title: Creating a computer-aided intellectual environment for a consultative center of intensive care.
abstract: A consultative centre for intensive pediatrics (cip) is a center for rendering aid to children in urgent conditions who are hundreds kilometers from specialized help. Such aid is typically rendered by: 1)moving the patient to the another hospital, 2) the specialized team going out by plane, or 3) consulting the local physician by phone. The complexities of the cip dispatcher-consultation of the local physician entail a real-time system that provides a consultant with simultaneous operation with a computer and a local doctor over a phone. In 1987, a computer program, DINAR-1, was used. The core of this program was the scale of a patient's state severity "FHD-5.4" and essential elements of informative services: both a reference subsystem and one accumulating and analyzing data about cip activities, treated patients, and faults in the system of medical care. Two years of DINAR-usage showed the necessity of strengthening the decision support system for cip consultant. In 1989, a new program variant, DINAR-2, was completed. During the new variant's creation, we developed a model of decision making under conditions of information distortion (e.G., as a result of the subconscious influence of diagnostical hypotheses). This model was necessary for DINAR-2, because the most part of all information for decision making had subjective issue. Distinctions between levels of medical aid at the spot (in local hospitals) demanded the special assessment of a patient's state severity in order to adequately choose between tactical activities of the CIP. The severity of a patient's state original index depended on necessary therapy type; volume was developed. Special methodological interaction expedients between the user and the decision making system were verified in DINAR-2. The following improvements were also developed: subsystem of tuning on a definite area (1990); block of analytical final instructions on a patient's treatment (1991); visualization of introduced information (1991); determination of factors causing aggravation of a patient state (1992); and specialized subsystem of consultation of neonatals (1993). During the work, CIP got a new important function. CIP became a methodical center of the medical children aid. In keeping with this, a collection and analysis of information for regional health ministry became important part of DINAR-2. It is especially connected with touched discovery and analysis of medical defects. A system of child's death-rate analysis was especially created to make impartial decisions (1990). Expert subsystems had also an original continuation. This subsystem became a basis of the new system DINAR-created for the common pediatric physician who is attending a severely ill child. A principle addition to this system is a more complicated method of tactic solution choice. The technology of CIP supported by DINAR-systems had been bought by 35 different regions of the former USSR by 1994 (1989: one region; 1990: 2; 1991: 5; 1992: 10; 1993: 17 regions). The total population of all these regions is more than 59,000,000 people, and the total area is more than 11 million square kilometers. The main direction of DINAR's development is the creation of a regional computer network, allowing DINAR-to communicate with DINAR-in local hospitals. The first place for the usage of such a network is going to be the Big Urals Region. Big Ural consists of eight states. The total population of this territory is 28 million people and total area is 3.1 million square km. Computer networks will link eight regional CIPs to one another and the medical analytical center. The CIPs will have to be connected with 259 local hospitals. At present, the DINAR-2-CIP is installed in six states of the Big Ural, and DINAR-H is installed in four hospitals of the Sverdlovsk state.
authors.affiliation: Urgent Pediatrics Ltd., Ykaterinburg.
authors.forename: E K
authors.initials: EK
authors.lastname: Tsibulkin
authors.forename: S I
authors.initials: SI
authors.lastname: Goldberg
authors.forename: A O
authors.initials: AO
authors.lastname: Makhanek
authors.forename: A B
authors.initials: AB
authors.lastname: Blokhin
authors.forename: S M
authors.initials: SM
authors.lastname: Galperin
mesh_terms: D002648:Child; D004632:Emergency Medical Services; D006801:Humans; D010372:Pediatrics; D019114:Remote Consultation; D014586:USSR