puter. To achieve this with a computer this small and inexpensive is highly significant in the economics of hospital operation and disease detection.

In addition to clerical work, there are 12 analog input lines that reach from the computer directly to the automated analytical equipment. While it processes other data as previously described, the computer actually takes readings directly from the various pieces of analytical equipment, interprets these readings, calculates the values and records these values as tests results in patient files stored on magnetic tape. This portion of the computer activity we call "on line" operation.

A display on the video screen allows us to select which test the computer should perform. By depressing the E key, for instance, an electrophoresis program is called into the computer. Briefly to explain, Senators, the electrophoresis test represents the separation of some proteins in the serum. This test can detect disease such as cirrhosis, some cancers and other diseases. A variation of this test can be helpful in early detection of heart damage. A display on the screen shows the actual electrophoretic pattern as it would show on the computer screen. As the next step, I instruct the computer to analyze the pattern, give certain qualitative information and print out a complete report. To give you a firsthand look at this test report, later I will generate a report in the caucus room on the teletypewriter via the Data-Phone. A routine physician's report formerly took at least 14 different slide rule calculations by a medical technologist, the time of the secretary to type it, and a considerable amount of time for the pathologist to review the pattern and arrive at some sort of diagnostic statement. We have programed our computer to do all of this including differential diagnosis. This computer will "diagnose" by matching the pattern for the present specimen against standard patterns programed into the memory. Reports are reviewed by the pathologist for validity and sent to the wards for placement on the patients' charts. Of course, you recognize that one could generate these reports on the hospital wards by the telephone lines as well as anywhere else in the world.

If we have requests for laboratory tests on a given day, we do these tests, and the computer puts information in the patient's file. When it is time to generate reports we add this data to all previous data on the patient, and prepare a new cumulative report. Patient information is provided on the heading and the test groups. We print out the normal values for each of the test procedures. We obtained these normal values in our own laboratory. Values are arranged in 12 different categories of sex and age. By doing this, every patient's test values can be compared against normal values for his sex and age. Senators, a 55-year-old male doesn't look like a 20-year-old student nurse. Why should we expect his blood chemistry values to be the same?

A program written exclusively by our team is for retrieval of data from our surgical pathology files. Several similar reports have been printed there previously and are available for examination. The output you will see is real data although we have deleted every other character to obscure the patient's name for this demonstration.

We are beginning to offer this type of data retrieval to various pathology and hospital laboratories. Soon we will handle the surgical

81-280-68-pt. 4- 4

pathology data from the Albert Einstein Medical School in New York City in a demonstrating project with Dr. Maeir. He will send us his data. We will enter it in the computer. If he desires a particular type of retrieval, he calls us and we print out on a teletypewriter in his department.

We have also programed a large computer at Rutgers University for retrieval of microbiology data. One result of this is a periodic report to our staff physicians correlating bacteria type, body site, and sensitivity of these bacteria to various antibiotic drugs. Such a report can help a physician select the most effective antibiotic to use in treating his patient even before the laboratory has positively identified the specific bacteria. Also underway under contract with the U.S. Public Health Service is a project to automate and computerize the screening and diagnosis of cervical Papanicolau preparations for the detection of cancer in women.

The community hospital and its medical staff will remain the principal agents for delivering health services for the care of the ill and for the preservation of the health of the well. Multiphasic health screening will become an important adjunct to community health services. Under our direction this hospital is establishing a multiphasic screening clinic in this vacant supermarket near the hospital. This will require the development of a considerable amount of automation and data processing capability coupled with the careful study of the logistics of handling large numbers of people. It is possible that such a clinic could become an important center for servicing not only this hospital but also several neighboring hospitals. We can readily see how remote data input and output directly becomes an important function of this type of operation.

Now for those of you who are interested we will begin to print out various report forms on your teletypewriter in the Senate caucus room. While these reports are being generated, I would be glad to answer any questions you might have.

Mr. CALLAHAN. Thank you, Dr. Pribor. We will pass out the copies of the reports that you sent yesterday.

Mr. Chairman, that concludes Dr. Pribor's remarks.

Senator NELSON. I want to thank Dr. Pribor for a very fine contribution and for taking the time to make this presentation to the committee.

Mr. CALLAHAN. Thank you, Dr. Pribor, and goodby.

Dr. PRIBOR. Goodby, and thank you very much.

Mr. CALLAHAN. As has been demonstrated here this morning, Telelecture enables a group or groups to discuss important subjects with specialists in their particular fields, using telephone loudspeaker equipment. The lecturer may speak to one audience or several, even thousands of miles apart. Communication is two way, so listeners may question the speaker, while he in turn directs his presentation to the interests and responses of his audiences. The discussion need not be confined to one specialist only since panel participation can readily be arranged for several speakers, who may be in different parts of the country-or the world."

The Upstate Medical Center, Syracuse, N.Y., is typical of a number of institutions using the medium of Telelecture in continuing

medical education. Richard H. Lyons, M.D., director of the central New York regional medical program states:

One of the biggest problems in conducting a regional medical program is in the communications between hospitals in the region. *** Most doctors are unaware of what other community hospitals have to offer in the way of facilities and talent. Ideally, if all hospitals could be interconnected, gaps would be greatly reduced so that consultations between doctors could be expedited as well as the continuing education of physicians, laboratory personnel, nurses and others.

With this objective and to make the best medical resources available to other hospitals in the region, Dr. Lyons established a multipoint telephone conference service interconnecting the Upstate Medical Center with 13 other hospitals within the region. This arrangement permits doctors in Syracuse to give lectures to groups assembled at the participating hospitals. The system is used between 6 and 13 hours per day and telephone conferences are conducted 6 days a week.

The University of Wisconsin Medical Center is also making wide use of Telelecture to some 60 hospital locations across the State. The university is also pioneering in another program of continuing medical education which deserves comment. A Wisconsin physician, confronted late at night with a problem in treating acute meningitis, needs only to reach for a telephone to obtain expert advice. The same is true for the Wisconsin physician who would like to review basic information on the diagnosis and treatment of moles and melanoma. Information on these and 86.other medical subjects are available 24 hours a day through a unique service provided by the university medical center. By dialing a special telephone number, the physician may listen to tape-recorded lectures prepared by members of the medical school's faculty or the hospital's staff. The lectures average 5 minutes in length, and if the recorded lecture does not provide the specific information sought by the physician, he may contact the lecturer directly, because each tape is concluded with the lecturer's telephone number.

Any new developments in the medical field can be directly taped and immediately made available through this program.

We would like to make a demonstration call to the tape library at the university now and after we hear how it sounds to the local physician, we will ask Dr. Meyer who has been closely associated with both the Telelecture and the tape library to comment on the effectiveness of these programs.

Senator NELSON. Is that call going to be made now?

Mr. CALLAHAN. Yes.

(Whereupon the demonstration described by Mr. Callahan was made for the subcommittee.)

Mr. CALLAHAN. In the interest of time, if it pleases you, we will cut off the tape and ask Dr. Meyer to continue.

Senator NELSON. As I understand, there are some 88 lectures on specific subjects which are available if a physician in Wisconsin makes the telephone call to the university hospital; is that correct? Dr. MEYER. Any physician throughout the country can call in to this and exhibit 2 in the exhibits I have given you, gives an idea of the scope of the tapes that we now have available. There are now some 170-odd tapes that will become available actually in the middle of November.

Senator NELSON. 170?

Dr. MEYER. Yes, sir.

Senator NELSON. I notice on the brochure-exhibit 2-that is issued by the university, it says "Toll-free medical lectures." Does that mean the cost of the call is free?

Dr. MEYER. It is free in Wisconsin. This was funded under the regional medical program. This is identified there and a physician calling in from anywhere in Wisconsin will get these lectures without cost of the telephone call to himself.

Senator NELSON. On the program, the cost of phoning of this program to make these lectures available, who paid for that?

Dr. MEYER. This was under agreement from the regional medical program in Wisconsin under Public Law 89-239.

Senator NELSON. What is the frequency of the calls that you are now getting?

Dr. MEYER. Currently over the first year of use of this library, there are on an average five calls a day. I would like to add to this that the funds that we had, when we initially started this, precluded us doing any more publicity than one brochure which was sent to each physician in Wisconsin in August 1966. The American Telephone & Telegraph exhibit has been carrying it around the country as part of the Bell seminars in Chicago and New York, and in actual fact, they have been doing more publicity for it than we have been able to do for lack of funds.

Senator NELSON. Are the county medical societies in WisconsinDr. MEYER. They are aware of it. The initial announcement of it went out throughout the State and county medical societies.

Senator NELSON. How long has this program been in effect? Dr. MEYER. Since April 1966. This brochure, the doctors in Wisconsin do not have it at the moment. They have the old one which was the one that we issued in August 1966.

Senator NELSON. Is the frequency of use increasing?

Dr. MEYER. No; at the moment it is really fairly static. It has remained at about five. For 4 or 6 weeks after they had printed this initial brochure, the calls went up to 10 or 12 a day, then they gradually dropped off and one's feeling is that this was just our lack of publicity of the service.

Senator NELSON. Do you anticipate that once you have broadened your list of lectures to cover a much larger number of medical problems, the frequency of use will increase?

Dr. MEYER. Yes; we do. We do feel that once people have gotten to know about it and have an opportunity to utilize it, they would utilize it more and more as a storage mechanism for information that they can get instantaneously; that they do not have to memorize or that they can get up-to-date or authoritative information instantaneously. We see a number of applications for this which we have not utilized as yet, but I think it is merely a matter of time before this is done.

Senator NELSON. Since this subcommittee is particularly interested in the question of drugs, will you at some time comment at least briefly on the question of whether or not you feel that there is readily available quickly reliable, authoritative information for physicians on drugs and reactions to drugs and whether or not such a system of

disseminating information to physicians would be a valuable one in the drug field?

Dr. MEYER. We do feel that this has a great deal of flexibility and we could put into it a tremendous amount of information which would be potentially of a great deal of use to physicians in the State. It is a matter of finding the right people to make the correct recordings of the subjects in which they are particularly interested. We do have problems trying to persuade people to try to condense down the information that they are used to giving in 30 minutes to 5 minutes, but this has been, and is being, overcome. I can see no good reason that we couldn't start a drug information service by which a physician encountering a new drug for the first time can call into the library and request information about that drug, whether it be 2 a.m. or during working hours. The drawback of the library is that it is the physician who has got to initiate the calls. We can bombard him with information about it, that it is available, that it is a free service, but unless he puts in the telephone call we are unable to get to him with whatever message he happens to want. Essentially it was designed to make available information to people as they required it-educationally this is sound, that you teach a child what it wants when it asks. You teach anybody, when they ask and in their most receptive phase, to absorb that information. This was the idea in the background with this library.

Senator NELSON. Could you give an example of how this system might be used to inform a doctor about a drug?

Dr. MEYER. What I would like to do is to obtain from the recognized probably university-based clinical pharmacologist their evaluation of drugs as they come on the market. When a doctor is approached by possibly a pharmaceutical representative concerning a particular drug, either at the time or immediately after the pharmaceutical representative has discussed it with him, he can then call in and ascertain the academic and practical view of that drug which has been detailed to him. Again, it is a matter of how we organize it-that it is merely a matter of getting it organized, that this could very well be put into effect within-we can put a tape into a library within a week of the person saying he will make the tape. If he says "I will make the tape tonight," we can put the tape in the library tomorrow.

Senator NELSON. Supposing the physician is going to prescribe a drug for a patient and he wanted to be certain that a patient who had, say, diabetes or some other disease, would not get a bad reaction to that drug, could he pick up the phone and find out whether this patient should or should not take the drug?

Dr. MEYER. This is what the clinical pharmacologist would put into the tape when he was asked to evaluate the drug. The clinical pharmacologist will say, "This is the action of the drug, this is what it will do, this is what it will not do, and these are the side effects; these are the toxic effects and these are the potentially extremely dangerous effects of the drug," and, therefore, he would say that your patientor if you are going to give this drug to this patient it should not be given in the presence of diabetes because it will aggravate the diabetes and this would be the type of information that the physician wants.