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the very near future, your medical consultation will probably be modulated by a piece of software that will be as indispensable to the doctor as the number spreadsheet is to the accountant. We have finally caught up with Dan Bricklin (of Visicalc fame, the forerunner of the accounting spreadsheet that launched the Apple II microcomputer) and Carolus Linneas (Swedish scientist who founded the Linnean classification system that gave us species names such as Homo sapiens in the 1750s). A new class of software called the PLUM Medical Spreadsheet® (patent pending) was demonstrated at the Royal Australian College of General Practioner (RACGP) Computer Conference, Melbourne Convention Centre, August 7-9, 1997 and the subsequent international Asia Pacific Association for Medical Informatics (APAMI) 97 Conference in the Darling Harbour Convention Centre, Sydney, Australia on August 10 -13, 1997. PLUM is a combination of the power of the iterative problem solving method, characteristic of the spreadsheet, and a medical belief system constructed along the lines of the Linnean biological system. The PLUM name is an acronym for Presentation Links Unity and Management, which is the health model used in the medical spreadsheet.

The typical accounting spreadsheet is a number cruncher and gives the accountant quick answers to "What if?" type queries. The results of this "What if?" analysis are placed in the spreadsheet cells; this sets up the conditions for the next round of calculations with no manual transcription. The accountant's electronic spreadsheet is prodigious for tasks that require repetitive work with a hand held calculator. Hitherto, there is no such equivalent spreadsheet in either the medical or legal domains. With PLUM, during a client encounter, there is the capability of :

allowing data entry and recording

performing "What if?" calculations pertaining to client diagnosis and management, with the results placed in cells for the next round of evaluation and

features such as scrollable worksheets which can be saved.

is used in a real or simulated patient or client encounter environment which introduces the spreadsheet metaphor into clinical medicine. There were at least two main barriers that needed to be surmounted to attain such an invention. The first was coming up with a replacement for the number system used in conventional spreadsheets. PLUM uses a word-based coding and medical belief system modelled on the Linnean classification. In this system a medical condition such as gout is a medical species with its own phyllum, class, order, family and genus. Surmounting the second barrier was finding a suitable homogenous clinical data model of patient health status at the local encounter and the global level. Typical queries, out of a theoretical set of 225, operating on the medical spreadsheet would be:

given symptoms and signs, show possible diagnoses

given a set of possible diagnoses, symptoms, signs and laboratory test results, show only diagnoses that conform to available data

given a list of diagnoses, show diagnosis that can unite several diagnoses.

Systems stumbled onto the PLUM Medical Spreadsheet almost by default. It is the originator of the Linnean Docle medical coding system used by over 2000 medical practitioners Australia-wide. It was the congruent classification of disease entities, akin to the building of a belief system framework that allowed the medical belief system to be viewed using the spreadsheet metaphor.

PLUM is relevant to any problem domain where the problem solver needs to arrive at a diagnosis given a set of indeterminate data. The knowledge domain that almost mimics the medical domain is the legal field, and an equivalent theory for legal problem solving in the spreadsheet form also exists. PLUM represents a new class of software - non-numerical spreadsheets and a new model of medical recording. There is a stark message to doctors - modern day medical practice is being swamped with information overload arising from the advances in medical technology. The medical litigation arising from the failure to cope with this plethora of information is ugly. The Information Technology solution is to well, go for PLUM or....... choke on SOAP (the existing clinical model which stands for Subjective Objective Assessment Plan). PLUM is in advanced beta, a subscription service is now available for those wanting to immerse themselves in the forefront of medical computing.


Plum Medical Spreadsheet®, Plum® and Docle® are registered or pending trademarks.
© Docle Systems 1997