Paula Cleggett-Haleim

Headquarters, Washington, D.C.

(Phone: 202/453-1547) February 26, 1990

Karl Kristofferson
Kennedy Space Center, Fla.
(Phone: 407/867-2468)

RELEASE: 90-30

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, rapid-

reacting, 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.
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"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 reso-

lution 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.

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"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 1-
800-638-9636.

TO: MDS/PRA Group

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DATE & TIME: FEBRUARY 28, 1990

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