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System advantages

The public health or home care nurse can keep the hospital, health department, or heart center aware of the patient's condition.

The increasing costs of medical service, the considerations raised by regional medical programs on heart, cancer, and stroke, make the role of computer systems even more essential in large hospitals, and in programs involving cooperative arrangements in a group of hospitals. It is also a practical way of coordinating outpatient services, nursing homes, and home care with medical centers.

Computer analysis of medical signals will reduce the cost of individual patient care, while at the same time increasing the number of patients who can be seen and effectively treated. If emergency situations dictate, interpretations can be made rapidly and continuously.

Computer analysis will speed the physician's diagnostic procedures to shorten hospital time and to alleviate crowded conditions.

The Medical Systems Development Laboratory of the U.S. Public Health Service has processed over 15,000 electrocardiograms for a National Institute of Health-sponsored study across the seas in Israel. Computer analysis is being used in a spirometry study in Ohio and another in Wisconsin. There is routine use of telephone and teletype transmission of EKG's from several Washington clinics.

Within a few short years, large populations of the United States can obtain electrocardiograms through computer analysis, making possible early detection and aiding in the prevention of heart disease, our major cause of death.

Discussing our Nation's urgent medical needs, and the effect of computer systems in medical practice and in research, the Public Health Service's Surgeon General has said:

However much we may do to build schools and train more physicians, there is an immediate urgency to use the available human resources in medicine to the highest degree for which they have been trained. The physician should delegate as many of his duties as possible and reserve his time for the exercise of his highest professional skills.

Computers and telemetry help him achieve that goal.
Thank you very much.
Mr. CALLAHAN. Thank you, Dr. Caceres.

Would you now transmit to us by teletypewriter a sample of the report that you would send back to a hospital after a computer analysis and interpretation?

Dr. CACERES. Fíne. It should begin to arrive now.

Mr. CALLAHAN. In the meantime, we have distributed to the committee copies of the reports which you sent yesterday.

Mr. Chairman, the Telelecture Service is two ways, so that using the microphone before you, if you care to ask questions of Dr. Caceres, it is as if he were in the room before us.

Senator NELSON. Thank you.

Dr. Caceres, this is Senator Nelson. Also with us is Senator Hatfield of Oregon.

Do I understand you are going to transmit an electrocardiogram-
Mr. CALLAHAN. Yes.

Senator NELSON (continuing). Which is going to come out on this teletypewriter here in this room

Mr. CALLAHAN. The teletypewriter is now answering the call, just as if it were located in the hospital. Then we will receive a copy of the analysis and interpretation, just as it would be received in a hospital.

(The illustration follows; printout appears on facing page.)

[graphic]

Senator NELSON. How is the information put in the transmitter at your end, Dr. Caceres, so you can put it in the teletypewriter?

Dr. CACERES. After the computer has performed the analysis, it puts out a punched paper tape that is used as the input to a teletype. It could be done electronically, by passing the punch paper tape. That will be done in the future.

Mr. CALLAHAN. Dr. Caceres, this is Mr. Callahan. Senator Nelson and Senator Hatfield were over at the teletypewriter and watched the printout come through. Do you have any additional comment you would like to make now?

Dr. CACERES. Only that we would like to have this sort of service made available as soon as possible, to hospitals, clinics, and physicians, so it can help them improve the quality of patient care. Senator NELSON. I could

not hear all of your original statement, so this may be repetitious. As I understand it, a physician with the proper equipment can transmit an electrocardiogram by telephone into some center?

Dr. CACERES. Yes.

Senator NELSON. And then the analysis of that electrocardiogram would be done by machine, interpreted by a cardiologist, and then sent back to the doctor in the same fashion that you have just sent it into this hearing room; is that right?

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Dr. CACERES. With one exception; the analysis is all done by machine. The patient is at the recording end, the computer receives the data from the patient, and the answer goes back to the physician requesting it without ever having gone through a cardiologists analysis. The physician cardiologist caring for the patient checks it before applying the results but is relieved of routine, repetitive procedures.

Senator NELSON. Is the receiving physician a cardiologist?

Dr. CACERES. The receiving physician need not be a cardiologist. For physicians who are not cardiologists, we are preparing a short program. At the end of the report you see, the computer will give him a statement to the effect that “this electrocardiogram is abnormal, further consultation is suggested," or that the tracing is normal. These statements would indicate to the physician whether he should get a cardiologist.

In other words, we are developing programs that will be suitable for different types of practitioners. We are aware that certain types of practitioners, because of their practices, should not be expert cardiologists but should be expert in their own field. So we will have phraseology for them to let them take advantage of this system.

Senator NELSON. So if the sending physician is a cardiologist and he has this patient there, he gets this mechanical interpretation back.

Dr. CACERES. Yes.

Senator NELSON. Then he reads this mechanical analysis and makes his interpretation; is that correct?

Dr. CACERES. That is correct.

Senator NELSON. What is the benefit to the cardiologist of following this system rather than simply looking at the electrocardiogram tape as it comes off the machine?

Dr. CACERES. At the present time, there are insufficient cardiologists to read the growing number of necessary electrocardiograms. Several hospitals in large centers find it impossible to obtain the services of cardiologists for routine reading of electrocardiograms. In the Hartford Hospital, for example, physicians have studied their speed in reading electrocardiograms with and without computer help. They found that the computer multiplies the quantity of work they do five times, which means that in reading electrocardiograms one cardiologist can do the work of five. Access to the computer system effectively multiplies the professional manpower resources available. What we envision would be the cardiologist in his heart center reading a great number of tracings, say five times more than he ordinarily would, and with greater precision.

In many other areas we are concerned with the problem of periodic examinations of people who must have electrocardiograms for such things as insurance examinations. These come to the cardiologist. It would be useful in these centers to have this type of work prescreened by a machine system.

One of the problems in the delivery of health systems to heart patients throughout the country is that there are an insufficient number of qualified readers of electrocardiograms. We need to train many more or to provide machine assistance. The latter is the easiest solution.

Senator NELSON. I understand you to say that a cardiologist using this computer system could, in fact, do the work of five other cardiologists daily?

Dr. CACERES. That is true. Those were the results of a study done in Hartford Hospital.

Senator NELSON. Thank you, Doctor.
Did you have any questions, Senator Hatfield ?
Senator HATFIELD. No.

Mr. CALLAHAN. Thank you, Dr. Caceres. We appreciate your assistance today very much.

Dr. CACERES. Thank you.

Senator NELSON. Thank you, Dr. Caceres. The committee appreciates very much the contribution of

Mr. CALLAHAN. A somewhat different use will be made of telephonic transmission of EKG's at Salem Memorial Hospital, in Salem, Oreg. Used in conjunction with physiological monitoring in the intensivecare section of the hospital, it will enable the hospital to present cardiographic data to a heart specialist at any time of the day or night. The time saved when an emergency strikes during periods when a cardiologist is not on duty can make the difference between life and death. The Salem Memorial Hospital system of EKG transmission is not for diagnostic use, as we have been discussing so far today, but rather

your time.

for determining the lifesaving steps that should be taken in an emergency that occurs, let us say, in the middle of the night.

Immediate indication of a patient's condition is highly important. If the doctor is at his home or office, precious time may be lost while he is driving to the hospital to prescribe the proper treatment. With the system as Salem Memorial is going to use it, when a patient's heart function either exceeds or falls below predetermined limits, an alarm system notifies the nurse. The nurse will call the doctor whose cardiac patient is experiencing difficulty, give oral details of the patient's condition, and then transmit the patient's EKG via a Data-Phone arrangement.

With this information, the doctor is able to determine what steps need to be taken immediately in treating the patient before he leaves for the hospital.

We do not have anyone from Salem Memorial Hospital to participate here today, but Dr. Meyer has indicated that if you have any questions about the application of this kind of a system, he would be glad to discuss them with you.

Senator HATFIELD. I would like to comment that this has created a great deal of excitement out in my hometown. This hospital to which you refer has not only been pioneering in this field, but I think is the first in our State, at least, to offer full helicopter ambulance service, with a heliport on top of the hospital.

When I was talking to Mr. Sukalak at Salem Memorial Hospital last time I was home, he indicated to me there was work well along on the heartline system about the development of a fully portable system, usable wherever telephone service would be available. Could you

tell me a little bit about how far along this particular development is?

Mr. CALLAHAN. Yes, sir. What he was referring to, of course, was a portable data-receiving set. The set which we have been demonstrating here is one which is used for the transmission and sending. Work is being undertaken now to look at adapting the EKG DataPhone receiving set for portable use. I cannot give you any indication at this time as to just exactly how far along that work has proceeded. or what the possible availability might be.

Senator HATFIELD. He also mentoned about the possibility of using the Data-Phone service to eliminate inventory or vastly reduce inventory problems as a service to hospitals. Would you care to comment on that, please?

Mr. CALLAHAN. I am not sure, Senator, I understand what he has in mind.

Senator HATFIELD. Well, areas of labor saving that would be involved would be as it relates to the operation of hospital delays and back-order delays due to mistakes, eliminates the need for extensive warehouse services, and things of this type.

Mr. CALLAHAN. Oh, yes. He was referring to administrative applications of data transmission. For instance, in the ordering of supplies, there are a number of systems in operation around the United States now wherein the hospital supply company has installed Data-Phone service so that the hospitals which they service can send their orders directly and be received on a business machine for prompt processing. By doing it in this way, they eliminate the always-present danger of error being inserted by human beings copying and recopying ma

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