IT in health (1982)

[Music] [Laughter] [Music] Information Technology gives doctors special ways of seeing [Music] this man died 27 times in one day now a computerized pacemaker has given him a new lease of [Music] life doesn't sound very good at all feeling off color this morning sore throat bad back worried it might be something worse well the first place you'd go for help is your GP this is the symptom of an interesting condition in the body of the medical profession a growing interest in Information Technology Mr Green 930 Mr Green first half of the alphabet his notes are already on the computer now there are more than 50 million people in this country that's a potential 50 million clients for our health services 50 million patients know notes the sheer quantity of Medical Care in our society is staggering take a town the size of Sheffield half a million people are served by some 250 GPS every year each doctor actually comes into contact with his patients about 10,000 times for the city as a whole that adds up to 2 and a half million consultations a year a single group practice may have to cope with up to 15,000 people and that is a lot of records and notes to have to look after what better than to store them on computer it saves time and space now in this surgery they're about halfway through putting all the files and notes into the computer it's true there has to be an initial outlay in money and time to get the system working but the benefits in terms of patient care and research are well worth the efforts in Sheffield Professor wils has been looking into the benefits of the computer for GPS and their patients I think one of the great gifts of the computer is its flexibility it can give the the doctor to a limited degree but not all that limited what he wants and it is the practices in primary care who will have to decide what they want from the computer and here I think we can divide the gifts of the computer into the housekeeping so that the GP for example can have for the first time a really accurate and upto-date register of the age and sex of all the patients for whom he's responsible or those especially at risk the babies the old ones and this will give him some uh opportunities to look at the practice population entrusted to him and this will lead on to the second great gift that lies within his grasp if he uses the computer and that is he will be able to look at those problems in his practice population that need surveillance from year to year or even decade to decade patients with elevated blood pressure the diabetic the asmatic the epileptic these are conditions that we can control but we need to audit our control see if we're doing what we think we're doing what we want to do and here the computer can be a tremendous and valuable Ally and using security codes all the information on the computer can be kept as secret as any patient or doctor could wish far safer at least than the old fashioned filing cabinets anyway Mr Green please Consulting room on the right doctors have special ways of seeing part of a doctor's skill is pattern recognition just as a Shepherd knows his sheep an art critic can identify a rembrand or a cook can name the herb in the middle of a stew so a doctor can spot the characteristic pattern of many illnesses even the way a patient indicates an area of pain whether he uses the palm of his hand or points with a finger tell the doctor quite a lot looking a bit yellow this morning is Mr Green jaundice but there are times when the pattern isn't so clear even to a doctor which of course I'm not human beings aren't computers and it can be difficult to sort out their complaints logically they may have several things wrong at once each contributing to a whole brand tub of symptoms no you the doctor making a lucky dip he has to make an educated guess at what's wrong we up the prob abilities now a computer isn't a human being don't ask it to be inspired but give it the facts and it's superb at calculating odds so at Glasgow University the computer is being developed as a diagnostic Aid by a team of researchers including Dr Robin nil Jones general practitioner when he's faced with a patient has many things to decide about that patient particularly if he comes with a symptoms such as headache or dyspepsia and what we've been trying to do with our computers and our statistical methods is to try to improve the diagnosis that people make when they see the patient for the first or perhaps the second time and we do this by doing a careful study in which we collect a lot of information from a lot of people with for example headache we find out what is wrong with them and when we've got all this information together then we are in a position to use it to improve our diagnosis of the very next patient who comes into our room the kind of thing that the computer Aid produces is rather like a a betting slip it has a list of this of diagnoses rather than horses and each diagnosis has the odds for it and if something comes up with odds which are very high then if you're a doctor you'd be certainly take notice of it and think that might be the best diagnosis you could make so it's just like betting really the only thing is that the computer has one thing different and that is we know how accurate it is and that is at least as accurate as the experts the other aspect of computer AIDS in general practice is that what one is doing very often is to collect the data in some kind of expert Center or perhaps in many centers even in different countries and then bring it into one practice so that the diagnosis of individual patients May therefore be improved we don't see this in any way as replacing the doctor it is really just another test but the important thing is that it is a test which he can do in his own surgery which is in fact very cheap to and information technology can now help Chemists in their search for new drugs in order for an organic chemist to make molecules which will interact with biological systems he must have a good idea of the shape of the compounds he's making and also try to get an idea of the shape of the systems with which he wishes them to interact since the war the Chemists in this country and else Weare have made great use of stick models rather like these which are very convenient to prepare and which can be bent around and molded into almost any shape one might wish these provide a very good representation of the shape of some molecules but with very floppy molecules like this ATP which is a a very important indeed essential constituent of all living cells as you can see the whole thing is rather floppy and it flails about all over the place as if I want to get an idea of the shape of this molecule in a particular situation I'll have some problems because it just will not keep still now that sophisticated computer representations are available to us we can make a model of a molecule like this inside the computer using all the sophisticated facilities the computer provides for display and calculation once the computer model has been set up we can manipulate it in any way we require it can be rotated around or parts of the molecule can be spun around in a controlled Manner and not in the rather random fashion that I'm doing it now furthermore we can use the computer to break Bonds in fact to take parts of the molecule apart throw them away or indeed see how the different bits inter interact with each other as a reaction will proceed it's our hope that these techniques will in the future enable us to develop more efficient and even safer drugs than we have today and from our point of view it would also help if they enabled us to reduce the time and effort required in research and development Mr Pink looking a bit pale today complaining of pains in the stomach dyspepsia quite common let's assume it's been diagnosed as an ulcer what can the doctor do about it well if he's in any doubt one of the first things he can do is look it up on doctor's view data this set is registered as a doctor's set and so is allowed access to medical information all the pages are free you just have to pay the phone bill on this new view data service by courtesy of Glo in the British medical journal the doctor can get instant access to case studies which he can then follow through as in for example the story of Miss Carpenter let's call her going to a mass X-ray and showing a slight abnormality what was the cause the service doesn't tell the doctor it asks him to test himself and then tells him what a consultant thought was the answer the service also carries information on new drugs how to prescribe them any side effects anything else the doctor needs to know through the prestel Gateway system it's also now possible to link a home television set with a Mainframe computer so Advanced research like that of the Glasgow project for example could soon be at the fingertips of the ordinary GP and when a new drug comes on the market he'll certainly they know what it can do instantly Mr Pink would have haired off with his prescription to his local chemist if it's half as efficient as this one his order would be handled by computer these neat little microcomputers have been supplied by a chesher based pharmaceutical wholesaler who wants to make it easier and more efficient for the phes to handle orders and keep tighter stock control for themselves [Laughter] [Music] hello Park Pharmacy is best here are you ready for your link now yeah we're ready to go f thank you bye-bye the micros send the orders in automatically over the phone to be processed by the company's Central Computer so there's no problem of a fuzzy line confusing say pedol with prosol and the orders can be processed in no time at all when there are 10,000 different items and orders have to be delivered four times a day the new technology can be an enormous bonus if you want something that will really penetrate something like CID with the High Street Pharmacy is an important part of the Health Service many people come for advice on medical matters perhaps because they don't want to trouble the busy doctor I mean feel that it's so dry it's like fan paper what did you take atan each order leaves the stock room with these orange coded labels all the pharmacist needs to do to replace anything is to dial in a code the computer prints out a clear label for the prescription and adds warnings like don't take with alcohol which takes responsibility from the pharmacist and is reassuring for the public [Music] the new system is so efficient that from order to dispatch can be as little as 15 [Music] minutes 50 million people 50 million notes and a new person born every 45 seconds next year's citizens are important even before they're born in anti-natal clinics mothers can now give the computer all their important and intimate details before they see the Midwife this friendly and reassuring Mickey program was written by Dr forry of St James in Leeds in antenatal care we ask a vast number of very simple questions uh and it seemed to me an area therefore where particularly computerized interviewing could be useful it's obviously a very powerful tool how do you see its potential being developed in two ways firstly it to actually analyze which questions are worth asking and secondly there is a great potential to put antinal care back into the community we've been trying to do this ever since 1948 and the whole trend has been the opposite direction with a computer in the local GP surgery there's no reason why the standards should not be raised at the same time as going back to local area there you go good lad this baby was a premature baby and we're doing this simple test to check on his breathing and now we're going to have a look at the pattern of flow through this Baby's Airways this portion of the graph represents the baby breathing in and this portion represents him breathing out as you can see it's a fairly straight line with no big loops which is what we would expect from a completely normal baby now I can show you a pattern we got from a baby earlier this week who was very abnormal and this is his pattern you can see that as he's breathing in he doesn't have much problem he's got a straight portion just like today's baby but when he comes to breathe out he has this big loop and that shows me that he's having to do a lot of work to force the air out of his lungs and we can pinpoint his problem to his lower Airways the small Airways deep inside his lungs the computer helps us from the point of view of cost because paper for our chart recorder is extremely expensive so we saved a lot of money by buying the computer instead of more paper but also we get a lot more information about each baby because the computer can analyze far more breaths more quickly than we do to get this information from the paper would take hours and hours of arduous work and we only did it for a very few babies in the past now we get all this additional information from every baby for maybe 5 minutes work these lines on my chest and abdomen have been created by projecting a grid of light the lines can be photographed using ordinary cameras and the photographs analyzed with a computer so that we can Define precisely the shape and movement of the chest and stomach as we breathe or cough an example of how this technique can be used is in the measurement of the flow of blood through the lungs in some patients those with disease of the heart the flow of blood is very low using this technique we can measure precisely how fast in fact the blood is passing through without using invasive methods such as cardiac catheters what I'm going to do is to take a breath in from a bag of a soluble gas and hold my breath and we'll see what [Music] happens no needles involved just painless patterns of light their movement tracks the shrinking chest to show just how much blood is circulating [Music] inside with patterns like these doctors can even study the breathing of accident victims in intensive [Music] care 6 months ago analyzing these pictures took two people a whole month to complete since all the points had to be calculated by hand but now using the digitizing table and the computer the analysis can be completed in about 20 minutes and down at IBM these same figures are used to reconstruct and study a model of the Torso as if in three dimensions and simulate the breathing in out in out in out that was a normal healthy adult breathing now let us see what this technique gives us when we study a patient with a curvature of the spine if you look at the breathing pattern on his back we see that this is primarily a twisting movement here we see a patient with a a muscular disorder before and after treatment the benefit of this technique is to allow us to to monitor her progress towards recovery [Music] doctors do have special ways of seeing Information Technology helps them see the invisible this infrared camera is linked to a computer it scans the human body and locates areas of hot and cold as someone smokes a cigarette his hands turn cold a lot of people know that when they have a drink their face gets hot mine does now doctors know that this FL blushing could be a sign of potential diabetes here's a thermal map of my face it's a Bluey green color because my Skin's at its normal temperature well let's see what a large Sherry will do to that in a few minutes you'll be able to see if my face lights up goes red there you are just after a few minutes the camera shows it all my face has gone red doctors can use these thermal imaging techniques to identify conditions like the inflammation caused by arthritis or perhaps thrombosis caused by an operation and the information can be sent down the line to the computer for accurate measurement computer aided analysis has made these non-invasive Imaging techniques both cost-effective and practicable in fact they've become an invaluable aid for research diagnosis and treatment [Music] take a big breath in and with computers we can take a closer look at pictures we've used for years this is a conventional chest x-ray and what we do in a digital system is to transpose the information in that film into a film into a computer memory and we do it by dividing the picture into small squares of picture elements and each picture element is assigned a specific value of greyness or shade of gray the idea is to have the data on this film in digital form in the computer and this permits us to manipulate the image in a variety of ways in the region of these squares we've altered the value of the gray levels and we can now see details of the spine here the each part of the spine is seen quite clearly and there the ribs coming off those uh vertial bodies as they're called if you compare it to the original where there's very little information it's almost uniformly white there the benefits of this system are that we get more information out of the uh examination and we can reduce the number of examinations that have to be done in consequence this means a reduction in patient dosage and also a saving in in money of course so it could save lives perhaps yes it could if it showed you an abnormality which you might otherwise miss this patient had no symptoms and yet he's got a cancer in his lung which you can see by comparing the density of this region here to this region here this region is too white and this was caused by a a growth in the lung at that point by altering the values of the gray Levels by manipulating the numbers in the computer we can produce images which enhance this appearance now you see the legion is standing out much more clearly because it's enhanced in relation to its surround and all that simply because it's possible to convert images into numbers digits just as we can convert pictures into numbers so can we convert the signature of a heartbeat into numbers as well the ECG the electrocardiogram I'm going to tell the machine something about you now you just relax and keep perfectly St this IBM machine has been designed for places like oil rigs where there may not be a cardiologist on hand you don't take any medication do you thanks it will quickly identify a fit man and single out those patients who need to be referred to a specialist I'm going to start recording now the internal computer converts the ECG wave forms into digital information then scrutinizes them along guidelines laid down by World experts homing in on the slightest hint of an abnormality [Music] [Music] doctors do have special ways of seeing they can take a small harmless quantity of a short-lived radioactive material and inject it into the bloodstream then with a special camera they can watch the actual beating of the heart and they can see the patient's heart react under strain this ice cold water is as much of a shock to the system as being made to run around the block on the screen the computer's comparison between strain and rest gives doctors a rounded picture to help them decide on treatment can I have patient monitor pleas and there are other ways of looking at the heart with seven views from Seven angles the computer can construct a picture of the heart as if it had been cut into several slices is Ernest Co had heart trouble in December he had a pacemaker put in over New Year he died nine times in one day his pacemaker was exchanged for this in his shoulder is the first computerized pacemaker to be implanted in this country since then he hasn't looked back up until very recently the function of a pacemaker was determined by the physical construction inside the factory thus what the pacemaker could do inside the patient was determined by how the wires were solded together when the pacemaker was constructed The softwar Driven pacemaker is released from that constraint in the sense that the function of the pacemaker is under the control of a language which is stored inside the microprocessor and this language can be changed so that at any time in the future even when the pacemaker is implanted we can use an external computer to communicate with the internal computer and change the language that controls the PAC Maker's operation this is called downloading the software from externally to internally this pacemaker not only has the ability to alter its pacing function in the sense that how it actually Paces the heart can be altered from minute to minute but it also has the ability to record its activity both the activity of the pacemaker itself and the activity of the heart over long periods of time oh great I why would be to do the things I'm doing now you I'll go to bed at night and know I'm going to wake up in the morning where I didn't before first match of the day and then the Sween Richard's disease affects him like a stroke or a car accident could affect any of us he knows what he wants to say but he can't talk this tape represents a conversation that we've been having in the last half hour or so the machine is Richard's voice it's very simple but it makes a complete world of difference to the way Richard can communicate with his friends it's just like another very simple thing that makes his life a lot easier and that is the ability to switch his television on and off thanks to a rediffusion cable system controlled from his bedside information technology is changing the practice of medicine in research in diagnosis and in treatment we've been able to show you some of what's happening but the really impressive developments are in the future by the end of the century scientists confidently predict that micro circuits are going to work miracles that they're going to make it possible for the blind to see and the deaf to hear and the paralyzed to walk already there are glimmerings of light for the blind with a system which is crude as yet but allows them to distinguish simple shapes and letters through micro circuits connected directly with the brain and the hope is that the quality of this electronic Vision will improve to something like that of a rather snowy black and white television set within 10 years people with paralyzed backs could have their spines repaired by implanting a chip circuit to link up the motor nerves and hence restore movement that's all in the future but it's not that far away during remember penicillin how that changed the course of medicine well information technology is going to have the same sort of effect it's up to you whether you're a patient or a doctor remember information technology is catching it's catching on fast we have got to take particular care that any system which is introduced has actually been evaluated and shown to be of benefit if that is done then three benefits will acre firstly there'll be much more time for patients to talk to doctors secondly the formal approach to collecting information which is necessary will teach us a great deal about clinical medicine thirdly and possibly most importantly we will learn a great deal about the efficient use of resources and thereby I think get better health for the same cost [Music] [Laughter] [Music] [Music] [Music]