Computer technologies in medicine: the history of communication, meaning and prospects. Part I

It's no secret that computer technology has penetrated almost all aspects of modern society: politics, defense, entertainment, education, and much more. Medicine is no exception. Now it is not a secret, but 60 years ago it all seemed like science fiction.

Today we will touch on the past, present and future partnerships of these very different branches of medicine and computer technology. We will find out what revolutionary discoveries have been made, what shortcomings and dangers this partnership carries in it and, finally, what future of medicine awaits us.

The use of computer technology in medicine

At the moment, computers have become widespread in many branches of medicine. Starting from the CPOE (computerized physician order entry) - a computerized physician prescription system (prescribing tests and / or medicines), ending with robots interns that help surgeons during surgeries. Also, computers play no small importance in the work of clinics as a whole, helping to plan and carry out various administrative tasks, keep track of finances, conduct inventories, etc.

The Internet has also played a minor role. Thanks to him, a new direction in medical diagnostics appeared - teleradiology (in other words, transmission of images and data of a medical nature through the world wide web). This innovation made it possible to analyze the patient's data and make decisions regarding his treatment while being away from him, thereby saving valuable time. Also, doctors were able to quickly consult with their colleagues from around the world. A huge base of medical knowledge stored on the Internet is available to patients, giving them the opportunity to get acquainted with their disease, recognize the symptoms, find out the necessary information about the doctor and / or clinic, about drugs, etc. Regarding the use of the Internet patient goes quite a bit of controversy. The fact is that trusting the patient himself to establish a diagnosis and prescribe treatment is extremely dangerous for him. On the other hand, if a patient combines the use of information from the Internet with a visit to a real doctor, this can improve the quality of his treatment.

And perhaps the most unusual use of computer technology in medicine is video games. They are used to train surgeons who will later perform laparoscopic operations (when small cuts are made in the area of ​​the operation for the operation inside, instead of a large incision and an “open” operation). Studies in 2004 showed that surgeons playing video games about 3 hours a week make 37% fewer errors during such operations.

Chronological scale of interrelation of computer technologies and medicine (1954-2006)

1954Computerized CytoanalyzerElectronic optical device for screening cells suspected of malignancy.
1960“Brains”The IBM 650 called “Brains” is a scan of medical records to detect subtle anomalies.
1960Computer patient surveyComputerized patient history
1961Administrative and fiscal functionsImplementing computers to perform administrative and fiscal functions
1962Electrocardiogram analysisElectrical impulses from the heart were transmitted by telephone to the central computer, which created the curve and analyzed it.
1963First decision support systemIntroduced a computer approach to rehabilitation. For example, a computer was used to determine the optimal time to wear gypsum during surgery.
1964IBM System / 360The release of computers S / 360
1964DEC PDP-8Presentation of the mini PDP-8 computer
1964MEDLARSMEDLARS is a computerized database system for indexing and retrieving medical quotes from the National Library of Medicine (NLM).
1965EMR ideaThe development of the idea of ​​an electronic medical record
1966MUMPS (Massachusetts General Hospital Utility Multi-Programming System)The Massachusetts General Hospital Multi-Programming System (MUMPS) - also called “M” - was the programming language for the healthcare industry.
1968IMIAThe International Medical Informatics Association (IMIA) was established in France.
1970Computerization of data processing from laboratoriesThe use of computers for laboratory calculations, such as the determination of the chemical composition of the amniotic fluid.
1971Computerized record processingIBM System / 3 Model 6 was used to process patient test results.
1971COSTARBase of outpatient patient records, written in MUMPS
1971MEDLINEMEDLINE went online
1972MYCINMYCIN is an interactive expert system for the diagnosis and treatment of infectious diseases. Developed at Stanford Medical School based on DEC PDP-10.
1972HELPHealth Evaluation through Logical Process (HELP) was developed in the LDS hospital
1974CT scanA CT scanner was invented by Hounsfield and Cormac in 1972 (for the head only). In 1976 - for the whole body.
1974Computerized gamma knifeIntroduction of the first gamma knife training dose planning computer program (method of radiosurgical removal of brain tumors).
1974Internist-1Computer diagnostic system developed by the University of Pittsburgh.
1977Medical informaticsDefined the term "medical informatics"
1978FilemanA set of utilities written in the MUMPS language that implemented metadata functions.
1981Ibm pcPersonal computer from IBM was published
1983NetworkNetworking Public Representation
1984ACMI (American College of Medical Informatics)The American College of Medical Informatics (ACMI) was created.
1987HL7Health Level Seven, Inc. (HL7) was established as a standard for sharing clinical data.
1988MUMPS and IBMMUMPS becomes language supported by IBM
1989WWW (World Wide Web)The invention of the World Wide Web
1992Windows 3.1Windows 3.1 release
1996Palm pilotLaunch of the Palm Pilot (Pocket PC)
1996HIPAA (Health Insurance Portability and Accountability Act)Congress passed the Portability and Accountability Health Insurance Act.
1999Da Vinci Surgical SystemThis robotic surgical system was developed by Intuitive Surgical. The prototype was introduced in the late 1980s at the Stanford Research Institute under contract with the US Army.
2000Image TransferThe clinics began to transmit electronic copies of diagnostic images (x-rays, MRI scans)
2001Widespread PDAIn the early 2000s, healthcare workers widely used handheld devices to perform tasks such as access to medical literature and electronic pharmacopeia.
2003Virtual colonoscopyVirtual colonoscopy uses a combination of CT scan technology and computer graphics.
2004WCGIBM launched this project to search for genetic markers of various diseases.
2004Multipoint CT ScannerThis new cardiac scanning technology can largely replace angiograms.
2004Decree number 13335President Bush issued a decree called "Incentives for the Use of Medical Information Technologies"
2005PenlopeA robot intern was introduced to the world.
2006Microsoft buys AzyxxiMicrosoft bought clinical medical software that can extract and display various types of patient data.

Electronic Medical Records (EMR)

Back in 1960, an article was published in the New York Times newspaper in which one doctor from the University of Tulane expressed an interesting thought about "medical records stored on film, or another method suitable for a computer that can completely crowd out written records of patients." In 1967, another article mentioned the following vision of the future - “every man, woman, or child can have all of their medical data electronically recorded in a huge memory system in Washington.” Let's discuss the benefits of such a system. If, for example, a person has a heart attack, and he is in another city. The article responded: “It will be enough for the prescribed doctor to call to Washington, and after a second before him there will be all the data from this patient. Now, more than half a century later, we see how such systems have become a reality and have spread widely in various medical institutions all over the world.

In addition to the advantage of remote data access, the EMR has others that will be discussed later. Based on these advantages and the fact that the idea of ​​electronic recordings has existed for many decades, you might think that EMRs are used absolutely everywhere. However, this is not quite true. For example, in the US, EMR is used only in 17% of clinics.

EMR history

In the late 1960s, a programming language called the Multi-Programming Multi-Programming System (MUMPS) Massachusetts General Hospital Utility Multi-Programming System (MUMPS) was developed for use in healthcare systems. It did not become widespread until the 1970s, when it began to be used to create many clinical programs. To this day, many old systems work with software based on MUMPS. Despite its initially medical direction, MUMPS is widely used in other industries that require a large number of simultaneous connections to the database (banks, stock exchanges, travel agencies).

For acquaintance with the MUMPS language you can follow the link to the pdf-tutorial

In 1978, Joseph (Ted) O'Neill and Marty Johnson, together with their team, developed Fileman using the MUMPS language. Fileman was a set of generalized procedures, specially simplified for users who do not understand MUMPS and programming in general. From the late 1970s to the early 80s, many utilities were designed on the basis of Fileman. Later, the US Department of Veterans Affairs began using Fileman as its official medical program.

In 1981, in Florida, Mickey Singer founded a software company called Personalized Programming Inc., which was one of many that later formed Medical Manager Inc. It provided clinics and private practitioners with software, the popularity of which was so great that by 1997 more than 24,000 clinics and 110,000 practitioners used it. However, only a fall followed. Instead Medical Manager Inc. came the Open Public Public License (GPL), which provides its users with the source code of the software, giving them the opportunity to perform the necessary customization.

Currently, the number of companies providing solutions for EMR varies from 250 to 500. Some of them are focused on small systems, such as prescription or medical history. Others offer package solutions.

EMR benefits

The main EMR users are doctors and other medical personnel. Standard EMR gives them access to the electronic version of the patient's medical history, which had been stored on paper for many years. So why change something that worked so long?

EMR Disadvantages

Despite the very impressive benefits of EMR, their speed of propagation is not impressive. Now we consider why.

Clinical Decision Support System (CDSS)

In this section, we discuss the history of clinical decision support systems (CDSS), current research, commercial orientation, and potentially interesting areas for future research.

CDSS history

Unexpected consequences of health computerization

As we have already understood, the computerization of the medical field is extremely important and must be developed. This process faces many challenges. Not everyone wants to spend money on the introduction of new systems, staff training. Someone is afraid of legal consequences in the case of data exchange between clinics. There is also the issue of confidentiality of information. All of these are factors hindering progress. But there are opinions claiming that this is not worth pushing, as unintended consequences may arise.


Dr. Gale Thompson, a practitioner since the 60s, said that computerization leads us to forget that there is concern for the patient. Doctors have forgotten how to determine the patient's condition by their pupils, relying more and more on diagrams and graphs on computer monitors. With this opinion fully agree, and Stephen Angelo, a doctor from Connecticut. He told how once the patient monitoring system had “laid down” at his hospital. Doctors were confused, did not know what to do.

Of course, more and more relying on modern technology, we forget about the good old methods. But, if computerization of health care reduces the number of deaths among patients, I’m ready to give up personalization, as such.

Medication errors

Some doctors argue that electronic systems, while helping to reduce the number of errors, but do not eliminate them completely. That's because a person, as a source of error, controls this electronic system.

This is incontestable, but the problem still remains in the human factor, and not in the system as such. To solve this difficulty, it is necessary to pay more attention to the training of med. the staff. If the staff does not know how to use the system, then, of course, all its advantages lose their meaning. As long as there is at least one person in the industry, there will be mistakes.

Invalid information on the Internet

There are many articles about various diseases, drugs, etc. Many of us used similar content for self-diagnostics and even self-treatment. Of course, information is power, but only when it is correct.

A lot of medical information on the world wide web contains errors. And this can lead to the fact that the patient will start the wrong treatment or simply ignore the potentially dangerous disease. This problem can be solved only by introducing standards for the accuracy of information and methods for its verification and control of publications.

Search for relevant information

Storing the entire patient history in one electronic folder allows the doctor to quickly access it. But is he able to quickly find what he needs in this particular case? The huge flow of information that is necessary not only to see, but also to analyze, may delay the formation of history and diagnosis.


The world does not stand still. Computer technology more and more crashes into other areas of our life, introducing many new, good or bad, it is sometimes difficult to say. But progress cannot be stopped, relying only on the fear of something new. This also applies to medicine. Many diseases would remain incurable if some brave souls did not decide to treat them differently, not like before. The main thing to remember is that man creates technology, man improves it and only he can be responsible for it.

Today, many clinics are moving to remote storage and processing of information. We also offer solutions for this type of customers, even solutions using the latest NVMe drives, which allow processing requests in large databases “instantly”. The data centers where the equipment is located correspond to the required levels of certification in the field of data security. And the geographical distribution and isolation of modules, even within the same location, allows you to organize the most fail-safe systems for clients of this kind.

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