We've used Macs running HyperCard to manage a medical clinic with over 4000 active patients since 1993. Patients see the secretaries, all the medical assistants, doctors and nurse practitioners using Macs to handle their personal medical information every day. After their office visit, all patients stop by the nursing station to schedule tests and appointments and pick up custom-printed instructions (my handwriting is lousy, but i kan tyPe) and graphs showing lab results etc. Recently replaced the drab PowerBook 1400/166 with a Graphite iBook. Patients comment every day on the flashy new computer, some turning a healthy green (easily diagnosed as iBook envy). More than one noticed the Apple logo on the iBook and realized for the first time we are NOT using Windows. It's been a great promo for Apple and hasn't hurt the perception of our office to have such cool technology.
Since the following letter was written in 1999, we have successfully overcome several obstacles to add G4 machines running OS9.0.4 to our network. We now save digital photos of various rashes and other conditions (taken with an HP Photosmart 618 and stored in jpeg format, which displays nicely using HC2.4.1). So an eye doctor emailed a photo of a retinal hemorrhage, and when the patient came in I showed him exactly where the problem was. The retired college prof was impressed! I can see a rash Monday and my colleague see the patient back Thursday and the photo shows whether the treatment is working or needs to be changed. Unfortunately we cannot upgrade to OS X until HC is carbonized, and we are looking at cross-platform alternatives (but after months of study haven't found anything as useful as HC). The letter was sent by certified mail but otherwise was not acknowledged by Apple.
December 5, 1999
Apple Computer, Inc.
1 Infinite Loop
Cupertino, CA 95014
To Whom It May Concern:
Enclosed please find two graphs displaying laboratory values for two patients whose lives may have been saved due to Apple technology. (The data are real, but the names were changed). The graphs were generated in a few seconds from data acquired, stored and processed in Apple systems. What's important to notice is that the patients were asymptomatic and their exams did not show any problem; even the laboratory values were "normal." The trend over several years revealed the diagnosis of prostate cancer, and both gentlemen have started treatment with good hope for cure. Note the dramatic drop in the Prostate Specific Antigen level for "Mr. Goodbody," showing his response to treatment. The other man just got started. Most physicians would have filed the "normal" PSA reports and allowed the cancers to progress.
We installed a Mac IIci and a pair of LCII's in 1991-92 in the business office, running MediMac software. In 1993 we put PowerBooks in each exam room (initially 145B's using LocalTalk, later 150's with a 10baseT hub when we needed graphics, currently 1400/166's) for preparing Lab and Xray forms. The MediMac scheduling module was cumbersome, and we replaced that with our own in-house solution which better supports multiple providers and automates patient recalls. In 1995 we stopped filing paper reports, switching to scanning all Xrays, EKG's and correspondence on a ScanJet 3P. We tossed out the laboratory-provided dot-matrix printer and using MicroPhone II software with AppleScript automated the receiving and filing of ASCII files from the hospital. Rather than punching holes and filing, the clerk sits at a workstation (initially a 6100/66, now a beige G3 running ASIP5.0.2) and uses a few mouseclicks to put the documents in patient folders. The records are accessible anywhere using ARA, and with 10 backup sets are far more secure than paper charts. In 1996 we replaced written messages with an office Email system, and implemented a prescription-writing tool that tracks patients' medications, allergies, drug formularies, and possible drug interactions. It ties in with a product from The Medical Letter which is updated every 6 months. Our malpractice carrier was so impressed they lopped over $1000 off the annual premium due to the reduced risk. In 1997 we replaced written referral forms with automated ones that can be faxed using the FaxSTF Network product, with considerable help from QuicKeys and AppleScript. With two years of lab data "on line" we built a graphing tool to analyze patient data, showing trends in blood sugar for diabetics for example, and the patients love it (and our vintage DeskWriters just keep going). We now have over four years of "live" lab data stored on an 18 GB drive in the old G3 and mirrored on a stack of APS 4GB drives. In 1998 to save time in the exam rooms we implemented a point-and-click patient instruction tool that more than makes up for any doctor's handwriting, and also generates the encounter "superbill" for use by the billing office. The provider signs the top half, the patient signs the bottom, and we split the perforated form. This year, to make the HMO folks happy, we showed them tools that analyze patient records to show, for example, all patients over age 50 who have not had a physical. The reviewers couldn't believe we could do this stuff and gave us their highest rating. In September we replaced a tired PowerCenter 150 with a blue G3 350 for our main application server, and we just bought AppleShare IP 6. We are looking forward to faster machines and OS 9 and beyond, so long as it supports our applications.
We had professional help with the Category 5 wiring, and I once hired consultants to switch my "prototype" system into a "real" relational database. They looked at FoxBase, FileMaker, and 4D, and couldn't quite match what I was doing using off-the-shelf software. I have spent $5-10,000 annually for hardware and software upgrades; I have been reading Intelligent Enterprise and DB2 for a couple of years, and realize I could probably duplicate my system with a team of programmers and a million bucks on UNIX or NT or worse. (I make under $100K per year, about average for a small town doctor.)
I ordered ASIP 6.3 from MacWarehouse but had to cancel the order and scrounge to find an older 6.1 version when I learned that OS 9 no longer supports the development tools that keep our office running a year or two ahead of the Wintel based offices. As you probably have guessed, the off-the-shelf software we use is HyperCard. I run one instance of HC 2.1 for our Appointments server and one of HC 2.3 for the Clinical server on the blue G3 (both licensed, of course) and the clients are application stacks. I don't need the special visual effects which I understand may be very slow under OS 9, but use the "answer program" call in setting up the clients, and require reliable file management with the AppleScripts built into the stacks. We desperately ask that you not abandon HyperCard, but continue to update it to allow us to acquire G4 and newer technology.
Please let me know if you want to see the stacks or if you want a demonstration tour of the office. Jonesville is a village about two hours' drive from Detroit. I would be glad to send the current version on disk or by Email (the office Email is email@example.com) if it would help to convince you why we must have functional HyperCard tools. HyperCard is helping us save lives!
Robert Shannon, M.D.
and office staff