Medical Information Management: Towards a Life Support System
Authors: Eriksson B 
Published: March 2009

Patient care managers (PCM) forms a system of software modules running on a workstation (a standard hardware platform) and a personal computer with optional plug-in boards for added functionality. PCM, together with the hardware platform, form the PCM system. The PCM system forms the heart of the Life Support System consisting of the ventilator, monitors, and infusion systems.

The design philosophy behind the PCM concept constitutes tying together all supervisory activities in one workstation where all medical instrumentation would be analyzed and controlled. Communications with the outside world would be also channelled through the PCM system, that is, other hospital information systems, including laboratory, pharmacy, X-ray, billing, admissions, etc. Medical instruments such as the ventilator, monitors, infusion pumps, and others, would only have basic, medico-legally safe, monitoring facilities, whereas the advanced monitoring and decision support facilities would reside on the PCM workstation. This enables the workstation to become an incremental developmental system: as diagnostic and therapeutic routines change and are developed further, so would the workstation, by simple upgrading of software modules, or new plug-in boards. In order for this to become economically feasible, networked personal computer, using the most common industry standard, would be employed. The most common industry standard today is the IBM PC and compatibles running under MS-DOS, soon to be replaced by PS/2-MCA systems and the OS/2 operating system. To get enough computing power, without having to go to larger machines, multiprocessing with dedicated processors employing the bus arbitration technique available to MCA under OS/2 would ensure both low cost and upgradability.

The PCM applications architecture (PCMAA) is made up of six main modules, which embodies the “clinicians workbench.” These modules are: 1. Clipboard or nurses desk: Patient admission/discharge/transfer, nursing care plan, Kardex, assignments, and scheduling, doctors orders, utilities. 2. Flowsheet: charting of hemodynamics, ventilation, laboratory work, fluid management, drugs, etc. The legal document and reports. 3. Calc: Calculated parameters of physiological data, hemodynamic-, respiratory-, metabolic-, and other advanced calculations and diagrams. 4. File or review: Archived charts and information from hospital information systems. 5. Monitor: Real time applications (RTA) and trends, advanced graphical presentation of real time data. 6. X-pert: Hypertext-like manuals with multimedia support, for procedures, equipment, treatments, etc. Provision for future inclusion of simulations, expert systems and artificial intelligence.

PCM applications are being developed separately and will be also released as stand-alone applications initially, for future integration in PCMAA. At present, limited functionality versions of Clipboard, Flowsheet, Monitor, and File are being released to the market. They will focus on the basic needs of the intensive care and anesthesia environments.

This paper will present the concept and examples of current developments.