Paula Cleggett-Haleim
Headquarters, Washington, D.C.             
(Phone:  202/453-1547)                           February 26, 1990

Karl Kristofferson
Kennedy Space Center, Fla.
(Phone:  407/867-2468)

RELEASE:  90-30

COMPUTERIZED MEDICAL REFERENCE HAS SPACE AND EARTH APPLICATIONS

     How would a doctor cope with an unfamiliar medical emergency 
if he is aboard a spaceship millions of miles from Earth and unable 
to communicate quickly with other doctors or reference libraries 
for help?

     NASA thinks it has the answer -- a computerized, rapid-
reacting, medical reference system that the doctor would take with 
him on the trip.  The system, called the Clinical Practice Library 
of Medicine (CPLM), was conceived in 1979 by a team of medical and 
computer experts from the University of Florida, Gainesville, and 
Kennedy Space Center, Fla.  The CPLM team believes the system to be 
the first general computer-based medical reference of its kind.

     Dr. Paul Buchanan, Director of Kennedy Space Center's Office 
of Biomedical Operations and Research, feels the system is vital to 
long-duration space flight because it frees the physician from his 
"umbilical" to Earth and allows him the capability for autonomous 
decision-making.  Buchanan and his staff plan and research ways to 
develop life support systems for spacecraft crews.

     "With this system, references could be looked up rapidly on a 
display screen rather than a textbook," explains Dr. Ralph Grams, a 
pathologist who heads up the software development team at the 
University of Florida College of Medicine.  "The amount of time 
normally spent digging through library stacks could be more 
profitably used in direct patient care."

     Both Grams and Buchanan wanted a system that would provide the 
spacecraft physician with nearly instantaneous access to the most 
complete medical references on Earth while millions of miles from 
home.  With this kind of support system, the physician could be 
confident that he or she was making an accurate diagnosis.

     Since the system is compact and lightweight, it can be used on 
practically any desk in any office, including Space Station 
Freedom, a Navy ship or a doctor's office.
                            -  more  -
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     "The U.S. Navy has just agreed to have several CPLM units 
installed on aircraft carriers and submarines," Buchanan points 
out.  Medical personnel will be field testing the system on these 
vessels.  A Navy ship environment, similar to that of a spaceship, 
would be an excellent testing ground for the CPLM system.

     The CPLM system consists of a personal computer, high reso-
lution color graphics monitor and a 300-megabyte hard drive.  
Loaded in the drive is a program that contains nearly all the text 
and graphics of seven medical reference books.  All together, the 
books weigh more than 20 pounds and contain 15,000 pages of text.

     To gain the medical profession's acceptance, Grams' team wrote 
the CPLM software to appear and function just like a book in a 
library.  Grams tells first-time users to compare the CPLM with a 
librarian who does reference searches for them.

     The opening screen of the CPLM program shows a drawing of the 
references on a bookshelf.  To refer to one of the documents, the 
user simply moves the computer cursor to one of the simulated books 
and hits the return key.  A full document search can be initiated 
by centering on another icon.

     Through a series of prompts, the CPLM system directs the 
doctor to establish the facts, or what he knows about the patient, 
such as sex, age and race.  The patient's symptoms are added to the 
inquiry by an OR or AND statement.  Since the system can interpret 
segmented statements in English, a typical inquiry might be MALE, 
AND ABDOMINAL PAIN, AND VOMITING AND FEVER.

     The inquiry establishes the combination of key words that the 
CPLM system uses to search all of the references.  The system first 
looks into the dictionary and thesaurus in its memory to find 
similar words.  It then displays a list of possible medical 
conditions to fit the symptoms stated in the inquiry.

     "When the reference comes up on the screen, the user will see 
it just as he would if he were to look it up in the book," Grams 
says.  But what he sees will be even better than looking at a 
printed page because of the quality graphics and zoom feature.  
With the zoom, the user can enlarge drawings when he or she needs a 
closer look at a cell structure, for example.

     The CPLM system also provides references to conditions that 
may be outside the knowledge and experience of certain physicians. 
"Even though the physician might not have considered this 
condition, the CPLM's reference to it could be the key to saving 
the patient's life," explains Dr. Albert Koller Jr., Chief of 
Programs and Planning for Buchanan's office.  This feature makes 
the CPLM system an excellent tool for medical students or 
physicians who want to update their medical knowledge in the most 
efficient fashion.

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     "The educational capability of the CPLM system may be one 
of its major benefits -- not only for the space program, but also 
for the terrestrial physician, nurse or physician's assistant as 
well," Buchanan stresses.

     Since the CPLM's electronic storage and retrieval capacity far 
exceeds the medical information a doctor can recall, the system 
also could be the basis for a revolution in medical education.

     "We could train medical students to solve diagnostic problems 
with access to a whole computerized spectrum of knowledge instead 
of teaching them to rely on just what's in their heads," Grams 
says.  "This approach could change the whole course of medical 
education."

     Another educational gap the CPLM can fill is that of keeping 
physicians up to date on current medical practices and getting the 
information to them faster.  It's often 3 to 5 years between 
printed medical reference revisions.

     Additional references also can be added to the CPLM data 
base.  "There's plenty of room in the hard disk we're using now," 
Grams says.  "We also can increase the size of the storage unit 
without slowing down the CPLM's operating speed."

     Other future possibilities for the system include adding voice 
activation and interactive hardware, adds Koller.  With these 
features, the CPLM could become a fully automated physician's 
assistant.  While the physician performed a minor operation, he 
could verbally instruct the CPLM to bring up a reference on the 
screen.  Then, the system could either display the information or 
read the text aloud to the doctor.

     Grams sees even further potential for the CPLM system that is 
directly related to the space program.  He envisions space suits 
with the CPLM system built in so that medical assistance could be 
given anywhere in space.  

     Another application would be a hand-held portable CPLM unit 
that would fit into a physician's black bag and supply him with his 
own library of medical knowledge anywhere he went.  According to 
Grams, the technology for the hand-held CPLM could be here within 3 
to 5 years.

     Before any future CPLM derivatives can be built, however, the 
present CPLM system must be clinically tested.  The first phase of 
testing will begin this year, where it will be used in several 
university clinics for about a year to see how well the system 
performs in the real world.

                             -  end  -

                              -  4  -

     NOTE:  Photographs illustrating this release are available 
from NASA Headquarters' audiovisual office, phone 202/453-8373:

     Photo Numbers:
     B & W - 90-H-73, 90-H-74, 90-H-75, 90-H-76, 90-H-77
     Color - 90-HC-71, 90-HC-72, 90-HC-73, 90-HC-74, 90-HC-75

     Beginning March 15, 1990, NASA news releases and other NASA 
information is available electronically on CompuServe and GEnie, 
the General Electric Network for Information Exchange.  On the same 
date, NASA information on the Dialcom electronic service will be 
discontinued.  For information on CompuServe, call 1-800-848-8199 
and ask for representative 176.  For information on GEnie, call 1-
800-638-9636.

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DATE & TIME:  FEBRUARY 28, 1990

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