Posts Tagged ‘Automated Multiphasic Health Test’

Kaiser Permanente and NASA – Taking Telemedicine Out of this World

posted on September 23, 2015

Lincoln Cushing
Heritage writer

STARPAHC logo

Space Technology Applied to Rural Papago Advanced Health Care logo

How do you handle medical testing and care in a remote location? A really, really remote location – such as outer space?

This was one of the challenges that the National Aeronautics and Space Administration faced in the early 1970s – and it got help from one of our founding physicians and Kaiser Permanente, through what was then the Kaiser Foundation International[i] program.

KFI to Help Develop NASA-Sponsored Health System”
Kaiser Permanente newsletter, August 9, 1972

Kaiser Foundation International became a major ($1.8 million) subcontractor to the Lockheed Missiles and Space Company to help design, develop and test a ground based remote health care delivery system.

The ground-based test unit will be installed at a sparsely populated site on earth to provide medical care to local residents. Trained physicians’ assistants will employ the unit to transmit medical information on residents of the area to physicians at an established facility many miles from the remote site. If the test program is successful, it may provide system technology to improve health care and medical services to remote areas on earth. Part of a four year NASA sponsored program, this concept, as applied to a remote area on earth, will be evaluated by NASA for possible use in advanced, long-duration, manned space missions.

Interior view of the mobile health unit with medical personnel, neonatal patient and mother, from "The STARPAHC collection: part of an archive of the history of telemedicine"

“Interior view of the mobile health unit with medical personnel, neonatal patient and mother” from Arizona Health Sciences Library

The back story is that in late 1970 Morris Collen, MD, attended a Northeast Electronics Research and Engineering Meeting in Boston that included a session on medical electronics. At that conference he served on a panel with Dr. Walton Jones, Director of Biotechnology and Human Research at NASA.

Kaiser Permanente’s Dr. Collen, in addition to being a brilliant physician in the Kaiser Richmond shipyards during World War II, was also an electrical engineer and considered one of the fathers of the field of medical informatics. He pioneered the use of the “multiphasic” examination, a battery of prescriptive medical tests for incoming health plan members, which later became the Automated Multiphasic Health Test.

By late 1971 J.P. Nash, the assistant general manager of Lockheed, told Dan Scannell, Kaiser Permanente’s director of public relations, some exciting news:

“Very shortly NASA is expected to solicit proposals for the design, development and testing of a Test Bed System for an Area Health Services Field Unit. This requirement has grown out of a NASA program for which [Lockheed] has been under contract for about four years called Integrated Medical and Behavior Laboratory Measurements System. IMBLMS is a four-phase program leading to the development and operation of a space flight biomedical laboratory, for research experiment in long-duration manned space flight in post-Apollo programs . . .”

IMBLMS project patch, circa 1973

Integrated Medical and Behavior Laboratory Measurements System project patch, circa 1973

On Jan. 4, 1972, Dr. Collen wrote to Sam L. Pool, MD, at the NASA Manned Spacecraft Center in Houston:

“Of special interest to us . . . would be the development of a completely automated self-administered multiphasic health testing laboratory in which a person in space could perform everything himself, utilizing automated equipment which enters the data into the computer which is programmed to provide advice and instructions. We believe that it is now technically feasible to develop such a prototype and with our experience we estimate such could be done within two to three years at a reasonable cost.”

The project, as noted in the 1972 news story, would use a “sparsely populated site on earth” to test equipment, systems, and personnel. That location would be the Papago Indian Reservation [now known as the Tohono O’odham Indian Nation] in southwest Arizona, with the catchy space-age title “Space Technology Applied to Rural Papago Advanced Health Care,” known as STARPAHC. Lockheed issued a summary report in June 1974 that explained the “Part 1 – Design and Definition” of the project:

STARPAHC will prototype a ground-based demonstration of IMBLMS space technology with two primary program objectives: (1) to obtain data for application to future spacecraft design and (2) to improve health care delivery through application of space technology. STARPAHC is designed to improve the capability for delivering health care to the Papago Indians located on the Papago Indian Reservation in southwest Arizona.

The STARPAHC operational concept was based on utilizing the professional staff of the Sells Hospital, where the Health Services Support Control Center will be located, to provide direction and consultation to paramedical and technical personnel stationed at the remote clinics, Local Health Services Center, and the Mobile Health Unit. The interchange of information between the HSSCC, LHSC, and MHU will be accomplished by voice, data, and video communication links. Computer-based data management techniques will implement record keeping, data retrieval, and data analysis.

“Patient viewing microscope” photograph from STARPAHC report.

“Patient viewing microscope,” STARPAHC report.

STARPAHC ended in 1977, and resulted in several advances in the nascent field of telemedicine. A 1979 article in Medical Care interviewed 47 individual care providers in the program, and concluded that the major problems were the unreliability of equipment and the time required for television consultations. The major benefit cited was improved access to health care for a population not previously receiving such care near their homes. Another positive outcome noted by non-physician providers was the linkage to physicians via television and voice communications from remote areas.

In 2001 the Arizona Health Sciences Library acquired important archival materials documenting the STARPAHC project and established the Arizona Archive of Telemedicine.

Telemedicine – terrestrial and beyond – has evolved considerably since the early 1970s. In 1980 Dr. Collen would serve as a member of the NASA Workshop on Space Shuttle Studies. And Kaiser Permanente is as deeply committed to exploring its applications now as it was when the field was brand new.

 

[i] In 1964 Kaiser Industries established the not-for-profit Kaiser Foundation International to administer foreign medical care programs. With Kaiser Permanente’s reputation on the rise, requests for consulting help started to come from places where Kaiser Industries didn’t already have a presence. Between 1964 and 1969, the international group was engaged for medical care projects in 15 African countries. When it closed down in 1975, KFI had been hired and paid for projects in 30 countries around the globe, including rural locations in California, Utah, and West Virginia. KFI was replaced by Kaiser Permanente International in 1996. Today KPI is a self-supporting subsidiary that offers educational programs about the Kaiser Permanente model and provides speakers at international conferences.

 

Short link to this article: http://k-p.li/1Ov8v0J

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Kaiser Permanente joins officials in tackling 1960s public health issues

posted on April 2, 2013

By Lincoln Cushing, Heritage writer

Lester Breslow, Director of the State Department of Public Health, reported in 1967 that the death rate from coronary heart disease was dropping in California while the national rate was still rising. Photo published in the December, 18, 1967, issue of the LA Times. LA Times photo

One of the major academic figures in American public health was Lester Breslow, MD, who passed away last year at the age of 97. Dr. Breslow was a former dean of the Fielding School of Public Health at UCLA and director of the California Department of Public Health from 1965-1968.

He was also president of the American Public Health Association from 1968 to 1969. Central to Dr. Breslow’s research was mathematical support for the premise that improving personal habits such as reducing smoking, eating better, and sleeping well could have a significant impact on life longevity and quality.

Dr. Breslow was also a pioneer in multiphasic screening and an advocate for the Automated Multiphasic Health Test developed by Kaiser Permanente’s Morris Collen, MD, an early medical informatics guru who turns 100 this November.

National Public Health Week, April 1-7, is a good time to revisit Kaiser Permanente’s role in the early recognition of preventive care as a way to address public health issues.

A longshoreman is greeted by staff of the Kaiser Permanente multiphasic health screening program in 1961. Photo from the KP Reporter, May 1961.

Breslow had developed the original multiphasic screening (the examination of large numbers of people with a series of tests for detecting diseases) during the 1940s, and Collen improved upon it with new technology. The first beneficiaries of Collen’s multiphasic process were members of the International Longshoremen’s and Warehousemen’s Union in 1951.

The AMHT was a battery of tests, administered in an efficient routine by medical professionals and supported by then-new mechanical and chemical analytic devices. The results were funneled into a powerful mainframe computer.

From a public health perspective, the ability to efficiently diagnose communicable and noncommunicable diseases not only benefitted the individual patient, it also helped to stem public health risks as well.

In Breslow’s 1973 Preventive Medicine article, “An Historical Review of Multiphasic Screening,” he noted: “Automated multiphasic screening opens the possibility of extending the health-maintenance type of health care to all groups of the population, particularly including those most likely to suffer from the conditions now responsible for the greatest amount of disability and death.”

Dr. Collen taught two semesters at UC Berkeley’s School of Public Health during the spring and fall of 1965; much of the curriculum explored the uses of multiphasic exams. Students included physicians engaged in their continuing medical education.

Final papers for the classes included such subjects as “Evaluation of Environmental Toxins Utilizing Automated Methods” by David R. Brown, “Obesity and its Measurements as it Relates to a Multiphasic Screening Program” by Clarence F. Watson, MD, and “Biological Effects of Magnetic Fields” by Earl F. White.

Although the multiphasic screening as it was developed in the 1960s has been replaced by other diagnostic methods, the efficient application of medical diagnostic tools – and the enormous Kaiser Permanente patient database that has accumulated over the years – continues to advance public health.

Also see: “Screening for Better Health: Medical Care as a Right”

http://bit.ly/10wyozK

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