Health Evaluation through Logical Programming (HELP)
Health Evaluation through Logical Processing (HELP) was the first hospital information system to integrate clinical data accumulation and clinical decision support. The real addition of this system was using the computer to aid decision-making, such as recognition of cardiac tamponade, by analysis of patient results. One trial suggested the the program had a 94% success rate of choosing an appropriate antibiotic regimen compared to a 77% success rate for physicians [Desouza KC 2002]. It also supports selection of appropriate antibiotics in case of infectious diseases. Clinical decision support also predicts and prevents many adverse drug events (ADE's).
HELP was designed by Gardner, Pryor, and Warner [Gardner RM 1999]. The original system was developed at the LDS Hospital in Salt Lake City, Utah, and has been active since 1967. The parent organization is now known at Intermountain Health Care (IHC). This system was designed with the primary purpose of understanding how circulation is controlled. It was used in the cardiac cath lab, and then extended into the Operating Room (OR) and Intensive Care Unit (ICU). Eventually becoming a hospital wide system, and then used at most of the 20 system hospitals.
HELP was developed at the University of Utah, and is enhanced with HCOM, a compiler that allowed Bayesian decision support modules to be developed.
The system originally contained two limitations: physicians had read only access (they were able to review data, but not enter data into the system); and it was not possible to exchange records between different facilities. That changed with the introduction of the Longitudinal patient Data Repository (LDR) starting in the late 1990s.
Advancements in information systems and medical technology present the need for an updated system to replace HELP. HELP2 uses modern software tools and database standards. Features of HELP2 include :
- Longitudinal medical record covering all inpatient and outpatient health care interactions.
- Vendor-supplied departmental subsystems integrated using HL7-based interfaces.
- Tools to continuously evaluate the effectiveness of decision support interventions.
- Well-supported data mining for new knowledge.
- A network tying together IHC’s facilities across the State of Utah.
The original HELP system was made up of the following components :
- An integrated clinical database
- A frame-based clinical decision support systems
- Programs to support both clinical and administrative functions
- Software tools to support and expand the system
Clinical Decision Support System
The clinical decision supportsystem within HELP has several different functionalities :
- Alerting systems - These processes function continuously, monitoring clinical data as it is stored in the patient’s electronic record. Ex. monitoring lab results
- Critiquing systems - These processes begin when an order is entered into the information system. HELP points out disparities between the order and internally defined proper care or proposes an alternative approach. Ex. ensuring compliance and proper use of blood products
- Suggesting systems - Clinicians call up a screen, enter requested data, and wait for suggestions. Ex. protocol systems to suggest care
Clinical Decision Support System features
- Knowledge-based – organized by decision frames
- Logic algorithms expressed in text easily understood by clinicians
- Data-driven – items with modifiers for searching patient records
- Structured vocabulary for uniform data representation
HELP is a knowledge-based hospital information system (HIS) . In addition to the HIS routine work, HELP has a robust decision-making function which is fully incorporated into the system. The decision support function can provide alerts/reminders, data interpretation, patient diagnosis and management suggestions, etc.
In 2013, IHC and the Cerner Corporation announced a partnership that will lead to the implementation of the Cerner system across all Intermountain hospitals and clinics. This system will include the existing clinical decision support and process care models. The new system will also be integrated with the electronic data warehouse that currently exists at IHC. The original timeline aimed for this transition to be completed across all IHC facilities by the end of 2015. 
Evaluation of HELP System
HELP has been evaluated in several ways. Some of the examples of these evaluations which demonstrate the applicability of this system in different contexts, follow:
User questionnaires in the early 1990's from 246 physicians and 374 nurses revealed several findings that encouraged development of medical expert systems contradicting concern that these types of systems would not be appreciated or utilized . These findings were:
- There was no correlation between age, specialty or general computer experience of the individuals with their attitudes about the HELP system.
- Users did not feel that the system would cause a "big brother" concern of external monitoring or sanctions.
- Computer decision support did not seem to diminish their decision making authority.
- Feedback from questionnaires provided the need for future system upgrades and rollouts.
Over a course of 13 years, this feature of the HELP, initially only a prophylactic antibiotic reminder system, evolved into a very sophisticated 'antibiotic assistant' in 1998. This has resulted in a significant improvement in antibiotic administration costs, adverse drug reactions, and total patient care.
Management of Adverse Drug Reactions
By using the HELP system, adverse drug reactions were detected more than 80 times more, compared to manual methods. The system can help detect these events quickly and prevent the effects, which in turn, results in reduced length of hospitalization and considerable cost savings. The Adverse Drug Reaction subsystem within HELP monitors the patient data that is entered at the bedside. This subsystem inspects for heart rate, mental status, fever, anaphylaxis, signs of rash, and changes in respiratory rate, among other vital signs and indicators .
- Gardner, R. M., Pryor, T. A., & Warner, H. R. (1999). The HELP hospital information system: Update 1998. International Journal of Medical Informatics, 54(3), 169-182. http://www.sciencedirect.com/science/article/pii/S1386505699000131
- Gardner RM, Pryor TA, Warner HR. The HELP hospital information system: update 1998. International Journal of Medical Informatics 54(1999)169-182.
- Desouza KC. Managing Knowledge with Artificial Intelligence. Westport, CT. 2002. Greenwood Publishing Group. P. 84. 17 Jan 2009.
- Berner, E. S. (Ed.). (2007). Clinical Decision Support Systems. New York, NY: Springer.
- Huag, P. J., Rocha, B., & Evans, R. S. (2003) Decision support in medicine: lessons from the HELP system. International Journal of Medical Informatics, 69, 273-284.