a. Existence in the 1930's of computing devices:

• Mechanical: gears & levers

(May be operated by electric motor)
• Electromechanical
• (Electro-magnets operating "relays")

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b. Other information-handing devices:

• Telephones
• Typewriters
• Tabulators

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c. The ABC Computer

• Designed by John V. Atanasof, built by Christopher Berry
• Principles first brought together, still used today:
• Electronic storage
• Binary numbers
• Comparison logic to control actions

• Hardware: Components used for CPU and RAM
• Software: How instructions are given to a computer
• Usage: How people give and receive information to/from computers
• Availability: How many computers were made

• Hardware: Vacuum tubes
• Software: Difficult programming
• Usage: Batch processing
• Availability: Few made
• Medical uses: very limited if at all

• Hardware: Transistors;
• Software: Higher level languages;
• Usage: Batch processing;
• Availability: Hundreds made.
• Medical uses: Larger hospitals business uses:
• Accounting and Patient Billing
• Inventory

• Hardware: Integrated circuits;
• Software: Operating systems;
• Usage: Interactive and batch use;
• Availability: Thousands made.

Medical uses:

• Most hospitals business uses continue and expand; plus...
• Experimental patient monitoring:
• Before computers:
• CRT and strip-chart monitors
• Measures of heart rate, respiration, blood pressure, etc.
• With computers, the goals were:
• More reliable alarm systems
• Data recording and analysis
• Rise of Hosptial Information Systems (HIS)
• Major HIS components:
• Business uses integrated into...
• Patient medical records
• Staff scheduling, training, etc.
• Pharmacy, lab, diet, and therapy records
• Electronic mail

• Hardware: Very Large-Scale Integration (VLSI) =chips;
• Software: Productivity software & menus;
• Usage: Personal use;
• Availability: Millions made.

Medical uses during the fourth generation:

• Continued development of HIS and patient monitoring systems
• Use of microcomputers with specialized software in clinics:
• Patient appointment scheduling
• Inventory and pharmacy control
• Insurance billing
• Computers used by staff on hospital "floors":
• Admission and discharge records
• TPR, Intake/Output charting
• Notes on patient procedures and conditions
• Electronic requests for patient services
• Staff scheduling
• Dedicated computers for medical equipment:
• Non-invasive patient exploration: CAT, ultrasound, MRI...
• Efficiency aids: robot delivery systems, etc.
• Staff training: Computer Aided Instruction, multimedia

• Hardware: Optical (laser) and biochemical circuits became available (but still not widely used). Here is an example of future directions in hardware:
  
  

MAJOR STEP TOWARD MOLECULAR COMPUTING Researchers from Hewlett-Packard and the University of California at Los Angeles have developed a way to create molecular-sized computing  omponents using chemical processes (rather than light beams) to make integrated circuits.  Although their accomplishment is just a first step for the new field of molecular electronics ("moletronics"), it leads in the direction of a new world in which computers will be 100 billion times as fast as a Pentium processor and a space no bigger than a grain of salt will hold the power of 100 workstations.  One moletronics expert explains, "A single molecular computer could conceivably have more transistors than all of the transistors in all of the computers in the world today."  With molecular-scale sensors and processors, computers could an integral part of every man-made object and every field of human activity (including  medicine, where they could be placed in a person's bloodstream to issue alerts if health problems are encountered).  (New York Times 16 Jul 99,; summary from Edupage electronic newsletter.) For details, see:  http://www.nytimes.com/library/tech/99/07/biztech/articles/16compute.html

• Software: Artificial intelligence

Expert Systems
Neural Nets for language and image processing
• Usage: Intimate use...

Handwritten input
Voice commands
Eye-controlled
360 sight and sound
Virtual reality
• Availability: More computers than people.

New medical uses during the fifth generation:

• Expert systems: diagnosis and treatment planning
• Simulations: mathematical modelling; virtual reality
• Outpatient monitoring:
• Phone/computer connections

Sabratek Corp. has developed a MediVIEW system that can monitor patients and adjust dosages in medication drip devices, all from a remote location.  "I will give you a scenario," says Sabratek's president.  "At two in the morning, a patient on a pain-management drug makes a call, tells a nurse that he's feeling pain and says the medicine doesn't seem to be working. The nurse calls the doctor, who increases the dosage.  In the old system, the nurse would need to get up at 2 a.m. and drive to the patient's home to reset the device.  This may cost $75 to $100 per trip.  Using MediVIEW, you can connect that device to a computer through a regular phone line and change the dosage from your own bedside.  And a doctor can download data to see what's going on with the patient."  To enhance its capabilities, Sabratek recently invested in a computer system called Medically Oriented Operating Network (MOON) that enables continuous online, real-time monitoring, charting, recording and reporting of clinical patient information from any location.  "Combining smart monitoring and infusion devices with the MOON system, we can create a virtual hospital at someone's home."  (Investor's Business Daily 21 Aug 97)
• medical toilet: Japanese development which monitors patient vital signs and performs simple urinalysis with patient sits on the toilet (!)
• embedded computers with radio transmitters
• Many more...

Audience:

Objectives

• Generally:
• The history of computers;
• How computers have been used in health care.
• Specifically:
• Historical differences between electronic computers and other computing and communication devices;
• The five "generations" of computers and their hardware, software, and useage differences;
• The major landmarks in the use of mini and micro computers;
• Development of Hospital Information Systems (HIS);
• Early use of computers for patient monitoring;
• Rise of computers in hospital nursing care;
• Rise of computers in clinics;
• Dedicated computers in medical instrumentation.

About this document...

Module M02c: History of Computers in Medicine

Author:

Laurence J. Krieg

Institution:

Department of Computer Information Systems, Washtenaw Community College

History:

Originally written 5 Feb 1992

HTML version 6 Feb 1996; this version posted Monday, 31-Aug-2009 11:47:58 EDT