Millions of patient hospital test results a year flow through an HP 3000 in Stockholm, Sweden, counting on the system’s reliability and uptime to keep medical information on track. The site shows how an HP 3000’s custom-written application keeps pace with new protocols, interfaces across several environments, and accomplishes a high degree of automation.

The population of the Stockholm area is close to 2 million, and Huddinge Hospital serves a million patients from its operations. The HP 3000 at this facility is close to being in 24x7 mode, being powered down only for about 30 minutes a week early each Wednesday morning.

At the Huddinge Hospital Chemical Lab, computer engineer Per Ostberg works on a six-person IT team responsible for chemical analysis of as many as 15,000 patient samples a day. The chemical lab is the largest in the hospital, and relies on high degree of automation with the HP 3000 Series 987RX at its hub.

The IT department must track every patient, doctor and lab test — as many as 40,000 analyses every day. A sample is taken from each patient and its test tube is barcoded, then placed in highly automated chemical analysis robots. The large robots can perform as many as 500 tests per hour. Orders for tests flow in from the HP 3000 to the robots, and then test results flow back into the 3000.

The Huddinge lab uses a custom-written application to track these test results, and keeps results on file for 13 months. The HP 3000 hosts millions of records regarding the testing. A 1.5 million-entry dataset holds doctor test requests, and a 10 million-entry dataset stores individual test results.

The lab averages between 150 and 200 users logged onto the Series 987 at once. The application is a mixture of FORTRAN and C, using IMAGE/SQL and VPlus screens. Tools in use include Robelle’s Qedit and Suprtool, Adager, and VEsoft’s MPEX.

Huddinge is using these up-to-date tools for its 3000 maintenance and ongoing development, working on a program that is already 15 years old. Ostberg recently took delivery of the newest version of Qedit for Windows that included the new Qedit Scripting Language (QSL).

Ostberg said the hospital has added EDI capabilities to the application, which are being used by increasing numbers of the hospital’s customers. “The hospital has recently implemented a hospital-wide medical-record-system capable not only of receiving reports on analysis performed, but also of performing requests,” Ostberg said. “That’s were we, the lab, are able to make substantial savings when we no longer need to manually enter requests into our system.

“The teams involved in the EDI traffic are proud of their operation and the load they handle, and the infrastructure is quite complex, with servers involved all over Stockholm. They allow a physician 80 kilometers away from the lab to see results not five minutes after they are performed here in the lab. Our HP 3000 plays a major role in this scenario.”

He said he has plans to implement the new QSL “mostly as a programmer’s productivity tool, for source maintenance and any kind of file management. I haven’t thought of many areas yet where it will help us in production yet, but I expect to, once I get to know it better. There are areas where it can be a real help.

“We’re more of a transaction-based operation, than a flat file operation,” he added. “Usually you get to know the tool, and then the problem that it will solve pops up.”

Spanning environments

Some robots in the chemical lab use aging CPM operating environments — but the HP 3000 is able to communicate with these older robots through a custom Pascal program.

While the lab is reaching back into 1980s technology to link the 3000 with CPM, it is also communicating with newer robots that use industry-standard TCP/IP protocols. The HP 3000 uses a listener which can process the standardized TCP/IP transactions.

When a robot does a test, the data is sent via a serial port to a Windows 3.x PC, although the hospital is moving to newer Windows platforms. A custom C++ program running on the PC interprets the robot protocol, creates a TCP/IP transaction in a standard format, and makes a TCP/IP connection to the HP 3000 to send the standard format transaction.

“The HP 3000 has two protocols to communicate with them, and the smaller interfaces take care of the specific robot interfaces,” Ostberg said. “That’s how clinical medical chemistry works now — we get in large amounts of test tubes and operators place them in a rack and put it into the robot. The robot queries the 3000 for what analysis to perform, and then reports back the results.”

Reporting results

Reports at the Huddinge lab are paper-based. Every night, printed reports for each doctor show all of the test results, by patient, that were done that day. The doctor is only allowed to see test results that he ordered. The hospital may have done multiple tests on a patient requested by multiple doctors. In this case, the report shows a blank line (or other placeholder) for the test results that the doctor did not order.

“Even though a lot of our reporting is done the EDI way, all our customers get a paper report, although it’s often just put in the shredder by the receiving customer,” Ostberg said. “Our medical auditors demand a lot of the receiving systems before we can drop paper replies.”

The lab is using four different LaserJet III printers to do reporting, mostly because newer HP LaserJet 5si printers jam more often on double-sided printing, and interpret PCL differently. They create a spoolfile for each doctor, usually only 10-12 pages long. Smaller spoolfiles make recovering from printer problems such as jams much easier.

Year 2000 maintenance

“We did all of the actual work, so we got to keep the knowledge about it,” Ostberg said of the lab’s Year 2000 remediation. Working on an application that was written before most of the staff arrived was a learning experience. “It was a big opportunity to get to know our own application, an investment in our own competence.

“This kind of application is common with the HP 3000 — it just keeps on running, and nobody knows why. Every time there’s a problem you have to go back to the source and look through it to see what happens. The 2000 work really helped us to get a wider perspective of the system.”

Finding help to do the Y2K work was not easy, Ostberg said. “We took in a consultant as project leader, but it was hard to find people knowledgeable in the HP 3000 and FORTRAN,” he said. The ICL consulting firm ultimately supplied the project leader’s expertise.

The 3000’s future at Huddinge

“Sometimes I feel like I’m the last defender of the HP 3000 here,” Ostberg admitted. The application running at the hospital was originally designed in collaboration between HP and Chalmers University of Technology in Gothenburg, in the south of Sweden to promote the system during the 1980s. The Huddinge chemical lab is the last hospital in Scandinavia to continue to use the program. More than a dozen other hospitals have moved their analysis work to Unix systems.

“There are strong feelings here that it’s not adequate,” Ostberg said of his application. The IT department for the lab are under pressure to provide more GUI interfaces to data. The department wants to help users manage reports and statistics for their end users. They currently write large extracts, which are then summarized into a form that can be imported into Excel.

But the HP 3000 is keeping up with a growing demand for test information. One reason is the system’s uptime. “I regard it as being an extremely stable environment,” Ostberg said. “The pressure on stability and uptime has really increased. When I started five years ago, we shut down for an hour for maintenance every day.