HELP (Health Evaluation through Logical Processing) LDS Hospital, Salt Lake City.

Ben Frein

Realizing the need to improve patient treatment, reduce costs, improve the quality of clinical research, Latter-Day Saints (LDS) Hospital in Salt Lake City partnered with the University of Utah to create the Health Evaluation through Logical Processing or HELP system. LDS is part of the Intermountain Health Care, Inc chain of hospitals in Utah, Idaho, and Wyoming. The hospital has more than 500 beds and features a teaching center associated with the University of Utah School of Medicine. The HELP system has been in development for almost 30 years and consists of several logical modules. These modules perform a variety of tasks from data collection and delivery, reminders, alerts, and prompts based on clinical protocols.

Since its development, the HELP system has been installed at many other Intermountain Health Care centers. The system is also distributed commercially by 3M and has been installed at several non Intermountain hospitals. While many of the Intermountain Health Care centers are using this sophisticated system, it features an integrated database and thus patient data cannot be shared from one hospital to another. A new system is being developed that takes advantage of "Windows" and IP-based technologies.

Through the direct involvement of physicians, nurses, researchers, and administrators LDS designed HELP to be compatible with all of their departments. The HELP system accepts data manually entered into over 5,000 terminals located at patient bedsides and other locations. This terminals are all connected to a centralized group of twelve fault-tolerant processors. These processors are also linked to many medical devices in the intensive care unit such as ventilators and pulse oximeters. The system is very robust and can process an enormous amount of data. Respiratory care data alone includes over 18,000 entries per day. Each entry, which is scanned by a decision making processor, alerts clinicians of drug allergies, interactions, selection, and dosing problems. The system can also detect organ dysfunction or critical changes in laboratory parameters.

In addition to providing higher quality health care and monitoring, the HELP system is reducing the costs associated with health care and prescriptions. In one example, HELP protocols are used to systemize the very complex and ever changing parameters required for ventilator support of respiration. This makes treatment less prone to human error as hundreds of potential variables are considered. Costs are also reduced by allowing fewer clinicians to care for more patients. Another key cost cutting feature of the HELP system is its antibiotic therapy recommendation protocol. As it is usually impractical to wait for laboratory results outlining which specific antibiotic should be prescribed, patients will usually receive a prescription for a more expensive broad-spectrum antibiotic. The HELP system is able to analyze the patient record and infection specific information to identify the most probable pathogens and the lowest cost antibiotics which will be effective. The HELP system can track and report information such as trend analysis of pathogens and antibiotic resistance patterns within a particular hospital which further enhance its antibiotic recommendations.

Teaching of medical students is also accomplished with a teaching module that can ask students questions or ask the student to outline particular lines of reasoning and appropriate findings given a particular medical diagnosis.

The National Institute of Health's Research Resource Division, the National Heart, Lung, and Blood Institute, and the National Center for Health Services Research have all provided grant assistance for the HELP system. This has resulted in over two hundred man-years of work and the programming of more than 6 million lines of code by the early 1990s. Since then, many similar systems, though not nearly as extensive, have been installed at Boston's Beth Israel Hospital, Columbia Presbyterian Medical Center in New York, the Indiana University Medical Center, and many more hospitals.

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