A Guide to Medical Computing: Computers in Medicine Series

Computers in Medicine Series

A Guide to Medical Computing

E.C. COLES, M.B., B.S., L.R.C.P., M.R.C.S., M.Tech., M.B.C.S.

Member of the Scientific Staff, Medical Research Council, Clinical Research Centre, Northwick Park Hospital, Harrow

Butterworths

Table of Contents

Cover image

Title page

Computers in Medicine Series

Copyright

Editor’s Foreword

Preface

Chapter 1: Historical Outline

Publisher Summary

EASIER CALCULATION

FORMALIZED LOGIC

TECHNOLOGICAL ADVANCES

Chapter 2: Some Basic Concepts and Terminology

Publisher Summary

LOGICAL MACHINERY

CONTROLLING INSTRUCTIONS

CLASSES OF COMPUTER

TYPES OF COMPUTER FACILITY

Chapter 3: Representation of Information

Publisher Summary

CLINICAL LABELS

CATEGORIZED ITEMS

BIT PATTERNS AS DATA

BIT PATTERNS AS INSTRUCTIONS

FLEXIBILITY BUT PRECISE DEFINITION

Chapter 4: The Computer – Central Units

Publisher Summary

CONTROL AND ARITHMETIC UNITS

INTERNAL STORE

A PROGRAM INSTRUCTION

HOW INSTRUCTIONS ARE OBEYED

OVERLAPPING PROCESSES

RELIABILITY OF ELECTRONIC UNITS

Chapter 5: The Computer – Input and Output Peripherals

Publisher Summary

INPUT DEVICES

OUTPUT DEVICES

DEVICES FOR BOTH INPUT AND OUTPUT

SCANNING A NUMBER OF INPUT/OUTPUT LINES

ANALOGUE-TO-DIGITAL CONVERSION

DATA TRANSMISSION

DIGITAL-TO-ANALOGUE CONVERSION

OTHER INPUT AND OUTPUT DEVICES

DEVELOPMENT OF INPUT AND OUTPUT DEVICES

Chapter 6: The Computer – File Storage Peripherals

Publisher Summary

MAGNETIC TAPE UNITS

MAGNETIC DISC AND DRUM UNITS

KEEPING FILES UP-TO-DATE

VETTING INPUT DATA

FILES IN SERIAL-ACCESS STORES

FILES IN RANDOM-ACCESS STORES

CHOICE OF FILE-HANDLING METHOD

Chapter 7: Systems Analysis and Design

Publisher Summary

TYPES OF PROBLEMS

DEFINITION OF OBJECTIVES

THE INFORMATION TO BE PROCESSED

EXISTING USE OF INFORMATION

OUTLINE SPECIFICATION

DETAILED SYSTEMS DESIGN

THE IMPORTANCE OF SYSTEMS ANALYSIS

Chapter 8: Programming

Publisher Summary

BASIC OPERATIONS

THE CONDITIONAL JUMP

LANGUAGES OF PROGRAMS

THE PROCESS OF PROGRAMMING

Chapter 9: Implementing a Computer System

Publisher Summary

WHAT EXACTLY IS TO BE DONE?

THE FEASIBILITY OF THE PROPOSED SYSTEM

THE TASK OF THE SYSTEMS ANALYST

PROGRAMMING AND TESTING

Glossary

Index

Computers in Medicine Series

Under the General Editorship of

D. W. HILL

M.Sc., Ph.D., F.Inst.P., F.I.E.E.

Reader in Medical Physics, Royal

College of Surgeons of England

Copyright

©

Butterworth & Co. (Publishers) Ltd.

1973

Suggested U.D.C. Number: 681·31 : 61

ISBN 0 407 54800 9

Printed in Great Britain by

Redwood Press Limited, Trowbridge, Wiltshire

Editor’s Foreword

The aim of this Computers in Medicine series is to present an account of both the clinical applications and the computer science aspects of computing in medicine. The balance between these two will naturally vary from volume to volume, but each author will write from personal experience of his specialty. Medical computing is advancing so rapidly that it can best be described by a coherent series of individual monographs.

Dr. Coles has written a foundation volume for the series. His monograph provides a simple introduction to the hardware and software of computers together with a useful glossary of terms. It should supply valuable background information for doctors who are new to computing techniques but need to make use of them in their clinical or research work. A plethora of computing terms can prove to be disheartening to newcomers and this monograph will do much to sustain their confidence. The sections dealing with the planning of computer-based projects and the introduction to the writing of computer programs are particularly valuable.

D.W.H.

Preface

Computers are increasingly being used in medicine, and many of them are bringing great benefit both to the practitioners and to the recipients of health services. This short book is intended to act as a guide to medical computing first by introducing the reader to computers themselves and then by outlining to him the processes involved in applying them in a particular instance. It aims to explain the subject in a way which will be comprehensible to those concerned with health services and it takes most of its examples from this field. It attempts to avoid technical terminology as much as possible, but where this is not practicable, the meaning of the term is either explained where it is first used in the text, or is defined in the glossary.

Those who claim to have little or no skill at mathematics are often discouraged from studying this subject because of the inference that ‘computing’ must be mainly concerned with arithmetical processes. This is not so. The majority of computers in use today are occupied for most of their time in selecting, testing and re-structuring sets of information using logical rather than arithmetical operations. ‘Informatics’ (derived from the French and German words ‘informatique’ and ‘informatik’) has recently been added to the English vocabulary of information processing, and it ought really to supplant the word ‘computing’ as it correctly implies the processing of information in a much wider sense.

Any technique which is as powerful as is computer processing of information, is inevitably open to misuse. Such misuse may arise from bad planning, from lack of skill or even from malice; and it is important that this possibility is most carefully guarded against. It is because of this, and because the best design of medical computing systems can only come from a partnership between specialists in medicine and specialists in computing, that doctors and other health service workers should know something of this subject. It is hoped that this book will enable them to do so.

E.C.C.

Chapter 1

Historical Outline

Publisher Summary

This chapter provides an overview of the history of the development of today’s computers, which can be traced back to three roots. The first of these was the development of systems of numbering and of calculation and the search for techniques to automate this, the second was the development of formal logic, and the third was the development of the electronic and mechanical technology without which the construction of computers would not have been possible. The development of electromechanical and then of electronic technology was the thing that finally made the construction of computers possible. The first machine to be built that would qualify as a computer by today’s definitions was the Electronic Numerical Integrator and Calculator (ENIAC). Valve computers are known as the first generation computers and the early transistor computers are known as the second generation machines. Printed circuits, the reduction in size of transistors and diodes, and the development of families of similar computers of varying power heralded a third generation of computers.

The history of the development of today’s computers can be traced back to three roots. The first of these was the development of systems of numbering and of calculation and the search for techniques to automate this. The second was the development of formal logic, and the third was the development of the electronic and mechanical technology without which the construction of computers would not have been possible.

EASIER CALCULATION

‘VII plus XXI’ or ‘three-fifths of VL’ are extremely awkward operations if the only notation available for manipulating the quantities is the Roman numerical system. The adoption of our present day numbering system, in which each digit has a constant relationship to that on each side of it, was necessary before advances were made in mathematics, commerce and taxation. In 1642 Blaise Pascal, son of a French tax collector invented a device to perform mechanically addition and subtraction and, by repeated additions and subtractions, multiplication and division.

Charles Babbage (1792–1872) was an English mathematician who conceived of a mechanical device which could, by reason of the property of fixed differences, compute tables of mathematical functions, such as logarithms, tangents of angles and astronomical tables. He built a pilot model of this ‘difference engine’ which worked quite well, but before he had finished constructing a larger version of it he conceived of a grander idea, that of an ‘analytical engine’ which would have worked on a more fundamental set of principles and would have had a much wider set of operations. In 1842 the Italian, L. S. Menabrea wrote a paper based on a series of lectures given by Babbage in Turin. Lord Byron’s daughter, Lady Lovelace, translated this paper into English, adding to it extensive notes. In this we have the first exposition of many of the principles which underlie today’s electronic digital computers. Lady Lovelace became Babbage’s ‘senior programmer’ and was the most perceptive interpreter