Difference between revisions of "Computer Stored Ambulatory Record (COSTAR)"

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Some of the major modules in COSTAR and percentage of use:
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- Registration (95%)
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- Medical Records (100%)
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- Accounts Receivable (43%)
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- Report Generator (75%)
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- Scheduling (52%)
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- Medical Query Language (50%)
  
  

Revision as of 06:08, 20 September 2009

COSTAR or COmputer-STored Ambulatory Record was developed by the Laboratory of Computer Science at Massachusetts General Hospital between 1968 and 1971 for Harvard Community Health Plan by Octo Barnett and Jerome Grossman. COSTAR operates using the MUMPS programming language. MUMPS was widely used in the 70's & 80's for medical applications. Both the system and the language are still in use to this current date(2).

COSTAR suppports patient registration, scheduling of patient visits, storage, and retrieval of clinical information, and billing accounts receivable.

The first implemenation of COSTAR was at Harvard Community Health Plan (HCHP), which adopted and began testing the COSTAR system in 1969 (Grossman et al., 1973). In 1986, more than 4.1 million pages of patient records were being printed annually. About 1.3 million patient encounters were documented, more than 2.5 million lines of text were catpured and about 650,000 laboratory test results were entered. By 1987, HCHP had installed 10 minicomputers to support clinical computing in their 9 care facilities, which together serve an active membership of more than 225,000 people.

COSTAR has two characteristics which made it possible to use the system in a variety of sites:


The first characteristic is a modular design allowing for extensive reuse of the separate modules at different sites according to each site's needs.


The other is its substantial, extensible data dictionary.  The core of he data dictionary is a controlled vocabulary of clinical terms, 
which includes the ability to associate modifier terms with primary name for a clinical concept - such as, synonyms added as modifier 
terms for a disease or a symptom acting as a clinical concept(2).


Some of the major modules in COSTAR and percentage of use: - Registration (95%) - Medical Records (100%) - Accounts Receivable (43%) - Report Generator (75%) - Scheduling (52%) - Medical Query Language (50%)


COSTAR was one of the first programs that used "reminders" that were generated once a patient's profile was used. This aided in proper observance of clinical guidelines by the practitioner (3). It has also had a set of reminders for follow ups for cases of hypertension (3).

COSTAR relied on a structured encounter form and clerical data entry. It also captured free-text entries, primarily to allow specificity of physicians' notes. Within the first 2 years, the system had records for 20,000 patients resulting from 80,000 visits. But the free-text format made summary analysis of medical records impossible. A review of natural-language parsing in 1983 found that, of 233 throat cultures for Beta Hemolytic Strep Group A, 90 were falsely labeled as normal by a natural-language processor that looked for specific strings in the free-text entries.

Researchers in 1983 urged a new system based on a series of menus that limited the data entry in some areas to pre-coded text that could be more accurately analyzed. They noted new developments with graphical interfaces that included "windows" that could be navigated with a new computer accessory, the "mouse."


References

1-Hattwick MA. Computer Stored Ambulatory Record (COSTAR) in Real Life Practice. Proc Annu Symp Comput Appl Med Care. 1979 October 17; 761–764.

2-The Computer-Based Patient Record By Institute of Medicine (U.S.). Committee on Improving the Patient Record, Richard S. Dick, Elaine B. Steen, Don E. Detmer, Edition 2

3-Luo JS. Electronic Medical Records. Primary Psychiatry. 2006; 13(2): pp. 22-30. Available from: http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=87


4-John McrLatchey, G. Octo Barnett, Geoffrey McDonnell, Judith Piggins,Rita D. Zielstorff, Frances Weidman-Dahl, Ekdward Hoffer, Jon A. Hupp. Proc Annu Symp Comput Appl Med Care. 1983 October 26; 329–332. Available from: http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2578353&blobtype=pdf