A doctor's prescription for hospital info system; Children's builds integrated system atop standards, best of breed packaged products - Dr David M. Margulies is VP of Information Systems at Children's Hospital, Boston

Software Magazine, April, 1990 by John Desmond

The client/server architecture is useful in Children's information system model, Margulies said. "It helps us achieve some of the benefits of a single, large institutional database, while allowing us to distribute to an appropriate-scale box." Most compound document and image manipulation is done through client/server processes, he said.

Ease of use, especially as provided by a consistent graphic user interface, wasa key requirement for Children's physician's workstation. The application uses icons familiar to its users, such as a medical chart, floor map and a nursing notebook. "We show people the same things they are used to seeing," Margulies said. "It's the Mac religion restated."

Children's has little interest in OS/2-Presentation Manager workstations. "DOS is fine and workstation equal Unix. The workstation technology we are standardizing on is X and graphical user interfaces using X. We are struggling among workstation user interfaces like many other users, but Presentation Manager is not in the mix, and neither is Mac OS. Both are usable graphical user interfaces, but they are not standards."

HL7 OPEN SYSTEM IMPACT

The open systems movement has been helpful to Children's effort to use standard systems, although the movement is only beginning to have an impact in hospitals nationwide. "We could not do an integrated hospital system without the emergence of standards inspired by the OSI model," Margulies said.

Simborg's StatLan is the basis for the Health Level 7(HL7) hospital protocol standard, a nonproprietary application-level data interchange standard for the health care industry. "It is a protocol in the early stage of acceptance," said Simborg. Consistent with the Ansi X.12 standard for wide area networking, HL7 is supported by a self-funded member organization. Through a coordinating committee, an effort is being made to converge overlapping standards in health care, Simborg said.

Departments that benefit by Children's move toward an integrated HIS acknowledge its contribution. "The system has coordinated results from labs all over the institution into a single database," said Dr. Joseph Alpers, director of clinical laboratories at Children's. "Now, the physician can find everything in a single search." The labs feeding the database include virology, immunology, cytogenetics, the blood bank, endocrinology and bacteriology.

The system serves an important academic purpose as well, he said. "To have all the objective results in a single database will be an extremely powerful assist to the hundreds of physicians and other professionals at this institution who perform clinical investigation. It is very important for research to be able to access data with such convenience."

Children's uses text management software to help retrieve research results. Margulies is experienced in this area as well. He authored a large-scale medical information system called Bibliographic Retrieval Service/Colleague (BRS/Colleague), and founded a company to market it in Latham, N.Y. Later sold to Maxwell Corp. of England, BRS/Colleague is used by tens of thousands of physicians. The online database contains the text of many medical books and journals, as well as the bibliographic holdings of the National Library of Medicine.