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The timely availability and presentation of critical and interesting patient data is essential to ensure quality patient care as well as ease of recognition and, secondarily, to provide material for teaching and research. The ability to accomplish these goals expeditiously in a complex and busy clinical laboratory may be difficult to acquire. An on-line, computerized system has been developed which automatically searches each patient record for up to 600 different laboratory tests, compares each result against individually established limits, and then formats pertinent test results for maximum discrimination. The report format also includes patient and specimen collection data, diagnosis, attending physician's name, and other desired associated test results. An additional feature of the system is that selected critical or interesting results for each laboratory division may be displayed on video display terminals located throughout the laboratory and at nursing stations. The system was written using the FORTRAN programming language and runs on a Control Data Cyber 18 computer.

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The development of a computerized system for the assistance of a nutritional support service (NSS) is described. A cooperative program exists between the NSS and the Department of Laboratory Medicine, whose computer system is used to support the activities of the NSS. A record is maintained on each patient followed by the NSS (15-20 patients per day). Demographic and anthropometric data, nutritional disorder(s), laboratory data, nutritional support therapy, patient response criteria, and concomitant drug therapy are components of the computer program. Computer reports are provided to the NSS for daily rounds. An automated nutritional assessment program has also been developed. Computer assistance has proven to be a valuable tool to support the patient care, education and research program of the NSS.

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In an attempt to determine the incidence of alloimmune neonatal neutropenia, a systematic study was initiated during a period of six months. Complete blood count, differential and absolute neutrophil count of all the newborns were determined to identify the newborns with neutropenia and those with persistent neutropenia were evaluated for the presence of maternal neutrophil antibodies. This resulted in the design and use of a computerized system which was successfully employed to identify several neonates born with this disorder. The system includes a main program and eight functional options, and is operated under a secret authority code so that patients' data are accessible only to the investigators. The major functional options are: create, display, update and delete a record for the newborn; display most recent neutropenic babies; search all records and display name and ID number; search all records for a given year and display data; and perform statistics. The statistical analysis includes the total number of babies, both normal and those with neutropenia, the total number of babies with neutropenia and with/without sepsis, and those with persistent neutropenia. Also included are the hematological data consisting of complete blood count and differential of all of the newborns. Several possibilities exist to expand and extend the program for additional research-related purposes.

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The need to obtain blood alcohol levels in the differential diagnosis of the acutely intoxicated or unconscious patient often presents an emergency situation. By simultaneously determining the measured osmolality, the calculated osmolality, and the enzymatically-assayed ethanol level, the presence of alcohols other than ethanol can be recognized rapidly. A computer program has been written in FORTRAN to perform the necessary calculations, check for internal consistency, and alert the technologist if a disparity occurs.

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A system has been developed which allows for the easy display of information concerning tests performed in the clinical laboratory. The system is designed for use at nursing stations as well as in the clinical laboratory. The information which can be displayed includes: 1) general information, such as sample type, tube type and minimum sample volume; (2) price charged for the test; (3) special instructions, such as sample transportation, hours when test is available, and sample collection information; (4) normal or reference values for the results. The programs are written in FORTRAN IV and, together with the data files, require 422 kilobytes of storage space.

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A system has been developed which allows for easy storage and retrieval of patient diagnoses using ICD-9-CM codes. Entered codes are automatically interpreted by the computer and then both the code and the interpretation are stored as in integral part of the patient record. Teaching clinicians may use an automated, keyword-search algorithm to display the code for a diagnosis of interest and then use that code to find any hospitalized patient with such a primary or secondary diagnosis. Entered diagnoses automatically appear on worksheets in the clinical laboratory. Retrospective studies also may be performed whenever a pathologist wants to compare diagnoses with laboratory results.

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A computerized system is described which improves turnaround time for completion of in-patient medical records and copes with the problem of delinquent records. Many patients seen at University Hospital are referred from throughout the State, thus the specialist must stay in contact with the referring physician for optimal patient care. The Medical Records Department assists in this effort through use of the system, which includes pertinent dates and other information concerning each patient. Several reports are generated from this information, e.g., outstanding records sorted by department/physician and outstanding records with charges pending. The total software system is comprised of 22 program, 2 sub-routines, and 4 data files; the total disk storage space required is 1413 kilobytes.

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The function of the clinical pharmacokinetic service (CPS) in University Hospital is described. A methodological procedure was developed for routine interpretation of specified drug serum levels. Work lists that identify analytical procedures to be included for clinical pharmacokinetic evaluation are prepared daily. The results of all analyses of serum drug levels are evaluated by a pharmacist who is trained in clinical pharmacokinetics. Patient variables that influence serum levels of drugs are mathematically manipulated by program logic. Projections of expected drug levels as a result of dosing regimens are made and compared to measured laboratory results. Iterative programming that modifies projections on the basis of actual measurements is employed to determine individual drug dosing regimens that provide therapeutic/nontoxic serum levels of drugs. The drug/test interference system, which accesses the CPS data base, provides information concerning the potential physiologic, therapeutic, or toxic effect of drugs on biochemical substances. The system allows display of data concerning each drug before it is administered. Information concerning the date and time of initiation and termination of drug therapy allows for a warning comment to be attached automatically to the appropriate laboratory test result if interference is indicated.

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Using a clinical laboratory computer system, software has been developed which checks to determine if the result of any test performed on a patient specimen may be affected by any drug administered to that same patient. If possible interference is detected, a comment is automatically attached to the result on the patient's computer-generated report warning the attending physician the result may be falsely elevated or lowered.

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The Clinical Laboratory Computer System currently in use at the Medical University of South Carolina is described. Not only is the existing hardware listed and shown in some detail, but also the workload, laboratory data center personnel, typical procedures, and examples of selected input and output documents are included. Particular emphasis is placed on the dynamic nature of the system, which allows the user to proceed easily in developing new programs as the requirements of the laboratory continue to change and grow. To illustrate this point, programs written by the user are described in general terms.

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Aminoacyl-tRNA's from Sarcina lutea were tested for incorporation into protein in a heterologous system from Escherichia coli or for biniding in a homologous system from Sarcina lutea. Aminoacyl-tRNA's from Saccharomyces cerevisiae were tested for biniding in a homologous Saccharomyces cerevisiae system. Synthetic polyribonucleotides were used as messengers. The code which exists in Sarcina lutea and Saccharomyces cerevisiae is the same as in Escherichia coli.

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