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A survey of the applications of computersin the community health services-community health systems
Pub/. Hlth, Lond. (1985) 99, 356-363
A Survey of the Applications of Computers in the Community Health ServicesCommunity Health Systems C. P. Catchpole Researcher
Dar//ngton Hea/th Author/ty, Memoria/ Hospital Dar/ington
In November 1984 a questionnaire survey was circulated to discover the current state of the art with regard to computer applications in the community health services across the U.K. This survey was combined with a more traditional literature search for relevant information, making much use of computerized on-line techniques for access to bibliographic databases such as Medline. This paper summarizes many of the applications discovered which make up the "state-of-the-art" such as the many recall systems and nurse workload analysis packages reported, and also presents a selection from the numerous "results" obtained following computer analysis of the responses collected. It is interesting to note the extremely widespread use of microcomputers within community health departments, and the enormously varied applications to which they are put. There is a whole proliferation of computer applications in the community, but only a small number of authorities when considering the country as a whole make any where near full use of the new technology. This is the only attempt that has been made as far as I am aware to collect together national data, regarding community health computer applications and make available a register of the applications reported on. Introduction
This paper gives the findings from a recent review of literature published over the last 5 years on the uses of computers in the community health services, and a questionnaire survey sent out to all health authorities in the country. From previous work carried out, it was obvious that very little had been published on computer systems in the community services. It appears that nurses are not inspired to write about their work in such an academic way, as for example, general practitioners are. In fact, there is an enormous range of literature written by doctors about systems they are using in the community, which I would refer to as community medicine, rather than community health systems. Because of limited published information, it became quite clear that a more practical approach would also be required to augment a traditional literature search. For this, a questionnaire was designed to be circulated to all health authorities regarding their current and future uses of computers in their community services. This questionnaire was devised in such a way as to provide information for this survey, and to allow the construction of a national data base of community systems providing useful operational and technical information. There is a tendency for many different grades of staff to be responsible for localized systems development, ranging in the community from unit administrators, through to nursing officers, and it was difficult to decide on a target grade to send the questionnaire to. Therefore, the chief nursing officers of each authority were selected as the contact 0033-3506/85/060356+08 $02.00/0
~) 1985 The Societyof CommunityMedicine
Computers and Community Health Systems
357
persons, with a request being made to forward the questionnaire onto the appropriate member of staff responsible for community systems. The questionnaire was sent out in mid November 1984, and responses started arriving soon afterwards, and continued to do so for a 3-month period. Eventually, a 95% response rate was achieved with only eight authorities failing to make a return. This can be regarded as an excellent response for any questionnaire type of survey.
A Summary of Reported Applications The following is a description of some of the applications discovered from both the literature search and the questionnaire survey.
The National Standard Child Health System This is obviously the most commonly used package, available to all health authorities throughout the country and currently used by more than half. The system, originally designed by the Welsh Health Technical Services Organization (WHTSO), consists of five major modules, of which all but the first are optional. The modules are: (1) the child register, (2) immunization module, (3) pre-school health, (4) school health, and (5) a statistical module. One of the main aims of producing the child health system has beenflexibility, to the extent that the systems would be acceptable for use by all authorities taking into account local variations in operational procedures, with the objective of capturing and maintaining accurate, up-to-date management and clinical data to ensure appropriate provision of services to all children. One recent development for the system as it evolves is to make use of microcomputers and distributed processing, and to use interactive methods of data capture using district based computers. The Computer Policy Committee are currently considering extending the system to make it into a complete community health package. This development may take place over the next 4 years or so. There are other child health packages available however, such as the Cheshire Child Health system, running on an IBM mainframe, the North Warwickshire System, also running on IBM equipment, and a micro-based system running in North Derbyshire on "Sirius/Apricot machines, based around commercially available software packages, and the "Childfile" system running in Nottinghamshire.
Community Loan of Nursing Equipment Systems Although stock control systems were one of the original most common applications for computerization in the community services, only three authorities Leeds Eastern, South West Hertfordshire and Islington reported having operational systems. South Birmingham do have a loan of equipment module in their Financial Information Project system. Many other systems are now under development however. The system in operation in Islington is particularly worth mentioning, known as the "Green Walk Aids" system, records pertaining to patients, equipment and suppliers are
358
C. P. Catchpole
maintained. Numerous reports are available including overdue order lists, reminder lists or labels for periodic checking. Delivery lists can be produced in walking or picking order.
Community Registers Many authorities have produced systems running on microcomputers to maintain various registers for purposes such as recall. Several authorities operate computerized mental handicap registers. Islington Health Authority maintain on a Rair computer, a register of persons with learning difficulties and disabilities. Patients from 5 years of age upwards are recorded on the system, who either live in Islington, or come from Islington, but are in long-stay hospitals. The information provided is used for service planning purposes. Other systems are in use in Sandwell, Clwyd and Croydon, who run a system known as MENINDEX. The maintenance of elderly, age-sex, incontinence and rubella recall registers is also common:
Cervical Cyto/ggy Recall Systems Many authorities operate such systems to give recall facilities and provide basic patient information on the results of smear tests. Fife Health Board have operated since 1983, a package known as t h e " Wellwoman System", which records attendances at family planning clinics, as well as handling cervical smear test records. The system produces patient register lists, outstanding and abnormal smear test results lists and numerous other reports by various parameters. This program runs on a Micro Data reality minicomputer system.
Community Nursing Statistical Reporting Systems A number of systems are available for collecting basic statistical information on activities and services. The system running in Wessex Region is one of the most comprehensive. It is running in six of the 10 Wessex districts, who each have Hytec microcomputers to locally collect data which is then transmitted by telephone link to the regional mainframe for analysis on a monthly, yearly or ad hoc basis as required. Workload data is collected for health visitors, district nurses, school nurses and community midwives on number of visits by age groups, dependency and disease classification for district nurses and by visit reason for health visitors. Other systems have been produced in Clwyd, Canterbury and Thanet, East Birmingham and in Kingston and Esher, who make use of the integrated package Lotus 1-2-3 on the IBM personal computer. This system provides for quick and accurate compilation of district nurses work returns and for easy analysis and interpretation of results.
Some Individual Novel Applications Many authorities have produced some extremely interesting programs to provide systems for: Centralized chiropody service management (in Shropshire), Dental workload (in Clwyd), Environmental health (in Sandwell), Survey analysis (in Central Nottinghamshire), "Children at risk" scoring system (in Portsmouth and S.E. Hampshire), Speech therapy statistics (in Bromley).
Computers and Community Health Systems
359
TABLE1. Package name
Applicationliaison system
Hardware
Authority
CardBox Maternity liaison system Sirius Maidstone Condor DBMS Dentalworkload HP 150 Clwyd Community nursing activity HP150 Clwyd Rubella vaccinationsystem HP150 Clwyd Resettlement recall system IBM Micro Clwyd dBASE II DBMS Family planning records Hytec Hastings Nursing Home records Hytec Hastings Community nursing records Hytec S. Glamorgan District nurse caseloads Hytec S. Glamorgan Community nursing directory Sirius C. Manchester Cervical cytology Equinox Harrogate Community nursing returns Hytec Somerset Communicable disease management Sirius Fife Personnel data TeleVideo Brent Family Planning statistics Cifer Lewisham Delta Package Kornerstatistics Sirius Hillingdon Demon DBMS Numerousapplications ICL DRS Nottingham Lotus 1-2-3 Districtnursing statistics IBM Micro Kingston SuperCalc II Chiropodystatistics Hytec Hastings Value-for-moneyexercise Hytec Hastings Nurse manpower returns Sirius Hounslow Community unit statistics Hytec S. Glamorgan Community unit statistics Micro Redbridge Silicon Office Schoolroll system Commodore S.W. Surrey Analysis of communitystatistics DEC 100 Worthing Wordstar Wordprocessing LSI Rochdale Wordprocessing Hytec Hastings Wordprocessing (using MailMicro Redbridge merge and ReportStar also)
Often, use is made of commercially available microcomputer packages to directly implement applications. Table 1 indicates the uses of which some common packages are being put.
Recent and Future Developments Two major information system projects, the Financial Information Project (FIP) and the Management Information Pilot Project (MIPP) both incorporate community modules which provide excellent community information. The publication of the K r r n e r Reports has greatly stimulated computer developments due to the nature of many of the recommendations. In fact the MIPP system has been produced as a direct response to K r r n e r in order to implement all of the K r r n e r minimum data sets. The community system will be ready to go live in April 1985. Many other authorities are now developing systems to fulfil the K r r n e r requirements. One such authority is Ealing, who will introduce in June 1985, a community nursing workload system which fulfils the minimum data set requirements of Krrner, and provides additional
C. P. Catchpole
360
TABLE 2. Type of programs running or being developed Type Cervical cytology Child health* Children at risk Chiropody Communicable diseases Community health stats Community registers Dental workload Environmental health Epidemiological data Loan of equipment Maternity liaison Nursing personnel Others/Miscellaneous Patient recall Primary health care Speech therapy Survey analysis Travelling expenses Total
N
%
6 46 2 2 1 29 8 1 1 1 7 1 14 12 3 2 1 2 1 140
4 33 1 1 1 20 6 1 1 1 5 1 10 9 2 1 1 1 1 100
* Not all authorities regarded the Standard Child Health system as a community health application. More than half of the authorities in the country, actually use it.
TABLE 3. Grades of staff technically/operationally knowledgeable about systems Grade of staff
N
%
Regional/district computing staff DNS (community) Unit administrators DNO/CNO Support nurses Administration staff
12
25
9 5 5 9 8
19 10 10 19 17
48
100
Total
Only 48 job titles were determinable from the questionnaires, on the majority of responses the job title was not given.
operational information for managers. This system will run on an IBM personal computer using Oracle. A 2-year study underway in Kettering will also implement Korner using the dBASE II package on a Sirius microcomputer.
Results of the Survey Out of a total of 237 questionnaires sent out to health authorities, the survey attracted a 95% response rate. Many authorities filled in multiple questionnaires since they were operating more than one system. A total of 261 questionnaires were received. A selection of the results are given in Tables 2-7 and Figure 1.
Computers and Community Health Systems
361
TABLE 4. Availability of systems to other authorities Availability
N
Free to N H S users At a cost N o t available Maybe in the future
39 26 9 31
37 24 9 30
105
100
Total
TABLE 5. Microcomputer usage in the c o m m u n i t y Type
N
Sirius Commodore Apple Hytec ~ ICL D R S HP Unspecified* DEC Televideo
10 15 2 9 7 3 34 4 3
11 17 2 10 8 4 39 5 4
87
100
Total
* The "Unspecified" could include microcomputers of the types in other columns as well as other microcomputers; this was not discernible from some questionnaires. TABLE 6. Minicomputer usage in the c o m m u n i t y Type
N
~o
ICL ME29 DEC PDP MicroData Unspecified*
2 5 2 7
12.5 31 12.5 44
Total
16
100
* The "Unspecified" could include minicomputers of the types in other columns as well as other minicomputers; this was not discernible from some questionnaires. TABLE 7. Languages used for community systems Language
N
~o
BASIC COBOL dBASE MUMPS Assembler Pascal Other Fortran
40 50 18 5 5 2 17 0
29 37 13 4 4 1 12 0
Total
137
100
362
C. P. Catchpole 25
20
15
"5 d
z
I0
I I I I I I I I I I t [ I i t I I I I I I I I I I I I I I I I I 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 [
I I I I 61 16
1968 1969 1970 1971 1972 1979 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986
Date
(month,
year)
Figure 1. Implementation dates of community systems.
Conclusion
This survey has shown that in fact there are a whole proliferation of computer applications in the community which run on an equally wide range of hardware. Developments appear to be made in an ad hoc manner however, with a community unit perhaps purchasing a microcomputer system to run an application designed and specified by themselves, often without any help at district or regional level. Consequently there is little standardization between hardware, software or operating systems, resulting in compatibility problems. This picture is typical, not just of the community but of all disciplines within the service introducing local computing facilities. The commonest type of community applications include systems which provide statistical data on the workload of community staff, community manpower systems, community patient registers and of course the National Child Health system, running in over half of the authorities in the country, and accounting for the majority of mainframe usage by the community health services, Micro systems tend to be purchased and sited locally within community units, although a small number of shared systems were reported. The most popular language in use is BASIC, not surprising considering the large number of" BASIC only" microcomputers, such as the Commodore, that are in use. However, many commercial microcomputer packages, such as spreadsheet and file management systems are in wide use, especially dBASE II. Although from the results of the survey, COBOL appeared to be the most popular language, this is only because of the large number of respondents who indicated using the National Child Health system, which is written in COBOL. One of the most surprising results from the survey has been the large number of systems, stated as becoming operational as of January, 1985. Obviously, the previous year has seen the purchase of much equipment, and the design of many new systems, this has perhaps been stimulated by the publication of the K6rner Reports, the Community Report being made available in July, 1984.
Computers and Community Health Systems
363
East Anglia Regional Health Authority maintain, on behalf of the N.H.S. as a whole, a register of all computer applications in use within the Health Service. A community section is included. In order to keep the register up,to date, individual uset-s must submit on a regular basis to East Anglia, details of new developments. This survey has shown however that many applications in the community, are not recorded in this register but which were reported in this survey. At the present time I would regard the National Register produced from this survey as the most accurate reflecting the current state of the art in community systems.
A Survey of the Applications of Computers in the Community Health ServicesCommunity Health Systems C. P. Catchpole Researcher
Dar//ngton Hea/th Author/ty, Memoria/ Hospital Dar/ington
In November 1984 a questionnaire survey was circulated to discover the current state of the art with regard to computer applications in the community health services across the U.K. This survey was combined with a more traditional literature search for relevant information, making much use of computerized on-line techniques for access to bibliographic databases such as Medline. This paper summarizes many of the applications discovered which make up the "state-of-the-art" such as the many recall systems and nurse workload analysis packages reported, and also presents a selection from the numerous "results" obtained following computer analysis of the responses collected. It is interesting to note the extremely widespread use of microcomputers within community health departments, and the enormously varied applications to which they are put. There is a whole proliferation of computer applications in the community, but only a small number of authorities when considering the country as a whole make any where near full use of the new technology. This is the only attempt that has been made as far as I am aware to collect together national data, regarding community health computer applications and make available a register of the applications reported on. Introduction
This paper gives the findings from a recent review of literature published over the last 5 years on the uses of computers in the community health services, and a questionnaire survey sent out to all health authorities in the country. From previous work carried out, it was obvious that very little had been published on computer systems in the community services. It appears that nurses are not inspired to write about their work in such an academic way, as for example, general practitioners are. In fact, there is an enormous range of literature written by doctors about systems they are using in the community, which I would refer to as community medicine, rather than community health systems. Because of limited published information, it became quite clear that a more practical approach would also be required to augment a traditional literature search. For this, a questionnaire was designed to be circulated to all health authorities regarding their current and future uses of computers in their community services. This questionnaire was devised in such a way as to provide information for this survey, and to allow the construction of a national data base of community systems providing useful operational and technical information. There is a tendency for many different grades of staff to be responsible for localized systems development, ranging in the community from unit administrators, through to nursing officers, and it was difficult to decide on a target grade to send the questionnaire to. Therefore, the chief nursing officers of each authority were selected as the contact 0033-3506/85/060356+08 $02.00/0
~) 1985 The Societyof CommunityMedicine
Computers and Community Health Systems
357
persons, with a request being made to forward the questionnaire onto the appropriate member of staff responsible for community systems. The questionnaire was sent out in mid November 1984, and responses started arriving soon afterwards, and continued to do so for a 3-month period. Eventually, a 95% response rate was achieved with only eight authorities failing to make a return. This can be regarded as an excellent response for any questionnaire type of survey.
A Summary of Reported Applications The following is a description of some of the applications discovered from both the literature search and the questionnaire survey.
The National Standard Child Health System This is obviously the most commonly used package, available to all health authorities throughout the country and currently used by more than half. The system, originally designed by the Welsh Health Technical Services Organization (WHTSO), consists of five major modules, of which all but the first are optional. The modules are: (1) the child register, (2) immunization module, (3) pre-school health, (4) school health, and (5) a statistical module. One of the main aims of producing the child health system has beenflexibility, to the extent that the systems would be acceptable for use by all authorities taking into account local variations in operational procedures, with the objective of capturing and maintaining accurate, up-to-date management and clinical data to ensure appropriate provision of services to all children. One recent development for the system as it evolves is to make use of microcomputers and distributed processing, and to use interactive methods of data capture using district based computers. The Computer Policy Committee are currently considering extending the system to make it into a complete community health package. This development may take place over the next 4 years or so. There are other child health packages available however, such as the Cheshire Child Health system, running on an IBM mainframe, the North Warwickshire System, also running on IBM equipment, and a micro-based system running in North Derbyshire on "Sirius/Apricot machines, based around commercially available software packages, and the "Childfile" system running in Nottinghamshire.
Community Loan of Nursing Equipment Systems Although stock control systems were one of the original most common applications for computerization in the community services, only three authorities Leeds Eastern, South West Hertfordshire and Islington reported having operational systems. South Birmingham do have a loan of equipment module in their Financial Information Project system. Many other systems are now under development however. The system in operation in Islington is particularly worth mentioning, known as the "Green Walk Aids" system, records pertaining to patients, equipment and suppliers are
358
C. P. Catchpole
maintained. Numerous reports are available including overdue order lists, reminder lists or labels for periodic checking. Delivery lists can be produced in walking or picking order.
Community Registers Many authorities have produced systems running on microcomputers to maintain various registers for purposes such as recall. Several authorities operate computerized mental handicap registers. Islington Health Authority maintain on a Rair computer, a register of persons with learning difficulties and disabilities. Patients from 5 years of age upwards are recorded on the system, who either live in Islington, or come from Islington, but are in long-stay hospitals. The information provided is used for service planning purposes. Other systems are in use in Sandwell, Clwyd and Croydon, who run a system known as MENINDEX. The maintenance of elderly, age-sex, incontinence and rubella recall registers is also common:
Cervical Cyto/ggy Recall Systems Many authorities operate such systems to give recall facilities and provide basic patient information on the results of smear tests. Fife Health Board have operated since 1983, a package known as t h e " Wellwoman System", which records attendances at family planning clinics, as well as handling cervical smear test records. The system produces patient register lists, outstanding and abnormal smear test results lists and numerous other reports by various parameters. This program runs on a Micro Data reality minicomputer system.
Community Nursing Statistical Reporting Systems A number of systems are available for collecting basic statistical information on activities and services. The system running in Wessex Region is one of the most comprehensive. It is running in six of the 10 Wessex districts, who each have Hytec microcomputers to locally collect data which is then transmitted by telephone link to the regional mainframe for analysis on a monthly, yearly or ad hoc basis as required. Workload data is collected for health visitors, district nurses, school nurses and community midwives on number of visits by age groups, dependency and disease classification for district nurses and by visit reason for health visitors. Other systems have been produced in Clwyd, Canterbury and Thanet, East Birmingham and in Kingston and Esher, who make use of the integrated package Lotus 1-2-3 on the IBM personal computer. This system provides for quick and accurate compilation of district nurses work returns and for easy analysis and interpretation of results.
Some Individual Novel Applications Many authorities have produced some extremely interesting programs to provide systems for: Centralized chiropody service management (in Shropshire), Dental workload (in Clwyd), Environmental health (in Sandwell), Survey analysis (in Central Nottinghamshire), "Children at risk" scoring system (in Portsmouth and S.E. Hampshire), Speech therapy statistics (in Bromley).
Computers and Community Health Systems
359
TABLE1. Package name
Applicationliaison system
Hardware
Authority
CardBox Maternity liaison system Sirius Maidstone Condor DBMS Dentalworkload HP 150 Clwyd Community nursing activity HP150 Clwyd Rubella vaccinationsystem HP150 Clwyd Resettlement recall system IBM Micro Clwyd dBASE II DBMS Family planning records Hytec Hastings Nursing Home records Hytec Hastings Community nursing records Hytec S. Glamorgan District nurse caseloads Hytec S. Glamorgan Community nursing directory Sirius C. Manchester Cervical cytology Equinox Harrogate Community nursing returns Hytec Somerset Communicable disease management Sirius Fife Personnel data TeleVideo Brent Family Planning statistics Cifer Lewisham Delta Package Kornerstatistics Sirius Hillingdon Demon DBMS Numerousapplications ICL DRS Nottingham Lotus 1-2-3 Districtnursing statistics IBM Micro Kingston SuperCalc II Chiropodystatistics Hytec Hastings Value-for-moneyexercise Hytec Hastings Nurse manpower returns Sirius Hounslow Community unit statistics Hytec S. Glamorgan Community unit statistics Micro Redbridge Silicon Office Schoolroll system Commodore S.W. Surrey Analysis of communitystatistics DEC 100 Worthing Wordstar Wordprocessing LSI Rochdale Wordprocessing Hytec Hastings Wordprocessing (using MailMicro Redbridge merge and ReportStar also)
Often, use is made of commercially available microcomputer packages to directly implement applications. Table 1 indicates the uses of which some common packages are being put.
Recent and Future Developments Two major information system projects, the Financial Information Project (FIP) and the Management Information Pilot Project (MIPP) both incorporate community modules which provide excellent community information. The publication of the K r r n e r Reports has greatly stimulated computer developments due to the nature of many of the recommendations. In fact the MIPP system has been produced as a direct response to K r r n e r in order to implement all of the K r r n e r minimum data sets. The community system will be ready to go live in April 1985. Many other authorities are now developing systems to fulfil the K r r n e r requirements. One such authority is Ealing, who will introduce in June 1985, a community nursing workload system which fulfils the minimum data set requirements of Krrner, and provides additional
C. P. Catchpole
360
TABLE 2. Type of programs running or being developed Type Cervical cytology Child health* Children at risk Chiropody Communicable diseases Community health stats Community registers Dental workload Environmental health Epidemiological data Loan of equipment Maternity liaison Nursing personnel Others/Miscellaneous Patient recall Primary health care Speech therapy Survey analysis Travelling expenses Total
N
%
6 46 2 2 1 29 8 1 1 1 7 1 14 12 3 2 1 2 1 140
4 33 1 1 1 20 6 1 1 1 5 1 10 9 2 1 1 1 1 100
* Not all authorities regarded the Standard Child Health system as a community health application. More than half of the authorities in the country, actually use it.
TABLE 3. Grades of staff technically/operationally knowledgeable about systems Grade of staff
N
%
Regional/district computing staff DNS (community) Unit administrators DNO/CNO Support nurses Administration staff
12
25
9 5 5 9 8
19 10 10 19 17
48
100
Total
Only 48 job titles were determinable from the questionnaires, on the majority of responses the job title was not given.
operational information for managers. This system will run on an IBM personal computer using Oracle. A 2-year study underway in Kettering will also implement Korner using the dBASE II package on a Sirius microcomputer.
Results of the Survey Out of a total of 237 questionnaires sent out to health authorities, the survey attracted a 95% response rate. Many authorities filled in multiple questionnaires since they were operating more than one system. A total of 261 questionnaires were received. A selection of the results are given in Tables 2-7 and Figure 1.
Computers and Community Health Systems
361
TABLE 4. Availability of systems to other authorities Availability
N
Free to N H S users At a cost N o t available Maybe in the future
39 26 9 31
37 24 9 30
105
100
Total
TABLE 5. Microcomputer usage in the c o m m u n i t y Type
N
Sirius Commodore Apple Hytec ~ ICL D R S HP Unspecified* DEC Televideo
10 15 2 9 7 3 34 4 3
11 17 2 10 8 4 39 5 4
87
100
Total
* The "Unspecified" could include microcomputers of the types in other columns as well as other microcomputers; this was not discernible from some questionnaires. TABLE 6. Minicomputer usage in the c o m m u n i t y Type
N
~o
ICL ME29 DEC PDP MicroData Unspecified*
2 5 2 7
12.5 31 12.5 44
Total
16
100
* The "Unspecified" could include minicomputers of the types in other columns as well as other minicomputers; this was not discernible from some questionnaires. TABLE 7. Languages used for community systems Language
N
~o
BASIC COBOL dBASE MUMPS Assembler Pascal Other Fortran
40 50 18 5 5 2 17 0
29 37 13 4 4 1 12 0
Total
137
100
362
C. P. Catchpole 25
20
15
"5 d
z
I0
I I I I I I I I I I t [ I i t I I I I I I I I I I I I I I I I I 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 1 6 [
I I I I 61 16
1968 1969 1970 1971 1972 1979 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986
Date
(month,
year)
Figure 1. Implementation dates of community systems.
Conclusion
This survey has shown that in fact there are a whole proliferation of computer applications in the community which run on an equally wide range of hardware. Developments appear to be made in an ad hoc manner however, with a community unit perhaps purchasing a microcomputer system to run an application designed and specified by themselves, often without any help at district or regional level. Consequently there is little standardization between hardware, software or operating systems, resulting in compatibility problems. This picture is typical, not just of the community but of all disciplines within the service introducing local computing facilities. The commonest type of community applications include systems which provide statistical data on the workload of community staff, community manpower systems, community patient registers and of course the National Child Health system, running in over half of the authorities in the country, and accounting for the majority of mainframe usage by the community health services, Micro systems tend to be purchased and sited locally within community units, although a small number of shared systems were reported. The most popular language in use is BASIC, not surprising considering the large number of" BASIC only" microcomputers, such as the Commodore, that are in use. However, many commercial microcomputer packages, such as spreadsheet and file management systems are in wide use, especially dBASE II. Although from the results of the survey, COBOL appeared to be the most popular language, this is only because of the large number of respondents who indicated using the National Child Health system, which is written in COBOL. One of the most surprising results from the survey has been the large number of systems, stated as becoming operational as of January, 1985. Obviously, the previous year has seen the purchase of much equipment, and the design of many new systems, this has perhaps been stimulated by the publication of the K6rner Reports, the Community Report being made available in July, 1984.
Computers and Community Health Systems
363
East Anglia Regional Health Authority maintain, on behalf of the N.H.S. as a whole, a register of all computer applications in use within the Health Service. A community section is included. In order to keep the register up,to date, individual uset-s must submit on a regular basis to East Anglia, details of new developments. This survey has shown however that many applications in the community, are not recorded in this register but which were reported in this survey. At the present time I would regard the National Register produced from this survey as the most accurate reflecting the current state of the art in community systems.