Integrated medical test data storage and retrieval system

Abstract

A patient report generating system for receiving, storing and reporting medical test data for an entire patient population by periodically forming individual patient reports containing all test results for each patient for the total time period during which the patient has been a member of the patient population. Each report is organized to present the cumulative test data in a highly compact pattern of data packages wherein each data package includes only results of tests making up a particular organ system disease related subset of tests. The disclosed apparatus includes a data entry terminal, such as a keyboard input, for generating a digital electrical field for each test which field identifies the test, the test results, the date of the test and the patient. Also included is a random access memory for receiving and storing all signal fields and a high speed printer for forming a hard copy of the patient report from the stored data. To insure that each patient report is formatted identically with all other reports, the system includes a control memory for generating report and data package formatting signals which cause the printer to present the test data in consistent orthogonally arranged data packages wherein the test data within each data package is organized to assist the clinician to assimilate and understand the test data in the least possible time.

Claims

I claim:

1. Apparatus for generating, storing and reporting medical test data resulting from the performance of various medical tests selected from a predetermined set of known medical tests which are divisible into subsets of tests useful to patient treatment personnel in diagnosing and treating organ system related diseases, such tests being conducted on a plurality of medical patients which collectively define a continually changing patient population, said apparatus comprising

(a) electronic data generating means for generating a digital electrical signal field for each test conducted on the patient population, said each field including

(1) a first set of electrical digital signals identifying a particular medical test from the predetermined set of known medical tests,

(2) a second set of electrical digital signals identifying the results of the test identified by said first set,

(3) a third set of electrical digital signals identifying the date on which the test identified by said first set was conducted, and

(4) a fourth set of electrical digital signals identifying the patient for whom the test identified by said first set was conducted;

(b) data storage means for receiving and storing all said digital electrical signal fields generated by said electronic data generating means on the entire patient population, said data storage means including a random access memory means connected with said electronic data generating means for permitting said digital electrical signal sets stored by said data storage means to be retrieved randomly in accordance with the information identified by said sets; and

(c) report generating means for generating periodically individual patient test data reports for each patient within the patient population wherein each report includes all stored test data for the particular patient for the total time period during which the patient has been a member of the patient population and wherein each report is organized to present the cumulative test data in a highly compact pattern of data packages wherein each data package includes only results of tests making up a particular organ system disease related subset of tests, said report generating means including

(1) printing means responsive to control signals for producing the individual patient reports by converting digital electrical signals representative of the type of tests and of the dates and results of such tests into visually perceptible indicia appearing in an orthogonal pattern of rows and columns on a hard copy report,

(2) data package formatting means for generating successive data package formatting signals to cause results of repeated performance of the same test on the same patient to appear in a single column of a single data package and to cause the results of all tests which are included in the data package and which were performed on the same patient on the same date to appear in a single row of the same data package,

(3) report formatting means for generating an identical succession of report formatting electrical signals each time a patient report is produced by said printing means for identifying the tests and sequence of tests included in each successively formed data package and for identifying the sequence in which said data packages are to appear in each patient report, and

(4) controller means connected with said data storage means, said printing means, said data package formatting means and said report formatting means, for generating printer control signals which cause the printing means to form a patient report for each patient within the patient population by retrieving all test data accumulated on each patient during the entire period that the patient has remained a member of the patient population and for causing the printing means to form a predetermined succession of comprehensive data packages in accordance with said report and data package formatting signals with each data package containing an orthogonal pattern of visible indicia including the results of all tests defined by the data package which were conducted on the patient during the entire period in which the patient has remained a member of the patient population and with the visible indicia in each column representing said second sets of all signal fields having identical first sets stored in said data storage means for such patient and for generating printer control signals which cause the printer to print the visible indicia in each column of each data package in chronological order as determined by said fourth set of each corresponding signal field, whereby each successively printed patient report supersedes all prior reports and includes all stored medical test results organized in a compact comprehensive organ system disease related pattern in which the order of the data packages and the order of tests appearing in each package is identical in all reports to assist patient treatment personnel to assimilate and understand organ system disease related test information in the least amount of time.

2. Apparatus as defined in claim 1, wherein said report formatting means includes label signal generating means for generating label signals representative of each type of test within the predetermined set of known medical tests and said data package formatting means includes label formatting means for generating label formatting signals to cause visible indicia identifying the type of test above each column of test results in each data package corresponding to the said first set of each signal field associated with the column, said controller means responding to said label signals and said label formatting signals to cause said printing means to form visible indicia at the top of each column in each data package identifying the type of tests which appear in the corresponding columns.

3. Apparatus as defined in claim 2, wherein said data storage means includes a patient register for recording signals representative of each patient making up the patient population and representative of the age and sex of each patient and a reference level storage register for storing reference level information signals indicating the normal range for a patient of a given sex and age for each test of the predetermined set of known medical tests and wherein said data package formatting means includes reference level formatting means for generating reference level formatting signals to cause reference levels for a patient to be displayed above each column of test results appearing in each data package, and wherein said controller means generates control signals in response to said reference level information and formatting signals for causing said printer means to print reference levels corresponding to the age and sex of the patient whose report is being printed in association with each column of test results appearing in each data package.

4. Apparatus as defined in claim 3, wherein said controller means includes a comparator means for comparing the test results represented by said second set of each signal field with the normal reference level for the age and sex of the patient whose report is being generated to produce an out of range signal for any test result which is out of the corresponding stored reference range, said controller means causing said printer means to place a visible out-of-range indicator adjacent the visible indicia appearing in the patient report which represents the out of range test result.

5. Apparatus as defined in claim 3, wherein said data storage means further includes supplemental information and threshold criteria storage means for storing information useful to a clinician in interpreting specific test results which are out of the normal range for such test, and wherein said controller means includes a comparator means for comparing the test results represented by said second set of each signal field with the stored reference level for the age and sex of the patient whose report is being generated and wherein said controller means is connected with said supplemental information and threshold criteria storage means for causing said printer means to print said stored supplemental information corresponding to a particular test whenever the results for such particular test is out of the range defined by said supplemental information and threshold criteria storage means.

6. Apparatus as defined in claim 5, wherein said supplemental information and threshold criteria storage means includes additional means for storing signals representative of information regarding alternative treatment and the current costs for each type of treatment and wherein said controller means is connected with said additional means to cause said printer means to print said alternative treatment and current cost information on the patient report in association with a particular printed test result whenever the results for such test indicate an out of range result given the age and sex of the patient as determined by said comparator means.

7. A method for generating, storing and reporting medical tests data resulting from the performance of various medical tests selected from a predetermined set of known medical tests which are divisible into subsets of tests useful to patient treatment personnel in diagnosing and treating organ systems related diseases, such tests being conducted on a plurality of medical patients which collectively define a continually changing patient population, wherein said method comprises the steps of

(a) generating a digital electrical signal field for each test conducted on the patient population including generating a first set of electrical digital signals identifying a particular medical test from the predetermined set of known medical tests, generating a second set of electrical digital signals identifying the results of the test identified by said first set, generating a third set of electrical digital signals identifying the date on which the test identified by said first set was conducted, and generating a fourth set of electrical digital signals identifying the patient for whom the test identified by said first set was conducted;

(b) storing all said digital electrical signal fields generated in step (a) on the entire patient population;

(c) generating periodically individual patient test data reports for each patient within the patient population wherein each report includes all stored test data for the particular patient for the total time period during which the patient has been a member of the patient population and wherein each report is organized to present the cumulative test data in a highly compact pattern of data packages wherein each data package includes only results of tests making up a particular organ system disease related subset of tests by

(1) converting digital electrical signals representative of the type of tests and of the dates and results of such tests into visually perceptible indicia appearing in an orthogonal pattern of rows and columns on a hard copy report,

(2) generating successive data package formatting signals to cause results of repeated performance of the same test on the same patient to appear in a single column of a single data package and to cause the results of all tests which are included in the data package and which were performed on the same patient on the same data to appear in a single row of the same data package,

(3) generating an identical succession of report formatting electrical signals each time a patient report is produced for identifying the tests and sequence of tests included in each successively formed data package and for identifying the sequence in which said data packages are to appear in each patient report, and

(4) forming a patient report for each patient within the patient population by retrieving all tests data accumulated on each patient during the entire period that the patient has remained a member of the patient population and forming a predetermined succession of comprehensive data packages in accordance with said report and data package formatting signals with each data package containing an orthogonal pattern of visible indicia including the results of all tests defined by the data package which were conducted on the patient during the entire period in which the patient has remained a member of the patient population and with the visible indicia in each column representing said second sets of all signal fields having identical first sets stored in step (b) and printing the visible indicia in each column of each data package in chronological order as determined by said fourth set of each corresponding signal field, whereby each successively printed patient report supersedes all prior reports and includes all stored medical test results organized in a compact comprehensive organ system disease related pattern in which the order of the data packages and the order of tests appearing in each package is identical in all reports to assist patient treatment personnel to assimilate and understand organ system disease related test information in the least amount of time.

8. A method as defined in claim 7, further including the steps of generating label signals representative of each type of test within the predetermined set of known medical tests and generating label formatting signals to cause visible indicia identifying the type of test above each column of test results in each data package corresponding to the said first set of each signal field associated with the column, forming, in response to said label signals and said label formatting signals, visible indicia at the top of each column in each data package identifying the type of tests which appear in the corresponding columns.

9. A method as defined in claim 8, further including the steps of recording signals representative of each patient making up the patient population, recording signals representative of the age and sex of each patient, storing reference level information signals indicating the normal range for a patient of a given sex and age for each test of the predetermined set of known medical tests, generating and printing reference levels corresponding to the age and sex of the patient whose report is being printed in association with each column of test results appearing in each data package in response to the stored reference level information signals corresponding to the age and sex of the patient whose report is being generated.

10. A method as defined in claim 9, further including the steps of comparing the test results represented by said second set of each signal field with the normal reference level for the age and sex of the patient whose report is being generated to produce an out of range signal for any test result which is out of the corresponding stored reference range, and printing a visible out-of-range indicator adjacent the visible indicia appearing in the patient report which represents the out-of-range test result.

11. A method as defined in claim 9, further including the steps of storing information useful to a clinician in interpreting specific test results which are out of the normal range, comparing the test results represented by said second set of each signal field with the stored reference level for the age and sex of the patient whose report is being generated, and printing said stored supplemental information on the patient report whenever any individual test result is out of the range defined by said supplemental information and threshold criteria storage means.

12. A method as defined in claim 10, further including the step of storing signals representative of information regarding alternative treatment and the current costs for each type of treatment and printing the alternative treatment and current cost information on the patient report in association with a particular printed test result whenever the result for such test indicate an out of range level given the age and sex of the patient.

13. Apparatus for generating, storing and reporting medical test data resulting from the performance of various medical tests selected from a predetermined set of known medical tests which are divisible into subsets of tests useful to patient treatment personnel in diagnosing and treating organ system related diseases, such test being conducted on a plurality of medical patients which collectively define a continually changing patient population, said apparatus comprising

(a) electronic data generating means for generating a digital electrical signal field for each test conducted on the patient population, each said field including

(1) a first set of electrical digital signals identifying a particular medical test from the predetermined set of known medical tests,

(2) a second set of electrical digital signals identifying the results of the test identified by said first set,

(3) a third set of electrical digital signals identifying the date on which the test identified by said first set was conducted, and

(4) a fourth set of electrical digital signals identifying the patient for whom the test identified by said first set was conducted;

(b) data storage means for receiving and storing all said digital electrical signal fields generated by said electronic data generating means on the entire patient population, said data storage means including a random access memory means connected with said electronic data generating means for permitting said digital electrical signal sets stored by said data storage means to be retrieved randomly in accordance with the information identified by said sets; and

(c) report generating means for generating periodically individual patient test data reports for each patient within the patient population wherein each report includes all stored test data for the particular patient for the total time period during which the patient has been a member of the patient population and wherein each report is organized to present the cumulative test data in a highly compact pattern of data packages wherein each data package includes only results of tests making up a particular organ system disease related subset of tests, said report generating means including

(1) image forming means responsive to control signals for producing the individual patient reports by converting digital electrical signals representative of the type of tests and of the dates and results of such tests into visually perceptible indicia appearing in an orthogonal pattern of rows and columns,

(2) data package formatting means for generating successive data package formatting signals to cause results of repeated performance of the same test on the same patient to appear in a single column of a single data package and to cause the results of all tests which are included in the data package and which were performed on the same patient on the same date to appear in a single row of the same data package,

(3) report formatting means for generating an identical succession of report formatting electrical signals each time a patient report is produced by said image forming means for identifying the tests and sequence of tests included in each successively formed data package and for identifying the sequence in which said data packages are to appear in each patient report, and

(4) controller means connected with said data storage means, said image forming means, said data package formatting means and said report formatting means, for generating image forming control signals which cause the image forming means to form a patient report for each patient within the patient population by retrieving all tests data accumulated on each patient during the entire period that the patient has remained a member of the patient population and for causing the image forming means to form a predetermined succession of comprehensive data packages in accordance with said report and data package formatting signals with each data package containing an orthogonal pattern of visible indicia including the results of all tests defined by the data package which were conducted on the patient during the entire period in which the patient has remained a member of the patient population and with the visible indicia in each column representing said second sets of all signal fields having identical first sets stored in said data storage means for such patient and for generating image forming control signals which cause the image forming means to form the visible indicia in each column of each data package in chronological order as determined by said fourth set of each corresponding signal field, whereby each successively formed patient report supersedes all prior reports and includes all stored medical test results organized in a compact comprehensive organ system disease related pattern in which the order of the data packages and the order of tests appearing in each package is identical in all reports to assist patient treatment personnel to assimilate and understand organ system disease related test information in the least amount of time.

14. Apparatus as defined in claim 13, wherein said image forming means is a CRT.

15. Apparatus as defined in claim 13, wherein said image forming means is a high speed line printer.

16. Apparatus as defined in claim 1, wherein said report formatting means includes a Coag. data package generator for generating report formatting electrical signals which define a single data package including the following medical tests: Prothrombin Activity, Activated Partial Thromboplastin Time, Bleeding Time, Fibrinogen and Fibrin Degradation Products.

17. Apparatus as defined in claim 16, wherein said report formatting means includes a Chem II data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Calcium, Phosphate, Uric Acid, Amylase, Lipase, Cholesterol, Triglycerides, High Density Lipoproteins and Low Density Lipoproteins.

18. Apparatus as defined in claim 17, wherein said report formatting means includes a Chem II data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Bilirubin Total, bilirubin Direct, Serum Alkaline Phosphatase, Gamma Glutamyl Transpeptidase, Serum Glutamic Pyruvic Transaminase, Serum Glutamic Oxalacetic Transaminase, Lactate Dehydrogenase and Creatine Phosphokinase.

19. Apparatus as defined in claim 18, wherein said report formatting means includes a Misc. Hem. data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Stool Occult Blood, Reticulocyte Count, Eosinophil Count, Erythrocyte Sedimentation Rate, Iron, Iron Binding Capacity, Ferritin, B.sub.12 and Folate.

20. Apparatus as defined in claim 19, wherein said report formatting means includes a Chem I data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Glucose, Blood Urea Nitrogen, Creatinine, Sodium, Potassium, Chloride, Carbon Dioxide, Osmolarity (Serum) and Osmolarity (Urine).

21. Apparatus as defined in claim 20, wherein said report formatting means includes a Coulter data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Hemoglobin, Hematocrit, White Cell Blood Count, Platelets, Red Cell Blood Count, Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, and Mean Corpuscular Hemoglobin Cencentration.

22. Apparatus as defined in claim 21, wherein said report formatting means includes a Diff(%) Morph data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Polymorphonuclear Leukocytes, Bands, Lymphoctyes, Monocytes, Eosinophils, Basophils, Other, Red Blood Cells, and Platelets.

23. Apparatus as defined in claim 1, wherein said report formatting means includes a Chem II data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Calcium, Phosphate, Uric Acid, Amylase, Lipase, Cholesterol, Triglycerides, High Density Lipoproteins and Low Density Lipoproteins.

24. Apparatus as defined in claim 1, wherein said report formatting means includes a Chem III data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Bilirubin Total, Bilirubin Direct, Serum Alkaline Phosphatase, Gamma Glutamyl Transpeptidase, Serum Glutamic Pyruvic Transaminase, Serum Glutamic Oxalacetic Transaminase, Lactate Dehydrogenase and Creatine Phosphokinase.

25. Apparatus as defined in claim 1, wherein said report formatting means includes a Chem II data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Calcium, Phosphate, Uric Acid, Amylase, Lipase, Cholesterol, Triglycerides, High Density Lipoproteins and Low Density Lipoproteins.

26. Apparatus as defined in claim 1, wherein said report formatting means includes a Misc. Hem. data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Stool Occult Blood, Reticulocyte Count, Eosinophil Count, Erylthrocyte Sedimentation Rate, Iron, Iron Binding Capacity, Ferritin, B.sub.12 and Folate.

27. Apparatus as defined in claim 1, wherein said report formatting means includes a Chem I data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Glucose, Blood Urea Nitrogen, Creatinine, Sodium, Potassium, Chloride, Carbon Dioxide, Osmolarity (Serum) and Osmolarity (Urine).

28. Apparatus as defined in claim 1, wherein said report formatting means includes a Coulter data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Hemoglobin, Hematocrit, White Cell Blood Count, Platelets, Red Cell Blood Count, Mean Corpuscular Volume, Mean Corpuscular Hemoglobin and Mean Corpuscular Hemoglobin Concentration.

29. Apparatus as defined in claim 1, wherein said report formatting means includes a Diff(%) Morph data package generator for generating report formatting electrical signals which define a single data package including the following medical tests:

Polymorphonuclear Leukocytes, Bands, Lymphocytes, Monocytes, Eosinophils, Basophils, Other, Red Blood Cells and Platelets.

30. Apparatus as defined in claim 1, wherein said report formatting means includes a Microbiology data package generator for generating report formatting electrical signals which define a signal data package including the following information: origin of the body fluid or tissue to be cultured, the presence or absence of micro-organisms as determined by microscopic examination, the identification of those microorganisms appearing in the culture, the names of antibiotic agents to which the identified organisms are sensitive, a numerical indication of the order in which the antibiotics are indicated for use against the identified micro-organisms and the cost per day of use for each of the numerically indicated antibiotic agents.

Description

TECHNICAL FIELD

This invention relates to method and apparatus for generating, storing and reporting medical test data on a given patient population such as the patients within a hospital. In particular the invention is directed to the generation and storage of hospital laboratory test results and to the formation of individual patient reports using the stored test results.

BACKGROUND ART

Medical knowledge in the areas of both diagnosis and treatment is now so advanced that good health care, in the aggregate, is as much a function of society's ability to pay as it is a function of the state of knowledge about proper health care. This fact has vastly increased the pessure on health care planners and administrators to seek greater cost effectiveness in health care delivery. One obvious technique has been to employ computerized data handling.

A variety of computerized data handling systems exist ranging from a computer assisted system for taking patient medical histories as disclosed in U.S. Pat. No. 4,130,881 to extremely sophisticated systems such as that recently instituted in a California hospital in which virtually all of the data handling functions within the hospital were computerized, 123 Cong. Rec. (June 10, 1977) (Remarks of Congressman Ottinger). A limited degree of success in reducing hospital costs has been achieved by the use of these systems. However, health care costs have continued to rise at a rate which far exceeds the rate of increase in the cost of living. Annual amounts spent for health care now account for about 10 percent of the Gross National Product and could easily exceed 229 billion dollars by 1981, double the amount spent in 1976. Prior attempts at computerization of data handling functions within the health care industry have generally centered around the use of electronic data handling as a mere substitution for normal recordation and transmission of information. While such attempts are certainly useful insofar as they go, they have failed to capitalize on the immense power of modern electronic data handling systems to sift, categorize and format information in a way which measurably improves the efficiency of individual medical practitioners.

One explanation for lack of success in health care cost containment despite wide spread use of computerized data handling is the fact that the amount of potentially relevant data has been expanding enormously. A careful medical practitioner thus requires vastly greater amounts of such information as laboratory test results, diagnostic information and pharmacological alternatives for treatment than was true only a decade ago when computers were first introduced. For example, in the last decade the number of available diagnostic laboratory tests has doubled and heretofore unknown diagnostic procedures are now commonly performed. The body of medical knowledge has undergone such an exponential increase that decisions regarding the best medical treatment can be reached only after careful consideration of a vast quantity of input. Generation of this input is extremely expensive and often turns out subsequently to have been unnecessary.

Further compounding this problem is the fact that health care planners and administrators are now calling upon the individual physician to be cost conscious regarding each of his diagnostic and treatment decisions. In response to this request, some medical schools have now integrated basic questions of cost with the standard considerations of diagnosis and treatment in their curricula.

This emphasis on cost containment has been stressed further by professional organizations such as the American Medical Association and the American College of Physicians as critical to making proper treatment decisions. Physicians are now being urged to become cost conscious by programs such as those designed to assess medical knowledge in preparation for the fulfillment of licensing and certification requirements. These programs evaluate physician decisions requesting tests and procedures in the diagnosis and management of given clinical conditions on the basis of cost to the patient, as well as such traditional factors as risk.

Physicians are thus being asked to include a whole new world of information on top of an already exponentially expanding body of conventional medical knowledge. Without new tools to provide assistance it is unrealistic to expect the majority of practicing physicians to contribute to effective cost reduction in the delivery of health services. Some hospitals have made attempts in this direction by instituting partially or fully computerized systems for presenting the results of diagnostic tests. While the available systems have helped physicians provide patients with the best available medical care, the information they present has not been organized with any conscious effort to save the physician's time and reduce costs. Accordingly, these systems do not enable the physician to assimilate significant information in a minimum amount of time so that information can be utilized optimally in patient care and management.

The greatest volume of information generated from diagnostic tests and procedures confronting the physician comes from those tests and procedures most often performed on hospitalized patients. These are most likely to be chemical and microbiological laboratory analyses of blood and other body fluids, x-rays, and electrocardiograms. All other diagnostic procedures, such as ultrasound examinations and isotopic scans of body organs, tend to be performed much less frequently. Of all of these diagnostic tests and procedures, the data generated by laboratory tests on blood is the most profuse and requires the most time for the physician to interpret and apply in making patient management decisions. For example, about one million of the 1.1 million diagnostic tests and procedures performed in one medium sized hospital, Kent County Hospital, Warwick, R.I., during one year were laboratory analyses of patients' blood. The data from these blood tests is quite diverse in nature and is quickly accumulated in massive amounts in patient records, especially if the hospital stay is a long one or the patient's clinical condition requires close monitoring of his blood chemistry. Unless this profusion of information is organized and presented in a format so that information regarding patient management is readily available, valuable physician time will be wasted in sifting through the mass of data to find the most significant test results.

In a large number of hospitals today, laboratory blood test results are entered manually by laboratory personnel on slips of paper approximately 7 inches by 3 inches in size including information regarding several sometimes unrelated tests which are then sent to the hospital floor and pasted in the patient's record by floor personnel. Each time a test is repeated, another slip reporting the results must be added to the petient's record. The physician who must utilize these blood test results to make a diagnosis, prescribe treatment and otherwise provide patient care is confronted with a confusing array of clinically unrelated data which can require considerable time to organize and assimilate before it can be used in any meaningful way. In the case of a patient whose clinical condition requires a long hospital stay or frequent laboratory blood analyses, the numbers of slips of paper containing test results can increase at a phenomenal rate. As the number of tests performed and, hence, the number of slips of paper increases, it becomes extremely difficult if not impossible for the physician to follow clearly the results of important tests and to determine the correctness of a diagnosis or the effectiveness of a prescribed course of treatment and therapy. In hospitals where such a system of presenting laboratory test data is in effect medical students or nurses are often required to make charts organizing the data so that the physician can make some sense out of it and devote more time to the patient. The time and cost consuming aspects of such a system are clear. It is neither cost effective nor beneficial to the quality of patient care for physicians to spend their time performing manual information processing tasks, especially when computer assisted methods of reporting diagnostic information are available.

However, computer assisted methods of reporting diagnostic information do not necessarily result in time savings to the physicians or other end users of the information. U.S. Pat. No. 4,053,951 discloses a system for recording and reproducing medical data which generates an individual patient report printout each time the data is recorded, which could be several times a day. The resulting multiplicity of individual slips are then compiled in the patient's chart in much the same way as the manual laboratory slips described above. While this system represents an improvement over previously used noncomputer assisted systems, the data is cumbersome to use and requires more time for evaluation than is desirable with an automated system.

While some of the automated data display systems presently in use have attempted to organize at least portions of the patient test data reports in some semblance of a relationship to recognized clinical conditions, none of the existing automated systems has fully integrated the relationship between diagnostic tests and the organ system related clinical conditions in which their use is indicated. An additional drawback presented by prior art systems producing hard copy reports of individual patient test data is the failure of such systems to present the test data in a truly cumulative form which enables the clinician to review at a glance a chronological listing of all the results of a particular test. Some hard copy reports display the data on which tests are performed across the top of the page and list the individual tests down the left margin, thus limiting the number of test results which can be chronologically displayed. The systems which use this format generally put four or five days worth of tests on each page of the patient test data report, which requires the end user to review many sheets of the patient report to follow the results of significant tests over the course of hospital stay which is more than four or five days in duration. Those systems which display test data across and the dates down the left margin of the patient test data report approximate more closely a truly cumulative report. However, some of these systems often print test data covering only a specified period of time on each page of the patient report. Therefore, all such reports must be saved since the information they contain will not appear in future reports.

An additional drawback of the automated systems for presenting patient test data presently in existence concerns the reference data and the way in which these systems indicate whether a test is within normal limits. Since the levels of most chemical substances in the blood depend upon the age and sex of the individual whose blood is analyzed, a truly meaningful patient test data report includes a reference range for each test which is adjusted to the age and sex of the patient. Some of the prior art systems do utilize reference ranges for which some adjustment has been made to take into account the age and sex of the patient. When this has been done, however, the pool of individuals from which the data has been drawn has not been as large as desirable to yield the best reference data.

If a test is outside the values determined to constitute the normal range, prior art systems have usually indicated this fact by printing an H or a + (for a value that is higher than the normal range) or an L or a - (for a value that is below the normal range). The end user of the patient test data report must then determine the significance of a test result outside the normal range. In the case of most commonly used diagnostic tests, the physician performs this task mentally in a minute or so based on his expertise. In the case of a diagnostic test or procedure which is used infrequently or when a consulting physician with a different area of expertise is called in, the indication of a test result outside normal ranges, while quite helpful, may necessitate the expenditure of considerable time to ascertain the significance of the suspect test result so that the information can be used correctly and effectively in the management of the patient's condition. Although such information has been provided as part of the raw data received from professional laboratory reports, no prior integrated hospital reporting system has been designed to incorporate such information. One known hospital system has utilized explanatory footnotes to describe, to a limited extent, abnormal cellular morphology, but this information was not generated as a result of comparing out-of-range test values with an established normal reference range.

In another partially automated system, employed at The Rhode Island Hospital, Providence, R.I., tests are grouped in one data package which relate to renal function and acid-base balance and in another some of the commonly used tests relating to liver function, both of which are clinically relevant data packages. However, the third and fourth data packages in this system do not share the same clinical orientation. the third combines indicia of liver function with those of parathyroid function and fat metabolism, while the fourth mixes therapeutic drug levels with a pancreatic function test and a metabolic test. Miscellaneous blood and urine chemistry tests are then listed randomly in a way that has no clinical orientation whatever. Normal ranges are presented with only some of the tests, the remainder being listed on a page separate from the patient test data report. In this system, however, all other diagnostic laboratory tests, including all blood tests commonly referred to as hematology tests, are reported manually on slips of paper as described above.

Still another system, which is fully automated and has been in use at Roger Williams Hospital in Providence, R.I. since 1971, presents one blood chemistry data package containing twelve separate tests in the order these tests are performed by the automatic blood analyzer operated by the hospital's laboratory. These tests are not performed in any organ system specific, clinically related order; therefore, the presentation of this data in the patient test data report does not facilitate the physician's performance of diagnostic and clinical patient management functions. Another data package produced by this system includes liver, kidney and metabolic tests arranged in a way which requires the unnecessary expenditure of valuable professional time to assimilate and interpret. Still another data package is labeled "Enzymes" and is somewhat clinically oriented in that it contains the remainder of the liver function tests not performed by the automatic analyzer. Such a data package, however, presents only a partial picture of the clinical condition to the end user of the data. This system includes an additional data package entitled "Elect:" (Electrolytes) which contains tests relating to acid-base balance, but only a single test of kidney function. This, too, presents data in a form which does not give the physician a complete picture. Other critical kidney function data which would enable the physician to evaluate acid-base balance/renal function interrelationships is buried with liver function data. Results of all other laboratory blood tests are randomly listed so that there is no logical clinical relationship between them. For example, an activated partial thromboplastin time (APPT) test, which relates to blood coagulation, is followed by a serum amylase level, which is indicative of pancreatic function. This system has also incorporated microbiological tests in the hard copy of the patient test data report. However, the format in which this information is presented is analogous to a compilation of manually printed slips since the microbiological data generated each time a body site is cultured occupies a space on the page about the size of one of the traditional manual laboratory slips. In addition, the data is not cumulative, thus requiring the physician to flip through many pages to determine, for example, if a prescribed course of antibiotic therapy is effective. A further problem encountered by the end user of the above described system is posed by the generally noncumulative nature of the entire data presentation. It accumulates all the data from certain tests for only a limited time period before reporting it in the hard copy of the patient test data report. Since this data will not appear in future reports, the page containing it must be retained to maintain a complete record. The test data report of a patient who spent four weeks in Roger Williams Hospital was over forty pages in length, and thus required a substantial amount of time for the physician to organize, assimilate, interpret and apply the information in the format generated by this system.

A third fully computerized system currently in use at the 500 bed Medical Center Hospital of Vermont, Burlington, Vt., presents in its patient test data report two data packages, one essentially complete and one missing an important element, which bear some clinical relationship to each other. The remainder of the test data is listed below these data packages. Unlike other systems which have listed test data vertically down the page, these are listed in somewhat of a related way. For example, the serum creatinine and BUN results, both important indicators of renal function, are set forth together. However, as a whole, the system is not designed to enable the end user of the information to focus on organ system related conditions in the most efficient way. Moreover, since the data in this system is cumulative for only seven days, the potential exists for a massive accumulation of data during a long hospital stay. This fact, coupled with the absence of a well-defined organ system relationship of the data, does not facilitate patient management for the clinician.

The patient test data report of still another fully computerized system recently instituted at Holyoke Hospital, Holyoke, Mass., is an improvement on the system just described in that all of the diagnostic tests are arranged in horizontal data packages so that the report is somewhat easier to follow. Two of the data packages in this system are essentially complete in that the data they present is sufficient to enable the end user to monitor a particular organ system related condition. These are data package labeled "Electrolytes -BUN- Creatinine", which contains most of the tests related to acid-base balance and renal function, and the data package labeled "Arterial Blood Gases", which includes the major information relative to changes in respiratory function. The remaining data packages provide, at best, only a partial picture of important organ system related clinical conditions. For example, the data package entitled "Enzymes" includes some of the diagnostic tests needed to diagnose, treat and follow liver dysfunction. However, to obtain a complete picture of liver function, it is necessary for the clinician to refer to a second data package which contains most of the rest of the clinically relevant information.

Only one prior art system, the patient test data reporting system offered by Burroughs Hospital Information System, is known which includes diagnostic data from other than laboratory tests in its patient test data. This system includes a concise statement of data generated from diagnostic radiology procedures in addition to the standard hematology and urinalysis data. However, the remainder of the patient test data report suffers from the same lack of orientation to clinically related conditions as the other prior art systems. For example, a blood chemistry data package generated by an automated laboratory analyzer is included under the heating of Hematology.

As can be appreciated from the above discussion, the known types of diagnostic test data presentation systems currently in effect range from those in which only some diagnostic data is reported by a computer assisted system to fully computerized presentations of information from laboratory analyses of blood and body fluids. Perhaps the most serious drawback presented by such computerized system lies in the difficulty encountered by the clinician or other end user in utilizing this information efficiently to manage patients. None of the known systems has attempted to include all known diagnostic tests and procedures within a single clinically oriented format. Moreover, none of the existing systems has organized all of the test data packages so that each data package includes tests which are diagnostic for certain organ system related medical conditions. All of the existing fully computerized systems present data from complete blood counts and differential blood counts together since most hospitals now have automated laboratory equipment which performs these laboratory tests. The patient test data report generated by these systems usually reflects the information in the order the tests are performed by this equipment. In addition, all existing fully automated systems put the standard information determined from a urinalysis in the same area of the patient test data report. Some of the existing systems have attempted to group together in data packages across the top of a page those diagnostic blood tests which are commonly ordered together. This has been attempted most often with tests which analyze the chemical composition of the blood. While grouping together those tests which are often ordered together may have some relationship to convenience, such an arrangement is not always the most clinically relevant one. No single computer assisted system has been developed which collects data from diagnostic laboratory tests and diagnostic procedures and reports it in a condensed, organized and clinically relevant form that is specifically designed to assist the clinical physician, primary end user of the data, in making a clinical diagnosis, prescribing a course of treatment or therapy consistant with the diagnosed clinical condition, and readily following the effects of the prescribed treatment or therapy on the clinical condition during the patient's hospital stay.

DISCLOSURE OF THE INVENTION

It is a general purpose of this invention to overcome the drawbacks of the prior art by providing a system for generating, storing and reporting medical test data in a manner to assist patient treatment personnel to assimilate and understand in the least possible time all of the medical test results necessary to properly diagnose and trest individual patients.

A more specific object of this invention is to provide apparatus for generating periodic cumulative patient reports superseding all previous reports and including all medical tests conducted on the patient during the time that he has been a member of a predefined patient population wherein the test results are formatted to assist in assimilation and interpretations of the reported data.

It is still another object of this invention to supplement the results contained on each patient report by providing automatically supplementary information in association with pre-defined out-of-range test results wherein the supplementary information is designed to assist the clinician to better treat the patient and to lessen overall medical costs.

The subject invention is designed to provide patient care personnel such as doctors, nurses and others with individualized patient test reports incorporating all accumulated test results wherein the results are consistently formatted in accordance with a predetermined pattern applied repeatedly to all patients existing within a patient population to thereby assist the patient care personnel in assimilating this information in the least possible time while eliminating the necessity to consider irrelevant test data which might otherwise become intermixed with that appearing in the patient report.

Still another object of this invention is to provide a system for generating electrical signals, storing the signals, and retrieving and formatting the signals to permit a high speed printer or CRT to display the formatted test results in a predetermined associative pattern having relevance to patient care personnel who must make diagnostic and treatment decisions based upon results and perceived patterns of results relating to organ system diseases.

The disclosed method and apparatus is designed to collect, organize, and consistently format relevant technical information for use by patient care personnel to assist such personnel in making not only correct medical decisions but decisions which are cost effective from the standpoint of providing the best possible care to the largest number of patients.

A still more specific object of this invention is to provide apparatus for generating, storing and reporting medical test data arranged to produce periodic cumulative patient reports organized to present test data in a manner to facilitate use of the test data by a wide variety of health care personnel including not only physicians but also nurses, students and other personnel who must assimilate and act upon the results. In particular, the apparatus is designed to generate periodic individual patient test data reports for each patient within a patient population wherein each report includes all stored test data for the particular patient for the total time period during which the patient has been a member of the patient population. Each report is organized to present the cumulative test data in a highly compact pattern of data packages with each data package including only results of tests making up a particular organ system disease related subset of tests.

Still another object of this invention is to provide method and apparatus for generating individual patient test data reports by means of a high speed printing device arranged to convert digital electrical signals representative of the type of test and of the dates and results of such tests into visually perceptible indicia appearing in an orthogonal pattern of rows and columns on a hard copy report combined with data package formatting means for generating successive data package formatting signals to cause the results of repeated performance of the same tests on the same patient to appear in a single column of a single data package and to cause the results from all tests within the corresponding subset of tests conducted on the same patient on the same date to appear in a single row of the same data package.

It is a more specific object of this invention to provide apparatus for generating patient reports of the type described above including report formatting means for generating an identical succession of report formatting electrical signals each time a patient report is produced by the high speed printer for identifying the tests and sequence of tests included in each successively formed data package and for identifying the sequence in which the data packages are to appear in each patient report.

Yet another object of this invention is to provide apparatus including a system controller connected with a high speed printer to cause the printer to form a patient report for each patient within the patient population by retrieving all data accumulated on each patient during the entire period that the patient has remained a member of the patient population and for causing the printer to form a predetermined succession of comprehensive data packages in accordance with formatting signals which cause each data package to contain a orthogonal pattern of visible indicia including the results of all tests defined by the data package which were conducted on the patient during the entire period in which the patient has remained a member of the patient population and with the visible indicia in each column representing the results of each corresponding test and for generating printer control signals which cause the printer to print the visible indicia in each column of each data package is chronological order as determined by the information stored in the system.

Another object of this invention is to provide method and apparatus for forming comprehensive patient test data reports including data packages containing not only test results pertaining to specific organ system diseases and reference level information for each test adjusted for the age and sex of the patient but also supplemental diagnostic, alternative treatment, and current cost information which is automatically generated in response to the existence of certain out-of-range test results as determined by the age and sex adjusted reference levels stored in the system.

Still other and more detailed objects of this invention will appear from a consideration of the following Brief Description of the Drawings and the Best Mode for Carrying Out the Invention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic diagram of a system for generating, storing and retrieving medical test data for a predetermined patient population in accordance with the subject invention.

FIG. 2 is a more detailed schematic illustration of the electrical apparatus for generating patient data reports in accordance with the subject invention.

FIG. 3 is still more detailed schematic illustration of a data storage, control memory and system controller of the subject invention.

FIGS. 4-39 are successive flow charts describing a program for operating the apparatus illustrated in FIGS. 1 through 3 by which medical test data may be generated, stored and retrieved in accordance with the subject invention.

BEST MODE FOR CARRYING OUT THE INVENTION

To provide a clear understanding of the subject invention, reference is initially made to FIG. 1 which discloses a schematic illustration of the overall flow of test data information within a hospital utilizing the subject invention. As in any hospital, medical services are dispensed to a changing patient population by a staff of professional patient treatment personnel including doctors, nurses, clinical technologists, and others whose responsibilities include generating test requests, conducting tests, storing the results, and interpreting the results upon retrieval. More particularly, FIG. 1 indicates that medical test requests 2 are normally generated by physicians but other personnel within the hospital may have limited authority to order patient tests such as nurses or other trained medical personnel. Prior to the use of computerized medical data handling systems, the test request 2 was given directly to those personnel charged with the responsibility of obtaining patient specimens after which the test request and specimen would be forwarded to the laboratory for performance of the test and recording of the results on the test request form for return to the physician.

In the system illustrated in FIG. 1, the test request 2 is no longer used in this way. Rather, the information contained on request 2 is entered into the system by test request entry apparatus 4 such as a keyboard input. Entry apparatus 4 may be equipped with a CRT display to allow vertification of the fact that the appropriate test request has been entered into the system. From the test request entry terminal 4, or other terminals which may be placed throughout the hospital, all requests are electronically forwarded to a test request compiler 6 for storage in a test request file 8. The function of compiler 6 and file 8 may be performed by a specially programmed general purpose digital computer having a capacity commensurate with the total volume of test requests which can be expected given the size of the patient population. Naturally, it is not necessary that the compiler and storage file be located within the hospitabl since the function of these two units could be performed by equipment located at a distance and used by the hospital on a time sharing basis with other data processing service users. The test request compiler 6 is organized to periodically generate specimen pick-up lists 10 which are then distributed to the various wards in the hopsital to assist nursing personnel or others in collecting the various patient specimens necessary for cnducting the specific test requests generated by the patient treatment personnel who prepared the original test request 2. Obviously, this sytem of organizing the requests can result in very considerable savings of time in paperwork. The system also promotes efficient execution of the specimen pick-up regimen which occurs within each ward since the pick-up can be organized in accordance with the classes of tests requested and the physical location of the patients from which the specimens must be derived.

Normally the patient specimens constituting body fluids, or tissue samples, which are forwarded to a laboratory 12 in individual specimen containers 14 marked to identify the patient and type of sample or specimen contained therein. Once received in the laboratory 12, the various requested tests may be performed on the specimen samples in accordance with a work profile generated by the compiler 6 on profile sheets 16 describing the specific type of test to be performed on the respective patient specimens. Again improved efficiency is achieved by this process since the various tests required to be performed may be organized in a logical fashion to assist the laboratory personnel to organize their equipment and their activities in accordance with a logical regimen or daily protocol to thereby assure greater accuracy and efficiency in their activities.

Once the tests are performed the results may be recorded on the work profile sheets 16 for subsequent manual and/or machine entry at an entry terminal 18. A keyboard input, card reader or other type of peripheral input device may be employed as the entry terminal 18 as long as it is capable of generating electrical signals representative of the patient, the type of test, the date and/or time of the test and the test results. Such signals may in some instances be generated automatically by on-line laboratory test equipment such as a COULTER COUNTER designed to generate electrical signals which may be directly received by a data processing system. The results received by terminal 18 are forwarded to a patient result compiler 20 for storage in a patient result file 22. Compiler system 20 and 22 may be the same equipment as compiler and request file 6 and 8 or may be a separate stand alone specially programmed digital computer which is capable of receiving, storing and formatting the test data received from the laboratory through terminal 18.

On a daily basis or at various times during the day, compiler 20 is designed to generate a ward report 24 consisting of all tests then in progress which were requested on patients located on a particular patient ward as well as all new test results for tests completed but not previously reported to the same ward. The ward report 24 may take the form of a hard copy generated by the compiler 20 and distributed to the wards or may take the form of an electrical signal designed to generate an image on a CRT tube located in the ward. Compiler 20 is also designed to generate a diagnostic data system patient lab report 26. As will be explained in much greater detail below it is a primary object of this invention to generate electrical signals through terminal 18 or otherwise for storage in the compiler 20 for subsequent presentaion in a patient report 26. The data appearing or report 26 is formatted to assist patient treatment personnel to assimilate the test results and related supplementary information and to arrive at a diagnosis and mode of treatment which represents the best possible medical service not only to the individual patient but to the overall patient population in light of the total amount of resources avaiable for health delivery services. When a patient leaves the predetermined patient population, his accumulated tests records are transferred to an archives file 28 for permanent storage and subsequent recall should the need arise.

Attention is now directed to FIG. 2 in which a detailed schematic diagram appears of the hardware which may be employed to implement the subject invention. Data representing the results of particular tests conducted on specimens of patients making up a given patient population, such as all of the patients in a particular hospital, is entered into the system by means of an electronic data generating means 30. This portion of the system may take the form of a keyboard input 32, located in the hospital clinical laboratory, with which laboratory technicians may enter individual test results. Input 32 may also be used to add addiational data to machine generated information for entry into the system storage as discussed hereinbelow. Test data may also be entered into the system by means of on-line laboratory equipment 34 of the type wherein one or more patient specimens are fed into the machine for serial or parallel tests, the results of which are converted to electrical signals compatible with the remainder of the data system illustrated in FIG. 2. The electronic data generating means 30 may further include a telecommunication interface 36 for connection with laboratory remotely located from the hospital such that data generated in the remote laboratory can be directly communicated to the system of FIG. 2 over communication lines such as commercial telephone lines.

The electrical signals generated by the electronic data generating means 30 may take the form of a separate digital electrical signal field for each test result stored in the system wherein each digital electric signal field includes (1) a first set of electrical digital signals identifying a particular medical test from a predetermined set of known medical tests, (2) a second set of electrical digital signals identifying the results of the tests identified by the first set, (3) a third set of electrical signals indentifying the date on which the test identified by the first set was conducted and (4) a fourth set of electrical digital signals identifying the patient for whom the test identified by the first set was conducted. Each of the digital electrical signal fields produced by means 30 is forwarded to a data storage system 38 which is designed to receive and store all of the electrical digital signal fields on the entire patient population serviced by the overall system.

Data storage system 38 includes a main random access memory 40 having the capabiity and capacity to store all of the test results produced for each of the patients making up the entire patient population serviced by the system for the entire period that each patient remains a member of the patient population. Thus, the capacity and form of the random access memory 40 will be dictated by the capacity required to store all of the data for the then existing total patient population. Obviously as patients are discharged from the hopsital, the stored test data relating to that patient may be removed from the main random access member 40 and placed in the archive 28 (FIG. 1). Even for a medium size hospital the amount of test data involved can become extremely voluminous necessitating the use of very high capacity storage memory such as magnetic tape and/or large scale magnetic discs. A critical characteristic of this memory, however, is that the data stored therein must be retrievable randomly in accordance with the informaion identified in each of the sets making up each digital electrical signal field. As will be described further hereinbelow, the data storage system 38 includes additional programmable storage registers which expand the capabilities of the disclosed system.

At predetermined times, such as once a day or more often if required, the system illustrated in FIG. 2 is operated to generate individual patient reports by withdrawing the test data for a particular patient, storing this test data in a temporary register 42, formatting the data, and generating an output image such as by means of a high speed line printer 44 designed to produce a hard copy bearing the medical test data in a desired format. In addition or alternatively, the patient report image may be formed on the screen of a CRT display 46. Both the printer 44 and display 46 may be located centrally in the hospital, or, alternatively, separate printers 44 and/or displays 46 may be located through the hospital to produce patient reports at desired locations adjacent the patient and/or the patient treatment personnel.

Register 42, printer 44 and display 46 form a portion of report generating means 48 which is designed to generate periodically the individual patient test data reports for each patient within the patient population. Each of these reports includes all stored test data for the particular patient for the total time period during which the patient has been a member of the patient population and is organized to present the cumulative test data in a highly compact pattern of data packages. A particularly critical characteristic of this invention is that each data package includes only results of tests making up a particular organ system disease related subset of tests out of the total set of tests which are available to the patient treatment personnel. The exact format of each data package will be discussed in greater detail hereinbelow.

In order to achieve a consistently repeated pattern of test results in each patient report, the report generating means 48 includes a control memory 50 containing a data package formatting means 52 for generating successive data package formatting signals to cause results of repeated performance of the same test on the same patient to appear in a single column of a single data package and to cause the results from all tests within the corresponding subset of tests making up the data package, which test were conducted on the same patient on the same day, to appear in a single row of the same data package. Thus, data package formatting means 52 has the function of insuring that each data package is formatted exactly in the same manner as all other data packages within each and every patient report generated by the system illustrated in FIG. 2. Control memory 50 also includes a report formatting means 54 for generating an identical succession of report formatting electrical signals each time a patient report is produced by the printer 44 or CRT display 46. The identical report formatting electrical signals are designed to identify the test and sequence of tests included in each successively formed data package and for identifying the sequence in which the data packages are to appear in each patient report.

Control memory 50 further includes a system program storage means 56 within which is sorted the iterative program commands necessary for operation of the overall system. Formatting means 52 and 54, in combination with storage means 56, may form portions of a single control memory 50 such as the control memory of a general purpose digital computer. Alternatively, means 52, 54 and 56 may be individual programmable read only memories. Ideally, each of these elements should be reprogrammable to accommodate changes in the data package formatting or the report formatting and to accommodate modification in the options of the overall system operation.

Connected with each portion of the control memory 50 is a system controller 58 adapted to generate image control signals which cause the printer 44 or CRT 46 to form a patient report for each patient within the patient population by retrieving all test data accumulated on each patient during the entire period that the patient has remained a member of the patient population. The system controller 58 is designed to cause the CRT or printer to form a predetermined succession of comprehensive data packages in accordance with the report and data package formatting signals generated by means 52 and 54, respectively. Each data package is caused to contain a consistent pattern of visible indicia including the results of all tests defined by the data package which were conducted on the patient during the entire period in which the patient has remained a member of the patient population. The visible indicia in each column represents the second sets of those signal fields having identical first sets of signals stored in memory 40 for each patient. System controller 58 is designed to generate printer control signals which cause the printer to print the visible indicia in each column of each data package in chronological order as determined by the fourth set of each corresponding signal field stored in memory 40.

By organizing the system as described above, each successively formed patient report will supersede all prior reports and will include all stored medical test results organized in a compact comprehensive organ system disease related pattern in which the order of the data packages and the order of tests appearing in each package is identical in all reports. This identity of pattern from one report to the next will assist the patient treatment personnel to assimilate and understand organ system disease related test information in the least possible amount of time. The system controller 58 is designed to respond to requests supplied on input line 61 for successive generation of patient reports for each of the patients contained in a patient register 60 which forms a part of the data storage system 38. Patient register 60 is designed to receive update data on line 62 consisting of signals representing the addition of patients to the total patient population upon admission of patients and conversely signals representative of the discharge of patients. The content of the admission signals will include the patient's age, sex, and other vital statistics useful to the hospital in maintaining adequate records relating to each individual patient.

System controller 58 is also designed to receive special system report requests on line 64 which can assist the hospital administration to manage and analyze the hospital operation particularly as regards to the medical test laboratory functions.

The printer 44 and display 46 may be controlled directly by the system controller 58 or may include a separate display controller 66 which is designed to operate semi-independently of the system controller 58 thereby freeing the system controller to operate more quickly and efficiently.

As further illustrated in FIG. 2, the data storage means 38 may include a reference level information storage register 68 for storing reference level information signals indicating the normal range for a patient of a given sex and age for each of the possible tests for ultimate display in the inidivudal patient reports. As will be described hereinbelow, the reference level information recorded in register 68 is caused to be printed on each inidivudal patient report at a position which allows the clinician to use the reference level information as an aid to interpretation of the displayed test results. Further assistance is given to the clinician by means of a comparator circuit 70 connected with both the main random access memory 40 and the reference level information storage register 68 to permit a comparison between the tests results stored in the main random access memory 40 and the normal range for each test adjusted in accordance with the age and sex of the patient whose report is being generated. Comparator circuit 70 is thus designed to compare the test results as represented by the second set of each signal field stored in the main random access memory 40 with the age and sex adjusted normal reference range defined by register 68. If an out-of-range test result is discovered, comparator 70 produces a signal over line 72 connected with the system controller 58 which signal is designed to cause the controller to generate a signal causing a visible out-of-range indicator to appear in the image formed by the CRT display 46 or the high speed line printer 44 adjacent the visible indicia appearing in the patient report which represents the out-of-range test results.

Data storage means 38 is designed to include an additional register 74 for storing information useful to a clinician in interpreting specific test results which are out of the normal range for such tests. This register may be deemed a supplemental information and threshold criteria storage means. The type of information stored in register 74 could include inidications of possible diagnosis normally indicated by a particular out-of-range test result or alternative types of treatment and the current cost for such type to aid thereby the clincain in selecting an appropriate treatment which is both suitable for the patient and the most cost effective under the circumstances. For example, certain types of antibotics may be prescribed despite their high daily cost when other types of antibotics having the same efficacy in a given circumstance, and costing significantly less could be prescribed without compromised quality patient care.

Turning now to FIG. 3, the supplemental information and threshold criteria storage register 74 is illustrated as including an additional storage means 76 which is designed to store signals representative of the information regarding alternative treatment and current costs for each type of treatment. Note that additional storage means 76 is connected to system controller 58 through line 78 and line 75 to cause the controller to generate signals operating the printer 44 to print the alternative treatment and current cost information on the patient report in association with the particular printed test results whenever the stored signals indicate an out-of-range result given the age and sex of the patient.

The data package formatting means 52 is shown in FIG. 3 as including a reference level formatting means 80 for generating reference level formatting signals to cause reference levels for a patient to be displayed above each column of test results appearing in each data package formed by printer 44. Similarly, the data package formatting means 52 may also include a label formatting means 82 for generating label formatting signals to cause visible indicia identifying the type of tests to appear above each column of test results in each data package corresponding to the first set of each signal field associated with the column. FIG. 3 further discloses that the report formatting means 54 includes a signal generator 83 for generating label signals representative of each type of test within each data package. Means 54 also includes separate data package generators 84 for generating the test identifying signals necessary to allow system controller 58 to retrieve, organize and format the test data for each patient report generated by the system in order to insure that test data corresponding to a particular test will always appear at the same location and within the same data package appearing within each patient report.

The hard copy produced by printer 44 on the image produced by CRT 46 will generally include, in its complete form, two parts: the Microchem Section, including all known microbiological and biochemical diagnostic tests, and the Subspeciality Section, including all known diagnostic procedures utilized by the various medical subspecialties such as Radiology and Cardiology. The Microchem Section includes most of the diagnostic tests known and used by the medical profession and is therefore subdivided into five categories to present all of this information in a logical, clincially oriented format. Category I includes the basic hematology tests, Category II includes routine urinalysis, Category III includes basic chemistry tests, Category IV includes special chemistry tests and Category V includes microbiological tests. Each category is subdivided into data packages to organize the information further so that all of the information is presented to the clinical physician so that it will provide the maximum assistance in diagnosing, treating and monitoring organ system related clinical conditions. The arrangement of the data packages has been determined to be one which will enable the physician to absorb critical information quickly and follow clinical trends at a glance. As discussed above with regard to FIGS. 2 and 3, the tests and sequence of tests appearing in each data package is determined by the electrical signals generated by the report formatting means 52. In response to the signals the system controller causes the line printer 44 or CRT 46 to produce the desired data package. In each of the data packages discussed hereinbelow the individual tests are identified by an abbreviation the meaning of which appears in the following Chart I along with an indication of the units in which the results are reported:

                  CHART I
    ______________________________________
    ABG             Arterial Blood Gases
    ACET            Acetone
    ALB             Albumin
    ALPHA1          Globulin
    ALPHA2          Globulin
    AMY             Amylase
    APP             Appearance
    APTT            Activated Partial
                    Thromboplastin Time
    BACT            Bacteria
    BASO            Basophil
    BETA            Globulin
    BILD            Bilirubin Direct
    BILT            Bilirubin Total
    BLD             Blood
    BND             Bands
    BT              Bleeding Time
    BUN             Blood Urea Nitrogen
    CA              Calcium
    CAP             College of American
                    Pathologists
    CHOL            Cholesterol
    CL              Chloride
    COAG            Coagulation
    CO.sub.2        Carbon Dioxide, Total
                    Carbon Dioxide
    CPK             Creatine Phosphokinase
    CREA            Creatinine
    CT              Count
    DIFF/MORPH      Differential/Morphology
    EOS             Eosinophil
    EPC             Epithelial Cells
    ESR             Erythrocyte Sedimentation
                    Rate
    FDP             Fibrin Degradation Products
    FE              Iron
    FIBRINO         Fibrinogen
    GAMMA           Globulin
    GGTP            Gamma Glutamyl
                    Transpeptidase
    GLOB            Globulin
    GLU             Glucose
    GM/DL           Gram/Deciliter
    HCT             Hematocrit
    HDL             High Density Lipoprotein
    HGB             Hemoglobin
    HT              Height
    IBC             Iron Binding Capacity
    IU/L            International Units/Liter
    K               Potassium
    K/MM3           Thousand/Cubic Millimeter
    LDL             Low Density Lipoprotein
    LDH             Lactate Dehydrogenase
    LIP             Lipase
    LYM             Lymphocytes
    L/MIN           Liter/min
    MCG/ML          Microgram/Milliliter
    MCH             Mean Corpuscular Hemoglobin
    MCHC            Mean Corpuscular Hemoglobin
                    Concentration
    MCV             Mean Corpuscular Volume
    MEQ/L           Milliequivalents/liter
    MG              Magnesium
    MG/DL           Milligram/Deciliter
    MIN             Minute
    MMHG            Millimeters of Mercury
    MMOL/L          Millimoles/liter
    MM/HR           Millimeters/hour
    MONO            Monocytes
    MOSM/KG         Milli Osmoles/KG
    M/MM3           Million/cubic millimeter
    NA              Sodium
    NG/ML           Nanograms/Milliliter
    OSM(U)          Osmolarity-Urine
    OSM(S)          Osmolarity-Serum
    OTHR            Other
    O.sub.2 RX      Oxygen Therapy
    O.sub. 2 SAT    Oxygen Saturation
    PCO.sub.2       Partial Pressure of CO.sub.2
    %               Percent
    % O.sub.2       Oxygen Therapy % O.sub.2
    PG/ML           Picogram/ML
    PLAT            Platelets
    POLYS           Polymorphonuclear
                    Leukocytes
    PO.sub.2        Partial Pressure of O.sub.2
    PO.sub.4        Phosphate
    PROT            Protein
    PTA             Prothrombin Activity
    RBC             Red Blood Count, Cells
    RETIC CT        Reticulocyte Count
    SAP             Serum Alkaline Phosphatase
    SEC             Second
    SGPT            Serum Glutamic Pyruvic
                    Transaminase
    SGOT            Serum Glutamic Oxalacetic
                    Transaminase
    SGR             Specific Gravity
    SHUR            Standard Hospital
                    Utilization Reporting
    STOOL OB        Occult Blood
    SUG             Sugar
    SUM             Standard Unit of Measure
                    (SHUR)
    TG              Triglycerides
    TP              Total Protein
    U               Units
    UG/DL           Micrograms/Deciliter
    URIC            Uric Acid
    UUG             Micro Microgram
    U3              Cubic Micron
    U/DL            Units/Deciliter
    WBC             White Blood Count,
                    Cells
    WT              Weight
    ______________________________________

                                      CHART II
    __________________________________________________________________________
    COULTER:
           HGB  HCT
                   WBC PLAT
                           RBC  MCV MCH MCHC
           GM/DL
                %  K/MM3   M/MM3
                                U3  UUG %
    __________________________________________________________________________

                                      CHART III
    __________________________________________________________________________
    DIFF (%)/MORPH:
               POLYS
                    BND LYM MONO EOS
                                    BASO
                                        OTHR
                                            RBC
                                               PLAT
    __________________________________________________________________________

                                      CHART IV
    __________________________________________________________________________
    MISC:
    STOOL
         OB RETIC CT
                  EOS CT  ESR FE IBC
                                   FERRITIN
                                          B12  FOLATE
            %     CELLS/MM3
                          MM/HR
                              UG/DL
                                   NG/ML  PG/ML
                                               NG/ML
    __________________________________________________________________________

                  CHART V
    ______________________________________
    COAG:
    PTA       APTT     BT      FIBRINO  FDP
    SEC       SEC      MIN     MG/DL    UG/ML
    ______________________________________

                                      CHART VI
    __________________________________________________________________________
    II. URINALYSIS
    ROUTINE:
           APP PH SGR
                     SUG ACET
                             PROT
                                 BLD BILE
    MICRO: WBC RBC
                  BACT
                      CASTS
                           EPC
                              OTHR
    __________________________________________________________________________

                  CHART VII
    ______________________________________
    CHEM I:
    GLU BUN CREA  Na K CL CO2 OSM(S) OSM(U)
    MG/DL         MMOL/L      MOSM/KG
    ______________________________________

                  CHART VIII
    ______________________________________
    A.B.G.:
    PH     PCO2 PO2   O2 SAT   CO2     L/MIN % O2
           MMHG       %        MMOL/L  O2 RX
    ______________________________________

                                      CHART IX
    __________________________________________________________________________
    CHEM II:
           CA PO4 URIC
                   MG   AMY LIP
                               CHOL TG HDL LDL
           MG/DL   MEQ/L
                        U/DL
                            U  MG/DL
    __________________________________________________________________________

                                      CHART X
    __________________________________________________________________________
    PROTEINS:
           TP ALB GLOB ALPHA 1 ALPHA 2 BETA GAMMA
           GM/DL
    CHEM III:
           BILT BILD
                  SAP GGTP SGPT SGOT LDH CPK
           MG/DL  ID/L
    __________________________________________________________________________

                                      CHART XI
    __________________________________________________________________________
    HOSPITAL LAB:
               TEST
                   RESULT
                         REFERENCE RANGE
                                      UNITS
    REFERENCE LAB:
    __________________________________________________________________________

                  CHART XII
    ______________________________________
    ORIGIN  MICRO EXAM   CULTURE    SENSITIVITIES
    ______________________________________

                                      CHART XIII
    __________________________________________________________________________
           ORIGIN
                MICRO EXAM
                         CULTURE
                                SENSITIVITIES
    20 APR 1600
           URINE
                GRAM POS.
                         STAPH. CHLORO(1);
                COCCI    EPIDER-
                                KANA(2); FURA(3)
                         MIDIS  CEPH: VANCO:
                         G.T.   METH; CLINDA;
                         100 K/ML TRIM; ERYTHRO
    (1) $10.00; (2) $2.50; (3) $6.00
    __________________________________________________________________________

                                      CHART XIV
    __________________________________________________________________________
    LAB REPORT -- Acute Care Hospital, Busytown, U.S.A.
    SMITH, JOHN J.
             ADM: 30 DEC 77
    DOB: 4/30/35
             AGE: 42  SEX: M
                           WT: 175
                                HT: 72
    29 88 04 LOC: 4S RM 470
    DR: COLI
    CUMULATIVE AT 04 FEB 1300
    __________________________________________________________________________
    I. HEMATOLOGY
            HGB  HCT WBC PLAT
                             RBC  MCV MCH MCHC
    COULTAR GM/DL
                 %   K/MM3   M/MM3
                                  U3  UUG %
    __________________________________________________________________________
    REFERENCE
            14.0 42.0
                     4.0 140 4.6   80 26  31
    RANGE   18.0 54.0
                     11.6
                         440 6.2  110 33  36
    30 DEC 0800
            15.4 47.5
                     9.6 300 4.48 105 24.1
                                          30.4
    31 DEC 0700
            15.3 47.3
                     12.5+   4.66 108 25.0
                                          33.0
    01 JAN 0700
            15.5 48.0
                     18.6+   4.78 106 24.0
                                          34.0
    08 JAN 0400
            10.8-
                 33.1-
    10 JAN 1400
            10.2-
                 31.4-
                     11.0
                         240 4.75 102 28.0
                                          33.0
    10 JAN 1700
            10.9-
                 33.1-
    11 JAN 0200
             8.6-
                 27.0-
    11 JAN 0700
            10.1-
                 30.8-
    12 JAN 1400
            10.1-
                 31.4-
    13 JAN 1700
             7.7-
                 23.9-
    13 JAN 2100
             8.9-
                 27.5-
    14 JAN 0700
             7.1-
                 22.1-
    14 JAN 1600
            10.0-
                 30.2-
    15 JAN 0700
             8.8-
                 28.2-
    16 JAN 0700
             9.8-
                 29.6-
    17 JAN 0700
            10.8-
                 33.4-
    18 JAN 0700
            11.8-
                 34.4-
    24 JAN 0700
            12.4-
                 37.2-
    26 JAN 0700
            12.8-
                 37.5-
    27 JAN 0700
            10.9-
                 33.3-
    28 JAN 0700
            11.5-
                 35.1-
                     7.0     3.77-
                                   92 27.2
                                          32.1
    29 JAN 0700
            12.6-
                 38.1-
    30 JAN 0700
            12.8-
                 36.0-
    31 JAN 0700
            13.0-
                 38.0-
    01 FEB 0700
            12.8-
                 36.8-
    02 FEB 0700
            12.0-
                 36.3-
    03 FEB 0700
            12.8-
                 38.1-
                     8.7     4.07-
                                   98 30.1
                                          32.1
    __________________________________________________________________________
     DIFF (%)/MORPH:
               POLYS
                    BND LYM MONO EOS
                                    BASO
                                        OTHR
                                            RBC
                                               PLAT
    __________________________________________________________________________
    REFERENCE  42    0  10   0    0  0
    RANGE      81    5  47  10    8  2
    30 DEC 0800
               54    20+
                        11  09   01 01  00  OK OK
    31 DEC 0700
               58    26+
                        10  06   00 00  00  OK OK
    01 JAN 0700
               52    21+
                        14   11+ 01 01  00  OK OK
    10 JAN 0700
               51    07+
                        30  05   02 02  00  OK OK
    28 JAN 0700
               43    21+
                        27  07   01 01  00  OK OK
    03 FEB 0700
               51   03  28  02   01 00  00  OK OK
    __________________________________________________________________________
                   RETIC CT
                         EOS CT  ESR  FE  IBC
                                            FERRITIN
                                                   B12  FOLATE
    MISC:   STOOL OB
                   %     CELLS/MM3
                                 MM/HR
                                      UG/DL NG/ML  PG/ML
                                                        NG/ML
    __________________________________________________________________________
    REFERENCE      0.2    40      2   45 250
                                            G.T.   200   3
    RANGE          2.5   423     20   200
                                         350
                                            20     900  16
    30 DEC 0800                   40+
    11 JAN 1400
            -      2.0                60 250
    12 JAN 0800
            +      3.1+
    13 JAN 0800
            +
    15 JAN 0800
            -
    __________________________________________________________________________
            PTA    APTT  BT FIBRINO
                                  FDP
    COAG:   SEC    SEC   MIN
                            MG/DL MCG/ML
    __________________________________________________________________________
    REFERENCE
            11.0   19    3  200   L.T.
    RANGE   12.5   32    5  400   10
    30 DEC 0800
            11.2   21.8
    16 JAN 1500
            11.8   23.0
    __________________________________________________________________________
    II. URINALYSIS
     ROUTINE:
            APP PH SGR
                      SUG ACET
                              PROT
                                  BLD BILE
    __________________________________________________________________________
    30 DEC 0800
            CLR 8.5
                   1.007
                      NEG NEG NEG NEG NEG
    31 JAN 1200
            CLR 5.5
                   1.017
                      NEG NEG NEG NEG NEG
    __________________________________________________________________________
     MICRO: WBC RBC
                   BACT
                       CASTS
                            EPC
                               OTHR
    __________________________________________________________________________
    30 DEC 0800
            0-2 0  0   0    0  0
    31 JAN 1200
            2-4 1-2
                    1+ 0     2+
                               0
    __________________________________________________________________________
    III. BASIC CHEMISTRY
            GLU  BUN  CREA
                         Na  K  CL  CO2  OSM(S)  OSM(U)
    CHEM I: MG/DL        MMOL/L          MOSM/KG
    __________________________________________________________________________
    REFERENCE
             65  6  0.5  134 3.5 96  25  282    50
    RANGE   140 25  1.7  145 5.5 110 32  296   1200
    30 DEC 0800
            103  9  0.8  142 4.2 93- 34+
    31 DEC 0700          142 4.9 87- 36+
    31 DEC 1600          138 4.2 88- 38+
    01 JAN 0700
            110 14       137  3.3-
                                 98  36+
    01 JAN 0700 11       135  3.1-
                                 87- 31+
    02 JAN 0700          135  3.2-
                                 90- 32+
    03 JAN 0700
            128 23  1.2
    10 JAN 0700 16        134-
                             4.3 92- 26
    20 JAN 0700           134-
                             4.7 98  28
    02 FEB 0700
             80  7  0.4-  142-
                              5.5+
                                 103 28
    __________________________________________________________________________
                PCO2  PO2   O2 SAT
                                 CO2   L/MIN  % O2
    A.B.G.: PH  MMHG        %    MMOL/L
                                       O2 RX
    __________________________________________________________________________
    REFERENCE
            7.38 35   75    85.0 24
    RANGE   7.42 45   85    95.0 30
    30 DEC 0800
            7.07-
                 143+ 76    86.0 44+
    30 DEC 1000
            7.45+
                 53+  371+  99.8+
                                 38+
    30 DEC 1400
            7.48+
                 56+  57-   90.5-
                                 43+
    31 DEC 0800
            7.52+
                 42   62-   92.8-
                                 35+
    01 JAN 0800



            7.47+
                 48+  61-   91.9 36+
    01 JAN 1400
            7.49+
                 46+  77    95.2+
                                 36+
    02 JAN 1000
            7.52+
                 41   73-   95.2+
                                 35+
    02 JAN 1400
            7.52+
                 42   87+   96.8+
                                 35+   45
    02 JAN 1500
            7.51+
                 41   73-   94.9 34+   40
    02 JAN 1900
            7.44 49+  72-   94.0 34+   50
    03 JAN 1200
            7.38 57+  91+   95.9 35+
    03 JAN 1400
            7.47+
                 44   74-   94.5 33+   40
    04 JAN 0900
            7.45+
                 46+  67-   92.8 33+   40
    04 JAN 2200
            7.47+
                 44   65-   92.8 33+
    06 JAN 1100
            7.31-
                 69+  79    92.8 36+
    06 JAN 1500
            7.36-
                 59+  72-   92.4 34+
    08 JAN 0100
            7.42 55+  49-   85.0-
                                 36+
    08 JAN 1200
            7.37-
                 65+  47-   80.1-
                                 39+
    10 JAN 0800
            7.37-
                 67+  44-   77.9-
                                 40+
    10 JAN 1100
            7.33-
                 74+  39-   70.0-
                                 40+
    12 JAN 1200
            7.26-
                 90+  64-   86.6 42+
    12 JAN 1900
            7.46+
                 53+  63-   92.0 38+   50
    14 JAN 0900
            7.54+
                 42   54-   91.0 37+
    14 JAN 2100
            7.50+
                 45   50-   88.0 37+
    16 JAN 1300
            7.50+
                 40   81    96.0+
                                 33+   55
    18 JAN 1100
            7.52+
                 40   66-   93.7 34+
    20 JAN 1100
            7.44+
                 43   92+   96.5+
                                 30
    22 JAN 1300
            7.42 42   82    95.2+
                                 28
    24 JAN 1000
            7.34-
                 55+  80    93.7 31+
    26 JAN 1100
            7.39 48+  72-   92.8 30
    26 JAN 1400
            7.44 42   60-   90.5 29
    28 JAN 0600
            7.48+
                 38   69-   94.1 30
    28 JAN 1100
            7.40 42   56-   87.8 27
    30 JAN 1600
            7.45+
                 37   79    95.0 27
    02 FEB 1100
            7.39 45   96+   96.2+
                                 28
    03 FEB 1300
            7.47+
                 36   56-   89.4 27
    04 FEB 1300
            7.40 39   67-   91.9 25
    __________________________________________________________________________
            CA  PO4  URIC
                        MG   AMY LIP
                                    CHOL TG HDL  LDL
    CHEM II:
            MG/DL       MEQ/L
                             U/DL
                                 U  MG/DL
    __________________________________________________________________________
    REFERENCE
            8.8 2.0 2.5 1.0   5  L.T.
                                    125  50
                                           25   60
    RANGE   10.8
                4.7 8.5 2.2  37  1.0
                                    300 200
                                           75  185
    30 DEC 0800
            9.5 3.0 6.7      20  0.5
                                    205 160
    __________________________________________________________________________
            BILT BILD
                    SAP GGTP SGPT SGOT LDH CPK
    CHEM III:
            MG/DL   IU/L
    __________________________________________________________________________
    REFERENCE
            0.1 0.0 10  1   1   1  90  0
    RANGE   1.7 0.3 50 40  70  70  250 125
    30 DEC 0800
            0.9 0.2 40 35  40  25  100 100
    22 JAN 1600                20  94  30
    28 JAN 1100
            1.2     36         26  90  37
    __________________________________________________________________________
            TP  ALB   GLOB
                        ALPHA 1
                              ALPHA 2
                                    BETA
                                        GAMMA
    PROTEINS:
            GM/DL
    __________________________________________________________________________
    REFERENCE
            6.2 3.6 1.9 0.15  0.50  0.60
                                        0.60
    RANGE   8.3 5.2 3.7 0.40  1.00  1.20
                                        1.60
    30 DEC 0800
            6.1-
                3.7 2.4
    28 JAN 0800
            5.8-
                 3.3-
                    2.5
    __________________________________________________________________________
    IV. SPECIAL CHEMISTRY
     HOSPITAL LAB:
              TEST     RESULT REFERENCE RANGE
                                           UNITS
    __________________________________________________________________________
    30 DEC 0800
              ART      non-reactive
                              non-reactive
    30 DEC 0800
              T3 uptake(resin)
                       32     25-35        %
    30 DEC 0800
              T4 thyroxin(RIA)
                       6.8     4.5-12.5    MG/DL
    08 JAN 0800
              DIGOXIN(RIA)
                       0.8    0.8-2.0      NG/ML
    __________________________________________________________________________
     REFERENCE LAB:
               TEST             RESULT
                                      REFERENCE RANGE
                                                   UNITS
    __________________________________________________________________________
    03 JAN 0800
               CEA              5.00.sup.1 *
                                      .00-2.50     NG/ML
    08 JAN 0800
               ALPHA 1 ANTITRYPSIN
                                200   80-260       MG/DL
    12 JAN 1400
               FACTOR VIII       90   50-200       % AC
    12 JAN 1700
               HEMOGLOBIN, PLASMA
                                 4    0-7          MG/DL
    12 JAN 1700
               HEMOGLOBIN, FREE, URINE
                                NEG   NEGATIVE
    12 JAN 1700
               HAPTOGLOBIN      140   25-180       MG/DL
    __________________________________________________________________________
     .sup.1 *Plasma CEA titers are not an absolute test for malignancy. In the
     management and diagnosis of the patient suspected or known to have cancer
     all other tests and procedures must continue to be given emphasis. CEA
     titers less than 2.5 NG/ML are not proof of the absence of malignant
     disease.


V. MICROBIOLOGY
           ORIGIN
                MICRO EXAM
                         CULTURE   SENSITIVITIES
    __________________________________________________________________________
    30 DEC 0800
           CSF  NEG      NO GROWTH
    31 DEC 0800
           URINE         NO GROWTH
    02 JAN 0800
           STOOL
                WNL      NORMAL FLORA
    11 JAN 0800
           BLOOD
                NEG      NO GROWTH
    11 JAN 0900
           BLOOD
                NEG      NO GROWTH
    11 JAN 1000
           BLOOD
                NEG      NO GROWTH
    __________________________________________________________________________