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The use of the computer in medical education has been in evolutionary development since the early 1960s; its adoption, however, has been less widespread than the promise of the medium should warrant. Computer-assisted instruction enhances learning, allowing the student the discretion of content, time, place, and pace of instruction. Information conveyed can take several forms, some better suited to undergraduate medical education, others more applicable to graduate and continuing education. The use of the computer in certification and licensure could, within a decade, transform the way competence is assessed. Its greatest promise, however, may lie in providing pertinent information at the time when, and in the place where, patient care takes place. New developments in data storage and retrieval forecast applications that could not have been imagined even a year or two ago.

Computer-based patient monitoring is a science in transition. Its purposes are vague, its technology variable, and there is no clear evaluation of its utility. Monitoring originally developed because of an intuitive feeling that if we knew more, we would be able to take better care of patients. Physiologic monitoring, statistical monitoring, and integrative monitoring will eventually combine to make a coherent patient care system. However, the subcomponents must be made to work before we reach this stage. It is still unclear what ICU measurements should be monitored and what to compute from those measurements. Once agreed upon, these measurements must be presented in human terms and, ultimately, used to make computer-based diagnosis. The day will come when the computer will be viewed as a tool to extend our medical power to let us take better care of the patient.

Medical imaging is an information business of rapidly increasing complexity. Imaging practice and imaging information support systems are inseparable. How both operate and how they ought to operate can be considered productively in terms of system theory. This concluding article on some practical system principles, therefore, presents one way of thinking about the rest of the volume.

A microcomputer based program package has been developed which utilizes a modified "average of normals" method to analyze data and monitor random and systematic error in the clinical hematology laboratory. The daily workload of normal patient values for leukocyte count, erythrocyte count, hemoglobin, mean corpuscular volume, prothrombin time, and activated partial thromboplastin time is entered through the keyboard and sorted by sex. The daily mean, standard deviation, standard error index, and F-ratio are then calculated for each test. Significant deviations from target values are automatically flagged. The system combines ease of data input with automatic statistical calculation, graphic display, and printout of the calculated data. The system has the capability of data analysis by shift, and incorporates cumulative sum, Trigg's tracking algorithm, and analysis of variance calculations. This statistical analysis had proven to be a sensitive indicator of random and systematic error in our laboratory and has allowed us to decrease the assay frequency of expensive commercial control material.

The various tasks associated with image and document handling are analyzed with respect to properties of competing technologies and media, such as micrographics, video technologies and interactive computer systems with magnetic or optical data disks. It is shown how changing economic parameters modify the spectrum of advantageous applications of micrographics. The benefits of integrating micrographics components into various types of computer-aided systems are emphasized.

Computer technology has advanced rapidly over the past 30 years as the computer has been more and more integrated into the practice of medicine. Current horizons of research have begun to make use of this newer technology in 1986. The numerous amounts of change and advances in computer systems with respect to medicine and specifically to dermatology will make the computer even more of an integral tool for the practice of this specialty in the future.