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Mr. Chairman, I wonder if you would care to be interviewed for allergy symptons?
Senator NELSON. We tried it for 5 minutes yesterday to be sure I was smart enough to operate it.
Mr. CALLAHAN. OK.
Mr. Murray, is the computer ready to talk with our patient?
Mr. MURRAY. In just a few seconds.
Mr. CALLAHAN. Just to remind you again, Mr. Chairman, in order to respond with a yes to the computer, you simply strike the No. 1 key. To respond no, strike No. 2. If you do not know the answer to the question presented, strike No. 3. If you do not understand the question, strike No. 4.
I will turn it over to you, Mr. Murray.
Senator NELSON. The teletypewriter has given me some instructions. It has just typed out, "The demonstration you are about to see will show how a physician can use a computer to assist him in the gathering of medical data. You will be shown how a computer many miles away can remotely take the medical history of the patient. This is typical of the on-line computer medicine research at the University of Wisconsin Department of Medicine and Clinical Laboratories at Madison, Wis.
"For complete program, push button 1 and return. For medical questions only, push No. 2 and return. For instructions, push No. 3 and return."
I pushed No. 2 and return for the next question.
"Are you a physician specializing primarily in the treatment of patients with allergies?"
I will fib to it a little and say "Yes."
So here are the questions that are being submitted now to the patient of a physician who primarily treats allergies. The question to the patient is, "Have you ever had asthma as defined by intermittent episodes of wheezing and dyspnea?"
I will answer that "Yes."
The next question is, "Have you ever had allergic rhinitis as defined by intermittent episodes of runny or stuffy nose and sneezing?"
I can push "Yes" or "No" or I can push button "I do not understand," or "I do not know."
I will continue with the yes and say "Yes" to it.
Next question is, "Have you ever been married?”
I had better say "Yes" to that.
Next question is, "Have you ever been married to a spouse with asthma, allergic rhinitis, or exzema?”
I will answer "No."
What I assume is that this will go through a series of logical questions based upon my answers until it has exhausted all of the information put into the bank.
Is that right, Doctor?
Dr. MEYER. Yes.
(The illustration and printout referred to follow :)
NUMBER 2 NO.
NUMBER 3-DON'T KNOW.
NUMBER 4=DON'T UNDERSTAND THE QUESTION.
PUSH NUMBER 1 THEN RETURN BUTTON TO SAY YES. TRY IT. ? 1
GOOD-HAVE YOU UNDERSTOOD THUS FAR IF SO SAY
YES BY PUSHING 1 THEN RETURN. IF NOT PUSH 2 THEN RETURN. ? 1
GOOD YOU ARE DOING WELL, ANSWERS ARE MADE BY PUSHING NUMBERED KEYS 1, 2, 3 OR 4. ARE YOU HAVING ANY TROUBLE
I'M GLAD. IF YOU DON'T UNDERSTAND A QUESTION YOU CAN
WHEN YOU ARE READY TO BEGIN THE MEDICAL QUESTIONS,
ARE YOU A PHYSICIAN SPECIALIZING PRIMARILY IN THE
HAVE YOU EVER HAD ASTHMA AS DEFINED BY INTERMITTENT EPISODES OF WHEEZING AND DYSPNEA
HAVE YOU EVER HAD ALLERGIC RHINITIS AS DEFINED BY
HAVE YOU EVER BEEN MARRIED
HAVE YOU EVER BEEN MARRIED TO A SPOUSE WITH ASTHMA,
WAS THIS ASTHMA
WAS THIS ALLERGIC RHINITIS
DID ANYONE LIVING IN YOUR HOME WHILE YOU WERE GROWING
UP HAVE ASTHMA, ALLERGIC RHINITIS, OR EXZEMA
WAS IT ASTHMA
WAS IT ALLERGIC RHINITIS
WAS IT EXZEMA
HAVE EITHER OF YOUR PARENTS HAD ASTHMA, ALLERGIC
Senator NELSON. Is Dr. Meyer now going to explain how this operaCtion works?
Mr. CALLAHAN. Yes, sir. Dr. Meyer, would you please discuss some of the medical aspects of this system of Dr. Slack's and any evaluatory comments about it you want to make?
Senator NELSON. I want to say that I appreciate very much Dr. Meyer's willingness to come here today and present this testimony for the committee.
STATEMENT OF DR. THOMAS C. MEYER, ASSOCIATE DEAN, UNIVERSITY OF WISCONSIN MEDICAL CENTER, MADISON, WIS.
Dr. MEYER. Thank you, Mr. Chairman.
You have heard of some of the uses to which computers are being put in medicine, and in fact, there are so many that this could be a subject of a hearing in itself.
In Wisconsin, we have been interested in the use of computers in what we believe to be two critical areas of the health care process. We believe that significant practical improvement in the process of health care delivery will result.
You have seen something of the use of the computer in taking a history and I will not go further into it. There are many benefits from this. Taking of a history is critical in the evaluation of a patient, but it is time consuming. While it is time consuming, it may be incomplete; therefore, something may be missed which is vital in the history and therefore to the diagnosis and management of the patient. There is lack of standardization by which histories are taken from interviewer to interviewer. Depending upon who is taking a history it may come out in a different way, although the same information may be there. Therefore, it is very difficult to abstract that history from the patient's chart.
You know well of the traditional illegibility of physicians' handwriting. The computer, once it has taken the history, prints it out in very legible form.
There are other advantages that I do not think really one needs to go into at the moment.
Dr. Warner Slack initiated this project of testing whether or not a reasonable history could be obtained from a patient by a computer and plans to do this routinely over the next several years.
The history is taken from the patient. It is printed out in a recognized form to the physician who can then utilize what is in the history. He knows what questions have been negatively answered. He knows what have been positively answered. His time in taking that history has been significantly cut down.
Dr. Slack has developed history programs for gynecological histories, for neurology histories, endocrinology histories, psychiatric history, gastroenterology, and currently pediatric histories are being developed.
The teletypewriter extends the programs which are currently in Madison available only to patients at the University Hospital in Madison. This process can be taken to wherever one plans to take it, utilizing the teletypewriter. This can then go from a doctor's hospital office or a remote hospital to the computer and can be done relatively simply. Senator NELSON. May I ask a question at this stage?
The doctor receives the typewritten result of the interview between the patient and the computer?
Dr. MEYER. Yes.
Senator NELSON. On a sheet just like the one there, I assume?
Dr. MEYER. Yes, he gets it in a digested form. The computer will ask all the questions and then it will print out the history in a digested form so that the physician does not have to go through all this.
Senator NELSON. So the doctor will not read it in the form of 320 questions and answers; is that right?
Dr. MEYER. No, sir; he will get the major portions of the history, the significant portions where that here been a positive response. He will get that; he will get the positively negative, if I could put it that way, points in the history. If he requests from the computer whether or not it has asked other questions, he can find out. The computer will also give the response to the particular question that the physician happens to be interested in, and that is not printed out in his printout.
Senator NELSON. Then how much reliance does he put on it? By that I mean does he read the history and then decide from reading of it whether or not he would like personally to explore some aspects of the various questions or answers in more detail? Or can you make this sufficiently sophisticated so that there would not be much point in the doctor going any further?
Dr. MEYER. I think that physicians will always ask some questions relating to the history. I think that the interview, and we teach in medical school that the history contributes significantly, probably 75 percent toward the diagnosis of the condition.
From the information obtained from the history, the physician is directed to what type of examination he should do, what type of tests he should do in establishing the diagnosis for the patient.
I think that physicians will be reluctant to not do anything in the way of questioning. I think that their questions will be very much more directed, having obtained this backlog of history which they must have before they can proceed with their diagnostic process.
Senator NELSON. I notice that on the machine the minimum number of questions that could be answered is 29, assuming, I suppose, that every answer was negative as to any allergic or complication at all. Dr. MEYER. Yes.
Senator NELSON. The number of questions in the machine is 500 and the maximum that can be answered is 320-is that what Mr. Callahan said?
Dr. MEYER. Yes.
Senator NELSON. If a patient answered 320, what is your rough estimate of how much time it would have taken if a physician had followed that same procedure himself?
Dr. MEYER. I would think it would be maybe an hour or an hour and a half, 2 hours. I really do not know. It depends a great deal on the ability of immediate recall of the patient. You know perfectly well that if somebody says to you, is there any diabetes in your family, you have to then think whether Great Aunt Maude had diabetes or whatever. It is dependent on the intelligence of the patient, and on his ability to recall immediately the facts which you require.
Senator NELSON. May I ask this-have you, in experimenting with this, taken some real situations in which you had an intern or doctor