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[Medical documentation and electronic data processing in a university hospital--(planning-experiences-suggestions)
1Institut for Medizinische Statistik und Dokumentation der Freien Universität Berlin, Berlin.
Abstract:
The University Hospital Steglitz has started the processing of case-records (basic documentation), which extends from 2 to 38 punch-cards per medical record, and is presently being stored on magnetic tape. Apart from the two programs for control, co-ordination and storage of the data, there is another program for subject-oriented scanning of the data file. Thereby several aspects can be linked logically by »AND« or »NOT-AND« instructions to make up the query. The answer to the search may be printed either in short-form (one-line/case-history) or in an extended form (one-page/case-history). The latter contains the details on the patient, the diagnoses and the special diagnostic and therapeutic measures to which the patient was subjected; on the basis of such lists the requestor can decide which case records are required.
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