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interview or take a history of a patient, and then have a patient do the same on the computer to see what kind of time-savings you would be making for the physician?

Dr. MEYER. This has been done and I wish I could give you the answer. I cannot give it to you

with any assurance. There is a considerable time saving to the doctor, but I cannot give it to you in minutes or seconds or hours.

What I can tell you is that Dr. Slack is always very delighted when his computer picks up facts that the physicians, and usually he is testing them against the medical student, the intern, and the resident and the staff man. He will take everything they have obtained in interviewing the patient and he will match it up against what his computer gets from the patient, and he is always very delighted when the computer picks up things that the physicians do not pick up.

To my knowledge, he has not yet got to the stage, or he has not found a significant number of questions that the physicians have managed to pick up that the computer has not picked up.

Now, this is in a development phase and when a question comes up, he can obviously have quickly put it into his computer program.

Senator Nelson. May I suggest at this point, that if you wish to extemporize on anything to shorten the presentation, I would be pleased. We will print in the record the complete presentation of your prepared text. So if you can summarize it so it will be available for me and for the committee at the appropriate time, it will shorten the time of presentation.

I do not know how soon the Senate may be taking some action, but I would suggest we recess for 35 minutes, until 1 o'clock, unless somebody has some time deadline or an airplane schedule they have to meet.

We will resume at 1 o'clock.

(Whereupon, at 12:25 p.m., the subcommittee recessed, to reconvene at 1 p.m. the same day.)

AFTERNOON SESSION

Senator Nelson. The committee will resume its hearings.

I have been told that in the rear of the room they have not been able to hear very well this morning. I think it is because we have not been speaking directly into the microphone. You have to be 5 or 6 inches away speaking straight into it.

I understand that you are going to have a demonstration that involves Dr. Hugo Pribor, chief pathologist at the Institute of Laboratory Medicine at Perth Amboy General Hospital, New Jersey. Is that correct?

Mr. CALLAHAN. Yes, Mr. Chairman. Senator NELSON. Congressman Edward Patten is here. Would you like to sit up here, Congressman?

Representative PATTEN. Thank you, but I will be leaving soon.

Senator NELSON. Nice to have you come over. You are from Perth Amboy!

Representative PATTEN. Yes.

2 See complete prepared statement of Dr. Meyer, p. 1204, infra.

Senator NELSON. I knew that was a good city.
Representative PATTEN. We have a lot of Nelsons there.
Senator NELSON. All right Mr. Callahan, go

ahead. Mr. CALLAHAN. Thank you.

Hospital laboratory tests are becoming increasingly complex and difficult to perform. In many hospitals there is an insufficient number of trained or experienced personnel to perform the various lab analyses. Also, smaller medical facilities do not have the automated analytical instruments to perform these tasks. The combination of communications and computers is helping to solve this problem at Perth Amboy General Hospital in New Jersey. A group of pathologists and other laboratory specialists there developed a clinical laboratory automation system which employs a computer to handle the large volumes of data associated with a hospital laboratory. The computer can, as with the other systems we have demonstrated, transmit information by telephone lines. By placing a call to any location equipped with Data-Phone service and a teletypewriter, the computer can print out a variety of medical data reports.

As Dr. Hugo C. Pribor, director of the Institute of Laboratory Medicine of Perth Amboy General Hospital, will explain in a moment, this communications arrangement makes it possible to deliver data from the analysis of multiphasic screening tests and accumulated patient records direct to other hospitals, nursing homes, or even medical departments of corporations. Dr. Pribor's presentation will show that any medical organization able to deliver patient specimens for analysis in a reasonable time could avail themselves of this service and enjoy the advantages of the most up-to-date laboratory facilities and almost instant access to patient medical records.

Dr. Pribor is on Telélecture now speaking from Perth Amboy and at the conclusion of his remarks we will have an actual demonstration of this system with the data being sent to the teletypewriter here in the caucus room.

Dr. Pribor.

STATEMENT OF HUGO C. PRIBOR, M.D., PH. D., DIRECTOR, INSTI

TUTE OF LABORATORY MEDICINE, PERTH AMBOY GENERAL HOSPITAL, PERTH AMBOY, N.J.

Dr. PRIBOR. Gentlemen, it is a pleasure to brief a Senate committee on our work in applying data processing to the improvement of health care. Last year, we described to the Subcommittee on Health of the Elderly our plans for setting up a multiphasic screening program

for disease detection at this hospital. I have taken the liberty of providing each of you with a copy of our testimony,

The activities I will outline represent a team effort. The team consists of our medical staff, Dr. Samuel Breslow, president, the hospital director Mr. Robert Hoyt, our governing board, and the laboratory specialists outlined in this slide. We have had good consultative support from Professors Welkowitz and Maloney in biomedical engineering at Rutgers, the State University of New Jersey. Through joint

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activities we have made considerable progress in developing a small computer system to be used in the hospital laboratories.

We certainly agree that "research is good, but results are better.” Those of us who minister to the ill have always looked for ways to apply the products of basic research to patient care. Some of the greatest recent advances have been made in the area of chemistry and biology of disease processes. Through testing procedures, the clinical laboratory can give physicians information which help them apply these newer medical developments to the care of their patients.

For the most part our activities have centered on providing physicians with more and higher quality data. One simple and inexpensive way is to perform a battery of “screening” tests on every patient as soon after admission as possible. Admitted patients come to an admission lounge where a chart is generated, physical measurements are taken, and blood specimens are drawn by a technologist. Then the patient proceeds through X-ray and EKG to the ward. Through the use of automated data processing, results of tests on specimens collected in early afternoon or evening are reported on the patient's chart by 11 p.m. the same day. This could just as easily be reported to any neighboring hospital by Data-Phone.

There are 12 chemical tests that comprise our basic "screening” program. In addition to this, a complete blood count, a test for syphilis, and a urinalysis are done on all adult patients. If patients are scheduled for surgery, a bleeding time, a partial thromboplastin time, and a tourniquet test are performed to rule out any bleeding tendency.

This encompasses our multiphasic screening program on inpatients. Often data is available to the physican by the time he sees his patient for the first time in the hospital. This eliminates a great deal of the piecemeal collection of data that usually goes on in hospitals and often gives only a piecemeal picture of the patient's condition. One recent report, in fact, shows that one out of 14 patients who undergo a battery of screening tests such as ours revealed a condition which would not otherwise have been diagnosed. So you see, biochemical screeening can establish a diagnosis more rapidly in order to help the physician evaluate his patient more accurately. We hope that, as a result, this effort will shorten the patient's stay in the hospital. It is quite possible that application of this principle on a nationwide basis could lead to more efficient utilization of already overcrowded hospital facilities.

In order to gather this laboratory data in our hospital, we have introduced a number of automated analytical instruments. The instrument you see in this slide simultaneously performs 12 chemical tests on a patient's serum. Other pieces of automated apparatus do the hematology testing. Many laboratories throughout the country are using automated equipment of this type right now and there is really nothing unique about it. What is unique about our system, however, is the fact that we have linked these instruments directly to a computer.

(The illustration referred to follows:)

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Dr. PRIBOR. Why a computer? The data gathered by newer analytical instruments is quite voluminous. Operating manually, medical technologists would have to spend increasing amounts of their time just handling data, and if we generate more and more data we would simply overload them.

Here is the computer we are discussing. Actually it has many of the desirable features that are found in the laboratory instrument computer.

(The illustration referred to appears on next page.)

Dr. PRIBOR. Dr. George Williams, Chief of the Clinical Pathology Department of the National Institutes of Health, in a recent talk said, and I quote:

Development and field evaluation of modular automated laboratory data processing systems is essential to permit adaptation to both small hospitals and large centralized laboratories. Two types of systems are minimal, one for the special purpose of hospital patient care, and the other for multiphasic diagnostic or screening use.

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We believe that our system precisely fulfills the first type of system Dr. Williams calls for and will be widely applicable in hospital laboratories throughout the country.

The memory unit in our computer is small, but the four tapes can store tremendous amounts of information and retrieve it rapidly. For example, one small tape handles all the laboratory information on all the patients in the hospital.

Another feature of our system is that any of our laboratory personnel can operate this computer. They converse with it through a standard keyboard entry device and a small television display screen. With only a few minutes' training the average person can learn to operate this computer. Much like a teaching machine, the computer guides the operator through the data processing sequence.

Our computer contains four small tapes, a cathode ray tube, the core memory, and the printers. This allows us to perform all routine data processing that was formerly done manually in the laboratory. For instance, the computer tells technologists what patients must have blood work. At the same time, it generates labels for technologists to place on specimen tubes. The computer also generates laboratory work fists and reports for the patient's chart. This is the type of clerical function that is normally expected of a computer, but of a large com

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