Paula Cleggett-Haleim Headquarters, Washington, D.C.

(Phone: 202/453-1547) Karl Kristofferson Kennedy Space Center, Fla. (Phone: 407/867-2468) RELEASE: 90-30

February 26, 1990

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, rapidreacting, 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 - 2 "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 resolution 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. - more - 3 "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 1800-638-9636.

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