How To Use A Computer For Health Care

Transcription

1 APPLICATIONS AND BENEFITS OF COMPUTER BASED EDUCATION FOR MEDICAL AND ALLIED HEALTH EDUCATION by Robert M. Caldwell, Ph.D. Department of Allied Health Education The University of Texas Health Science Center at Dallas Dallas, Texas ABSTRACT 1. BENEFITS FOR INSTRUCTION Advances in computer technology have provided unique opportunities to apply computer systems to a wide variety of medical and health care functions. One area which holds great potential for using computer systems is medical and health science education. The following paper focuses on 1. The benefits which can be derived from using computers to deliver many forms of medical education but particularly continuing medical education. 2. The applications of computer technology to medical and health science training. 3. The future applications of computers to medical and health science education. The paper cites numerous examples of how computers are currently being used in health care training and what new developments might be used in the very near future. It is difficult to determine exactly when computers were first used to deliver instructional programs, but by the late 1960's computer systems had already proved themselves to be extremely powerful tools for delivering high-quality, interactive instruction in a variety of subjects and locations. As we enter a new decade, improvements in computer technology and the introduction of inexpensive microcomputers adds considerable potential for promoting learning, for managing instruction and data, and for interfacing laboratory and diagnostic equipment. Given this potential, then, we must turn now to finding the applications of computer technology which are most appropriate to the needs of the medical and allied health care professions. The purpose of this paper is to 1). detail within a limited scope some of the benefits which can be derived from applying computers to medical and allied health education, 2). cite examples of unique applications currently available in the health professions, and 3). discuss future possibilities for computer-based education in the medical and health sciences. The potential of computers for delivering medical and allied health education to hospitals, clinics, medical schools and inservice training environments is almost unlimited. The following are but a few of the many ways in which the computer can be used to offer alternative forms of instruction: 1.1 Continui_ng Medical Education Evidence of participation in continuing medical education programs (CME) has become a requirement of relicensure in fifteen states in the United States as of August 1976 and is planned as a part of specialty recertification by all twenty-two certifying boards. As medical, scientific and technological advances applicable to patient care accelerate, groups such as consumers, malpractice insurers, third party carriers, and governmental agencies supporting patient care advocate an increase in the availability of new information and procedures to physicians and health care professionals1. Fulfilling this requirement for an increase in continuing medical education is difficult at present for a number of reasons: A. Many medical schools neither have adequate facilities or available staff to handle the heavy instructional requirements of extensive continuing education. The University of Texas Southwestern Medical School in Dallas, for example, conducts inservice education for over 30,000 physicians a year. Much of this instruction is done in hotels, public buildings or wherever space can be found. Also, it is often difficult to find qualified professionals who can devote time to continuing education. B. Physicians in rural areas or in remote locations have a difficult time attending continuing education seminars without large expenditures of time and money. Many find it difficult to leave large patient loads for the several days required to travel to a large city for seminars /81/0000/0675$ IEEE 675

2 C. Increased case loads in many urban areas prevent physicians from participating in continuing education classes. Many cannot find the time necessary to spend at inservice training. D. At present most continuing medical education carries no accountability. Physicians who attend are not required to demonstrate any new knowledge or skill from the seminars they attend. They are granted AMA Category One credit simply on the basis of their attendance. Large computer networks can help to provide a partial solution to these problems. One such system is capable of supporting instruction on over 7,000 terminals simultaneously in over 100 cities in the United States and Canada. This same system is also now available in five countries in Europe and Africa. A vast networking system of this type is capable of delivering interactive instruction to wherever it is needed whenever it is needed immediately. Unfortunately, courseware of sufficient quantities is still not available but instructional developers working with health care professionals are closing the gap quickly. If high quality materials can be developed by qualified medical educators and knowledgeable instructional designers, a large computer network could have the following advantages for conducting continuing medical education: A. Instruction could be delivered wherever it was needed regardless of the location of the physician and without extensive requirements for physical space. B. Instruction could be accessed at the physician's convenience on an individual basis. C. Medical schools could grant AMA Category oie credit based on achievement. This achievement score could be easily accessed from the computer records file. A system of this type would enable medical educators to certify physicians on the basis of competency rather than attendance, a feature which might have its advantages in malpractice cases. D. The computer courseware delivered on the network could provide a more common learning experience for all physicians and provide more opportunities for sharing information with physicians who rarely have an opportunity to gain access to the latest medical research. This information could be constantly updated and accessed any time. E. More planning and research into the development of courses and seminars would be possible since computer-delivery requires exacting statements of objectives and performance points. In addition, information can be easily added or updated in a relatively short period of time. F. Physicians would save much time traveling to meetings and seminars. The ultimate benefit in CME delivered in a computer-based format, as one might hope, is improved patient care. However, computer-based delivery can also offer the additional benefits of availability of large data bases, patient profiles and case studies, and inter-terminal information exchange. In short, using a large networking system can allow health care professionals at many levels to access a wide variety of information and data quickly and accurately. 1.2 Improved Instructional Delivery At present the most common mode of instruction which is found in medical schools and continuing medical education is lecture. This traditional form of instruction is adequate for most all situations except when it is difficult to locate well qualified experts who are both extremely knowledgeable and proficient at lecturing. Where such a shortfall exists the computer can provide self-paced instruction which is highly interactive and which provides learners with a variety of applications of the knowledge they want to acquire. The computer can also provide a wide range of advantages over the lecture mode by A. Presenting simulations and case studies which require problem-solving, decision-making and general applications of the concepts under study. B. Offering detailed graphics, some animation capability, and, more recently, color presentations. Computer-generated graphics, charts, scatter plots, and illustrations are currently adding significantly to computer-based presentations of course material. C. Interfacing with other delivery systems such as slide projectors, audio equipment, video tape and video disk. D. Interfacing with various types of laboratory equipment for instruction in diagnosis, monitoring, and data base management. E. Generating testing and practice materials from on-line item pools which can aid drilling or testing one's understanding of material. When computers can be interfaced with a variety of equipment and be made to use a wide range of teaching strategies, the result is usually increased understanding and very often savings in both the time of instruction and its overall cost. Section 2 of this paper will deal more specifically with some of the unique applications of computer technology to situations which use many of the features listed above. A further feature of the computer which improves the instructional process is its ability 676

3 to measure and monitor learner achievement. By specifying periodic performance points within each instructional sequence, the computer can diagnose each learner's level of competency and monitor his/her progress toward content mastery. In this way, each learner is guided along an instructional route appropriate to his or her level of understanding. In addition, mastery can almost be assured because of review sequences, variable path branching, and performance checks. In medical school education this is not a trivial feature. In many classes mean scores on examinations often range from per cent mastery. Individualized instruction on an interactive, self-paced computer system can improve these mean scores considerably. 1.3 Increased Efficiency and Cost-effectiveness It is only fair to recognize that sophisticated computer systems capable of delivering the type of instruction cited thus far are expensive. Complex networking systems can cost well over $1,000 per terminal per month. These costs, however, must be put in their proper perspective and factored into the amount of use they receive, how many individuals they serve, savings in personnel or travel time and a host of other considerations before they are dismissed as costly fads. To date, few people have been able to calculate exact cost-benefit data when using computers as an instructional delivery system even though numerous studies have shown improved achievement, savings in time at instruction, and cost reductions in personnel utilization. The reason for this is that many of the savings to be found in computer-based instruction are difficult to quantify and measure accurately. For example, how much does it cost to take individuals away from their jobs for hospital inservice? How much time is required for a technician to learn how to use a new piece of laboratory equipment? How much time is wasted searching for a qualified professional to deliver a lecture? How much is lost when the lecturer takes time to prepare and deliver that lecture? These are difficult questions but they imply numerous factors which can influence the true costs of conducting training. The costs of computer-based education, therefore, cannot be based entirely on how much it costs to develop instructional materials or the cost of a terminal or microcomputer. These costs must be amoritized against the real costs of conducting training in traditional ways. Certainly, more research is needed in this area before computer-based instruction is dismissed as an expensive adjunct to medical education. 2. APPLICATIONS OF COMPUTER TECHNOLOGY TO HEALTH CARE TRAINJING The applications of computer technology to medical and allied health education are many and varied. Obviously, in a paper of this length all of those applications cannot be cited. What follows, therefore, is several examples which represent some of the ways computers are being used in the field of health care training. These examples have been grouped to illustrate how the various capabilities of the computer are being used to improve instruction. 2.1 Graphics Because of the highly illustrative nature of much of what is presented in traditional medical and allied health education, the graphic capabilities of the computer offer enormous possibilities for instruction and research. The graphic, animation, and color features offered by many computers allow complex graphs to be drawn, detailed cross sections of organs and molecules to be displayed and even animated, and multicolored illustrations to be presented on a monitor. Learners can respond to questions presented about these graphics and watch the computer modify them as a result of those responses. At the University of California, San Francisco, for example, computers are being used to simulate various molecular fusions. By colorcoding each molecule, researchers can study bonding thus saving valuable time in pharmaceutical research. Computer color display is also playing an increasingly important role in research with tomography and variety of other photographic processes. 2.2 Utilization of Data Bases At present the utilization of data bases is certainly one of the most common uses of computers in medical education. At the University of Texas Health Science Center at Dallas, for example, data based instruction is a common element in the education of health care professionals. The following serve as examples which are fairly typical of the way in which computers are used in many institutions: A. SCARS The Surgical Coding, Reporting and Retrieval System is a data base used in the Department of Surgery. It processes about 6,000 surgery cases annually for the purpose of establishing a record of the most common surgical procedures used in various types of operations. In preparing for surgery, surgeons can consult this data base on procedures, anesthesia, recovery rates, and a variety of other factors. Following surgery, the surgeon can add to the data base so that others might share in the experience of that surgical operation. B. Biochemistry Item Pool Over 5,000 test items in the area of biochemistry have been compiled and stored in the 677

4 University's DECsystem-10 for use in reviewing for biochemistry examinations. The DECsystem-10 supports over 125 terminals simultaneously; these are usually in full use prior to an examination. Students may review as many items as they wish and receive a hard-copy print out of the items they answer incorrectly. This data base has been extremely popular among students and is well used. A similar data base is currently being established by the Department of Nutrition and Dietetics. 2.3 Equipment Interface Another common use of computers in health care has been to interface computer systems with various types of existing and new equipment. For instructional purposes computers are being used to control slide projectors, 16mm film projectors, video tape and video disk units. In most instances, the computer allows random access to these other media with the exception of the 16mm film projector. The range of possibilities for interfacing both media systems and medical equipment is almost endless: A. A dental education program at the University of Iowa uses the plasma display PLATO terminal to rear-project slides on the terminal screen. Computer generated text can then be superimposed on these visuals. This allows random access of the slides as well as the presentation of textual material. This technique has also been used in a burn care simulation at Iowa. B. Successful experiments in the use of video tape and video disk under computer control are being tried at a number of medical schools. Video disk particularly adds a new dimension to individualizing instruction in a computerbased mode. Learners may access taped or filmed segments immediately or they can be presented over and over for review instantaneously. Students may view surgical procedures from a variety of angles if they are recorded on the disk. In short, the potential of this medium interfaced with the computer is almost unlimited. C. Computers linked to various diagnostic and laboratory equipment is now commonplace in most hospitals. The rapid development of many new fields such as nuclear medicine would be severely handicapped without the use of computercontrolled equipment. Some researchers are also trying to link some commonplace equipment with microcomputers. A researcher in Montana, for example, has developed an interface that will allow an Apple computer to monitor a spirometer. The computer compares parameters to formulas for predicted means, prints the actual and per cent predicted results and stores them in a data base for later use. As computer systems become less expensive and more complex and as health professionals become more sophisticated in their use, the applications of computers to a variety of equipment will burgeon. 2.4 Computer Based Education Computers have been used to deliver health care education since the medium was first used for instruction. It has not been until recently, however, that courses have been developed for use in large-scale networking systems. The Control Data Corporation is one company that has invested hundreds of thousands of dollars in educational materials for delivery over their PLATO system. These materials cover a broad range of topics and are intended for continuing medical education. The Miliken Publishing Company also offers limited medical courseware for delivery on the Apply II microcomputer. Milliken calls their courseware computer-based "seminars" and can be used for Category One credit. Seminars are offered in surgery, medicine, psychiatry, and urology. Most of the courseware used to deliver computer-based medical education is currently offered "in-house," that is, it was developed at the institution at which it is used and gets little use outside of that environment. Research is needed to identify these various courses and catalog them for use by other professionals. 3. FUTURE APPLICATIONS The future applications of computers to medicine and health care depends heavily on furthur developments in computer technology. However, current applications and research promises many new and exciting developments in the very near future. The following are some recent projects which give some indication of the direction computer applications will take: A. "Spectracs" Programmable Pacemaker - This device, as the name implies, is a pacemaker which can be programmed, but it is done after the pacemaker has been implanted. The obvious advantage in this device is that constant adjustment can be made in the pacemaker without surgery. This is of particular benefit to small children who must have pacemakers replaced as they grow older. B. Interactive Television - Interactive television operates from a video disk unit that is under microcomputer control. An event is recorded on the video disk by many different cameras making it possible to later view the event at the angle of the viewers choice. The viewer then has options of seeing a procedure or event from the top, side back or from whichever angle has been recorded.e C. Digicasting - Digicasting is a new technique for actually broadcasting digitized data over airways in the same manner that television signals are transmitted. This eliminates expensive terminal charges, phone line connections and delays. These signals can also be transmitted via satellite to most parts of the world. 678

5 In sunmmary, the applications of computer technology to all phases of medicine and health care are unlimited. We must, however, continue research into the most advantageous use of these new technologies and begin to train health care professionals in the operation and use of computer systems of all types. The result can only be improved medical and health care in the future. REFERENCES 1. Greenburg, A. G., Bruegel, R. and Peskin, G. W. "Surgical Continuing Medical Education: Format and Impact," Surgery, Vol. 81, No. 6, June 1977, Caldwell, R. M. "Evaluation of a program of Computer-assisted Reading Instruction for Semi-literate Adults." Paper presented at the American Educational Research Association Annual Meeting. Chicago, March Levin, S. "Inter.active Movies," paper presented at the American Educational Research Association Annual Meeting, Boston,