storage of 1/2 megabyte, Clinical Com- puting Limited software. Approximately f 12,500. Hardware and software expandi- ble. Software a limited subset of CDS. Contact Dave Allen, Clinical Computing, 41 King Street, Belper, Derbyshire, DE5 1PX (tel 0773 320955).

(2) DLB Systems (Diabetic): This system is not, as yet, up and working in a diabetic clinic but is promising. Qpe of computer used - Micro, Apricot XI or similar instru- ment. Cost €2,000-3,000. Can be expand- ed to multi-user (€8,000 upwards). Addi- tional terminals €300-800, printer €300-f1,500 depending on quality. Soft- ware f2,000 upwards by DLB Systems Limited.

The system provides a patient record system with initial patient record, follow- up patient record and cumulative time- related data record. It provides listings, outpatient appointments, and an enquiry and reporting system. The system is very friendly and uses simple English for in- terrogation. Data may be collected on forms completed in the clinic by doctors, clerks, or secretaries. Similarly, data may be entered directly via a VDU.

DLB produce a tailor made system for each doctor or clinic. The expandible nature of the database allows the addition of new fields in existing records and the addition of new records in existing files. The system can therefore grow with the doctors’ requirements, with small begin- nings expanding out indefinitely.

Basically, DLB Systems Limited pro- duce a “handholding” service and con- sultancy for doctors. The system has yet to be tried in the field but looks very promising.

Back copies of Practical Diabetes Back copies of Practical Diabetes are available to NHS health professionals at €1 each.

Send your order and cheque/money order to the publishers: Asgard Publishing Co Ltd,

Foxcombe House, South Harting,

Petersfield, Hants, CU31 5PL

292 Practical DIABETES NovlDec 1986 Vol 3 No 6