The practice of veterinary medicine at a zoo or aquarium can be a challenging balance of art and science. The sheer diversity of species and numbers of animals can be overwhelming. Much of our current therapy is based on recent experience, data from in-house "baseline" normal values and consultation with colleagues. Effective management of the volumes of medical data is critical to the medical management of an individual case as well as the development of the field of aquatic and exotic animal medicine. The few computerized medical database systems that have been developed for veterinary medicine were not designed to handle the types of medical cases found in zoos or aquaria, which can range from intensive care for a single marine mammal to the collective health problems encountered by a large group of unidentifiable schooling fish.
To address these needs, we have developed a novel computerized medical records system which integrates video, audio and text data while allowing for rapid and easy utilization, safe storage, and facilitation of information sharing between practitioners. Using the software we have developed, a computer from the Macintosh Quadra audio-visual line, and some fairly low-cost, input peripherals, it will be possible to combine all video data (histology, cytology, ultrasound, radiographs, endoscopy, video behaviors, necropsies, fecals, etc.), audio data (heart sounds, lung sounds, vocalizations, voice annotation, etc.) and traditional text data (progress notes, differential diagnoses, pathology reports, blood chemistries, cell counts, water quality, feed records, etc.) into an animal's medical record. Searching this rather large database is accomplished through numerous parameters such as species, animal ID, disease, treatment, parasites, blood chemistry parameters, etc.
All numerical data are immediately available for graphing. Text data can be imported from faxes received by the computer with optical character recognition software and in the near future it will be possible to enter text via direct dictation without the use of a keyboard. Once any of the forms of data have been digitized they can be shared by exchanging conventional computer disk media or directly via modem. We feel that this system can be a valuable diagnostic, medical management and teaching tool in the rapidly expanding field of aquatic and exotic animal veterinary medicine.
The practice of veterinary medicine at zoos or aquaria can be a challenging balance of art and science. The sheer diversity of species and numbers of animals can be overwhelming. It is easily argued that no other area of veterinary medicine is as broad and presents more opportunities, while at the same time, has a dearth of published medical information. By definition, this field continues to expand and diversify as zoos and aquaria strive to present larger, more complex exhibits with many species that are new to captivity. Much of our current medical therapy is based on recent experience, data from in-house "baseline" normal values and consultation with colleagues. As in other areas of veterinary medicine, information on the health status of our patients is conveyed visually (cytology, histology, direct observation, ultrasound, radiographs etc), aurally (coughs, sneezes heart sounds, etc.), numerically (blood CBC's and chemistries, water quality, etc.) and in text form (progress notes, problem lists, differential diagnoses, etc.). Volumes of new data are generated on a yearly basis. It has been very difficult to record and organize these disparate forms of medical data into an easily accessed and utilized database. To that end, we have developed a novel computerized medical records system specifically designed for zoos and aquaria. Using the premiere Macintosh relational database programming software, 4th Dimension by ACI, and a computer from the current Macintosh Quadra Audio/Vision (AV) line, it is easy to integrate video, audio, numerical and textual data into an animal's medical and husbandry records. This allows for expeditious data utilization, safe storage, and facilitates rapid information exchange between institutions.
Materials and Methods (Table 1)
Database Software. 4th Dimension Runtime (3.0.1) RTml and Relevant Technologies' Data
Aquisition®TM software2. The architecture of this database is designed to follow the standard problem-oriented medical record keeping paradigm, starting with history and physical examination findings, followed by problem lists. Each problem is linked to its own set of differential diagnoses, diagnostic tests and treatments. Each of the routine diagnostic tests have their own "windows" with the appropriate data fields. [The current version of Data Aquisition® TM software will run only on Apple Macintosh computers running System 7.0 and higher. ACI is currently developing software which will run on PC compatibles using the Windows NT system platform.]
Video, numerical and text data can be recorded for all of the following test types; cytology, histology, fecal examination, skin scrapes, gross exam, ultrasound, radiography, endoscopy, hematology and gross pathology. Numerical and text data can be recorded for all of the following diagnostic test types; complete blood counts, blood chemistries, urinalysis, water quality and food records. All numerical parameters are immediately available for graphing. It is possible, for instance, to graph the progression of a selected parameter through time and then overlay a plot of in-house normals for comparison. Text and numbers can be entered via traditional keystroke and imported from faxes or scanned images with the appropriate Optical Character Recognition (OCR) software.
Searching this rather large database is accomplished in numerous ways. It is possible to quickly search and obtain data through such individual or combined parameters as; animal identification number, species name, animal location, diagnosis, treatment, problem, diagnostic test, parasite identification, treatment, etc.
Soon options will be available to manage medical supply inventories, track quarantined animals, create general treatment and laboratory protocols, record audio and full motion video behaviors, record husbandry techniques and create a custom formally.
Table 1. Software and hardware guide.
*Cost is in US dollars and presented at the current street prices. 8224This represents the stand alone cost. Sometimes this software is bundled with other items thus reducing its price. 165This software is provided free of charge, additional development is on a contractual basis.
Image manipulation software. Applications such as Adobe Photoshop 3 are invaluable for analyzing and enhancing all digitized images, whether the images are photos acquired through a flatbed scanner or video capture from the microscope or ultrasound machine. [See "A preliminary study of pathologies associated with the maintenance of blue fin tuna (Thunnus thynnus) in captivity," in these proceedings.]
Presentation software. Applications such as PowerPoint 4 can be extremely useful. They allow the capability to create 35mm slides, VHS video tape and even on-line computer presentations from database images, graphs and text. [See this presentation.]
Optical Character Recognition. OCR software allows for the direct importation of bit mapped text information from faxes and typewritten reports. Although OCR technology is not infallible, it can dramatically reduce time necessary to input reports on blood work, pathology and bacterial culture and sensitivities.
Computers. The Data Aquasition®TM software was designed to be run on a MacintoshTM computer from the Quadra5 audio/visual line, either a 660 or 840AV model with at least 8 Megabytes RAM, 1 Megabyte VRAM (for 16 bit video output) and a 230 Megabyte internal hard drive. These Quadra computers incorporate a fast (33-40 Megahertz) Central Processing Unit (CPU), a 50 megahertz Digital Signal Processor with on-board audio and video capture hardware. Alternatively, accessory video and audio capture hardware are currently available for many standard Macintosh and PC compatible computers. Thus, adding this capability to your current computer system may be possible but can be costly and is potentially complicated, especially when dealing with PC compatibles. The 660 and 840AV machines offer the advantage of being a low-cost, user friendly, "plug and play" package. All standard audio and video equipment can simply be connected to the back of the computer for direct import and export of data. Using an AV Quadra, it would take the average computer user no more than four hours to connect all the necessary hardware, install the software and begin to collect data.
A new computer line, the Power PCTM, has recently been introduced by Macintosh TM. The Power PC uses a new CPU chip which is dramatically faster than all existing personal computer CPUs and has the added advantage of being able to run PC platforms (DOS, Windows, Windows NT) concurrently with Macintosh System 7.0. If you are a PC user, you can still run all of your current software and use all of your old data with the added benefit of complete compatibility with all Macintosh applications. A Power PCA V machine is also available. This computer has all of the Power PC benefits described above, along with the integrated audio and video capture hardware found in the current Quadra 660 and 840AV machines.
Standard Video Camera
A hand held camcorder can be used for video capture of external lesions, pathology found on gross necropsy and even radiographs. Medical procedures such as ultrasound can be recorded, and selected still or motion images captured for medical records. A Hi8 camera6 with macro focus capabilities and SVHS import/export options is recommended because it combines high quality image recording with a wide range of focus depths at a reasonable cost.
Video microscopy camera. A high resolution video camera for light microscopy can be invaluable for the recording and analysis of blood smears, fecal exams, skin scrapes, histology, etc. As with all other digitized images, video capture from the microscope can be transferred immediately via modem, traditional computer disk media or video tape to colleagues for visualization. We currently use a Sony6 CCD 500 camera which is mounted on a Nikon Labophot-2 microscope.
Flatbed Scanner7. This piece of equipment can be used to rapidly import text and numerical data, high resolution images of radiographs/CAT/MRI scans and photos. Scanned images such as radiographs can then be stored in the animal's medical record. These images can then be analyzed measuring and comparing bone or tissue densities. Qualification of object sizes, shapes, and volumes, is simple using an image analysis software such as Photoshop.
Data Storage Devices
Some sort of mechanism is recommended to facilitate long-term storage of data destined for infrequent use or backup. A large variety of drives using removable media are currently available. Drives utilizing magneto optical (MO) disks8 are reported to provide the most reliable form of long-term data storage while being the least expensive media per megabyte. Removable tape media type drives represent an inexpensive albeit less reliable alternative.
The following is an excerpt of an active medical case at the New England Aquarium. It will be used to demonstrate some of the capabilities of the current Data Aquasition (R) TM software running on a Macintosh Quadra 840AV computer. The following text refers to the computer screen illustrations.
Lana is an adult, female harbor seal born into captivity at the New England Aquarium. Her medical history includes a recent flare-up of a chronic, intermittent discharge from her right ear. Although she is currently not clinical, plain radiographs and CAT scans reveal an occluded right external ear canal, an intact tympanic membrane and some tissue with the density of scar tissue within the middle ear. Local and systemic treatments do not appear to have significantly altered the course of the problem.
Presentation and Initial Workup
Recently, Lana's trainers noticed that she had a green, mucoid discharge which was presumably vaginal in origin. Free-catch samples were collected for cytology and culture. Differential diagnoses for this problem include; bacterial/yeast infection of the vagina pyometra, or an anomalous GI discharge. Diagnostic tests may include; physical examination, cytology and culture of the initial discharge, aseptic sample collection for repeat cytologies and cultures, CBC, blood chemistries and abdominal ultrasound. The medical plan should include a thorough examination of Lana's recent food intake records and an examination of her pool's water quality records, noting chlorine levels and coliform counts. For the purpose of this demonstration, we have chosen to start her on an oral cephalosporin twice a day (Figure 1).
Cytology from the first sample revealed numerous epithelial cells, gram negative bacteria, and abundant unidentifiable variably staining basophilic objects (Figure 2). The results of hematology (Figure 3) and blood chemistries were unremarkable with the exception of a continuing elevation of total protein (TP) and globulin, as compared with inhouse normal values for female harbor seals.
Culture and cytology of subsequent vaginal swabs, results of feed records and water quality investigations, as well as the ultrasound exam were all within normal limits. It is believed that the rising TP and globulins are due to the chronic ear problem. The "vaginal" discharge has not recurred.
The field of aquatic/exotic animal medicine continues to rapidly evolve and the information base produced by zoos and aquaria is expanding at an exponential rate. This type of information explosion necessitates the development of a computerized database which can integrate all important data forms. Veterinary medicine and animal husbandry are, by nature, visually based fields of expertise. We do not base our evaluation of an animal's state of health solely on numbers such as those derived from blood chemistries, food records and water quality. The vast majority of data about our patients is conveyed visually. Aside from the obvious examples of behavior and gross external lesions, much information (results of many diagnostic tests) comes to us in analog form. Fecal exams, cytology, histology, skin scrapes, ultrasound, radiology, endoscopy and gross necropsy are all examples of important visual/analog data. Until the recent advances in computer technology, it has been exceptionally difficult to record, manage and effectively utilize the seemingly disparate forms of video, numerical, text and audio data.
The advantages of having numerical and text data in an easily searched database are apparent; retrieval, comparison and graphing are all facilitated. However, the advantages of computer-aided video image capture are initially less clear. Once a video image is captured (the analog signal is digitized), this data can now be easily quantified, analyzed, enhanced, presented and rapidly communicated to colleagues via modem or computer disk media. Analysis of an image can take many forms; automated cell counts, sub-cellular measurements (nuclear to cytoplasmic ratios, etc.), bone/soft tissue density quantification, blood vessel volume, wall thickness, and quantification of stain uptake by various cell types. With such capabilities, the personal computer is a solid medical record storage/retrieval device, teaching and research apparatus and a powerful diagnostic tool.
1. ACI (Manufacturer: 4D Runtime 3.1) 10351 Bubb Rd. Cupertino, CA 95014, Phone: (408) 252-4444.
2. Relevant Technologies 545 Concord Ave. Cambridge, MA 02138 PHONE: (617) 864-9500.
3. Adobe Systems, Inc. 1585 Charleston Rd., P.O. Box 7900, Mountain View, CA 94039-7900, Phone: (415) 961-4400
4. Microsoft Corporation One Microsoft Way Redmond, WA 98052-6399
5. Apple Computer Inc., MacIntosh Division 20525-T Mariani Ave. Cupertino, CA 95014, Phone: (408) 996-1010.
6. Sony Corp. Sony Drive Park Ridge, NJ 07656, Phone: (201) 930-1000.
7. Hewlett Packard Co., P.O. Box C-006, Vancouver, WA 98668, Phone: (206) 254-8110.
8. LaCie Limited--A Quantum Co. 19552 SW 90th Ct. Tualatin, OR 97062 Phone: (503) 520-9000.