Introducing MedCalc 3000

MedCalc 3000 is a unique computerized medical tool set that encompasses a wide array of pertinent medical formulae, clinical criteria sets, and decision tree analysis tools used everyday by clinicians, medical educators, nurses, and healthcare students of all types.

With the growing emphasis on an application of Evidence-Based Medicine, there has never been a greater need for a system such as MedCalc 3000. Medical error detection and elimination are also hot topics in the new millennium. MedCalc 3000 can help in these areas as well.

When striving to practice, teach, and learn medicine based on solid, literature-based data, practitioners can be easily overwhelmed by the breadth of information that they must uncover and master. MedCalc 3000 helps simplify this task by assembling easy-to-use, interactive tools that facilitate the practice of Evidence-Based Medicine.

Academic Collaborations

The MedCalc 3000 system has been under constant development and refinement since 1998 and is used around the world. Through academic collaborations, we have even created Japanese- and Spanish- language versions. Through collaboration with the Harvard Health System and the St. Francis Health System of Pittsburgh, we created the MedCalc Connect module that simplifies the process of interfacing the MedCalc 3000 equations into a hospital/lab information system. A summary of MedCalc 3000 and the MedCalc Connect feature is contained in the following abstract presented at the Association of Program Directors in Internal Medicine (APDIM), spring 2000.

The MedCalc 3000 CollaborationLouis Leff, MD, FACPDaniel Sands, MD, MPH

MedCalc 3000 is a popular Internet-based software system. As a component of the St. Francis Health System IAIMS (Integrated Advance Information Management Systems) project, it is being developed as a publicly accessible tool for use in medical education. MedCalc 3000 comprises a variety of common equations, clinical criteria scores, and decision trees used in medicine. Formulae such as A-a gradient, Body Mass Index, creatinine clearance, and hundreds more are implemented in Web-based JavaScript. Some equations, such as the Bayesian analysis and cardiac output pages, are shown in a “multicalc” format that produces multiple output results from multiple calculations. Clinical scoring systems are adapted from the medical literature and presented in interactive Web pages. These comprise clinical criteria sets such as the Child-Turcott score, Ranson criteria, and Goldman cardiac risk criteria. A recently added MedCalc 3000 feature is the “TreeCalc,” a decision tree analysis navigator. With this tool, the user can easily work through literature-based decision trees like the hyperlipidemia monitoring and treatment recommendations, or the ACP thyroid disease screening recommendations. The system’s Web interface makes these formulae, score systems, and decision trees easy to use and search. There is also a handy “Quick Converter” module that enables physicians to convert values from one unit to another, as well as a general math calculator. Another exciting new feature of the system is called MedCalc Connect. MedCalc Connect offers a way to automatically integrate the MedCalc 3000 equations with a patient’s actual lab data. Its development was inspired by a similar system that has been in place at Beth Israel Deaconess Medical Center since 1992. Through simple hypertext transfer protocol network requests, you can send lab results to the MedCalc site, choose an equation, and have the data and calculation results displayed immediately. There is no need (or facility) to transmit any patient identification information to the site. Full instructions on how to use this feature are provided at the MedCalc 3000 site.

MedCalc 3000 has been accessed more than 17,000 times since it was made available in September 1999. It is currently used by clinicians more than 5,000 times each month. The growth and widespread use of MedCalc 3000 can be attributed to the collaborative effort of the APDIM listserv members. Many list members have contributed formulae and references to the project; many more list members from around the country have shared the project with their housestaff and students. Through this exciting collaboration, the MedCalc system will continue to grow and add functionality and capability.

A Very Popular Web Tool

The MedCalc 3000 website now receives thousands of hits a day, making it the most popular medical calculator system on the Internet. Most major Internet search engines will show the system as the number one search result returned for searches using the term “medical calculator.”

Handheld Versions of MedCalc 3000

The need for handheld versions of the MedCalc 3000 system has been obvious from the start of the program. Due to high demand through our Internet feedback system, the Windows CE version of MedCalc 3000 was created in late 2001. This handheld system mimics the Web version in its use of graphics and colors. Like the Web version, the CE version relies on JavaScript that is built into the Internet Explorer supplied with most modern Windows CE systems. The CE version is not processor-dependent, and works well on a variety of Pocket PCs, such as the Compaq iPaq and the HP Jornada. The current CE/Pocket PC version contains all of the same equations, criteria sets, and decision trees as the online Web version. And don’t worry Palm users; a version for the Palm OS is in the works.

A second handheld version is also available for use on cell phones using the iMode protocol popularized by NTT DoCoMo of Japan. To perform calculations on an iMode or similar Internet-ready phone, the user may connect to the system anywhere within his or her cellular coverage area. The iMode version relies on

a server-side calculating engine, so JavaScript is not required on the phone side of the connection.

Foundation Internet Services also maintains a series of user-friendly tutorials, installation tutorials, and usage guides for our handheld products. These can be found online and are available in print versions as well.

MedCalc 3000 Customized Installations

As a highly customizable system, MedCalc 3000 can be easily embedded in any Intranet or private network. Many hospitals, health systems, medical education programs, and other entities and institutions currently license the MedCalc 3000 system. Prominent installations include the US Army Medbase One system, the Beth Israel Deaconess Harvard Health System Hospital, The Canadian Center for Health Evidence/AMA Interactive Guide to the Medical Literature, and most recently, the ePocrates RxOnline

system.

Multi-Language Support

Due to popular international demand, and aided by international academic collaboration, the MedCalc 3000 system has been translated into both Spanish- and Japanese-language versions. A Russian version is also being considered. These are not simple or automated translations so commonly found on other Web pages. These translations are instead built directly into the MedCalc 3000 compiling engine and into all of the source files. This dedication to the accuracy of the translation has produced proper foreign versions that satisfy native speakers in every way.

Peer Review and Feedback

The system has a large following of Internet-savvy clinicians and educators who regularly provide important feedback, criticism, and suggestions for improvements. Equations, clinical criteria sets, and decision trees are constantly reviewed, updated, and expanded through open, Internet-based academic channels and peer review. Many of our users are leaders in the field of medical education. They often submit new references for new formulae and criteria sets and other tools and resources. Furthermore, they commonly recommend the system to their residents and students.

Into the Future

As medicine and the Internet become intertwined and symbiotic to an ever greater degree, tools such as MedCalc 3000 will come to occupy an even more prominent place in the physician’s armamentarium. Whether viewed in terms of its error-reducing potential, the self-evident benefits derived from decision- support tools that incorporate the latest peer-reviewed data from the literature, or the way in which it facilitates and fosters collaboration among far-flung colleagues to share and disseminate new information and formulae, MedCalc 3000 and other cutting-edge resources that fully maximize the medical Internet are clearly the standard bearers for the exciting possibilities offered by medicine in the 21st century.