An extensive computer-based instrumentation system in a large health care center is described in this interesting paper. The distributed system covers several health care centers, with several computing elements at each center. Of particular interest is the real-time application described via a case example. In the example, blood flow has been cut off to a portion of the patient’s body as a repair is made to an artery. The effects of stimuli applied to the patient are monitored. The computer must vigilantly examine the response to each stimulus and “ring an alarm” when the response is deemed to be outside of certain expected boundaries. As a history of the treatment is required, and inasmuch as outside advice may be needed, the computer gathering the data and making the analysis is connected to a database computing system in which archival and consultation computing is performed. As the operating rooms are not devoted to any one procedure, the actual computing devices used are on transportable instrumentation work racks.
Much effort was devoted to constructing rugged systems capable of performing in the relatively noisy electrical environment of the operating theater. The authors describe a four-layer backup system: beta test system, new system, working system, and old system.
According to the authors, the system has been used on several thousand cases without failure, a testimony to the care with which it was designed and installed. If the authors plan to extend the applications to similar areas, the complexity of the systems will grow and more attention will have to be given to system testing, systems interactions, and failure modes.