la.! MISSOURI Material for This Column REGIONAL is furnished by MEI-31CAL ARTHUR E. RIKLI, M.D. Director for Operations PR -OGRAM Missouri Regional (MRMP)* Medical Program OPERATIONAL PROGRAM FOR MISSOURI REGIONAL MEDICAL PROGRAM The Missouri Regional Nfedical Program The pbysician's office is where most pa- seeks to provide optimum health for the tients gain access to the services of health greatest number of people by accelerating worlers and related resources that make the application of effective preventive and therapeutic measures for heart, stroke and up the health delivery system. Analysis of cancer patients or those with related dis- health care systems as an aid in determin- eases. ing rational innovation is the responsibility The Nlissouri Regional Medical Program of the "Operations Research and Systems Operations Divisions is responsible for im- Design" project. This project is using its plementing activities developed by the esoteric and highly technic-,LI skills to an- Planning Division through the Missouri alyze the many forces at play within the Regional Nledical Program review groups \Iissouri Regional Medical Program, and and given financial support by the Regional soon should be in a position to propose Medical Program National Advisory Coun- more effective use of available resources. cil, As we acquire information germane to a These projects fall into three groups: specific problem we attempt to simulate (1) those that define the nature of the situation by model development and heart, stroke and cancer problems. testing through the "Data Evaluation and (2) those that aid in bringing these pa- Computer Simulation" project. tients or suspects into the health The most difficult task in introducing an delivery system, and innovation into the health delivery system (3) those that aid physicians in pro- is to foretell the effect or value of the in- viding effective diagnostic, thera- novation. Today's health delivery system peutic or preventive measures to is the product of innumerable variables that those who need them. have been introduced from several sources. It is the \Iissouri Regional i\ledical Pro- Nfost changes have been made on an em- gram plan to help close the time gap be- pirical basis rather than on a carefully tween discovery and application by intro- calculated cost-benefit basis. As therapeutic ducing innovations into the Missouri health measures (such as renal dialysis and organ delivery system on a demonstration basis. transplants) which can prolong a productive (1) TO DEFINE AND MEASURE life at costs that few individuals or their For any health program to be effective families can afford, there arises a critical it is essential to know who has or is prone need for metbodolgies to evaluate the prac- to have disease. In what kind of an en- tice of such extraordinary measures. The vironment are they living, what health development of these methods is one of the services do they need, and which ones are responsibilities of the "Program Evaluation they demanding and r4iceiving? The "Pop- Center" project. ulation Study Group Surveys" represents *The Missouri Re Medical Program is sup- MRMP's effort to determine the nature of ported by plannin operational grants from the heart, stroke and cancer problem in the Division of Rel Medicol Programs of the this region. This project will be supple U.S. Public Health . This column regarding mented by the "Automated Hospital Pa- the Missouri Regional Medical Program does not necessarily represent the views of the U.S. Public tient Survey." Health Service. The "Communications Research Unit" has the diagnostician or the practicing phy- ,et out to determine and measure the elu- sician. They neither can, nor likely ever sive factors in communication .vhich cause will, supplant the basically vital "doctor- people to react or not react under varying patient" relationship that is the keystone circumstances. The medical profession has of effective medical practice. had little real success in "selling" the prin- We look upon all such activities as critical experiments and we are carrying them out, ciples of well being to the public. Our in two carefully selected communities un- "Communications Research Unit", for the der limited and controlled conditions and first time, is delving deeply into this crucial only with the closest collaboration with problem on a scientific and closely con- professional and administrative personnel trolled basis. in these communities. Our reason for pro- (2) TO DETECT OR PREDICT ceeding with caution is because we believe Although, there are many forces that in- that the future of the Missouri Regional fltience the ways a person ma,,, gain access Niedical Program depends on our ability to to the health delivery system, MRMP is learn how to carry out experiments like the (lirecting its primary effort toward means "Smitbville" project and the "Compreben- of detecting signs of disease. Three of sive Cardiovascular Care Unit" in Spring- these projects are self explanatory: field in such a way that when these pro- 1. Multiphasic Testing jects are completed the heart, stroke and 2. Mass Screening-Radiology cancer patients in these communities will 3. Automated Patient History. continue to enjoy an improvement in their A fourth, "Bioengineering", provides sup- health services. port to several projects through the de- At Smitbville, which is, in effect, our velopment of new or different kinds of "pilot" community, we are considering the electronic and mechanical "packages". One %,-hole person and the several factors which such development, for example, has in- may have brought him to the condition of volved the design and building of a "diag- apparent illness at the time he seeks his nostic chair". In less than two minutes and doctor's help. Health care doesn't begin without the need for attached terminals, when a patient goes into a doctor's office it can produce three-lead electrocardio- or when he enters a hospital. Nor does total grams, and other measuring devices are now health care end when he is discharged. We being built into it. need to be concerned %Atli such matters (3) TO CLOSE A GAP as; how do you keep from becoming ; Modern information storage and retrieval what is the best care for a person who is methods are being blended together so ill,, and bow does one best readjust to they will aici the physician as he considers normal living once medication has ended? various diagnostic possibilities suggested by At Springfield, through the energetic ef- signs and symptoms in a patient. It is the forts of a number of highly motivated phy- mission of the "Computer Fact Bank" to sicians, the Missouri Regional Medical Pro- provide information more rapidly and gram is acting as a powerful catalytic force pertinently than would be available in any in developing an ideal comprehensive other way. cardiovascular care program. To this end "Automated Electrocardiography" which a model "cardiac ball" has been developed provides computer interpretation of electro- at St. john's Hospital where an entire area cardiograms is currently being "field tested" is devoted totally to intensive, intermediate at six different locations in \Iissouri. It and recuperative care of heart patients. is anticipated that in the near future com- A "Nlanual of Services", prepared by a puter interpretation of electrocardiograms Nlissouri Regional Medical Program team of will be as readily available to physicians in researchers, in cooperation with the Mis- iklissouri as their telephones. This same souri Health Council, lists for the first time, technique could be used with pbonocardio- a thorough description of all medical and grams, electroencephalograms, and many paramedical services in the state. It soon other diagnostic signs. Computers are find- will be available to every physician in the ing their place in the practice of medicine state, as well as to many other persons who as a diagnostic aid to a physician. are concerned with the well being of our But computers are merely tools to help people.