Florida Family Physician
January 1996 / Volume 46 / Number 1
Computers are fast becoming an integral part of the practice of medicine. Family physicians practicing in the coming years will need to have a good understanding of computers and be comfortable working with them. The University of Cincinnati Department of Family Medicine recognized this and began a major upgrade of computer resources for their Residency Division in 1994. This coincided with the relocation of their university hospital-based residency training site to Providence Hospital, a local community hospital. In cooperation with the University of Cincinnati, Providence Hospital established a family practice center and provided office space for residency faculty and administrative staff.
As part of this joint effort, Providence Hospital and U.C. Family Medicine contributed funds and computer equipment to improve the residency program. Prior to the move, there were two IBM XT clones available to the residents with WordPerfect 5.1, Harvard Graphics 2.3, and a couple of DOS based medical education programs. One faculty member had a laptop computer and the secretaries had lower-end computers (based on the Intel 80286 and 80386 chips). While these resources may have been sufficient in earlier years, times change and it was time to reevaluate computer needs.
Plan of Action
A four part plan was devised. First, adequate computers were needed and they had to be accessible to everyone. To this end, new computers were purchased for all faculty and staff, two high performance machines (based on the Intel Pentium chip) were purchased for those involved in research and data analysis, a new PC was placed in the residents' lounge along with one of the better existing PCs, and PCs were placed in the conference room and preceptor library for presentations and other shared uses.
The second part of the plan was to establish a local area network (LAN) within the practice. The appropriate wiring was installed along with a fileserver and Novell 3.12 as the network operating system. The LAN connects all of the computers together with wiring and allows files, programs, and other resources to be shared among users.
The third part of the plan was to provide the latest software and reference materials. Since the new computers can easily run Microsoft Windows, it was decided to standardize on Windows software. One of the additional benefits of having a LAN is that software can be shared. With twenty-one computers it would be rather expensive to have a copy of each software program on each machine, so only a limited number of licenses were purchased along with metering software to insure copyright compliance. The software actually resides on the fileserver where everyone can access it. The software chosen was WordPerfect for Windows, WordPerfect GroupWise, Microsoft Office (includes Word, Excel, and PowerPoint), Lotus 123, Harvard Graphics, and SAS. Four CD ROM drives were installed on the fileserver for network access. STAT-Ref, Scientific American Medicine, American Family Physician, and MAXX (Little Brown series) were installed and can be referenced from any PC in the practice.
The fourth part of the plan was to provide connectivity to the rest of the world. This connectivity has three parts: dialing into and out of the Providence site by modem, having links to the rest of the Department through WordPerfect GroupWise (E-mail and scheduling software), and having Internet access. A Shiva LanRover was added to the LAN which provides four networked modems that can be used anywhere in the network. This unit also allows users with PCs and modems at home to dial in and access their files from home. Faxes can be sent out directly from any PC and users can connect to Physicians' Online for Medline and reference access. An Integrated Services Data Network (ISDN) link was established with the University's wide area network (WAN) that allows direct connection to any network at the University and provides Internet access at each PC. An ISDN link is essentially a high speed phone line that permits multiple connections at the same time.
Results
It has taken approximately eighteen months to get the system to the current state. The LAN was functional in September of 1994 and people started using it immediately even without formal training. Table 1 shows the number of hours of use by software type. WordPerfect is consistently used most often with 945 hours in the first quarter and rising to 1,544 hours in the last quarter. It accounts for 84% of the computer use. Unfortunately numbers on the use of the CD ROM references are not available as of this writing, but residents and faculty have mentioned that the ready access to the references has improved their patient care. In a matter of minutes they can quickly search through dozens of medical texts to find information they need. Residents and faculty are finding new sources of information at their fingertips and are using this information to better care for their patients.
| Software | Oct-Dec 1994 | Jul-Sep 1995 |
|---|---|---|
| WordPerfect 6.1 | 945 | 1,544 |
| MS Office | 82 | 213 |
| SAS | 20 | 39 |
| Harvard Graphics | 23 | 26 |
| Other | 21 | 12 |
| end |
Current and Future Directions
At the time of this writing, the task of integrating the users into the University's GroupWise E-mail system is still in progress. Remote access to the network is being setup to allow the other U.C. Family Medicine practice sites to dial in for E-mail and file sharing. A major goal is to use this communications and computing infrastructure as the basis for accessing and maintaining patient care data from the practice sites. This data can then be used to give feedback to residents and faculty about patient care and can provide the foundation for practice based research.