MedARKS Workshop Manual

Durrell Wildlife Conservation Trust 1-4 April 2000 J. Andrew Teare, DVM Dalen Agnew, DVM Cyd S. Teare, MT Chris Tabaka, DVM

MedARKS Technical Support Voice: (904) 277-1645 Fax: (904) 277-1645 E-Mail: andy@isis.org 1

MedARKS Workshop Manual

Basic Concepts Computers - general information and principles for successful use ..................................................5 A short glossary of terms...............................................................................................................5 Things that are bad for your computer, your records and your peace of mind..............................9 Backup copies - make them or else!............................................................................................10 Paperless records ? ......................................................................................................................11 MedARKS - general guidelines for using the program....................................................................11 The Escape key (<Esc>)..............................................................................................................12 Function keys ..............................................................................................................................12 Menu organization.......................................................................................................................13 Utilities and data dictionaries......................................................................................................15 MedARKS modules Anesthesia records ...........................................................................................................................18 Data entry ....................................................................................................................................18 1. Animal Identification ............................................................................................................18 2. Baseline animal information .................................................................................................19 3. Anesthetic drug, dose and related information .....................................................................20 4. Information regarding the immobilization and the recovery ................................................21 5. Physiological data .................................................................................................................22 6. Comments .............................................................................................................................23 Anesthesia Reports......................................................................................................................23 Anesthesia Utilities .....................................................................................................................24 Parasitology records .........................................................................................................................25 Data entry ....................................................................................................................................25 Parasitology Examination Schedule............................................................................................26 Parasitology Reports....................................................................................................................26 Parasitology Utilities ...................................................................................................................27 Prescription (treatment) records.......................................................................................................27 Data entry ....................................................................................................................................27 Prescription Scheduling...............................................................................................................31 Prescription Reports ....................................................................................................................31 Prescription Utilities....................................................................................................................32 Analysis of Blood, Urine and Other Fluids......................................................................................32 Data entry ....................................................................................................................................33 Blood, Urine and Other Fluid Analysis Reports .........................................................................33 Blood, Urine and Other Fluid Analysis Utilities .........................................................................34 Cryopreservation (Serum) Bank Records - Sample storage.............................................................35 Data entry ....................................................................................................................................35 Cryopreservation Bank Reports ..................................................................................................35 Cryopreservation Bank Utilities ..................................................................................................36 Clinical text records .........................................................................................................................36 Data entry ....................................................................................................................................37 Master Problem List Options ......................................................................................................38 Clinical Notes Reports ................................................................................................................38 2

Clinical Notes Utilities................................................................................................................ 39 Pathology records ............................................................................................................................ 40 Data entry.................................................................................................................................... 40 Pathology Reports ....................................................................................................................... 42 Pathology Utilities ...................................................................................................................... 43 Pathology Module - Special Features ......................................................................................... 45 Reports and Record Selection Criteria Filters explained.......................................................................................................................... 46 Electronic Data Transfer and Information Sharing Sending clinical pathology records to ISIS ................................................................................. 47 Creating an ISIS data transfer file - the nuts and bolts ............................................................. 47 Library disks ............................................................................................................................... 48 Sending a medical history to another institution: ....................................................................... 48 Sending medical records to SSP Medical advisors..................................................................... 49 Loading a medical history from another institution.................................................................... 49 Special features Standard Text Dictionary (< F5> pick list)................................................................................ 49 Non-accessioned specimens........................................................................................................ 49 Full-screen browse of reports...................................................................................................... 50 Exercises ......................................................................................................................................... 51 Advanced Topics General data consistency Abbreviations.............................................................................................................................. 55 Dictionaries ................................................................................................................................. 55 User-defined pick lists ................................................................................................................ 56 Data Quality Utilities .................................................................................................................. 56 Clinical Notes - Problems and Text Text Editing (MedARKS temporary clipboard) ......................................................................... 56 Standard Text Entries (MedARKS permanent clipboard) .......................................................... 57 Defining a Formal Clinical Problem and Adding to the Master Problem List ........................... 57 Organizing your text records (pseudoclinicians) ........................................................................ 58 Interface with the prescription and weight modules ................................................................... 59 Interface with other modules from within Clinical Notes........................................................... 60 Pathology Records User-defined field ....................................................................................................................... 61 SSP Necropsy, Sample collection and Research protocols......................................................... 61 Importing Computerized Text into MedARKS: ......................................................................... 62 Exercises ......................................................................................................................................... 63 Appendix Hardware requirements and recommendations for MedARKS 5 .................................................... 64 Critical files in MedARKS 5 ........................................................................................................... 66 Suggested Backup Procedures for MedARKS ................................................................................ 68 Creating an icon for MedARKS in Windows 3............................................................................ 70 Creating an icon for MedARKS in Windows 95.......................................................................... 73 Moving the ARKS files to the MedARKS computer ...................................................................... 74 MedARKS Files/Support on the World Wide Web ........................................................................ 75 3

Accessing Library (Reference) Data Disks ......................................................................................76 Merging records on a medical history transfer disk into MedARKS 5.3.........................................77 Contributing blood analysis results to the ISIS Physiological Reference Values Project................78 Suggestions for tracking experimental contraceptive methods with MedARKS.............................80 Text editing commands in MedARKS.............................................................................................81 Common Problems and Questions...................................................................................................83 Error message - Corrupted or missing memo file .......................................................................83 Can I run MedARKS on a network? ...........................................................................................83

Basic Concepts
Computers - general information and principles for successful use
There is a tendency to view computers as glorified adding machines, which is not surprising given the origins of the computer as a glorified adding machine. However, the modern PC (personal computer) has evolved into a whole new beast and is truly a multifunction tool. Most of us will never be involved in calculating pi to a million decimal places, so the ability to perform vast calculations will be a side issue when compared to the capacity of this machine to manage information (store, search, manipulate and retrieve). When it comes to medical records, think of your PC as an electronic filing cabinet, complete with an electronic secretary and you will have a better concept of the capabilities of this little box. This concept of your PC as an electronic file cabinet extends into the terminology that is commonly used. Information is stored in units called files and some operating systems (e.g. Windows) organize those files into folders. In DOS, these folders are called directories or subdirectories. Just as folders allow you to organize a physical file cabinet, directories and subdirectories allow you to organize the programs and data files in your electronic file cabinet (computer). Some keyboard basics Anyone that has used a typewriter is familiar with the shift key. Computer keyboards also have a shift key and it serves essentially the same function as on a typewriter. However, PC keyboards have other keys that allow the user to interact with the program to trigger specific events or actions. Two of these keys, the control and alternate keys are used like another shift key (i.e., these keys are held down and used in combination with another key). These two keys are commonly abbreviated <Ctrl> and <Alt>. Your keyboards should also have a series of 12 general function keys that are usually abbreviated <F1> through <F12>, 4 arrow keys (up, down, left and right) and 6 specific function keys (insert, delete, home, end, page up and page down). In this manuscript, specific key combinations will be expressed in the format <Ctrl><A> and should be interpreted as hold down the control key and then press the A key.

A short glossary of terms

Hardware and Software - what is the difference? Hardware is all the physical parts of your computer (those things you can touch). It is the file cabinet portion of the information management system. Sooner or later you will have hardware problems (i.e. some component will fail). Historically, computer hardware problems required the service of highly trained repair technicians. The unique aspect of PCs is that almost anyone can learn to diagnose minor problems and make repairs by replacing the non-functioning part. For the first time, computer users are empowered with a measure of control over hardware repairs. However, if the thought of disassembling your PC does not appeal to you, dont panic; there are many people happy to make a living repairing PCs. Computers require very detailed sets of instructions to perform useful work. Software is the set of instructions (also called programs) that give the computer the abilities to perform tasks. Software is the electronic secretary portion of the information management system. Software takes care of the retrieval and storage of information (onto hard or floppy disks) and performs tasks that are assigned (e.g. spell checking this document). Without software, a computer is just a box of silicon and metal that consumes power. There are many classes of software (e.g. word processing software, games, databases, graphics, accounting and statistical). MedARKS is a database software program that is written in a database language called FoxPro. The main function of MedARKS is to save and access information (medical records) in an organized fashion.

Speaking Computerese - understanding your favorite computer nerd bit This is the smallest piece of information handled be a computer. It is the equivalent of a single switch that can be either open or closed (on or off). These switches form the binary code (0-1) that computers use to store information. The good news is that you do not need to learn binary code and you will never have to worry about bits to use your computer effectively. However, it may be useful concept to know that your computer is not actually storing letters and numbers, but only 0's and 1's. It is also a term you can use to impress colleagues at the ice breaker. It turns out that single bits are too small to be very useful (even to computers). Reading a single bit equivalent to reading the first letter in this paragraph. Just as we tend to use letters in groups (words) to code information, computers handle bits in clusters that are usually a multiple of 8 (2). A single cluster of 8 bits is known as a byte. Bytes are the basic unit of measurement for hard disks, memory and files, although it is often used in combination with a prefix like kilo-, mega- or giga- to make the number more manageable. A kilobyte. Logically you would think that this is 1000 bytes. Close, but not quite correct. Remember that this is a binary system at its heart, so a kilobyte is actually the binary number that first exceeds 1000 (210 bytes or 1024 bytes). In the real world, most of us find that rounding to 1000 is close enough. A megabyte. Approximately a million bytes (slightly more). Read the definition for a kilobyte and if you feel ambitious you can calculate the binary number that first exceeds one million to find out exactly how many bytes are in a megabyte. A gigabyte. Approximately a billion bytes. Again, I will leave it to you to calculate the binary number that first exceeds one billion if you have a desire to find out exactly how many bytes are in a gigabyte. This is a disk of magnetic media (similar to the material in cassette tapes) that can be used to store information. Just like magnetic tape usually comes packaged as a cassette, floppy disks come wrapped in a protective container, and the entire assembly is called a floppy diskette. Floppy diskettes for the modern PC come in 2 sizes (5.25" and 3.5") and several flavors (double-density and high-density are the most common). Know what flavor and size of diskette you have available; trying to use a double density diskette as a high-density diskette can make the diskette unreliable (i.e. you might lose information). A. The 5.25" diskette was the original size but is now almost extinct. The plastic case covering the magnetic media was flexible and part of the media was exposed, so you had to be quite careful with these diskettes to avoid damage; folding and/or spilled coffee will quickly render these diskettes useless and result in the loss of any information on the disk. For IBM - compatible computers, the 5.25" diskette comes in several flavors. 1. Single-sided: Only stores information on one side of the disk (the original flavor!) 2. Double-sided, double density: Able to store information on both sides and able to store the information more densely. These diskettes hold 360 Kb of information. The box holding this type of diskette is usually labeled as 2 DD (2 sides, Double Density). 3. Double-sided, high density: The data is packed even tighter on these diskettes, so they are able to hold 1.2 Mb of information. The box holding this type of diskette is usually labeled as 2 HD. B. The 3.5" diskette, smaller and protected by a hard plastic case, is much more robust and in just a few years has become the industry standard. In addition to the hard plastic case, the slot where the magnetic disk is exposed for reading (by the computer) is covered by a retractable metal or plastic flap. When the diskette is out of the computer, it is completely protected from casual damage. However, despite the rigid case around the disk, it is not a hard disk (the case may be hard, but the disk inside is still very thin and floppy). 1. Double-sided, double-density: Able to store 720 Kb of information (yes, it does hold more than the 5.25" double density). You can recognize this type of diskette even without other labels since the plastic case has a small hole in only one corner. 2. Double-sided, high-density: The diskette can hold 1.44 Mb of information. There are small holes in two corners of the plastic case.

byte

Kb

Mb

Gb floppy disk

hard disk

ROM

RAM

CPU

floppy drive

hard drive

As the name implies, this type of disk is rigid (actually made of metal). As a result, the disk can spin much faster which allows more data to be packed onto the same area. In 1986, the original hard disks for PCs held 10 Mb of information. In just over a decade, the manufacturers have increased the capacity of hard disks and decreased their size, increasing the information density by incredible amounts. Dont confuse memory size with hard disk size. Hard disk size controls how much information can be stored (i.e. the size of your file cabinet). Memory is where the instructions (programs) are kept when a program is running; this impacts the size of the program and the speed at which the program runs (i.e. the speed and capabilities of the electronic secretary). Read Only Memory. Any form of information storage media that can be read by the computer (i.e. information can be accessed), but which cannot be altered by the computer. The most common form that you will deal with is the compact disk (CD-ROM). Random Access Memory. The memory used by your computer to hold the operating system, the instructions being executed (program) and the information being manipulated. Running MedARKS in DOS requires only 4 Mb of RAM, while if you are using Windows 3 as the operating system, 8 Mb will be required. However, most new computers come with Windows 95 and 16 Mb of memory, which is adequate to run MedARKS under this operating system (if your computer has less than 16 Mb of memory, you should not even be running Windows 95, and MedARKS will not work reliably). More memory will make a significant difference in the speed of the program. Central Processing Unit. As the name implies, this is the heart of the computer. All program instructions are processed by this unit. There are several types of CPUs in computers. The speed at which a program runs is controlled by many factors, but CPU power and CPU speed are two of the most critical. The speed at which the CPU processes instructions is measured in megahertz (MHz). Other things being equal, the higher the MHz, the faster the computer will run your programs. 1. 8086 chip: The original CPU found in the original IBM-PC; it ran at 4 MHz. Now mainly a museum piece, except in the Zoo community where they still can be found performing vital functions. If this is all you have available, you do not have enough CPU power to run MedARKS 5. Go talk to your director about upgrading your computer equipment. 2. 80286 or 286 chip: The second generation of CPU for IBM-type PCs. More powerful and still (unfortunately) in fairly common use. Still not powerful enough to run MedARKS 5. 3. 80386 or 386 chip: The third generation of CPU for IBM-type computers. Now you can run MedARKS 5 (but you will be happier with a more powerful CPU). 4. 80486 or 486 chip: Several million transistors packed onto a 2" by 2" wafer of silicon. Now you are into serious CPU power. These units run at minimum speed of 25 MHz and units running at 100 MHz (or higher) are available. 5. Pentium chip: Just 3 years ago, a 100 MHz Pentium was a cutting edge machine. Now, with enhanced flavors of Pentium available (MMX, Pentium II and Pentium III), a plain vanilla Pentium computer is almost dull, but it still remains an extremely powerful and extremely fast computer. Computers based on this CPU are the standard for the home PC market and it is possible to find a basic Pentium-based computer for well under $1000. The component of the computer that accepts a floppy diskette and allows the computer to retrieve information from the diskette (read the disk) and to store information on the diskette (write to the disk). Drives are made for 5.25" or 3.5" floppy diskettes, although now that the 3.5" diskette has come to dominate the industry, it is becoming more difficult to locate a 5.25" drive. Most floppy drives are capable of reading and writing either double density or high density diskettes (on an older machine you may find a floppy drive that can only read double density diskettes). A small box that contains a hard disk (or a vertical stack of hard disks) and all the components to allow reading and writing of information to the disk(s). Most hard drives are bolted into the computer, although there are some removable hard drives that can be pulled out. Hard drive capacities of 1.2 Gb (a 12,000% increase in capacity from the original PC) are now routinely included in most PCs and even 10 Gb hard drives are available for a very reasonable price. In this day and age, buy a computer with at least a 6 Gb hard drive. The cost of a larger hard drive will be minimal (compared to the overall computer cost).

tape drive

WORM drive

CD drive

OS

multitasking

MODEM

mouse

Network

As you would expect, this drive accepts a tape cassette. Several sizes of cassette are available with different capacities. For many years, the cassette size known as DC2120 was probably the most common for PCs, but it held a maximum of only 250 Mb of information. As hard drives became larger, higher capacity tape cassettes (up to 1.6 Gb capacity) have been developed. Tape drives are used to make a copy (backup) of data and programs from the hard drive. The hard drive in your PC will fail at some time. When the hard drive fails, you will lose access to all the information on the disk. Having a copy of the information on the hard drive is the only way to recover that information (unless you want to type it all in again). With large hard drives, putting a copy of all information onto floppy diskettes gets impractical (it would take several hundred floppy diskettes to backup a 1 Gb drive). Tape drives are slow and not appropriate for storage of information that needs to be accessed on a regular basis. However, tape drives are perfect for easy backup of large amounts of data and can be fairly inexpensive. Write Once, Read Many. A type of disk drive that accepts a disk that looks like a blank compact disk. The drive can write to the disk (using a laser), but once written the information cannot be changed. However, it can be read many times (just like a CD). The disk typically hold 300 to 600 Mb of information. Good for making archival backup copies of large amounts of data that do not change (e.g. used by law firms to store copies of letters and other documents that are not altered once in the final form). A drive that accepts compact disks. There are several types of CD formats available (audio, CD-ROM, Kodak photo and CD-interactive). Most newer CD drives will accept all formats and combined with the correct software, allows you to listen to music, run programs or look at photographs. Most CDs hold about 600 Mb of information. Just for your information, full stereo, CD quality music requires about 10 Mb of data for 1 minute of sound. Operating System. The set of instructions (program) that give a computer a basic set of functions that can be used by other programs. For example, the ability to write to the computer screen is a basic function that almost all software needs. The operating system takes care of this kind of basic function, so the higher level programs (like word processing programs) only have to issue general instructions. The original PC operating system was DOS (Disk Operating System). Currently, the two most popular PC operating systems are Windows 3 and Windows 95. Novell NetWare is an example of an operating system that handles basic network functions (new versions of Windows also have networking functions built in). Often operating systems build on each other (e.g. Windows 3 actually adds functions on top of DOS, so you cannot run Windows 3 without also having DOS). Other operating systems that you may hear mentioned are System 7 (Macintosh computers) and UNIX (runs on many types of computers). The ability to run several programs simultaneously (e.g. to listen to an audio CD on your computer as you write the handout for the MedARKS workshop). From a physical point of view, the computer is only running one program at a time, but as it can switch between tasks (programs) many times a second and work on each task for a few milliseconds, it appears to the user that the tasks are running simultaneously. Multitasking is a function of the operating system. Windows allows multitasking, while DOS has virtually no multitasking capabilities. A device that converts computer files (digital information) into sound waves (acoustical information) to be transmitted over phone lines and is also capable of converting sound waves back into digital information. With a modem on each end of a phone line, two computers can exchange information. A device that translates movement of the device into movement of a cursor on the computer screen and has 2 (or more) buttons that allows the device to signal the computer and control the flow of the program. MedARKS is a mouse compatible program. Any group of computers that are connected together so that information can be exchanged or shared between the computers. MedARKS will run on a network, allowing several people to enter data simultaneously.

LAN

BBS

Internet WWW

Web Page

Forum

List Server

Local Area Network: The most common form of network, the computers that are connected together are in relatively close proximity (usually the same building). LANs are available in 2 flavors: 1. Client-server: Most of the programs and data reside on a single, quite powerful computer known as the file server. The sole function of this computer is to send and receive information (files) from the workstations which are usually less powerful PCs (clients). The advantages lie in the centralization of the programs and data (when a new program is available, it only has to be loaded onto a single computer to give everyone access to the program). The disadvantages also lie in the centralization of the programs and data (if the file server stops working, the network stops functioning). 2. Peer-to-peer: All computers on the network are essentially equal (some may be faster or have larger hard disk) and information transfer can occur directly between any of the computers on the network. No computer is critical to the system, so if one fails, the necessary information can be transferred to another computer (from a backup copy) and the remainder of the network can continue to function. The disadvantage can be in locating a particular file if you simply know that it is on the network, but you do not know which computer hard disk contains that particular file. Bulletin Board Service: A computer with a modem and running software that allows it to be accessed by another computer with a modem. The BBS computer functions like an electronic bulletin board (i.e. you can post messages, general information or make request for information). If someone leaves a file (information) on the BBS, you can retrieve that file onto your computer. ISIS ran a BBS for many years, but now offers many of the same services via the World Wide Web. A worldwide group of computer networks (university, government and commercial) that are connected together. Access to the Internet system allows you to send and receive information around the world. World Wide Web. Really a protocol for exchanging information (files) across the Internet, rather than a physical entity. When you look at a Web page, your computer is actually retrieving a file from another computer attached to the Internet. Because the file is written in a standard language (called HTML), your Web-browser program can display the file correctly and retrieve other files (graphics, video, audio) that are referenced by the original file. In addition, the Web page can contain references (links) to other Web pages. Clicking on a web page link starts the process of connecting to the computer containing that Web page, retrieving that Web page (file) and displaying the page. It is the linking of pages that gives rise to the web (think of a spider web, with each intersection on the web representing a page and the strands representing the links between pages). Also called a Web site. A file or group of related files that can be accessed on the Internet and is written in a standard language (format) known as HyperText Markup Language (HTML). If your computer is running a program called a Web browser, you simply have to provide the location (address) of the page (file) and the Web browser program will handle the connection to that Internet computer, retrieval of the file and display of the contents of the file (text, graphics, video and/or audio information). An electronic bulletin board on the Internet. Anyone with access to the forum can post a message, read messages posted by others and respond to posted messages. ISIS hosts a forum for International Zoo Veterinarians through their Web site (www.isis.org). Essentially, an E-mail address that automatically forwards any messages received to an entire list of recipients. Groups of people with a common interest can use a list server to manage the exchange of Email messages. While most E-mail programs will let you send a message to an entire group of people, having everyone in a group maintain a list of addresses for the entire group quickly gets unmanageable as the group changes. The list server takes care of maintaining the list of members. To send a message to everyone in the group, you just send the message to the list server and a copy is forwarded to everyone without you having to worry about who belongs to the group this week.

Things that are bad for your computer, your records and your peace of mind
Power Fluctuations Most people are aware that high voltage surges can occur in power lines and that these voltage spikes can damage your computer. Surge protectors are almost universally used to filter out these high voltage spikes and prevent computer damage. Most computer users are also aware that turning off the power to your computer while it is being used, causes the loss of whatever work was residing in computer memory that had not been saved to a disk. Even worse than just losing the last

information entered, is that power failures can often cause file damage when you are using a database program (MedARKS is a database program). Database programs differ fundamentally from most other computer programs (e.g., word processing programs) that manipulate one file at a time. Database programs are usually manipulating a series of related files (at times, MedARKS will have over 100 files in simultaneous use). When you add a record in a database program, information usually must be added to several files to complete the data transaction. With data base programs, there is a critical period of time when those multiple file changes (updates) exist in memory, but not all have been written to the disk. A power failure during this period will result in a loss of the information in memory that was not written to the disk, causing a partial data transaction and resulting in data files that are damaged (corrupted). Damaged files must be repaired or replaced (from a backup copy). Mainframe data base programs have a feature called transaction tracking that allows you to recover from this kind of problem by rolling back the data files to the last completed transaction (essentially repairing the file). Most PC data base programs (including FoxPro for DOS) do not include this feature (at the time FoxPro was originally written, PCs were not powerful enough to simultaneously run a data base program and transaction tracking). The newest generation of PC data base programs include transaction tracking (CPUs are now much more powerful), so future versions of MedARKS will probably be more robust in the face of power failures. What is not commonly realized is that voltage drops (brownouts) can be just as bad as a power failure. Some of you may have had the experience of sitting at a computer when the lights dim and your computer resets itself (reboot), even though the power does not go off completely. It is easy to understand why this can damage files, since the voltage has dropped enough that it has become the equivalent of pulling the plug on your computer. However, even a voltage drop that does not restart the computer can still damage files. A surge protector provides no protection against power failures or voltage drops, but an Uninterruptible Power Supply (UPS) will keep your computer running during a power failure and supplement the voltage during a brownout. If you live in an area where you have a significant number of power failures or brownouts, an UPS can provide fairly cheap protect for your computer files. <Ctrl><Alt><Del> Unfortunately, most people are aware that they can restart their computer by holding down the Control (Ctrl) and Alternate (Alt) keys and pressing the Delete (Del) key. It is also unfortunate that most people do not realize that this is equivalent to turning off your computer and turning it back on. Windows will give you a warning that you may lose unsaved information when using this key combination, but fails to warn you that files may be damaged (see above). Restarting the computer with this key combination, while using MedARKS, is one of the most common causes of MedARKS file damage. In short, avoid this key combination at all costs. Viruses - the electronic kind As good clinicians, we would not consider allowing an animal to enter our institution without screening it for infectious diseases, but most of us will transfer information into our computers (from home, from another computer or from the Internet) without even thinking twice about it. Computers are susceptible to viruses, and, like the organic viruses that we are more familiar with, computer viruses are self-replicating and can multiply quickly in an infected host. While many computer viruses are fairly benign, there are some that are very destructive (think rabies). Computer viruses are not just scare tactics designed to sell you another piece of software; they are a real threat to anyone that accepts information (programs or data files) from any source (there was even one case where the disks being distributed by a commercial software maker were found to be infected with a virus). The ISIS office receives several hundred disks a year from various institutions around the world and every year they get a few infected disks (which means that the computers at the sending institution are infected). A good preventative medicine program is just as important for your computer as for your animal collection, so invest in some software to protect your computer files against viruses. Magnetic fields It is probably stating the obvious, but when you are dealing with information stored on a magnetic media (floppy or hard disks), it is prudent to avoid exposing this media to magnets or strong magnetic fields. However, sometimes we dont pay attention to the local environment and sometimes there are people who are not aware of the hazard posed by magnets. If you have floppy diskettes that are mysteriously developing bad sectors or other read/write problems, at a rate that seems too high for normal diskette aging, at least think about magnets and make sure the diskettes are not being accidentally exposed to a magnetic field.

Backup copies - make them or else! 10

The only way to avoid needing a backup copy of a critical file is to avoid using computers. Since, in this day and age, avoiding computers is not generally advantageous to your career, virtually everyone will need a backup of a critical file at some point in time. Your computer files can be damaged or destroyed by accident (e.g., delete the wrong file), by deliberate mischief (e.g., a computer virus), by computer loss (e.g., theft, fire or hurricane), by hard disk failure (all hard disks fail eventually and often without warning), by power surges (e.g., lightning strikes to the power grid), and by power failures. Computer files differ from paper records in a very fundamental way. Paper sheets (records) in a file folder are independent data events, but records in a computer file are not independent; each record in a computer file is linked to the next record in a continuous chain of data events. Break that chain and you dont just lose a record, you lose the entire chain beyond that point. Imagine having a file cabinet full of medical records where if you removed a single sheet of paper from that cabinet, and destroyed that record, then you rendered the entire file cabinet useless - wouldnt you want to have a second copy of that file cabinet for safety? Now imagine that the cabinet is not full of paper, but contains plates of steel covered with tiny magnets and that the orientation of those millions of magnets encodes your information - now you dont have to remove a metal plate, you can destroy the entire file system by simply changing the orientation of a few of those magnets (makes you realize just how reliable computers have to be to manipulate billions of these magnets every day and keep everything linked together). I hope that this view of a computerized records system makes it clear why good backup procedures are critical. Fail to keep backup copies of your critical files and sooner or later you will find yourself starting over with a nice, empty file cabinet.

Paperless records ?
Some people view computerized records as a paperless system and there is at least one institution that actually uses MedARKS as a paperless medical records system. I would argue that this is not appropriate. Even in the presence of appropriate computer data safety programs (i.e., adequate backup procedures, virus protection, etc.), paper records should be viewed as the ultimate data backup. While we do not believe that it is necessary to have the paper record system completely up-to-date at all times, the paper files should contain most of the day-to-day information generated on a specimen. At the time the specimen is de-accessioned (death or shipment), the closeout process on the specimen should result in the generation of a complete set of paper records for the archival files.

MedARKS - general guidelines for using the program

MedARKS - why bother to computerize ? Keeping good, complete, legible records will always require much more effort than simply keeping a few scribbled, abbreviated notes to yourself. However, it is generally no longer considered acceptable to avoid the task of maintaining good records. Once you have made the commitment to keep complete medical records, MedARKS simply becomes a tool to help you to accomplish that goal with less effort. Like most activities, computerizing your records will have both positive and negative aspects. On the negative side, MedARKS is a computer program and (like any other program) there is a learning period before you become proficient and comfortable when using the program. MedARKS is a program that allows a great deal of flexibility, but some adaptation to a standardized record format is required. This can be the most difficult part, since as clinicians, we tend to hold very personal views about the structure and content of our medical records. Accepting a medical records system, even when it was designed by your peers, can be a difficult process (the that is not the way I have done it syndrome). This is much less of an obstacle when learning to use a new spreadsheet or word processing program, although the same problem is faced to some degree when trying to get someone to switch to a new word processor after years of using the same program. So, what does MedARKS offer? Some aspects of the MedARKS program are basically secretarial in nature (e.g., producing typed reports and filing the medical records by animal and in date order). Other parts of the program provide some decision support by allowing you to easily access and summarize information in your existing records (e.g., using the anesthesia taxonomic report to quickly review drugs and dosages used in previous immobilizations). The ability to access records from other institutions that have been compiled onto library disks can also serve as a powerful reference tool. MedARKS also has features designed to improve your productivity, allowing you to insert predefined sections of text into your records, to quickly and easily create a complete medical record. You can also fill out simple worksheets that then allow volunteers

11

or other non-medical personnel to perform the data entry on fairly complex records. Finally, the software promotes cooperative projects between institutions by providing records in a common format and by providing the means to easily exchange and share those records.

The Escape key (<Esc>)

For most of the MedARKS program, this key serves to cancel the current program condition and return you to the previous step in the program. Make a mistake during data entry, and the <Esc> key will allow you quickly back up to the appropriate point in the program and correct the problem entry. The <Esc> key can also be used to terminate the printing of long reports. On menus, pressing the <Esc> key will go back one level in the menu. Essentially, when all else fails, press the <Esc> key.

Function keys
The function keys in MedARKS are described below: <F1> <Alt><F1> <F2> <Ctrl><F2> <F3> <Alt><F4> <Ctrl><F4> <F5> Accesses the Help files. The help system is not currently functioning, but will be available at some point in the future System configuration summary. Information from this screen may be requested by MedARKS technical support staff to help them solve a problem. For institutions running with multiple collections, the <F2> key provides a quick means to switch to a new collection. This key is only active when you are at a menu. In most memo (free-form text) fields, pressing <CTRL><F2> activates the spell check program. Expands a dictionary listing to include related dictionary entries based on the groupings of the current list In the clinical notes module, this key is used to indicate that a problem is chronic. In the clinical notes module, this key will mark a procedure to indicate that it is scheduled. When the <F5> key is active (most memo fields), pressing the key displays a list of standard text strings. Selecting an entry from the list will insert that text into the current text record. The text strings are defined through the utilities of each module. Think of this key as giving you access to a permanent clipboard from which you can grab a commonly used text entry and insert it directly into a record, saving considerable typing and ensuring consistency in data entry. In the clinical notes module, when the <F5> key is active, pressing <ALT><F5> pops up a list of standard, multiple line, text entries (forms). Selection of one of these forms will place all the text into the current text record. In the clinical notes module, allows you to switch between windows. In the medical text entry area, pressing <F6> will switch the cursor from the current record to the window displaying the previous records. Pressing <F6> will return the cursor back to the data entry window. This is useful when copying text from a previous record to the current record. This key is only used in the anesthesia module. It allows you to insert a drug record between two existing drug entries. This may be needed when editing an anesthesia record. Signals that the record should be deleted. MedARKS will almost always require you to confirm this action before actually removing the record. Accession number help. If the accession number is not known, pressing <F9> when MedARKS is waiting for an accession number will give you access to assistance in looking up an accession number based on information that is known (species and some other identification information).

<Alt><F5>

<F6>

<F7> <F8> <F9>

12

<Alt><F9>

<Ctrl><F9>

<F11> <F12> <Alt><F12>

<Ctrl><Y> <Ctrl><W> <Ctrl><End> <+> <-> <Right Mouse Button>

Non-accessioned specimen access. If the animal is not in the ARKS files (accessioned), pressing this key combination will allow you to access the non-accessioned specimen file and select an existing animal or add a new non-accessioned animal. An alternate means to access a specific record that used in the parasitology and pathology modules. In the parasitology module this key combination allows a search by the sample identification number. In the pathology module this combination allows a search by pathology case number. Will erase the contents of the current MedARKS data field. Will close a memo field that is being edited and save the text entered. When a report has been saved to the disk, the report may be viewed on the screen using this key combination (on page 50). Using this viewing process the viewer is able to scroll forward and backward through the report. This key combination can be used at any menu level. Same as <F11> Same as <F12> When editing a memo field, this is the same as <Ctrl><W> (save and exit). When inside a selection criteria window (filter), this key combination exits and closes the window. When a yes/no question is posed, the plus key is the same as pressing the Y key. When a yes/no question is posed, the minus key is the same as pressing the N key. Pressing the right button on the mouse is the same as the <Enter> key.

Insert Versus Typeover: In the text editing windows, when the cursor is visible as a rectangular box you are in the typeover mode. This means that what ever you type will overwrite anything that the cursor travels over. Pressing the <Insert> key will toggle the cursor to an underscore (_). In this mode, text that you type will be inserted at the current cursor position (i.e., it will push all the text following the cursor to the right).

Menu organization
MedARKS menus are organized into cascading levels, making the current menu level clear at a glance. All the modules (parasitology, anesthesia, clinical notes, etc.) have 3 basic functions that are accessed through the module menus: 1) add or edit records (main module level) 2) retrieve data in the form of a variety of reports (module report menu) 3) utility programs (module utilities menu)

13

Main MedARKS Menu: The first level menu for MedARKS. This menu offers the access to the various record modules.

MedARKS second level menu: For each module, this menu provides access to Add/Edit records or to the third menu level (report and utility menus).

14

MedARKS third level menu: This menu level offers a selection of reports or utilities for each module depending on which choice was selected at the second menu level.

Utilities and data dictionaries

Utilities are programs that empower the user to validate their data, personalize each module to ease the task of data entry, or customize the behavior of certain aspects of the module (e.g., pre-determine what reports are going to look like). When MedARKS is delivered, there are a number of utilities that need to be run to customize your system. Some of the parameters you set will depend on your hardware (e.g., the printer), while others will be determined by personal preference. Once these parameters have been set for your system, the values will be saved and used each time MedARKS is run. Of course, the parameters can be changed if either the hardware or your preferences change. There are system utilities and module utilities. System utilities are utilities that affect the entire MedARKS system. These are accessed from the main MedARKS menu. Module utilities, in addition to providing customized settings for the module, offer special functions or features that pertain only to that module. The module utilities menu can be accessed by selecting choice number 5 from any main module menu. Parameter setting utilities: Within each MedARKS module are settings that control the behavior of that module or provide default values for particular data fields. The settings that can be adjusted by the user are called parameters. An example of a parameter that can assist with data entry is the list of default clinician initials for the clinical notes module. Rather than have to type in the clinician initials (a data value that varies between institutions, but stays fairly constant within an institution) for each clinical text record, a clinical notes module parameter can be set to hold this information. Then during data entry, you just pick from the existing list. Similarly, in the clinical pathology module you can list the laboratories that your institution uses most frequently, allowing the user to simply choose from a standard list for most records that are entered. The parameter utilities may also allow access to the data file names for the module, but you should not attempt to reset these parameters without consulting with MedARKS Technical Support staff. Dictionaries utilities: Each module has one or more dictionary (or authority) files that are used to help maintain data consistency within an institution, and between institutions. The utility programs activated by the dictionary option will allow the user to customize their dictionary file. MedARKS is delivered with fairly extensive set of dictionary files. The anesthesia and prescription modules access a drug dictionary (contains most of the common generic drugs and trade names), while the parasitology module dictionary contains a list of common parasites. The dictionary files are used to determine the full name and correct spelling for an entry. Since data integrity is dependant on the dictionary file, it is very important that additions to the dictionaries are accurate. The data in MedARKS can only be as accurate as the data you enter into these files. In some modules, you may specify a preferred term as part of any dictionary entry and MedARKS then allows you to use this preferred term in your records, but still keeps the full term behind the scenes. For example, if you prefer to see spay on all of your records instead of ovariohysterectomy, you may select spay as your preferred term. MedARKS will remember ovariohysterectomy internally but display spay in all your records and reports. To maintain some consistency between institutions, there are some dictionary terms which are designated as ISIS standard terms. You can modify the preferred term and/or synonyms for these terms, but you cannot modify the dictionary term

15

itself. Dictionary Reports: These utilities simply allow you to print or view the contents of a module dictionary. The format and options is dependent on the dictionary being accessed. Data Quality Utilities (Data Validation and Global Editing): Over time, particularly if several different individuals are performing record entry, it becomes essential to check the quality of the information in your records. MedARKS comes equipped to assist you in this task by providing data quality utilities for each of the record modules. These utilities will help you locate variations or mistakes in your data and often aids in correcting these problems. When an animals record arrives from another institution, these programs will help you identify drugs, parasites or problems which are in the records from that institution, but not currently in your files. The validation routines are MedARKS attempt to keep the garbage in, garbage out problem to a minimum. However, it should also be stated that these utility programs should be used with great care since many are very powerful, global (potentially impacting all records) editing routines. The data validation and editing routines are as follows: Anesthesia: Drugs not in the dictionary file Missing drug route code Missing time that drug was given Missing bottle number entry for narcotic drugs Missing an overall rating Missing clinician initials Check for possible duplicate records Parasitology: Global edit of Collected By initials Global edit of Examination By initials Global edit of Purpose of Examination Global edit of Enclosure information Global edit of Department Search and replace of Sample Descriptions Search and replace of Comments Validate Tests against Standard Choices Validate Results Against Dictionary File Prescription: Remove old scheduled prescriptions Tuberculin tests without final results Global editing of clinician initials Global editing of prescribing initials

Fluid Analysis (Clinical Pathology): Verify against test dictionary Check differentials (add to 100%) Check hematology records against normal range Check chemistry records against normal range Check for possible duplicate entries Check that baseline and restraint data is complete Global edit of collection site Global edit of Collected By initials Global edit of Hematology Laboratory Global edit of Hematology Analysis By initials Global edit of Chemistry Laboratory Global edit of Chemistry Analysis By initials Clinical Notes: Verify against Problem Dictionary Pathology: Verify Diagnosis Records

Sort, Pack and Index Utilities: This utility allows for "housekeeping" of your files. When records are deleted, they are really just hidden from sight by the program. Although they are no longer visible as part of your MedARKS records, they do take up space on your hard disk. This utility will sort through your records, permanently eliminate those that were "deleted" (but still taking up space), and reorder the remaining records. It is a good idea to use this utility once in a while as part of your MedARKS maintenance tasks. There is a sort, pack and index utility for each module that accesses only the files for that module. In addition, there is a sort, pack and index utility on the system utilities menu which will do the housekeeping on all of the modules of MedARKS at one time. You will also be given the option to pack, sort and index the ARKS data files with the system sort, pack and index. If you are having a problem with MedARKS, the sort, pack and index utility is often a good place to begin trouble shooting and often simply running these utilities will resolve your problems.

16

Other Useful Utilities: Calculate in-house reference values. This utility, found on the clinical pathology utility menu, will calculate the normal inhouse hematology and chemistry values for either a single species or all species with samples in your data base. Only samples from animals with normal health will normally be included in the calculations. Occasionally you will need to recalculate the reference ranges, as you add more data to MedARKS, to ensure that your in-house reference ranges reflect your current data. Set Order of Tests for Data Entry: This utility is found on the clinical pathology utility menu. This routine allows you to specify a list of routine tests and the order of these tests for data entry for each laboratory in your routine laboratory list. Since reports from different laboratories often have a different format, this utility allows you to "customize" your data entry screens to request test results in the same order that they are reported by that laboratory. Obviously, this makes data entry a much easier process. Hematology/Chemistry/Serology ISIS Data Transfer: Found on the clinical pathology utility menu, this utility is used to transfer clinical pathology information to ISIS (on page 78). Edit/Update Sample Request File: Found on the pathology utilities menu, this utility assists with the tracking of in-house live and dead animal sample requests, and SSP/TAG research protocols, tissue requests, and necropsy protocols. Print Sample Request File: Also on the pathology utilities menu, this program will print one or more records from the sample request file. Medical records Data transfer: Located on the Inventory and Medical History menu, this utility will allow you to transfer medical records to a floppy diskette or merge into your MedARKS records, medical information that has been sent on a diskette from another institution ( on page 48 and on page 77).

17

MedARKS modules
Anesthesia records
Value to the user! Anesthesia is arguably the most important use of computerized medical data for the zoo veterinarian. If anesthesia is ever going to become more standardized and leave the realm of personal cookbooks, we must pool the experiences of veterinarians around the world. Collecting a standard set of information allows a veterinarian the opportunity to review all the past anesthetic protocols, episodes, and experiences of an institution and access the experiences of other veterinarians in an efficient and organized manner. Overall Comments: Like most of the MedARKS record modules, the anesthesia module can collect, organize and standardize a large amount of information, perform calculations, pass relevant information to other record modules and retrieve information based on selection criteria that can be either simple or quite complex. The initial design of the module, involving about a dozen zoo veterinarians, resulted in broad specifications for the information that the program should be able to collect, and requests for improvements from the users have lead to the addition of further data fields when the program was revised. A MedARKS anesthesia record must contain a very basic set of facts, but the program is capable of collecting and organizing a very comprehensive set of information related to the immobilization procedure. Data collection: In general, a record is generated every time an animal is anesthetized. The entire anesthetic episode, from initial evaluation to induction to recovery is documented. While many veterinarians have developed their own anesthesia form, using the suggested anesthesia data collection form (see appendix) will make MedARKS data entry very easy. Of course, any personalized adaptation of this form that retains the basic organization and flow of the information will make life easier for the data entry person. The worksheet also has many check boxes that makes the task of data recording much simpler and a list of the common codes for use when filling out the record.

Data entry
After filling out the anesthesia form completely, it is time to enter the information into MedARKS. Select the anesthesia module (main menu, option 1), and then select data entry (anesthesia menu, option 1). There are 6 basic sections to the data entry process: 1. Animal Identification 2. Baseline animal information 3. Anesthetic drug, dose and related information 4. Information regarding the immobilization and the recovery 5. Physiological data 6. Comments 1. Animal Identification The initial prompt requests animal identification information. The default request is for entry of the ARKS accession number (this is the simplest and most common way to identify an animal and is used throughout MedARKS). However, when you do not know the accession number or when the animal does not have an accession number, there are 2 additional options that will be useful. Your choices for identifying the animal are: a) Enter the accession number. The program checks the ARKS inventory files for information on this specimen. If the accession number exists, the program will display the species, accession number, house name, age, and sex on the screen. If the animal information is not correct or the program cannot locate the animal, the three most common reasons are: I. you entered the wrong accession number II. the animal has not been entered yet into ARKS. (i.e., it is new or your registrar made a mistake). You may either set this record aside until the ARKS inventory is updated or enter the record as a non-accessioned animal and convert to the correct number once the ARKS files are up-to-date.

18

III. you have a multiple collection system and the wrong collection is active. Under these conditions, you are given the option to switch to another collection. b) Get help locating the correct accession number. If you know some information about an animal (e.g., a name or band number), but not the accession number, then press <F9> to produce a help screen to track down the accession number for that specimen. You will be prompted to enter the species (common names will work, but the genus and/or species are the fastest if you know it!). A filter screen is produced, but unless you are dealing with a large group of individuals and need to filter to produce a shorter list, just press <Ctrl><End> to accept the default selection criteria. You will be shown a list of the accessioned animals that meet the selection criteria for that species. The list includes the accession number, sex, housename, tag/band, tattoo, and birth date. From this data, you should be able to identify the animal and you can simply point and click at the appropriate specimen. The program will automatically transfer the correct accession number to the data entry program. c) Enter a non-accessioned specimen record. If you are dealing with a non-accessioned specimen (on page 49), then press <Alt><F9>. This allows you to enter data for a non-accessioned animal. Again, you must first specify the genus and species. If there are any existing non-accessioned specimens for this species, a list will pop up. You can choose from this list or add a new one. If you add a specimen, you will be able to provide sex (unknown is valid), birth date or age (again, UNK or unknown is a valid response) and other identification information (e.g., a rehabilitation case number). Non-accessioned specimen records are not as convenient as accessioned records for either data entry or retrieval, but allow you to record medical records on specimens that are not in ARKS.

Once you have a specimen identified, the program will check to see if there are any previous anesthetic records on this specimen. Existing records will be listed in date order. Your options at this point are to choose one of the existing records for editing or add a new record. Click on the appropriate choice. 2. Baseline animal information You will now be prompted to enter the baseline information for the animal. This is all information that can be collected prior to the start of the immobilization procedure. Some of the baseline information is required (the program will not allow you continue until an answer is specified), while other fields are optional. In addition, some data fields have an auto-skip feature that can be switched on when you customize this module to your needs. The data fields and their status are: Date of the anesthetic procedure (required) Health status (required.) Pre-anesthesia fasting time (required.) Activity at the start of the procedure (required.) Demeanor (optional) (auto-skip) Environmental temperature (optional) (auto-skip) Humidity (optional) (auto-skip) Physical status/Anesthetic risk (optional) Immobilizing conditions (optional) Body condition (optional) (auto-skip)

Note: When there is a limited list of possible responses, a list of the valid responses appears on the screen. To make data entry quick and easy, you need only press the number key next to the desired response (as listed on the worksheet). For example, when prompted for health status, simply pressing either a <1> or <2> to indicate an answer of Normal or Abnormal respectively. You can also indicate your choice by using the up and down arrow keys to select the appropriate choice and then press <enter> to accept that choice or click on the correct response with the mouse. Special notes: Temperature: If a temperature is entered, the user will then be prompted to indicate if the units are Fahrenheit or Celsius. The program will accept either <1> or <F> for Fahrenheit, or <2> or <C> for Celsius. All Fahrenheit values will be converted to Celsius in the display, but both are printed on reports. Physical status: The program will compare this entry to the health status entry and the user will be warned of any discrepancies (like all warnings, this one can be ignored at the user's risk).

19

Body condition: The program will compare this entry to the health status. A warning is issued if the health status was normal and the body condition was emaciated. The <Esc> key can be used at any time also to back up one or more steps to correct data entry mistakes 3. Anesthetic drug, dose and related information Any drug given during the procedure can be entered in this section. Data entry for each drug consists of a series of questions relating to the drug's administration and effect. When performing data entry from the anesthesia worksheet, the data prompts for each drug will comprise one row from the worksheet. Classification of drug dose: (optional field) This field, in part, records your intention (or expected outcome) for the drug dose being entered. If the initial drug(s) you give have the intent of producing immobilization, then this dose would be classified as the immobilizing dose. Should the initial dose be too low, and more drug is required to reach the required depth of anesthesia, then the extra drug given would be the supplemental dose. Finally, the doses of drug given during a prolonged procedure to maintain the desired depth of anesthesia should be classified as maintenance doses. Confusion of supplemental and maintenance doses is probably the most common misuse of this data field. However, once you understand that supplemental doses are to supplement an initial immobilizing dose that failed to produce the desired effect, while maintenance doses are to maintain the desired degree of anesthesia, the correct use of this data field should be clear. All the dose classifications and their quick entry codes are as follows: P = Preanesthetic dose I = Immobilizing dose S = Supplemental dose M = Maintenance dose A or R = Antagonist or Reversal dose O = Other drug dose (i.e., antibiotics, anti-inflammatories, contraceptive implants, etc.) Drug: (required field) Enter the first 4 letters of the drug administered using either the generic or trade name. The program will check the master drug dictionary and locate one or more matching entries. If only a single entry is found, the program will automatically fill in the full drug name. When there is more than one possible drug, a list of the possible drugs (based on the letters entered) will be displayed and you will need to choose the appropriate entry from the list. If the drug is not found (no matching entries), the user has, at this time, the option to add the drug to the drug dictionary. Amount given: (required field) Only the digits need to be entered. The master drug list maintains a set of default units for each drug and will add in the units portion automatically. If you are not using the normal default units for a particular dose, the units can be edited. Route: (optional field) Use a one or two letter code to specify the delivery route for the drug dose. The second letter codes can only be used in cases where the first code indicates an injectable route. Any of the second letter codes can be used with a valid first letter code. The codes are as follows: Second code letter First code letter P = Polesyringe M = intraMuscular B = Blowdart V = intraVenous D = capture (metal) Dart P = intraPeritoneal N = Non-metal (plastic) dart S = Subcutaneous H = Hand syringe O = Oral F = Facemask T = endotracheal Tube V = Venous catheter C = Induction Chamber In addition, IV, IM, IP and SQ are valid 2 letter codes that give the expected results. Finally, intraosseous and intracoelomic can be chosen as valid delivery routes, but must be chosen from the list of routes during data entry (no available short-cut code letters for the data entry process).

20

Time drug is given: (optional field) Enter the time the drug was administered (in 24 hour format!). Note: In the module parameters, you can specify whether times will be given in absolute time (24 hour format) or relative to the time of the first dose. The first time must always be given in absolute time. Success of delivery: (optional field) The amount of drug actually delivered into the animal. Use one of the following codes: C = Complete P = Partial 1 = 10% 2 = 20% 3 = 30% 4 = 40% 5 = 50% 6 = 60% 7 = 70% 8 = 80% 9 = 90% N = None The last success entry (none) is useful when attempting to account for controlled drugs. A missed dart has a delivery success of 0% (none), but the narcotic or other controlled drug must still be accounted for. Entering the drug dose with a success of none ensures that your controlled drug log will be accurate. Effect or stage of anesthesia: (optional field) This field is only requested for anesthetic drugs and this is where you indicate the maximum result observed (effect), for the drug and dose given to this point in the procedure. The short cut, data entry codes are: 0 = no effect 1 = light sedation 2 = heavy sedation 3 = light anesthesia 4 = surgical anesthesia 5 = excessively deep 6 = dead (think "deep 6!") Time of effect: (optional field) The time that the effect recorded in the previous field was reached (in absolute or relative time) Bottle number: (optional field) Usually used for tracking controlled drug usage. MedARKS can report on drug usage by bottle number if this field is being used. If you are making full use of the drug tracking system, then for controlled substances, MedARKS will validate the bottle number entered against the bottles that have been registered in the tracking system. This section of the anesthesia record can contain as many drug entries as are needed. As soon as you finish one drug entry (all fields), you will be prompted to start another drug entry. Essentially you will be in a continuous loop to collect drug and dose information until you signal MedARKS that drug entry is complete. You signal to MedARKS that drug entry is complete by either pressing <Ctrl><End> at the start of a new drug record. 4. Information regarding the immobilization and the recovery This section of the record contains information that is generally collected after the start of the anesthetic procedure, but is information that is only collected once for each anesthesia (e.g., weight). This section also contains your assessment of the procedure; information that you will use in the future to help optimize drug dosages. Time of initial effect: (optional field) This is the time at which you first observe some effect that can be attributed to the initial dose of drug.

21

Time of sternal / lateral recumbency: (optional field) This is the time at which you first observe sternal or lateral recumbency. Body weight: (required field) Either an actual or estimated weight is acceptable. The weight may be entered in pounds or kilograms, but all units will be converted to kilograms for storage. Both pounds and kilograms will be displayed in reports.

Endotracheal Tube Size: (optional field) If the route of administration for any drug has been by endotracheal tube, you will be able to record the size of the tube for future reference. If no drug was given by endotracheal tube, the program will automatically skip this field. Occurrence of anesthetic complications: (optional field) There are 4 options for classification of anesthetic procedures with regards to complications. 1. None - no complications 2. Minor - e.g., mild bradycardia 3. Major - e.g., regurgitation that could lead to inhalation pneumonia 4. Fatal - self-explanatory Anesthetic recovery: (optional field) There are 5 options for classification of anesthetic procedures with regards to the recovery period. There is a generic abnormal recovery choice and 3 more specific abnormal recovery categories. In all cases of abnormal recovery, further details can be included in the comments section of the record. Recoveries can be classified as: 1. Normal 2. Abnormal 3. Prolonged 4. Violent 5. Renarcotized Induction rating: (optional field) The first of 3 rating (induction, muscle relaxation and overall) for the anesthetic procedure. This is your rating of the induction period for the anesthetic procedure. All the rating fields are categorized on the same scale (poor to excellent). 1. Excellent 2. Good 3. Fair 4. Poor Degree of muscle relaxation: (optional field) The rating for the state of muscular relaxation during the anesthetic procedure. Overall Rating: (optional field) The overall rating for the anesthetic procedure. Time of recovery and Recovery stage (at that time): (optional field) There are 2 places to record the stages of recovery (same scale as used for drug effects) and the time that the animal reached that stage. Veterinarian's initials: (optional field) The initials of the veterinarian responsible for the procedure. Recorder's initials: (optional field) 5. Physiological data The MedARKS anesthesia record allows you to record physiological data (heart rate, respiratory rate, blood pressure, oxygen saturation and body temperature) that is collected during the procedure. You can also record the time that blood samples are collected and the type of sample obtained (serum, EDTA, heparin, etc.). There are no limits on the number of physiological data record that can be associated with each anesthetic procedure. As with drug entry, the program enters a loop and continues to request physiological data until you signal that data entry is complete by pressing <Ctrl><End> or

22

<PgDn>. All physiological and blood collection data fields are optional and this entire section of the record can be turned off through the module parameters. Information from the blood sample data fields will be passed to the hematology and chemistry module to reduce data entry effort for those records. Physiological data fields are: Time (of data collection): The absolute time must be entered here. Body Temperature: You will be asked to specify Fahrenheit or Celsius Heart rate: Measured in beats per minute. Respiratory rate: Measured in breathes per minute. Oxygen saturation: Measured in percentage. Blood pressure: Measured in mm of mercury with room for systolic, diastolic and average pressure. Blood sample collection data fields are: Time (of sample collection): The absolute time must be entered here. Hematology sample: Indicate the type of anticoagulant used. Chemistry sample: Indicate serum or plasma. Collection site: The vein or artery used for sample collection. Collected by: Initials of person collecting the sample. 6. Comments The final section of the anesthesia record allows you free-style text entry. The program has some text editing abilities (on page 81). This area can be used to comment on any aspect of the anesthetic procedure; details on any complications, problems during induction, the purpose of the procedure, or any notes on how the next procedure might be improved. MedARKS will allow some record retrieval based on information in the comments, so consistency of data entry is helpful. Standard text entries can be defined through the anesthesia module parameters, allowing to produce a list of common purposes or problems that can be chosen from a pop-up list (see the section on data dictionaries starting on page 15).

Anesthesia Reports
Once the data is entered, you will want to retrieve it for use. Your choices are: Individual Specimen report: This option allow the production of a complete anesthesia report on an individual specimen. Records may be selected individually (from a list of all anesthesia records for that animals) or filtered by select criteria that you apply to the records (e.g., only records where the animal was in normal health and fasted for 8-24 hours). Refer to the section on filters (starting on page 46) for more information on selection criteria during record retrieval. Taxonomic Group report: This option allows for the retrieval of all anesthesia records for a taxonomic group that you specify. Again, selection criteria may be set to filter the records shown in the final report. Three output formats are available: Full record: This prints the entire anesthesia record for each selected record Long summary: A summary of each anesthesia record is distilled into 3 lines of procedure information plus one line for each drug given during the procedure Short summary: A summary of each anesthesia record is distilled into 2 lines of procedure information plus one line for each anesthetic drug given during the procedure Drug usage report: This option is mainly designed to account for all usage of narcotic and controlled substances. However, it can print a report for any drug recognized by MedARKS. When prompted by the program, the user enters the drug and the range of dates to be included in the report. The report consists of two sections: Summary of the drug usage organized by immobilization Summary of the drug usage organized by taxonomic group Body weights report: This report allows access to weight records in several different formats (useful for quickly accessing weight data or transferring this information to curators and keepers).

23

Daily activity report: Provides a simple, day by day listing of all immobilizations performed during a time period that you specify. The report merely lists the date, common and scientific name of the animal immobilized, the accession number, sex, and the first 30 characters of the comment section (it may be useful to remember this and use the first 30 characters for a brief description of the purpose of each immobilization). At the end, a summary is produced which totals the number of immobilizations performed on each taxonomic group recognized by ARKS (mammals, birds, reptiles, amphibians, and fish). This last summary is available without the daily listing, allowing you to determine the total number of immobilizations in a given period (useful for an annual report to the director of medical department activities). Count of records report: This report gives an actual count of anesthesia records. The report can summarize for the entire anesthesia data file, producing a list of the number of records for each species/subspecies. The report will also summarize within a species or subspecies, producing a history of previous experiences and drugs used for that taxonomic grouping. Retrieve a sequence of records: Sometimes there is a printing problem after data entry. Rather than having to print file copies one at a time, this allows you to print a series of anesthesia records all at once.

Anesthesia Utilities
These are the nuts and bolts activities of the anesthesia module. With the options offered here, you can make the anesthesia module work for you. Edit/Update module parameters: This utility program is used to change the parameters that control data collection and data entry choices for the anesthesia module. It is very important to run this utility to start the process of customizing MedARKS to meet your preferences and needs (on page 15). Within the anesthesia module are several data fields which can be turned "on" or "off" and lists that you can create to make data entry easier. The system is delivered with all the data fields turned on and the custom lists empty. So, if you never collect humidity data, you can turn off this field, saving data entry time. Drug Dictionary Editing: MedARKS is delivered with an extensive list of drugs (generic and trade names) that are recognized by the program. This utility program allows the user to customize the drug list that arrives with the program; new generic and trade names can be added and drugs not used can be deleted. Drug dictionary reports: Since the list of drugs can be expanded and customized, this option allows you to examine the contents of the master drug list using any one of the four different report formats. Generic drugs in alphabetical order Trade name drugs and their generic drug contents Drugs with multiple components (compound drugs) Generic drugs and all the trade names and synonyms associated with each generic drug Sort, Pack, and Index: This is a housekeeping function that is normally used to repair damaged index files (on page 16). Transfer records for a specific drug: This allows an institution's anesthesia data to be easily downloaded and transferred for cooperative programs. Data quality: These utilities can be used to check your records for a variety of problems, including inconsistencies in data entry, duplicate records and drug entries that are not in the dictionary. Controlled Drug Tracking: MedARKS has always assisted with tracking of controlled drug usage (required by DEA), but this group of utilities significantly expanded the capabilities of the system. The enhanced capabilities not only track the drug usage for a particular bottle, but also can track other required information for the bottle, including the supplier, the lot number, invoice number, and drug usage or losses. This is information important for DEA reporting, but information that is not recorded in the MedARKS anesthesia record. Edit Bottle Information: The routine that allows you to record and edit information about a specific bottle

24

including: Bottle number Drug Date received Vendor/supplier Manufacturing Lot Number Expiration date Invoice number Total Amount in bottle General notes on the bottle Amount discarded and reasons for discard Amount lost and reasons for loss Date bottle was finished Report for a bottle: Searches both anesthesia and prescription records for records of drug use from a specific bottle number and prints a summary of all usage, any losses from the bottle and lists the amount that should be remaining in the bottle. Report for a vendor: Lists the bottles of controlled drugs that have been obtained from a specified vendor. List bottle numbers used in existing records: Searches existing records for bottle number information for a particular drug and produces a list of the bottle numbers that have been entered. Very useful for identifying typographical errors in the existing records. Having the correct bottle numbers is critical for retrieval in the drug usage reports.

Parasitology records
Value to the user! One of the most common preventative medicine programs in zoological medicine is parasite control. This module of MedARKS not only records the types of parasites seen within collection animals but also assists the clinician and technician in scheduling regular parasite examinations. This module can be used for any type of parasitology evaluation, which includes samples such as skin scrapings, or ear swabs as well as fecal samples. Data Collection: When a parasitology sample is submitted to the laboratory for evaluation, the results must be recorded. As with the anesthesia module, a worksheet is usually used to record the data in a standard format to simplify the data entry process (see appendix). Since the parasite control program is dependent on having up-to-date records available to the program, the data entry step should as important as any other step in the parasitology examination process. With some experience, very rapid record entry is possible into the parasitology module, so there is little excuse for not providing the clinician with printed results for all parasitology examinations.

Data entry
Add/Edit Update Parasitology Examination Records: Allows you to add new records and edit or delete existing parasitology records. MedARKS will accept data from both accessioned and non-accessioned specimens and samples can linked to a single animal or to an entire group of animals. As with all basic data entry options, the access password is required for access. Change Parasitology Sample Identification Number: Each sample examined and entered will be assigned a unique sample identification. All aspects of the data for that sample

25

(baseline information, animal(s), tests and results) are linked via that identification. If for some reason this sample identification number needs to be changed, this option allows access to the routine that allows the sample identification to be changed. The access password is required for use of this option.

Parasitology Examination Schedule

This feature assists with arranging the parasitology examination workload by providing a summary of parasitology samples that are expected (scheduled examinations). This pending list of samples can be quickly examined and, if necessary, sample requests can be moved to a different date to produce a more evenly distributed workload. This option will also produce reports listing parasitology examinations that are on the schedule. One report is in a format suitable for the laboratory personnel, while the other report will print sample request forms which can be distributed to the keepers.

Parasitology Reports:
Once parasite examination data has been entered there are several different retrieval capabilities. This menu option results in the display of a third level menu that lists the various reports available. Individual Specimen Records Report: This option will produce a report of the parasitology records for an accessioned specimen. The report can contain the complete history for that accession number or retrieval may be specified to produce a subset of the available examination records (e.g., records after a specified date). Taxonomic Group Records Report: The taxonomic group report provides a summary of parasitology examination records based on retrieval by the taxonomic group (species or subspecies). The report can be further restricted using the selection criteria filter. The report is designed to enable a rapid evaluation of previous parasite problems in an entire taxonomic group. Individual Parasitology Records: This report is similar to the Individual Specimen Report, however, the records may be retrieved either by date of sample collection or sample identification number. The report can be further restricted using the selection criteria filter. There is also an option to print a separate copy for each individual listed in a group sample record. Due for Parasitology Examination: The last piece of data collected during entry of parasitology records is the date for which the next parasitology examination should be scheduled. This option uses that information to produce a report of the specimens due for an examination during a time period that you specify (e.g., next month). Two output formats are available; a list format that is most useful for laboratory personnel and a sample request form that can be distributed to keepers. These are the same reports that can be accessed through the parasitology examination schedule option. Delinquent Parasitology Examinations: The Delinquent Examinations report will assist in running a parasite control program by providing a list of accessioned specimens that have not been examined within a specified time period. For example, if the parasite control program calls for examinations on all mammals every 6 months, this report can be used to generate a list of mammals that have not been examined within the last 6 months. Any specimens listed on the report are overdue for an examination (delinquent) and the appropriate sample requests can be made. Count of Records Report: This report gives a counting summary of how many parasitology samples were submitted and/or examined. The report can be further restricted using the selection criteria filter. The report is done for each taxon and each type of test performed (useful for an annual report to the director regarding the activities of the medical department). Summarize Parasitology Examinations: This summary report gives a simple report listing only the animals, date of sample, tests and results. This report can be further restricted using the selection criteria filter. Parasitology Results and Prescription Records: This report is a summary of parasitology examinations and corresponding prescriptions. This report will help determine whether treatments have been prescribed, and their effectiveness.

26

Parasitology Utilities
This option also produces a tertiary level menu that gives access to the various utility programs used by the parasitology module. The utility programs include: Edit/Update module parameters: This utility program is used to change the parameters that control data collection and data entry choices for the parasitology module. It is very important to run this utility to start the process of customizing MedARKS to meet your preferences and needs (on page 15). Add/Edit/Update Parasitology Dictionary: MedARKS is delivered with a file of parasites that are recognized by the program. This utility program allows the user to customize the parasite list that arrives with the program. Parasite Dictionary Reports: This option allows you to examine the contents of the dictionary file. Sort, Pack, and Index: This is a housekeeping function, which is normally used to repair damaged index files (on page 16). Rebuild Pointers File: More computer housekeeping. Don't worry about this unless you're really in trouble and you have consulted a MedARKS expert. Update Standardized Text and Forms Dictionary: This utility allows you to create and edit text entries that can easily be inserted into your records during data entry with just a few keystrokes (on page 49). Remove Old Sample Requests from Schedule: This utility is another housekeeping tool. This purges the scheduler of old sample requests prior to a given date. Data Quality Validation and Edit Routines: These utilities can be used to check your records for a variety of problems, including inconsistencies in data entry and parasite entries that are not in the dictionary file.

Prescription (treatment) records

Value to the user! Tracking prescription and treatment success and failure is critical in monitoring animal health. Without a "Zoo Formulary," most zoo veterinarians are dependent on past experience to guide treatment decisions - a computer data base of this information keeps this data safer and more easily retrievable than most human memories! Communication between the prescriber, dispenser, and administrator of a treatment can also easily break down resulting in dangerous lapses in medication or inaccurate assumptions about the success or failure of a treatment. Computer data bases can smooth over all these problems, as well as assist in the calculations necessary to determine an animal's correct dose. Overall comments: In general, a record is generated every time a drug is given to an animal for a particular reason. The treatment module is similar to other modules in that there are essentially 3 sections, a place to enter or edit prescriptions, a reports menu and a utility menu. In this module, editing includes one program to convert scheduled treatments to active prescriptions, and another to discontinue active prescriptions (i.e., it got better or it died!).

Data entry
Every time you wish to prescribe a drug (whether it be a vaccine, anthelmintic, antibiotic, or contraceptive), this program can be used. As with the rest of the modules, MedARKS will accept data from both accessioned and non-accessioned specimens. Prescription records in MedARKS may be written for an individual specimen or for an entire group of

27

specimens. The individual specimen prescription is the more common record, but in some cases it is not possible to know the drug dose received by each individual (e.g., anthelmintic treatment of a herd by adding the drug to feed to which all animals have access). Under these conditions, the MedARKS group prescription record is appropriate. With a group prescription, the drug and the dose given to the entire group is recorded, along with information about the composition of the group at the time of treatment. In a group record, no information is available about how the total drug amount was divided among the specimens (although to calculate the total dose, you may have assumed that each animal was going to get a particular dosage, like 10 mg/kg, and you should have also recorded this assumption in the prescription record). You can also have the option of treating only those animals in the taxonomic group within a certain enclosure (assuming your ARKS records are up to date.) **IMPORTANT NOTE** One of the more common misuses of the MedARKS prescription records is to enter a series of individual treatments as a group record (e.g., individually vaccinating each zebra in your herd and then entering this as a group vaccination). While most clinicians looking at the record would realize that the specified dose (e.g., 1 ml) of the vaccine was probably not divided among the 23 zebras listed, the MedARKS program is not able to make this judgement. In addition, there are a few situations where other clinicians may have difficulty deciding which is the correct interpretation of the information, so it is imperative to understand the correct usage of these two types of records. In general, group prescriptions are for herds of animals which are medicated all at once without separating them at all (i.e., Panacur to a herd of oryx mixed in their pellets.) Recording multiple individual prescriptions as a group prescription will also cause other problems with MedARKS. First, the default keeper instructions will be incorrect, since they will indicate that the drug dose should be given to the entire group, rather than to each individual. This will require retyping the keeper instructions to provide the necessary clarity, which is data entry effort that probably would not be needed if the records had been entered for each individual. In addition, the program will only print a single copy of the keeper instructions form for recording compliance with the prescription. While it is possible to record what treatment success was obtained for each animal on one sheet, it then requires copying that single sheet to file in multiple individual animal records. Entering separate prescriptions for each individual will result in a keeper instruction sheet for each animal and this sheet (when returned with keeper notations) can then simply be filed with the rest of the medical records for this individual. Finally, when attempting to calculate drug usage (useful for planning drug purchases and annual budget requirements), MedARKS will underestimate the total drug used for each incorrect group record, since the program will assume that the recorded dose was the total dose used and not multiply that amount by the number of individuals in the group. It might appear that increased data entry time would be a major problem for multiple individual prescriptions, but after entering the first prescription, MedARKS will allow you to simply duplicate the previous prescription for a new specimen. This feature was added specifically to make it easier to handle multiple individual prescriptions, and as a result, it takes only slightly more effort to enter multiple identical prescriptions that it takes to enter a single group prescription. Add/Edit Prescription Information: Accession number(s): The animal or animals associated with a prescription are the first information requested by the program and is required information. Drug to be Administered: (required field) Enter the drug using either the trade name or generic name. You may enter as little as the first 3 letters of the name, and the program will then display all of the names from the drug dictionary that are similar, allowing you to choose the most appropriate name and formulation. If a drug does not appear in the list, it is not in the dictionary. You will be offered an opportunity to add the drug to the dictionary - make sure that you spell any additions correctly as all your future records will be validated against this dictionary entry. It is also useful at some point to enter the various concentrations and formulations available for an individual drug, as this will save data entry effort in the future. Note: TB tests are slightly different. All TB tests should be entered as tuberculin. A list of the various types of tuberculin will be displayed for your selection. The date treatment is/will be started: (required field). The Drug Calculator window will now appear. The calculator is designed to assist with the prescription process by performing many common calculations for you. The fields available in this window include:

28

Loading Dose: This gives the opportunity to set a different initial dose for a prescription which may enable to the drug to reach therapeutic levels faster. This field does not interact with the dosage calculator. Dose: Enter just the digits of the dose - units of measurement are entered in a different field. Units: The default units of measurement are determined by the dictionary, but can be changed if necessary (e.g. mg may not be a useful measurement for phenylbutazone when dosing an elephant). The program also allows you to prescribe in dispensing units. For example, it is possible to write a dose of 4 with units of "tablets" and if the size of the tablet is defined in the drug concentration area, the program will convert the dose to the more appropriate units (as defined by the units of measurement for the tablet). This is not very valuable for 500 mg tablets where the calculation is easier to do in your head, but when prescribing 3.5 tablets containing 56.8 mg of a drug, it is a useful feature. Frequency of administration:. The standard choices are: SID BID TID QID q4h q6h q8h q12h q24h q48h q72h q7d q14d ad libitum as needed

Other choices can be entered by using the formula: qNh or qNd where N is the number of hours (h) or days (d). Duration: The treatment duration can be entered as the number of days, or the number of treatments to give, or UFN (until further notice). If you enter a number, the program will assume (default) that it is for days unless you indicate that it is the total number of treatments. Treatment duration units: You must decide if the number you entered for treatment duration is for days or treatments. Simply check the appropriate one (point and click or just <enter>). Route: There are 18 standard choices. Type in any of the standard two letter codes that you use routinely (e.g., PO, IP, IM, IV, SQ, etc). If the program does not recognize the code that you have entered, the full list of routes will be displayed. If the route that you desire is on the list, simply pick the appropriate choice from the list. When the route is not on the default list, you can always use your own 2-letter code. Formulation: Default values will often be obtained from the drug dictionary, but check the entry and correct if necessary. There are many standard formulations; start by using the first two letters of the formulation when entering data (e.g., SO = solution and SU = suspension). Again, if the program does not recognize the code that you have entered, the full list of formulations will be displayed Concentration: Default values are also obtained from the drug dictionary, but check that the information is correct. Weight: The program will obtain the most recent actual weight available from the historical records. If no recent actual weights are available, you can click on the "Get Last Weight" button to see if there are any recent estimates in the prescription file. You can enter a weight if the program cannot locate the information or if you have more recent information than is available on the computer. Dosage: When combined with a treatment weight, the program can calculate the drug dose (amount of drug) from this dosage (drug per unit body weight) information or the program can calculate the dosage prescribed if you provide dose and weight information. Both these calculations can be useful.

29

Dilution Calculation - You can enter the dilution factor you will use to prepare the final solution to administer. This will allow the computer to calculate the final volume of solution you will need to administer. Calculator Buttons (bottom right of window) <Calculate Dose> Will fill in the dose and units fields if you have provided dosage and weight information. <Calculate Dosage> Will fill in the dosage and dosage units fields if you have provided dose and weight information. <Calculate Volume> With liquid prescriptions, this will show you the volume that will be given, based on dose and concentration information. <Get last weight> If the weight field is empty, this will check the medical records for weight information. <Ok - done> Click on this button to move to the next data entry section. The next few fields record the initials of the clinician writing the prescription and the person that dispenses the prescription, along with date information and drug response information. The prescribing clinician initials are required if you want MedARKS to insert a one-line summary of the prescription into the clinical text records. Prescription purpose: The animal's active problems (obtained from clinical notes module) are automatically entered here. You may edit, delete or add your own text to this field. Comments and notes: This may contain a computer generated note (depending on your module parameters) that details the preparation of the drug for administration (i.e., how many doses and what dilution and what size dose should be administered). Any computer-generated notes can be deleted or edited. Other comments on the prescription can also be entered here. Keeper instructions: This part of the prescription record is printed directly onto the prescription compliance form that is given to the keeper with the drug. The computer will generate a default set of instructions for the keeper and these are generally accurate and concise. However, you can edit these instructions if necessary and your customized instructions will be printed on the keeper form. Your description of the location for a topical treatment will also be entered here. You can use the <F5> function key to access your own "pick list" of standard comments and/or keeper instructions (such as "Do not give with milk products."). You can paste any of these comments into the keeper instructions with just a few keystrokes. Daily Treatment Log: This section of the record collects information about the actual administration of the treatment, such as the date, time, success of delivery, who administered the treatment, and any comments (such as "ate well in a banana."). This information may not be available when you first write the prescription, but can be easily entered at a later time. Prescription schedule: If this prescription needs to be repeated at a future date, you can now easily add that information to the prescription scheduler. Simply indicate either the number of days to the next treatment (calculated from the end of the current prescription) or enter an absolute date for the repeat of the current prescription. That information will be saved and one of the standard reports will show you what prescriptions are coming due. MedARKS can generate a one-line summary of the prescription and enter it into clinical notes. One parameter setting offers you the opportunity to edit this line before it is saved into the clinical text records. Finally, MedARKS will mark the prescription that you have just entered for printing when you exit the module. The marking options are to: mark to print a keeper instruction/compliance sheet and a file copy mark to print just the keeper sheet mark to print just a file copy do not mark the record (no printed copy of the prescription will be produced) You are now ready to go on to the next entry. MedARKS offers several options to help save data entry time for multiple prescriptions: 1. New prescription: Sends you back to the "Accession number:" prompt, ready for a completely new prescription

30

entry. 2. Different drug for same animal(s) as last prescription: Sends you back to the drug prompt and bypasses all the animal information, which remains the same as for the last prescription. Useful when you give several drugs to the same animal. Same drug as previous prescription, but new animal(s) and dose: This sends you back to the accession number prompt, but as you go through the record, many of the data values from the previous prescription will already appear and the user need only press <enter> to keep the existing entry. You can edit as necessary. Duplicate last prescription for new animal(s): This duplicates the previous prescription information exactly, and allows only changing the animal information (very useful when you vaccinate a large group of animals). Repeat a prescription for the same animal and dose, but with a new date: This is useful for anthelmintics and scheduled procedures (such as Panacur - Rx for 3 days SID and then repeat in 2 weeks). This option allows you enter only the first prescription (rx for 3 days SID) and then duplicate the record for a future date (in 2 weeks), essentially halving your data entry time. Quit data entry: This brings you back to the main prescription menu. When quitting, the computer will ask you how to process the records that are marked for output. You can print the reports immediately, write the reports to your hard disk and print the file when you leave MedARKS, leave the records marked (come back and print later) or remove all the marks from those reports and forget about printing them.

3.

4.

5.

6.

Prescription Scheduling
Scheduling prescriptions for the future can be done in several ways. One method is simply to write (enter) a prescription using a starting date in the future and simply store the paper copy until the prescription comes due. The disadvantage of this method is that if the animals dies or is shipped out prior to the start of the prescription, you have to go into the medical records and delete the existing prescription record that was not actually filled. The second method is actually a reminder to repeat a current prescription at some point in the future. If the animal leaves the collection prior to the reminder coming due, there is no record cleanup required. When the prescription comes due, you can use the "convert scheduled treatment to prescription " option on the main treatment menu to very quickly enter the new prescription. Discontinue an Active Prescription: When you write a prescription on an "until further notice" basis, there will come a time when you issue that "further notice" and stop the treatment. You could at this point go back and edit the original prescription to indicate the correct duration of the treatment, but MedARKS offers a quicker and easier means to do this. From the main menu, select the "Discontinue an Active Prescription" option, enter the accession number and choose the appropriate prescription is from the list of prescriptions associated with that animal. You will be asked for the date that the prescription was discontinued and MedARKS will calculate the duration of treatment and make appropriate changes in the prescription record. A few keystrokes and the prescription is inactive and your records are accurate.

Prescription Reports
Once prescription information has been entered there are several different retrieval options that can be accessed from the prescription reports menu. Individual specimen records: This option results in a complete treatment and vaccination record for a specified animal. To generate this report, enter the animal's accession number. As with most of the report programs, a filter is available to help select records for retrieval (on page 46). Taxonomic group records: This option allows you to examine treatment records for an entire taxonomic group.

31

Treatment instructions/ Compliance (Keeper) form: This form is designed for use by the keeper or medical staff responsible for treatment administration. The first section identifies the animal(s) to be treated; the second section identifies the drug and provides directions for drug administration (amount, frequency, etc.). The final section provides spaces for the keeper(s) to record the date, time, delivery success, their name, and any other comments. Due for treatment report: This report identifies animals which are due for scheduled treatments during a specific time. A range of dates must be entered (this can be on a day by day basis or printed monthly - whatever works in your hospital). Drug usage report: This report is mainly designed to account for all use of controlled drugs or vaccination lot numbers. It can, however, generate a report for any drug recognized by the MedARKS dictionary. This is a very similar report to that generated in the anesthesia module. Active prescriptions/treatments report: This option produces a listing of currently active treatments. This can help monitor treatments which are designated "Until further notice" or can serve as a communication tool among veterinarians and staff so that all know which animals are being actively treated at all times. List prescriptions written report: This option lists all treatments prescribed for all animals for a specified period of time. This report is initiated by entering a desired range of dates. Count of records report: This report summarizes the total prescriptions started and total specimens treated. The records are also summarized by major taxonomic group (i.e., fish, amphibians, etc.)

Prescription Utilities
This option also produces a tertiary level menu that gives access to the various utility programs used by the prescription module. The utility programs include: Add/edit/update module parameters: This utility program is used to change the parameters that control data collection and data entry choices for the prescription module. It is very important to run this utility to start the process of customizing MedARKS to meet your preferences and needs (on page 15). Add/edit/update drug dictionary: Same utility that you can access from the anesthesia module. Drug dictionary reports: Same utility that you can access from the anesthesia module. Sort, Pack, and Index: This is a housekeeping function that is normally used to repair damaged index files (on page 16). Rebuild pointers file: More computer housekeeping. Don't worry about this unless you're really in trouble and a you have consulted a MedARKS expert. Update Standardized Text and Forms Dictionary: This is your opportunity to add phrases and even entire paragraphs of instructions you want to enter on prescriptions with the click of a few keys (specifically the <F5> key when you have a text entry box on the screen). Data quality: The MedARKS program has several methods to check data for inappropriateness (such as scheduled prescriptions that were never done and are long overdue and need to be deleted).

Analysis of Blood, Urine and Other Fluids 32

Value to the user! Diagnostic medicine in zoo veterinary medicine frequently revolves around clinical pathology results. This module of MedARKS organizes the blood sample results that you obtain on the animals in your collection. In addition, this module will provide you with reference values derived either from the animals in your collection or from the ISIS physiological values data base. Data Collection: This will be somewhat dependent on the paper flow at each institution. Ideally the results should be entered as soon as the results are returned from the laboratory. This affords the clinician the convenience of seeing the laboratory results in relation to the reference values as the medical assessment is being made.

Data entry
Add/Edit - Fluid Analysis Record: Allows you to add new clinical pathology records to the data file, and allows you to edit or delete existing records. As with all other modules, MedARKS will accept data from both accessioned and non-accessioned specimens. The original module accepted only blood sample analysis information, but recently the program was enhanced to accept analysis information for a number of body fluids (urine, CSF, saliva, joint fluid, etc.). Link to Anesthesia Records: Goals of MedARKS include reducing data entry effort and encouraging data consistency. Towards that end, blood samples collected using chemical restraint will attempt to link to a record in the anesthesia module. If you have been tracking blood sample data on the anesthesia worksheets, that information will be forwarded to the clinical pathology record during the data entry process. You can certainly enter a clinical pathology record without ever linking it to an anesthesia record in MedARKS, but in cases where the anesthesia record is entered after the clinical pathology record, this option will attempt to link the records. When it appears that an anesthesia record now exists for an unlinked clinical pathology record, you will be given the opportunity to link the anesthesia record to the matching clinical pathology results. If you do link the records, the program will warn you of any data inconsistencies (e.g., in the anesthesia record the sample collection time is given as 10:20, but the clinical pathology record says 10:02). This program can also print a list of clinical pathology records where chemical restraint was specified that are not currently linked to an anesthesia record.

Blood, Urine and Other Fluid Analysis Reports

Once clinical pathology data has been entered there are several different retrieval alternatives. Choosing this menu option results in the display of a third level menu that lists the various reports available. Individual Specimen Records Report: This option will produce a report of the clinical pathology records for an accessioned or non-accessioned specimen. The report can contain the complete history for that accession number or retrieval may be specified to produce a subset of the available records using selection criteria or by selecting individual records. Taxonomic Group Results by Sex and/or Age: The taxonomic group report calculates the mean, and standard deviation for all test results from the records of an entire species. A standard selection criteria window lets you specify various filters and in addition, the population that is of interest to you can be filtered by sex and/or age criteria. The result can be reference ranges for a very specific subpopulation of your collection (e.g., healthy, female kudu less than a week of age). The results are calculated from your records and not the ISIS pooled data, so it will probably take time to accumulate enough records to make this report useful for calculating more than an overall average. Individual Specimen Spreadsheet Report: The spreadsheet report allows you to print up to 3 hematology and/or chemistry records, from a single individual, on the same sheet of paper. The test results are printed in columns to allow easier comparison of data from different blood samples. This report also has a graphing option, (if you have sufficient memory), which allows you to produce a visual representation of the changes in test results over time. Up to 4 different tests can be plotted on a single graph.

33

Count of Records Report: This report counts all the clinical pathology records for all taxonomic classes during the time period identified. This option allows you to easily generate a summary of activities for such things as annual reports. In-house and ISIS Reference Range Report: The In-house and ISIS Reference Range Report allows you to print a summary of in-house and ISIS hematology and chemistry reference ranges for either a particular species or the entire reference values file. This report essentially gives you the ability to print the ISIS Physiological Reference Values book, or any part of it, at your own institution. Values for a Specified Test Report: This report allows you to list specific test results for an individual, an entire species, a taxonomic class or all results for the specified test in the data base. You have the option to produce a frequency distribution graph (if you have sufficient memory). You can also specify specific criteria such as results from a specific laboratory or from a specific date range.

Blood, Urine and Other Fluid Analysis Utilities

This option also produces a tertiary level menu that gives access to the various utility programs used by the clinical pathology module. The utility programs include: Edit/Update module parameters: This utility program is used to change the parameters that control data collection and data entry choices for the fluid analysis module. It is very important to run this utility to start the process of customizing MedARKS to meet your preferences and needs (on page 15), particularly with this module. Test Dictionary Editing: MedARKS is delivered with a file of clinical pathology tests that are recognized by the program. This utility program allows the user to customize the test list that arrives with the program. This is also your opportunity to create and edit text entries that can easily be inserted into your records during data entry with the click of a few keys (specifically the <F5> key when you have a text entry box on the screen). This utility allows the addition of those phrases and even entire paragraphs of text. Test Dictionary Reports: This option allows you to examine the contents of the dictionary file. Calculate In-house Reference Values: This utility will proceed through your entire set of clinical pathology records and calculate overall reference ranges for each species where you have records that meet the criteria you have specified. Hematology/Chemistry/Serology ISIS Data Transfer: This utility will extract information from your records to submit to ISIS for inclusion in the Physiological Reference Values Project (on page 78). The utility creates a data transfer file containing the necessary information on your hard disk. The file can be sent to ISIS on a floppy diskette or by E-mail. This replaces the old method of copying the information onto paper forms. Institutions that provide data to ISIS will receive annual updates of the ISIS reference values file for use with MedARKS. Sort, Pack, and Index: This is a housekeeping function that is normally used to repair damaged index files (on page 16). Data Quality Verify Against Test Dictionary: These utility can be used to check your records for test entries that are not in the dictionary file. Data Quality Suspect Test Results Report: This utility will help find test results that are possibly incorrect, assists with finding data entry errors. Data Quality Global Edit of Select Fields: This data validation utility searches, and enables correction of, data fields that may have problems such as inconsistencies in data entry. Set Order of Tests for Data Entry: One of the most useful and overlooked utilities. For each default laboratory that you have specified in the module parameters (see first utility above), you can specify the tests and the order of the tests that appear on the data entry screen for that laboratory. Thus, the data entry order for the laboratory can be made to match the

34

order of results on the report from the laboratory, which greatly simplifies the data entry process.

Cryopreservation (Serum) Bank Records - Sample storage

Value to the user! Many different types of sample are often kept long term in zoos. These may be serum, plasma, tissue, semen, whole blood or urine to name a few. To be a useful resource, it is essential to know what material is available and to be able to retrieve samples in a timely fashion. The cryopreservation bank keeps track of all information about samples, including their location, the quantity and quality of those samples and where samples have been sent. Once your freezer is organized, the material becomes a useful resource and not a black hole where samples are tossed, never to be seen again. This module also keeps track of empty storage space in your freezer(s), allowing you to recycle space that is available because samples have been sent elsewhere. Data Collection: Samples should not be placed into the bank or removed from the bank without recording the pertinent sample data. It is quite easy to record sample information onto worksheets as the sample is placed into the freezer. The information can then be entered into MedARKS at a later time, although much of the value of this resource will be lost if records are not kept current. On the positive side, data entry is simple when worksheets are completed properly, so data entry is definitely a task that can be assigned to volunteers with minimal training.

Data entry
Add Cryopreservation Bank Record Allows you to add new records to the data file. MedARKS will accept data from both accessioned and non-accessioned specimens. To add a new record, you will need to identify a unique location where the sample will be held. The address for this unique location can make use of primary, secondary, and tertiary location information. For example, the primary location code may specify a rack in the freezer, the secondary location may specify the particular storage box in the rack, and the tertiary location could identify the specific grid location within the box. If a sample location system has already been established for your institution, it should be possible to adapt this system for use within this MedARKS module. Edit/Update Cryopreservation Record This option allows you to edit or delete existing cryopreservation bank records. To begin editing serum/tissue record, you must first identify the location of the sample. Remove, Discard, or Change Location of Samples When a sample is removed from storage for any reason, it must be logged out of the MedARKS records as well. This option provides the mechanism to easily record sample removal information. To remove or change the location of the sample within MedARKS, you must first identify the exact location of the sample. When you are sending a sample out (e.g., send to a laboratory for analysis), MedARKS will generate a list of addresses where you have previously sent samples to assist in maintaining data consistency.

Cryopreservation Bank Reports

Once cryopreservation bank data has been entered, there are, several different methods for retrieval. Selecting this menu option results in the display of a third level menu that lists the various reports available. Individual Specimen Records Report: This option will produce a report of the samples (current or historical) that have been placed into the cryopreservation bank for an accessioned or non-accessioned individual. The report can contain the complete history for that individual or retrieval may be specified to produce a subset of the available records using selection

35

criteria. Those criteria may include such things as date, sample types, or quality to name a few. Taxonomic Group Records Report: This report retrieves the locations of all of the banked samples for a species. This report is particularly useful when a researcher requests serum from all of your cheetahs. As with the other reports, retrieval may be filtered by a variety of selection criteria. Samples Removed From Storage: This report is a log of the disposition of samples. You have the option of reporting samples that have been discarded, sent elsewhere or all removed samples. This report will also list the recipient when samples have been sent out and any information in the sample comments (e.g., the reason for sending out the sample). Samples Currently in Storage: This report lists the current contents of the bank by sample type. This report can be limited by location, so it is most useful for listing all the samples in a particular box or tray. There is also an option to limit the retrieval to human samples for those institutions that are storing baseline serum samples from staff members. Empty Storage Locations: Keeping track of open space in a storage freezer or container is difficult to do without this report. This listing of open locations in your bank makes it easy to reuse locations that have been vacated by removed samples. Recorded Data for Individual Samples: This report requests a sample location and then summarizes all the information about the sample stored in that location. The output includes information about the animal (species, sex, age, etc.) and the sample (type of material, quality, quantity, date collected, etc.). This report can be sent to researchers with the actual samples so that they have information about both the sample and the animal. List of Valid Sample Locations: This report gives a list of valid locations for sample storage within your bank. This is most useful for assisting with data quality issues.

Cryopreservation Bank Utilities

This option produces a tertiary level menu that gives access to the various utility programs used by the sample storage module. The utility programs include: Edit/Update module parameters: This utility program is used to change the parameters that control data collection and data entry choices for the cryopreservation bank module. It is very important to run this utility to start the process of customizing MedARKS to meet your preferences and needs (on page 15). Update Standardized Text and Forms Dictionary: Allows you to create and edit text entries that can easily be inserted into your records during data entry with the click of a few keys (specifically the <F5> key when you have a text entry box on the screen). This utility allows the addition of those phrases and even entire paragraphs of text. Standard Text and Forms Report: This report allows you to examine or print the contents of the standard text and forms dictionary. Sort, Pack, and Index: This is a housekeeping function that is normally used to repair damaged index files (on page 16). Sample Recipient Report: Lists all the people or facilities that have received samples from your institution. Data quality Global Edit of Selected Fields: This utility gives you access to global search and edit routines for the samples comments or the recipient address information.

Clinical text records 36

Value to the user! The clinical notes module enables free-form, medical text records to be recorded in a systematic manner, retrieved for use within an institution, and merged with records from other institutions. The heart of this module is a combination of a narrative text record and a more formal diagnosis entry (master problem list). Overall Comments: The clinical notes module is the first text based module for MedARKS. As a text based module it is very different from the other modules in which you are primarily entering quantitative data. It gives the user tremendous power, since virtually anything can be entered into this module (medical observations, speculations, urinalysis or microbiology results, etc.). At the same time, if the information is to be retrievable, this module also requires the user to exert the greatest discipline to maintain consistency during data entry.

Data entry
Add/Edit - Clinical Note Record: Once the clinician has entered his or her initials and identified the animal for which a record is being added or edited, you will be presented with a fairly complex screen. The top of the screen shows the active animal identification information. Immediately below this is an area showing the active problems for this animal as well as the last actual weight. The last medical text entry will be displayed in the lower middle portion of the screen. Along the bottom edge of the screen are a series of buttons that give you access to various parts of the clinical notes records as well as limited access to most of the other MedARKS modules. The menu options along the bottom of the screen are: Weights: Allows you to add, edit, or delete actual weights for the active animal. So, if part of the neonatal examination on the kudu included obtaining a weight, you do not need to exit from the clinical notes module to add that weight. Click on the weight button, enter the date and the weight and you will return to the clinical notes screen. Medical Text: Clicking on this button allows you to enter or edit the narrative records for this animal. The existing records will be listed in order by date and clinician. Choosing an existing record allows you to edit that record. You can also add a new record and then the program will prompt you for the date of the record. Text is entered as freely as the clinician wishes. Pressing the <F5> key will access a list of Standard Text Strings (on page 49). This is a list of phrases that you commonly use in your text narrative. Choosing entries from the standardized text list will save a considerable amount of typing effort. In addition, by choosing items off of the list, you are entering them in a standardized format (i.e. the same words and spelling are used each time) which enhances your data consistency. A spell checker can be accessed with the <CTRL><F2> key combination. When editing narrative records, the screen will be split with previous records shown in the upper half and the record you are editing in the lower half. It is possible to change the record displayed in the upper window and to make that window active (this is useful if you wish to copy text from a previous medical text record into the current record). Problems: This button will actually display a pop-up menu of options. These options give you access to adding\editing the more formal diagnoses, displaying all of the past and current problems, and adding\editing terms in the master problem dictionary. A diagnosis consists of a "problem" (clinical sign, procedure, infectious disease, or other problem) combined with an optional "qualifier". Qualifiers are topographies (parts of the body), etiologies, or other qualifiers which describe the problem. Text Strings: Another means to access to the utility that allows editing of the standard text string dictionary. Find that you are typing the same phrase over and over? Simply add it to your standard text strings and you can access that phrase from the <F5> list. Previous: The text narrative record displayed on the initial clinical notes screen will be the most recent entry. The previous button will show you the previous text narrative record (if one exists).

37

Next: Once you have started moving back through the text narrative records, this button will allow you to move forward through the records. Quit: Exits you from medical notes for the active animal. You can then access the records for another animal or leave the clinical notes add/edit mode by pressing <Esc>. Rx Records: This option accesses the prescription records for the active animal. It is very convenient during the addition of a clinical note on an animal to be able to jump directly to the prescription module to record the antibiotic or vaccine that was administered during the procedure and then be returned immediately to clinical notes. The prescription module also makes your life a little easier by inserting a one-line summary of the prescription into your narrative record thus saving the effort of having to type in the data. View Other Module Records: This option is the one stop shopping center, providing a viewing window for records of an animal from each MedARKS module. It allows direct viewing access from the clinical notes module to the pertinent anesthesia, parasitology, treatment, blood and other fluid analysis, clinical notes, and even ARKS3 notes. The records in each of the above modules can be viewed (cannot be modified in this area) to get a complete look at the various details regarding that specimen. Text can be copied from this viewing window into the clinical text record (on page 81). Key Field Edit-Clinical Notes Record: This menu selection allows you to edit the accession number, date, or veterinarian who wrote the clinical note. For example, if you entered a clinical notes record for an incorrect accession number, you can use this utility to easily change the respective entry to the correct animal.

Master Problem List Options

This selection is similar to the Add/Edit Clinical Notes Record option except that it is geared for the formal master problem list instead. Enter the Same Problem for Multiple Animals: As titled, this option allows you to enter the same problem for multiple animals. For example, if you took liver biopsies on a dozen birds, this utility would allow you to enter biopsy / liver for each animal without having to type the data for each individual. Add/Edit Problem List for an Individual Specimen: This option is simply another way of adding or updating a specimens problem list without going through the clinical notes record entry section. Display Problem List for an Individual Specimen: This option displays the entire formal problem list for a specimen.

Clinical Notes Reports

The report menu selections allow you to print or view clinical note records based upon selection criteria that you specify. The available reports are: Individual Specimen Records: This report prints the clinical notes records for an individual animal with filtering based on the selection criteria chosen. Taxonomic Group Records: This report is a listing of the formal problems (diagnoses) recorded for a species. The output can be limited to a specified date span. This list can be used to give you an idea of the particular problems you are seeing in a species. You can elect to run the report to include or exclude qualifiers. Daily Activity Report: This report prints all of the clinical notes entered for a particular day or span of days. This can be

38

used to print the clinical notes for the animals examined on a particular day by a particular vet. It is a very useful report for keeping hospital staff informed of active cases, particularly in institutions with multiple clinicians, this report will quickly bring someone up to date after being off work for a few days. This report can also serve as a method of archiving medical records by printing out and binding the daily activity reports. Search by Key Word: This report offers very powerful text search capabilities to this module. The report searches medical text records for a key word or combination of key words. The report may be filtered by date span, by clinicians initials, and may include or exclude non-accessioned animals. You have the ability to select the search text from your standard list of text strings or you can create your own key word combinations by simply typing in the text. Search by Problem: Similar to the search by key word, but searches the formal diagnosis (problem) records instead of the text narrative records. Unresolved (Active) Problems Report: This report lists those animals with problems that are not resolved on a specified date. The report may include all active problems in the collection or it can be filtered to locate only active problems for an individual, a taxonomic group, or a taxonomic class. The report may include long term chronic problems (e.g., diabetes in your orangutan) or the chronic problems can be ignored to give you a list of problems that you have a chance of resolving. Scheduled Activities Report: This menu selection will print a report of all scheduled procedures which have not been completed by a specified date. This selection serves as a reminder for such procedures as vaccinations, annual examinations, or MGA implant removals (in the case of the latter, its always nice to have a computerized reminder rather than a newborn on the ground!). Clinical Note - File Copies: This report will print hard copies of the clinical notes entered for all animals over a specified date range. This report can be used periodically to print out hard copies to update an animal's paper file or as a form of data backup for the computer. Activity Summary Report: This report provides a summary of clinical notes for a specific time frame. Included in this report are the total number of clinical notes entered, the number of individual specimens evaluated, and the most common problems. Useful for that end of the year report to show your director just how busy you have been! Master Problem List: This report will print a list of the problems for an individual along with onset and resolution dates. This corresponds to the master problem list found in many traditional paper record systems. It is also similar to the Master Problem List Options- Display Problem List for an Individual Specimen with the added benefit of allowing you to specify a specific date range for record retrieval.

Clinical Notes Utilities

This option produces a tertiary level menu that gives access to the various utility programs used by the clinical notes module. The utility programs include: Edit/Update module parameters: This utility program is used to change the parameters that control data collection and data entry choices for the clinical notes module. It is very important to run this utility to start the process of customizing MedARKS to meet your preferences and needs (on page 15). Add/Edit/Update Dictionary Entries: MedARKS is delivered with a file of clinical problems that are recognized by the program. This utility program allows the user to customize the problem dictionary as well as the standard text strings dictionary. Problem Dictionary reports: This option allows you to examine the contents of the dictionary file including clinical problems and qualifiers, groupings, and the standardized text and forms. Sort, Pack, and Index: This is a housekeeping function that is normally used to repair damaged index files (on page 16).

39

Data quality- Verify against Problem Dictionary: This utility can be used to validate your problem records against the dictionary file. Data quality- Validation and Edit Routines: This utility can be used to do a global edit of clinician initials. For example, if you used to enter records using only two initials and wanted to go to your current 3 initial name, you can use this routine to convert all of the old records to your current format. Global Search/Replace of Clinical Notes: This menu selection starts one of the data quality utilities that permits you to search for and, if desired, replace text in clinical notes records. You have the option to either edit a record manually or replace the term automatically. For example, if you have previously made a clinical note entry of "surgery" and you wish to change the term to "Surgical Procedure:", this utility will search every text record to locate all occurrences of the term "surgery" and allow you to replace each occurrence with "Surgical Procedure". Use this option carefully, since it is just as easy to turn every occurrence of surgery into lameness or obesity or any other nonsense that you can imagine.

Pathology records
Value to the user! The necropsy may be the end point of an individual medical record, but complete pathology records are clearly valuable for monitoring the long-term health status of a collection. The MedARKS pathology module allows you create complete necropsy and biopsy records that can be organized and searched to reveal patterns that otherwise might not be noticed. The ultimate goal is to use this information to modify either preventative health programs or animal management.

Data entry
The pathology record is fairly complex and consists of more than 40 different data fields (some of which can repeated as often as needed). The data entry flow is envisioned as follows: Step 1. When an animal dies or a biopsy is collected, the pathology record is started immediately. The initial information consists of the specimen accession number, date of death (or biopsy), carcass weight, enclosure, person submitting the biopsy or carcass, a keeper history and some other baseline information. With the completion of this initial information, the program will print a report that gives: A summary of the recent medical history (extracted from the MedARKS records) The baseline specimen information that was just entered A blank necropsy form (you can enter your own form) Research protocols that can use samples/parts from a dead animal of this species A TAG/SSP necropsy protocol (when available for this species) This entire printout can then be given to the pathologist/prosector to provide some background on the animal, a blank necropsy form for recording notes and a list of samples/tissues that need to be collected for special projects. Currently there are a limited number of SSP/TAG protocols available, but the AAZV Information Management committee is in the process of collecting other research protocols/sample requests and necropsy protocols for inclusion in the release version. There are utilities that allow you to add your own research protocols, so if you have research interests for a particular species, enter a research protocol for that species and at each necropsy you will be reminded of what samples and/or measurements you wanted to collect for that species. During this initial baseline data entry, you will also have the option to terminate all clinical problems that are active on the date of death and MedARKS can also insert death into the clinical problem file (if you set this feature in the pathology module parameters). This feature saves having to remember to go clean up the clinical problem file at a later time. Another pathology option is to simply assign a death number (no necropsy). This routine allows you to enter all the initial

40

baseline information, then skip all the gross and histopathological information (since there is no necropsy) and proceed immediately to a final cause of death. This allows you to quickly track deaths due to predation, missing and presumed dead (MIAs), or large groups of animals that die at one time but which are not all necropsied (e.g. 50 froglets die during a power outage). Step 2. After the necropsy is completed, you can return to the record using the accession number or the necropsy case number (using <Ctrl><F9>). Use the <PgDn> key to skip through the initial part of the pathology record to get to the new data fields or press <Ctrl><G> when you first start editing the record to skip directly to the gross necropsy report section of the existing record. The information to be added to the record includes: the prosector necropsy date necropsy interval gross necropsy report, gross diagnoses, organ weights laboratory samples The gross diagnosis entry may be a little confusing at first. You can type all the terms into a diagnosis, separating the terms with a comma (e.g., Lung, pneumonia, chronic, lobar, unilateral) or you can type in each term, validate the term against the dictionary, and then add the next term. When multiple terms are entered, the program will attempt to validate each term in the initial entry and then allow you to add other terms. There is no limit on the number of gross diagnoses that can be added to a pathology record. Each gross diagnosis must contain a topography term (organ/tissue/body part) and a disease process/lesion term as the absolute minimum standard. For example Liver, hepatitis is a complete diagnosis and is acceptable to MedARKS. However, you can add further terms to each diagnosis, including: modifier terms (e.g., interstitial, bacterial or granulomatous), a severity term (e.g., mild), a lesion duration term (e.g., peracute), a lesion distribution term (e.g., multifocal), an etiology term (e.g., Mycobacterium avium), and, when appropriate, a lesion symmetry term (e.g. unilateral). New diagnostic terms can be added to the dictionary, either through the utilities or at the time of entry. If you attempt to add a diagnostic term that the dictionary does not recognize, it will ask you if you want to add this term to the dictionary. You may, but think seriously first - for the program to be a useful international pool of information, we need to use as standard a dictionary as possible. Diagnostic terms found only in your dictionary will make your data slightly incompatible with other pools of data around the world. Step 3. If you are using an outside pathologist for the histopathology, the pathology record to this point (including the gross examination and diagnoses) can be printed and included with the tissues to give the pathologist a complete history on the animal. Step 4. When the histopathology and laboratory data come back, you can return again to the record and edit the record to add such information as the pathologist, the histopathology report, laboratory results, histopathology diagnoses and the cause of death. As with gross diagnoses, it is possible to add your own diagnostic terms to the histopathology diagnoses, but again, do this with caution and forethought.

The laboratory results and cause of death are modified versions of the gross and histopathology diagnoses. For example, a culture result consists of a topography term (organ or tissue that was cultured) and an etiology term (organism isolated). In addition, you can add a comment to a laboratory result by starting the comment with an equals sign". A valid culture result "diagnosis" entry would be "Kidney, Salmonella sp., =many". The comments portion of the diagnosis is not validated against the dictionary, so do not use it for terms that you may want to search for in the future (i.e., comments are not

41

validated for spelling like the rest of the diagnosis). Three type of laboratory results are recognized: culture results toxicology results other laboratory results (e.g., fluorescent antibody testing) The advantage to putting your laboratory results in as a form of diagnosis is that you will be able to retrieve results more easily and consistently. For example, it would be possible to easily retrieve and print all kidney mercury measurements for a particular species, by selecting for toxicology diagnoses containing kidney and mercury and restricting to a specified species. The cause of death diagnosis is like the gross and histopathology diagnoses, in that it requires a topography term and a disease process term, but only a single "cause of death" diagnosis is allowed. The cause of death entry should reflect the ultimate underlying cause for the death of the animal (yes, "body as a whole, undetermined" is a valid cause of death). Step 5. Once all the reports, diagnoses, laboratory results and pathologist's comments have been entered, the record needs to be marked as being finalized. Once finalized, the editing of the pathology report is restricted to people with "master" password clearance. However, an addendum can still be added to the report by anyone with data entry access. To make it easy to locate records that need to be finalized, one of the standard reports will print a list of pathology records that have not been finalized.

Global Search/Replace of Pathology Text: As in the clinical notes module (on page 40), the pathology module allows you to search out particular text and edit this text or replace it with a predefined text string. It is crucial that this be used with caution, as this is a powerful editing tool. By entering the exact text you wish to replace, you can change or update a phrase that is no longer valid, or is confusing. For example, if you have used x-ray and radiograph throughout your records and would like consistency, this utility will help solve the problem. Entering x-ray, as the search term and replacing with radiograph will improve your records throughout the module. The program will allow you to confirm each replacement, so if you really want x-ray left in a certain context, you can skip that particular replacement. Finally, you could also search and replace for "xray" and "x ray" just in case you were inconsistent in your use of the abbreviation.

Pathology Reports
As with the other modules, various reports can be generated and customized by the use of filters (on page 46). Individual Specimen Record: This record allows you to pull up a pathology record by the individuals accession number. By entering the accession number, all the pathology reports available for a specimen are displayed (biopsies and necropsy). You can choose to print the record(s) of your choice. Taxonomic group records: This option can display various collections of pathology data from a particular taxonomic group. Again filters can be used. Individual pathology records: This allows the user to print out any part or parts of a pathology record (or the whole thing). Same as the first report, except the record desired is specified by the pathology case number. There are 12 different parts available for each report. Medical history Baseline data Special requests for pathologist Gross examination narrative Gross diagnoses/findings Laboratory studies Histopathology examination (narrative)

42

Histopathology diagnoses/findings Cause of death Pathologist, finalization data and comments Report addendum Organ weights This option also allows for rapid selection of multiple reports, so that at the end of a data entry session, full pathology reports of a group of pathology records can be rapidly printed. Pathology Diagnoses and Associated Case Numbers: This allows the user to seek out and retrieve case numbers associated with a particular diagnosis. Count of records report: This report provides simple totals for records meeting certain criteria (i.e., a filter!). Search by diagnosis: This allows records to be sought out and selected by diagnosis. Search by Key Word: This allows records to be sought out by a key word in the text (such as seeking all records where the ovaries were specifically examined and noted in the gross necropsy or histopathologists report). Unfinished /Pending pathology Records: This report will seek out and list all pathology cases which are still in need of more information or attention (especially useful if these tasks are delegated). Pathology case summary: A listing of all pathology cases, the specimen ID, the final diagnosis, and the status during a specified period of time. Useful for keeping a running tab on all cases in a brief format.

Pathology Utilities:
Edit/Update module parameters:: As always, this utility program is used to change the parameters that control data collection and data entry choices for the pathology module. It is very important to run this utility to start the process of customizing MedARKS to meet your preferences and needs (on page 15). Setting the pathology module parameters before you start to enter pathology records will make the data entry easier and ensure that your records have consistency. The parameters that can be set are: Prosector: A list of the staff that routinely perform necropsies can be entered, allowing a quick pick from the list during data entry. Remember, that these lists will be used with just a point and click of the mouse - it behooves you to use full names for prosectors, pathologists, staff, and institutions (disposition and necropsy location) since this data may be pooled internationally at some time. (e.g. MSU means different things to people in Michigan, Mississippi, and Missouri!). Pathologist: A list of the staff or consultants that routinely have responsibility for finalizing pathology cases can be entered, allowing a quick pick from the list during data entry (for many institutions this will probably be the same as prosector list). Necropsy Locations: A list of the common locations where necropsies are performed - will be most useful for institutions that send cases to outside facilities for necropsy (like the local veterinary school, state diagnostic laboratory, or primate center). Staff: The list of staff that routinely submit carcasses for necropsy. For many institutions, this will include keeper and curatorial staff, so it may take some effort to create a complete list. However, there is no limit on the number of names that can be included in the list and picking from a complete list will be easier than typing in a full name for each record. Carcass Disposition: A list of the routine methods used by your institution to dispose of a carcass after necropsy (e.g., burial on zoo grounds, rendering, incineration, local museum, researcher, university biology program).

43

Institutional Category: This is something new for MedARKS - a searchable data field where you get to decide on the information that will be stored in the field. If there is some piece of information that you want to routinely track on pathology cases (and even retrieve records based on this information) and the pathology record does not already handle this information, then this is the field that you can use to track this information (30 character limit). Confused? all right, here is an example (the only one I can think of). Your institution has a standing policy that the appropriate curator receives a copy of the final pathology record, so you need to track the information about which of the 8 specialty curators gets the report for this specimen - here is the perfect place to do it. Your institutional category list will consist of the names of the 8 specialty curators so that this information is easily added to the pathology record making it is elementary to ensure that the copy of the final report goes to the correct person. Anyway, think about this one for a while. If you do not need an institutional category list, leave it blank and the program will skip this portion of the record during data entry. Report heading: If you defined an Institutional Category list, then this is the heading that will appear on the pathology reports (for the above example, the heading might be "Curator" or "Copy final report to"). If you did not define a list, you will not be asked for this information. Pathology Case Numbering Scheme: You are given 3 choices. Sequential numbering, Sequential numbering within a year and manual numbering. The first 2 methods assign the appropriate case number when you start a pathology record, while the last method forces you to assign a unique case number to each pathology record. Reporting period for prior medical problems: When the pathology program generates a summary of recent medical events from the MedARKS records, it will look back through the records for this period of time. Choose the time span that you (or your pathologist) find most appropriate. Resident/Intern/Student question: If your institution is involved in a training program, it will probably be necessary to track information on the resident, intern or student with responsibility for the case. The resident reading the histopathology slides may not always be the prosector and is not the pathologist with responsibility for "signing off" on the case and this field allows you to record this information. If this information does not apply to your institution, answer "no" to this question and you will "turn off" this portion of the data entry program. Custom Report Formats: When the pathology records are printed, there are 12 different sections to the report. You can choose to print any or all of these report sections. In addition, you can predefine 2 custom report formats for your institution. Time for another example? Do you send a copy of the gross examination (necropsy) report to the curator? You might decide (in the interest of saving paper) that the curator does not need a copy of the recent medical history section, the special instructions to the pathologist section, or the laboratory samples submitted section, so one of your custom formats would be to print the baseline data section, the gross examination report section and the gross diagnoses section (a custom format that prints only 3 of the 12 possible sections). When you need to print a copy of a record to send to a curator, you simply pick this predefined custom format (the report program will ask about the report format to be printed) and the appropriate sections are printed. Add/Edit/Update Dictionary Entries: MedARKS is delivered with a file of pathology terms that are recognized by the program. This utility program allows the user to customize the pathology dictionary as well as the standard text strings dictionary. Problem Dictionary Reports: This option allows you to examine the contents of the pathology dictionary file by term categories and by grouping. You can also retrieve entries from the standardized text and forms list. Sort, Pack, and Index: This is a housekeeping function that is normally used to repair damaged index files (on page 16). Data quality- Verify Diagnosis Records: This utility can be used to validate your pathology diagnosis records against the pathology dictionary file.

44

Print Sample Request Information: Allows you to extract information from the sample request file (see below). Edit\Update Sample Request File: The utility allows you add protocols that are specific for your institution, to update SSP and TAG protocols from a master file maintained by ISIS and to delete expired protocols.

Pathology Module - Special Features

< F5> pick list: As with all other modules in MedARKS, you can define a list of standard text phrases or paragraphs that can be chosen from a pop-up menu and inserted into your pathology record with just a few keystrokes. This <F5> list is separate from the lists for clinical notes or other modules. By default the list is empty when you receive the program - it must be filled in by YOU. The pop-up list is available by pressing the <F5> key when you are editing the keeper history, the special requests for the pathologist, the laboratory sample submissions, the gross examination report, histopathology report, and the comment section of the record. For example, if you always find yourself typing "Please perform a cosmetic necropsy - museum wants carcass" into the "requests to the pathologist" section, then you can reduce this entry to just a few keystrokes (or clicks of the mouse) by putting this phrase in the <F5> pick list. The standard text list of the pathology module also has a special entry that can be made. Here is where you can define a blank necropsy form for your institution that can be printed from the pathology dictionary report utility. In addition, if this form is specifically called "Blank Necropsy Form" in the standard text list, the program will automatically locate and print a copy of this form whenever a necropsy record is started (along with the recent medical history and baseline death information). The prosector then receives not only the animal and recent medical history information, but also a blank necropsy form that has been customized to meet the needs of your institution. ASCII File Import: Many institutions use consulting pathologists to perform all or part of their pathology work. If the pathologist will send you their report on a floppy disk, as an ASCII text file (most word processing programs will allow you to save a document in this format), then you can import this text directly into the gross examination or histopathology report section of the pathology record. This can potentially save considerable data entry time and avoids the problems associated with retyping a printed copy of the report into the pathology record. Even when the necropsy report and histopathology report are delivered on a floppy disk as a single file, it will be quicker to import the entire file and delete the sections that are not applicable. The mouse and delete key can be used to quickly block out and delete text that does not apply to the section being edited. Some university laboratories (e.g. Michigan State University Animal Health Diagnostic Lab) offer their reports on a web site - easily downloadable in ASCII form. Other pathologists can also E-mail the report, either as part of the mail message or as an attached file. For those of you with historical pathology records saved as word processing files, it should be possible to save those reports in ASCII format and import those old reports into MedARKS, considerably reducing the amount of work required to get your historical pathology records on-line. SSP Necropsy, Sample collection and Research protocols The pathology records module includes a file that is designed to help you manage the requests for samples, requests for body parts, research protocols, experimental treatment protocols and necropsy protocols that generally accumulate in large piles on our desks or in file cabinets. Originally this protocol management system was designed for necropsy related samples, but there is no fundamental difference between an experimental treatment protocol or a blood sample request and a necropsy sample request (other than the fact that the animal is dead in one case). As a result, the protocol manager was generalized to enable MedARKS to assist you with managing requests for live animal samples in addition to the important pathology functions. As you start a necropsy record and have identified an animal (and thereby a species), the protocol manager checks for sample requests that pertain to that species, and will automatically remind you about applicable sample requests or necropsy protocols.

45

Reports and Record Selection Criteria

Much of the value of computerized data is not the process of collecting that data, but in using the data to help make decisions and to learn either from a historical perspective at your institution or from a more global perspective when records from multiple institutions are merged. One of the most important parts of every module is the report section, where you get the opportunity to make the data work for you (and the zoo community). To a large extent, the issue of reports has been addressed in the individual module sections, but there is one general concept that applies to many of the report programs that does need to be explained. Retrieving every piece of information is frequently too overwhelming to be very useful, so you have to be able to control what data is retrieved. The tool you use to select a portion of the available data is called a filter.

Filters explained
Every report is filtering data at some level (e.g., selecting anesthesia records for a particular specimen is filtering all the available records so that you only see the records for that specimen). MedARKS will frequently give you the chance to specify filters prior to retrieving the records. These filter windows vary in details from module to module and range from simple to very complex, but all have the same basic appearance and function. The filters in MedARKS are referred to as Selection Criteria. Filters allow the user to pick and choose the data that is presented. By putting restrictions on the data (e.g., you only want data from the past 2 years and you dont want data from sick animals) you can limit the number of records reported, and thus improve the usefulness of that report. Like sand running through a series of filters, only a select fine grade of very valuable sand finally passes out the bottom of the filtration system. While prudent use of filters is often helpful, there are clearly times when it can be too much of a good thing. Some thought must go into choosing the filtration for a record retrieval. Just as you can make a sand filter so fine so that no sand comes out the bottom, too many selection criteria on a record retrieval can leave you with no data to examine. The simplest example would be using two mutually exclusive filters. Records that pass one criteria for inclusion cannot pass the second test for inclusion in the retrieval. Less obviously, if you simply add too many restrictions (selection criteria) you may end up with no records retrieved. However, if you are looking for one specific record in a large data set, then multiple selection criteria are justified since having one record at the end of the retrieval is the goal. In MedARKS, the selection criteria windows have a fairly standard appearance. The selection criteria window will offer a list of items that you can activate as filters. Activate none and you get all the records available (no filter). If you click on any of the filter options offered you apply a filter to the retrieval process. While multiple filter options offer the ability to perform complex filtering of the data, the types of filter options are actually quite limited (not all filter types may be present on a selection criteria window). The basic filter option types are: 1. A text search on a particular field: Records selected will contain a specific word or phrase (that you choose) in that particular field. For example, a filter could offer the ability to select for a specific word or phrase in the comment section of the record. Activate this filter and you are given the opportunity to type in a word or phrase; now only records with that word in the comments will be retrieved. 2. Filter by date: Click on this type of option and you get to specify the starting and ending date for the record retrieval. For example, you only want records for the past 2 years; activate this type of filter option and you can specify the desired date range. 3. OR lists: Click on this type of filter option and you are presented with a list of choices. You may click on one or more items on the list to build the filter. When you choose more than one item, records are retrieved when they include any of the items. Essentially you should interpret this filter option as saying: Select records that contain this item OR that item. An example is from the anesthesia selection criteria window. If you choose the Overall rating option, you are presented with a list of 4 items (excellent, good, fair, poor) and if you if you choose to filter on both excellent and good, then the records retrieved will be rated as either excellent or good. When you have finished making selections from an OR list, click off the list or press <enter> to return to the main filter window. 4. Range options: This type of filter allows you to specify a range of values for the field specified by the option. Click on the option and you will be prompted for minimum and maximum values. An example is from the anesthesia module where you can filter by body weight, allowing you retrieve records where, for example, the animal weighed between 75 and 150 pounds.

46

5.

Toggle options: These filter options allow you to choose between a limited list of mutually exclusive options. Like a toggle switch that can flip between a limited number of positions, these options work the same way. Click on a two-position toggle and the other option becomes visible. Click on a 3-way toggle and you get a list from which you can choose one option.

As stated earlier, you can activate as many or as few of the filter options as you desire, but remember, that the more options you activate, the longer the filtration process will take and the fewer records will be retrieved in the end. When you have activated all the filter options that you need in a selection criteria window, press <Ctrl><End> to signal the program that you are done with building the filter. The power of filters to control your data and give you meaningful reports will be demonstrated in the exercises. The final thing to say about filters is that applying a filter implicitly states that you have been consistent with your data entry. There is little point in searching for all records containing left tarsus if you have sometimes made the entry as l. tarsus or lt. tarsus or left hock. MedARKS offers tools to assist with data consistency, but in the end, the responsibility falls on your shoulders.

Electronic Data Transfer and Information Sharing

General information One of the advantages of having multiple institutions keeping medical records in a standard format is that it is much easier to share and merge that information. The ability to transfer (or export) information has been included as part of the MedARKS program. Several record transfer routines are available. You can transfer MedARKS records based on accession number, based on genus or species, or based on a date range. Each of these transfer options is most useful for particular circumstances. In addition, you can transfer anesthesia records based on the use of a particular drug. Finally, you are able to export hematology and serum/plasma chemistry results for ISIS to include in the Physiological Reference Values Project.

Sending clinical pathology records to ISIS

Background on the Physiological Reference Values Project ISIS has been collecting hematology and serum chemistry information from member institutions for about 20 years. The goal of this project was to provide reference ranges for a variety of species by combining information from multiple institutions. Most institutions have a fairly limited population of any particular species, so it can take years to gather sufficient information to generate useful reference ranges, but combining (or pooling) information from multiple institutions can quickly generate larger sample sizes. While there are potential problems with combining information from different institutions (different test methods and transcription errors), these are the often the same problems faced even within a single institution that sends samples to multiple laboratories. Rigorous screening of the test results submitted to ISIS helps to eliminate erroneous results. For most of the past 20 years, data was submitted to ISIS by transcribing results onto paper forms and mailing those forms to the ISIS offices. This was a fairly labor intensive process, and the combined data set grew fairly slowly. With the release of the MedARKS hematology and chemistry records module, it became possible to submit the information electronically. Anyone that is using MedARKS to maintain their clinical pathology records, has already done most of the work required to submit information to ISIS. We ask that all institutions send their information, to ISIS, once or twice a year. In return, all institutions submitting records to ISIS will receive an updated set of reference values for use with the MedARKS program.

Creating an ISIS data transfer file - the nuts and bolts

After you have been using MedARKS to handle your hematology, chemistry and serology records for a few months it is time to transfer some of those records to ISIS. Start the MedARKS program, go to the analysis of blood, urine and other fluids menu and choose the utilities option. This will display the blood, urine and other fluid analysis utility menu. Choice

47

#5 is the utility that assists with the transfer of information to ISIS. Starting this utility gives you the following 4 choices. Create transfer file containing data records for ISIS: This choice will browse through your records, locate records that have information that should be sent to ISIS and create a data transfer file that contains a summary of these records. If you have more that 1000 records to send to ISIS, multiple data transfer files will be created; each data transfer file can contain up to 1000 records. Once all your records have been processed, you will be given the chance to copy the data transfer file(s) to a floppy diskette. If you are familiar with E-mail, you can also attach the file(s) to a message and send the file(s) to andy@isis.org. The subject line should contain the phrase "MedARKS FILES". b) Copy previously created ISIS transfer file to floppy disk: Usually, you will have transferred the ISIS file to a floppy diskette at the time it is created. However, there are situations when you will need to copy the ISIS data transfer file(s) to a floppy disk at a later time. This routine will list the ISIS data transfer files on your hard disk and allow you to copy them to a floppy diskette. c) Mark all records for complete transfer to ISIS again: The MedARKS data transfer system is designed to keep the ISIS data set synchronized with your records, and normally only changes in your records are sent to ISIS. However, occasionally it may be necessary to have you send all your records to ISIS again. This utility marks all your records as in need of transfer to ISIS and then when you create the data transfer file (see above, section a.), it will contain information from all appropriate records. d) Count the records available for transfer: Curious about how many records you have that may need to be sent to ISIS? This routine will quickly count the records that are currently marked for transfer to ISIS. Note: There are several factors that control the actual transfer of records to ISIS, so the number given by this routine is the highest possible record transfer number. At the time you create a data transfer file, some records may not pass all the tests for inclusion, so fewer records may be in the actual data transfer file than was initially indicated by this routine. a)

Library disks
Library (or reference) diskettes represent a compilation of information from a single institution or a number of institutions. These diskettes can include records from all modules of MedARKS or just a single module (e.g., only anesthesia records). Library diskettes can be accessed by the MedARKS program and the records searched and examined using the standard MedARKS reports. You can create your own single institution library diskettes by requesting a MedARKS data transfer diskette from any institution using MedARKS. For example, you have just received your first chimpanzees, so you request chimpanzee data diskettes from several institutions. You then examine these records, using the MedARKS library functions, to see what problems and routine procedures are common at these institutions. Library diskettes from ISIS all contain information compiled from multiple institutions. This merging of records from multiple institution requires a special utility that is not included as part of the MedARKS program. However, the MedARKS technical support office will combine records to generate library diskettes for SSP medical advisors if the advisors will collect the institutional diskettes. Library diskettes, representing the combined experience of multiple institutions, currently exist for okapi, New world tapirs and Old world tapirs. There is also a carfentanil anesthesia library diskette. Detailed instructions for accessing Library diskettes are included in the appendix of this manual (on page 76).

Sending a medical history to another institution:

The medical history data transfer routine allows you to specify an accession number (or a series of accession numbers) and then copy the appropriate medical records to a floppy diskette. This feature was designed to make your job easier when you ship an animal (or animals) to another institution. No longer is there a need to pull paper files and run dozens of sheets through the copy machine. Instead, just start the MedARKS program, choose #7 from the main menu and then start the Medical History - Data Transfer utility (choice #4). Choose to transfer records to a diskette and then choose to transfer records based on accession number. Enter the accession number (or a series of numbers), place a blank diskette in the floppy drive and all the medical records will be copied to that diskette. At the receiving institution, the records on the diskette can be loaded into their copy of MedARKS, making the complete medical history of the specimen(s) available in a familiar and searchable format.

48

Sending medical records to SSP Medical advisors

This is essentially the same as sending a medical history to another institution, but you want to send the records on multiple animals. You could enter all the accession numbers (current and historical) for the species requested, but the MedARKS data transfer routine offers a much more convenient option - transfer by taxonomic group. This option allows you to copy records for an entire species (or genus) to a floppy diskette. The SSP medical advisor can use MedARKS to access the records on each diskette or MedARKS technical support can assemble all the diskettes into a single data set to allow easier searching of the available information. IMPORTANT NOTE: This utility should only be run once per diskette. If you are transferring records on more than one genus or species, you need a separate diskette each time you run the transfer routine. Running this utility more than one time per diskette will overwrite the data that you have previously transferred and the diskette will contain only information on the last genus or species that you transferred.

Loading a medical history from another institution

When you receive a MedARKS data transfer diskette along with a new specimen, you can merge the medical records on that diskette into your MedARKS records (once the new specimen has been entered into your ARKS records). Start the medical records data transfer utility (see above), but choose the option to transfer records from a floppy diskette. The program will display the accession number (used at the previous institution) of the first specimen on the diskette and you will be prompted to enter the accession number that has been assigned by your institution. If there is more than one specimen on the diskette, the next specimen will then be displayed and you will be prompted for the new accession number of this specimen. Once all the specimens on the diskette have been associated with their new accession number, the program will begin reading the medical records on the diskette and adding the records to the appropriate specimen in your system. Once the program is complete, the medical history of the specimen(s) should be available through the MedARKS program.

Special features Standard Text Dictionary (< F5> pick list)

Every module in MedARKS allows you to define a list of standard text phrases or paragraphs. When you receive the program, the clinical notes list contains some text entries (as examples), but the standard text lists for the other modules are empty. Adding routinely used text entries to these lists can significantly ease data entry effort and provide more consistency within your text records. When you are working in a section of the record where the <F5> key is active, that information is displayed at the bottom of the screen. The list of standard text entries for the module will be displayed if you press the <F5> key and selecting an entry on the list will cause that text to be inserted into the record. The <F5> list for each module is separate from the lists for the other modules, so the list of choices is specific for the currently active module.

Non-accessioned specimens
MedARKS version 5 introduced the ability to maintain medical records on individual animals that are not in the ARKS inventory files. This feature was originally designed into MedARKS 5 to allow clinicians to maintain medical records on injured wild animals or other specimens (e.g. fish) that would not be accessioned into the institutional ARKS data files. However, other functions have been found for non-accessioned specimen records and the MedARKS 5 program was enhanced to make this feature even more useful. Examples for use of the non-accessioned specimen feature include:

49

1.

Wildlife Rehabilitation: Many zoo hospitals function as the local treatment center for injured wildlife, although it is much rarer to for an institution to accession these wild specimens into ARKS. A non-accessioned specimen record can be established in MedARKS for each individual treated and complete medical records maintained on each animal, with notes on the ultimate disposition of the specimen. Wildlife Research: Many zoos are involved in conservation projects or ecological studies that involve monitoring of wild populations and often this involves collection of medical information. For example, if an animal is immobilized to attach a radio tracking device and a blood sample is collected, the non-accessioned specimen feature can be used to maintain anesthesia, hematology, serum chemistry, serology, and weight records on this individual animal. If the same animal is handled again, at some time in the future, the MedARKS non-accessioned specimen records provide valuable historical information on that individual. Records obtained on many individuals from the population being studied can provide invaluable data on the health status of the population and information, such as immobilization techniques for wildlife, can be shared with other wildlife researchers. One institution in the U.S.A.. is using MedARKS to track medical and other information on over 700 wild Humboldt penguins as part of a long-term study of a breeding colony in Chile. Temporary Identification for an Accessioned Specimen: In many institutions, the ARKS records are maintained on a separate computer from the MedARKS records. An animal received into quarantine will begin to generate medical records immediately, but it may be several days (or longer) before an updated copy of the ARKS files is placed on the MedARKS computer to allow data entry for this newly accessioned specimen. This lag, between animal arrival and the ability to enter records on an accessioned specimen, makes it difficult for the clinician to keep the medical records up-to-date and increases the risk that some information will be forgotten or lost before MedARKS data entry can begin. The non-accessioned specimen feature can be used to provide a temporary identification for the new animal and allow medical record entry to begin immediately. Once the ARKS records have been updated, all the records entered on the non-accessioned specimen can be assigned to the correct accession number using the conversion routine included in MedARKS 5 (from the main menu, press option 7, then 9). This ability to maintain records on an accessioned specimen prior to updating the ARKS files should reduce the need for frequent transfer of the updated ARKS files to the MedARKS computer. Institutional Non-accessioned Specimens: Not every specimen at an institution will be entered into ARKS, yet the specimen may be an identifiable individual or part of a recognized group that is treated by the clinician. Exhibits of fish are a common example, where larger fish may be marked with tags or transponder chips for easy identification as an individual specimen, but few institutions accession these specimens into ARKS. Under these conditions, the clinician can use the non-accessioned specimen feature to maintain medical records on individual fish or groups of fish in a single exhibit, even though these specimens are not tracked in the ARKS files.

2.

3.

4.

Full-screen browse of reports

The MedARKS program offers 3 forms of output for reports. You can print a report, save the report to a file on your hard disk (for printing later) or display on the screen, one page at a time. After a few years of use, most people found that their MedARKS records had became too complex for the screen display to be very useful. Users often needed to refer back to earlier pages in long reports and the screen output, which discards a page after it is displayed, does not allow the user to go backward through the report. What was requested was a means to look at a report on the screen (to save paper), but also to be able to browse back and forth between various pages of the report. The browse utility (System Utilities menu) was added as a solution to this user request. It takes advantage of the existing capability of the program to write a report to the hard disk and gives you the capability to display that complete report in a window where it is possible to browse all the pages of the report. If you do not need a printed copy of a report, get in the habit of writing reports to the disk rather than using the screen output option and then use the browse utility to look at the entire report. You can activate the browse utility from the system utilities menu or by pressing the <Alt><F12> key combination from any MedARKS menu.

50

Exercises
Using a filter One complete example will serve to demonstrate the power of filters. Follow along in this exercise to build a filter. A keeper tells you that she thinks the kudu currently showing signs of weight loss and abdominal distension (cause is currently undiagnosed) is related to the female that died a few years ago with similar clinical signs. The keeper remembers nothing else about the female kudu except that it had a red eartag. You want to examine the medical records to determine if the case that the keeper remembers has any similarity to the present case. The problem is that your institution has held over 70 kudu. You clearly do not want to examine the records on every animal. How do you narrow (filter) that list down to something that is more manageable? Go into the clinical notes section and when the accession number is requested, press <F9> to start the accession number search routine. Now you can start the filtration process by specifying kudu as the species. Next you are presented with a selection criteria window with the following filter options: 1. Current inventory or historical inventory (toggle type option) 2. Sex (OR list type option) 3. Acquisition date range (Date range type option) 4. Disposition date range (Date range type option) 5. House name (Text search type option) 6. Tag or band information (Text search type option) 7. Tattoo information (Text search type option) 8. Transponder chip information (Text search type option) Use these options to build your filter. Click on #1 to specify the historical collection (you know the animal is not in the current collection), then click on #2 and specify Female and finally click on #6 and specify the color red. Now click on the <Ctrl><End> to apply that filter to the data records. The result of this filtration will be a list of 2 animals. Now the task of examining the medical records is quite manageable. Inventory and History Module 1. 2. What is the current age of Chester the cheetah? You will be performing routine physicals on your entire collection of cheetah. To help plan the procedures, you need to know the age, sex, and number of cheetahs that are in the current collection. You have received a exotic felid growth survey asking for all the weight data available for all cheetahs held at your institution.

3.

Anesthesia Module 1. You are planning an immobilization of the gorilla, Linda. In your planning, you wish to review previous immobilizations and drug protocols to determine what combination seems to work best with this animal. You need to anesthetize the new 2 year-old male cheetah for a routine quarantine examination. Generate a summary of drugs and dosages used in immobilizations of similar cheetahs. You are preparing the annual report for 1994 (you are behind on your paper work) and want to include the total number of immobilizations done during the year. A new analgesic called Medetomidine Hydrochloride has recently come onto the market. The trade name is Domitor and it comes in a concentration of 1 mg/ml. Add this drug to the MedARKS dictionary.

2.

3.

4.

Bonus exercise: You have just received the first okapi at your institution and, wanting to be prepared for any emergency, you review the

51

carfentanil doses used by other institutions to immobilize okapi. Parasitology 1. Its October of 1998 and your technician has gone on maternity leave. In her absence you are running the fecal examinations for the routine parasitology program. Which samples do the keepers need to collect for you? A Humboldt Penguin B292 arrived late last night to your zoo from another institution. The keeper staff, being ever so eager and able, has already collected quarantine fecal for examination. On floatation the technician finds Capillaria. The registrar has not even begun to think about entering last weeks records into ARKS let alone last nights arrival. Enter the record into MedARKS

2.

Clinical Pathology Module Exercises Hematology / Chemistry: 1. 2. You have a sick bongo antelope and want to look at the ISIS reference values for bongo. Humboldt penguin B2643 has been treated for suspected aspergillosis for the past several weeks. The bird seems to be improving, so you collect a blood sample. Compare the hematology and chemistry results with last two sets of clinical pathology results from this bird and decide whether the bird seems to be recovering. You are publishing a paper in the Australian Journal of Rhinoceros Physiology and need to know the BUN conversion factor for American unit values to International units. The bontebok (Damaliscus dorcas dorcas) EEP is surveying institutions for cases of anemia. Specifically, they are requesting information on hematocrit and iron saturation values. Much to your surprise, you remember at least one case in your records. a. Identify the animal and the time period of the illness. b. Retrieve hematocrit and WBC values for the last two years. You have received a survey from the Cheetah EEP. You need to send them a report of all of the FIP titers (IFA method) obtained from your cheetah. A new laboratory called Zoolab has recently moved to your area. Since the CBCs are half the price of the lab you are currently using you decide to switch labs. When the results come back the labs report has the test in the following order RBC HGB HCT WBC Platelet count Set up MedARKS to make data entry for Zoolab easier.

3.

4.

5.

6.

Serum Bank Module: 1. You have received a black rhinoceros from another institution. You suspect that the fat, scruffy looking rhinoceros suffers from hypothyroidism. You submit a sample for thyroid hormone measurements, but you do not recall ever running thyroid levels on other rhinos. What serum samples are available in your freezer for obtaining comparative thyroid hormone measurements ?

Clinical Notes Module

52

1.

You've just finished another busy day of saving lives and preventing plague and pestilence. You sit down at your computer and want to enter the following information from one of today's cases into the medical records. The events go like this: Keepers call on the radio for you to look at Ralph, a Mitchells Cockatoo, who is bleeding from a laceration on the lower abdomen. Upon arrival to the enclosure, you talk to the keepers. Apparently, Ralph was plucking feathers and tore the skin on the abdomen. On visual inspection you find that Ralph has a steady stream of blood coming from his lower abdomen. Keepers have him isolated and he has not been fed today, so you decide to immobilize him using Propofol. You draw blood in Heparin and serum tubes for CBC, serum profile, and banking. You confirm that this bird has the ID transponder chip 00-0014-3C4C. You complete your physical exam and found no other problems besides the laceration. At the request of the EEP, you measure the wing span. You suture the laceration and start him on Bactrim, 200 mg PO BID for the next 10 days. Recovery from anesthesia is normal and suture removal is scheduled in 14 days. Now delete this entry about the Mitchells Cockatoo.

2.

You have been lucky enough to convince your director to hire a new associate (Edward Nigel Dothbert). Add his initials to the clinical note module before he begins employment. You spent the morning doing quarantine examinations on 6 penguins. You now must write records and you wish to reduce the number of times that you record the same basic information for each bird. Create standard text for a bird quarantine examination and then enter a record for bird B292.

3.

Pathology Module a) Its 6:00 pm, and as you get into your car to leave work early, you are notified that a Maned Wolf has just been found dead in its enclosure. You prepare to do the necropsy and want to know if there are any EEP requests for Maned Wolf tissues.

Bonus exercise: Greater kudu #2520 just gave birth to a 18 kg male calf. The calf is alert and is able to stand, but appears slightly weak. The keepers report that the calf appeared to suckle within a couple of hours of birth. You are trying to determine whether this calf should be watched more closely than the other kudu calves. a) Is this a normal birth weight for a male kudu? b) What is the history of the dam regarding previous births? c) Check the weights of her previous calves. d) Check the medical history of these calves.

53

Helpful Hints for the Exercises Inventory & Medical History 1. Use the collection data - individual specimen report and the <F9>. 2. Use the collection data - taxonomic group report. 3. Use the specimen weights menu. Anesthesia 1. Use the individual specimen report section. Choose <F9> to look up animals accession #. 2. Use the taxonomic group summary in the anesthesia reports. 3. Use the daily summary from the anesthesia report menu. 4. Use anesthesia utilities, add/edit dictionary Bonus: Use the taxonomic group report on the carfentanil library disk and print the complete anesthesia records Parasitology 1. Parasitology reports, due for examination report 2. Parasitology add/edit, <alt><F9> to enter the animal as non-accessioned, continue adding the record Clinical Pathology 1. Hematology/Chemistry/Serology 2. Use the ISIS reference range report of the hematology reports menu. 3. Use the spread sheet report from the hematology report menu. 4. Use Hematology/Chemistry/Serology utilities - dictionary reports. 5. Select clinical notes report. Search by problem (anemia) to get an accession #. Go into clinical pathology record and select individual specimen spreadsheet report. 6. Select clinical pathology reports. Values for a specified test report. Serum Bank Module: 1. Use the sample records for taxonomic group report from the cryopreservation bank reports menu. Clinical Notes Module: 1. Add a clinical note and then delete it. 2. Clinical Note utilities, edit/update module parameters 3. Clinical Notes utilities, add/edit dictionary, standard text entry. When entry is complete, return to add/edit clinical note record, medical text, use <F5> hot key to select the newly created bird quarantine text Alternate method: Add/edit clinical note records, select text string button, add the standard text entry. Upon completion, select medical text. Use <F5> hot key to select the newly created bird quarantine text Pathology Module 1. Use Pathology Utilities. Sample Request Information. Bonus: Retrieve birth weights for other kudu calves (0 to 4 days old), using the taxonomic weight report. To identify previous calves for this dam, run a historical collection data - taxonomic group report and look for the animals where 2520 is the dam. Run medical history reports on these individuals to identify any medical problems for prior calves of this dam.

54

Advanced Topics
General data consistency Abbreviations
The simplest thing to say about abbreviations is avoid at all costs. Abbreviations were invented to allow us to spend less time writing common phrases into the medical record, but this is the computer age! It is now often possible to insert the complete phrase into the record with the same (or sometimes less) effort than typing the abbreviation. In addition to the fact that the abbreviation no longer saves you a significant amount of time, there are problems associated with using abbreviations. First, there is no national standards committee that publishes a list of acceptable abbreviations, so abbreviations often become specific to a region or even an individual. If one of our goals is to produce medical records that can be merged to produce a larger data set, then regional or personal abbreviations are only going to cause confusion and problems with interpretation of these records. Another problem with many abbreviations is that they are often not used consistently even within a single institution (for example, do you always write OS, or do you sometimes put left eye or lt eye into the record?). Inconsistencies in your records make searching the records a more difficult process, so you should strive to minimize any inconsistency in your records. One easy method to maintain a degree of consistency is to avoid using abbreviations. Finally, abbreviations often contain fewer unique characters making their search signature quite large. The phrase left eye will also match on records where you have written left eyelid, but if you are trying to locate records containing OS, you are going to be looking at a large number of records that have nothing to do with the left eye. The reality is that we are individuals and therefor inconsistent by nature. If you believe that computerized medical records are a tool to help you do a better job, then the value of that tool depends to some extent on the degree of data consistency within the records. Avoiding the use of abbreviations will make the records more useful to yourself and to anyone else attempting to gain wisdom from your experiences.

Dictionaries
Dictionary or authority files are another method that MedARKS uses to try and maintain data consistency. Just as you would use a dictionary to check the spelling of a word, MedARKS uses the information in the dictionary file to verify some of the critical information that you enter. However, MedARKS does more than simply verifying the correct spelling of terms. Here are some of the other functions that are provided through the dictionary files: Search on partial entry: When you are entering a drug (or any other critical item), you do not want (or need) to enter the entire drug name. Usually entering just the first few letters of the term is sufficient. MedARKS will then use those initial letters to search the dictionary for matching entries and produce a short list of possible terms. Now you can just pick from this list. In fact, typing the first few letters is usually more efficient, since even if you type the entire entry, MedARKS is going to verify your entry using the dictionary anyway. The computer can search for the correct entry much faster than most of us can type in the full entry. Thesaurus services: In many cases, there are multiple terms that are synonymous (e.g., bumblefoot & pododermatitis or ketamine & Vetalar). MedARKS can perform instant translation of synonyms back to the original term. In this case, the dictionary file is acting like a reverse thesaurus; you type in a synonym and MedARKS uses the authority file to determine the original term (the one you want saved). Translation services: For some modules, MedARKS supports the use of preferred terms. In this case, MedARKS will store a particular term in your files (e.g., pododermatitis), but reports will show the term that you prefer (e.g., bumblefoot). Some foreign languages can also be accommodated within this feature, allowing non-English speakers to have reports in the local language while maintaining records that can be merged with those from institutions in English speaking countries..

55

As MedARKS is delivered with dictionary files that contain hundreds (and sometimes thousands of entries), these files provide a degree of data standardization between institutions. For this reason, additions to the dictionary file should be undertaken carefully. When you add a new term, be certain that it is not a synonym for an existing entry and try to add new terms in the spirit of the existing entries. For example, the clinical problems dictionary file contains an examination procedure. While you could add a new entry called dental examination, the intent of the original entry was to provide a generic term for the procedure (examination) and then allow you to specify the type of examination with a qualifier term (e.g., dental). The broad, generic term allows for easier retrieval of related problems, while the addition of a qualifier term allows for retrieval of a more specific problem.

User-defined pick lists

Almost all the record modules have lists of standard answers that you, as the user, get to define. Then, when you get to the appropriate place in the data entry, the list you created shows up and you are now picking an answer from a list that is appropriate to your institution, rather than having to type in an answer. Your data is more consistent because you are picking from a defined list, but the list is unique to (customized for) your institution. The most common user-defined lists are the initials of clinicians and technicians at the zoo, although the list of laboratories routinely employed by your institution is another important example. These lists have to be defined by each institution using MedARKS, but once defined can remain unchanged for years. All these lists are defined through the edit parameters utility of the appropriate records module. Take the time to define all these lists, as it will make data entry easier, and help keep your data internally consistent. Finally, when defining your pick lists, make them as specific as possible; abbreviations should not be used if there is room for more information. Your records are going to be shared with other institutions. Imagine the researcher searching carcass disposition records in a set of pooled pathology record: the entry Museum is going to be much less useful than Milwaukee Museum or Chicago-Nat. His.. It makes no difference to you during data entry; an obscure abbreviation takes just as much time to pick as an entry that uses the maximum space allowed. However, the longer, more specific entry produces a much more useful record. Once again, the advice is avoid abbreviations.

Data Quality Utilities

The final tool that MedARKS provides, to assist you in maintaining data consistency, are the data quality utilities. Present in almost every module, these are very powerful search and edit programs that allow you to change your records en mass rather than the 1 record at a time that is allowed by the normal edit routines. Be extremely careful when using these data quality utilities as you have the potential to make massive changes throughout your entire records system with almost no effort (e.g., it would be possible to change every anesthesia where you used carfentanil to read that you gave carbenicillin). For this reason, the master password is required to access all data quality routines and it is strongly suggested that every MedARKS system have this master password set. Only the most trusted and competent personnel should have access to these routines. On the other hand, when you discover that you have not been consistent with a data field entry, it may be possible to correct all your records with very little effort, which will increase the value of your records.

Clinical Notes - Problems and Text Text Editing (MedARKS temporary clipboard)
When you use the text editing commands (on page 81) to copy text to the clipboard, this is a temporary clipboard. It can only hold one piece of information, so if you copy another section of text to this clipboard, the first text is lost. Also if you exit from MedARKS anything in the clipboard is lost. So, what good is such an ephemeral clipboard? Well, the most common use is when you perform a series of similar examinations or procedures. For example, you have a group of 5 green pigeons in quarantine, and you spend a morning performing your routine quarantine examinations on all 5 birds, and with minor exceptions, all the birds appear healthy and in good condition. When it comes time to write the clinical text records

56

for the day, the temporary clipboard will be very useful. Write the first record in great detail. Now copy this record to the clipboard and start the record for the next bird. Paste the complete record from the clipboard into this second record. Now make the minor editing changes that are required for this bird (for example, if you placed transponder chips in all 5 birds; the chip identification will need to edited for each bird). If you are consistent in the performance of your procedures, most of the record will be correct. Repeat this process for the remaining 3 birds. The end result is 5 complete medical records in only slightly more time than it took to write one record.

Standard Text Entries (MedARKS permanent clipboard)

The standard text list is one of the most important features for maintaining some consistency in your text data and for making text records quicker and easier to produce. Think of this feature as a permanent clipboard filled with short and long notes. A single keystroke (<F5>) will let you look at that clipboard and browse through the contents. Find an entry you want and another keystroke will paste that entire text entry into the text record that you are currently working on. Thus, an entire page of text might be assembled with a small number of keystrokes. The text entry is rapid and spelling mistakes are avoided. The clipboard can be completely customized to meet your needs (see below). However, like a real clipboard, this virtual clipboard can also become unworkable if too many notes are attached to it. If you make your list of text options too long, it becomes more and more difficult to find the entry you want, so your productivity begins to decline. The trick is to find the right balance between enough notes so that you are not typing the same entry again and again and few enough entries on the clipboard so that you can quickly locate the entry you want and paste it into your record. MedARKS helps control the clutter by maintaining separate standard text lists for each module. This means that when you press <F5> in the anesthesia module, you see that list of notes that pertain to the anesthesia record and not those written for the parasitology, clinical text or prescription modules. Creating new permanent clipboard entries Customizing your virtual clipboard to suit your institutions needs is a relatively painless process. Each record module that supports a standard text list (anesthesia, parasitology, prescriptions, fluid analysis, clinical text and pathology) has a utility that will allow you to edit the list for that module. To access the utility, go to the module utilities menu and then select the Add/Edit/Update Dictionary Entries option. Now choose the standardized text and forms dictionary option. You will be presented with the current standardized text list for this module of your system. The clinical text utility can also be accessed from within clinical notes data entry program by using the text strings button on the data entry screen. If you wish to eliminate some of these text entries to streamline your list, simply pick the entry you wish to eliminate then press the <F8> key to eliminate that entry from your list. If you wish to add a standardized text entry or form, press the escape key. You can now enter a new standard text entry (either a single line of text or multiple lines of text).

Defining a Formal Clinical Problem and Adding to the Master Problem List
The master problem list for an animal is part of the clinical notes module. Like the master problem list in a traditional paper medical records system, it is meant to be a formal summary of the major medical events in the life of an animal. The formal (or structured) nature of the master problem list makes it easier to search for particular problems. This section of the clinical notes module is can also be at least partially standardized, making it possible to share information between institutions.. In contrast, the text records are not structured and searching for a particular problem and extracting useful records is a much more difficult process. Unfortunately, despite the importance of the master problem list, it is often an underutilized feature of the MedARKS system. MedARKS recognizes four categories of entries into the master problem list: Infectious diseases contracted (e.g., Salmonellosis) clinical signs observed (diarrhea, coughing, lameness, etc) other problems experienced (bite wounds, fractures, etc.) medical procedures completed (surgery, examinations, vaccinations, etc.) In addition, every disease or other problem entry can be marked as either "suspected" or "confirmed". A chronic-active

57

diseases status can also be indicated, allowing you to produce reports that list the current problems only. Two different routes can be used to access the master problem list for an animal. During data entry of clinical text records, the Problems button at the bottom of the data entry screen allows editing of the master problem list. This data entry mode allows you access the master problem list only for the currently active animal. The second route for data entry into the master problem list is directly from the clinical notes module menu (option #3 on that menu). Accessing the master problem list from the module menu level yields an additional data entry method. This alternate data entry option allows you to easily enter the same problem (or procedure) into the master problem list of a number of animals (essentially batch entry of a problem). So, in cases where the same procedure (e.g., vaccination) or the same problem (e.g., quarantine) needs to be entered for a group of animals, this data entry option obtains the problem/procedure information and then just allows entry of a series of accession numbers. All entries into the master problem list are validated against the problem dictionary included with the module. Each record in the master problem list must contain a term from the "problem" category (see below). In addition, some "problem" terms allow the entry of a term from the "qualifier" category. Qualifiers enhance, or describe the entry in the master problem list are also validated against the dictionary. As an example, consider the entry of "lameness" into a master problem record. By itself lameness defines the clinical sign that the animal exhibits, but when you add a topographic qualifier term of "left rear leg", you have a better overall view of the condition of the animal.

Master Problem List Entries Problem categories Clinical signs Procedures Infectious Disease Other Diseases, Problems and Illnesses Qualifier categories Topography Etiological Agent Other Qualifiers

In general each of the categories have been defined as follows: Clinical Signs: This category contains of clinical signs and symptoms that may be used to describe a problem. Examples: abdominal distention, abnormal gait, constipation. Infectious Disease: This category contains infectious diseases. Examples: Tuberculosis, Feline Leukemia. Procedures: This category contains procedures that were felt to be important to record and be able to extract from pooled data. Examples: contraception, SSP requested procedure, transponder failure, radiograph, physical examination. Diseases: This category contains common non-infectious diseases. Examples: Focal Palatine Necrosis, neoplasia, sprain. Other Problems/Illnesses: This category contains other problems which are not clinical signs, symptoms or recognized diseases. Examples: Neonate, Parturition, Supranormal Chemistry Value. Topography: This category contains anatomic parts or regions that describe where a problem is located. Examples: Tail, right front leg, femur (left). Etiological Agent: This category contains agents which cause disease or problems. Examples: Mycobacterium tuberculosis, Escherichia coli, Toxocara canis. Other Qualifiers: This category is a catchall for qualifiers that do not fit in other categories. Examples: Names of local medical consultants, names of enclosures, and adjectives used to describe the problem component (e.g., watery as a descriptor for diarrhea)

Organizing your text records (pseudoclinicians) 58

MedARKS has record modules specifically designed for recording many types of laboratory results, including hematology, blood chemistry, serology and parasitology information. However, other categories of laboratory data, such as culture results (microbiology), and cytology do not have specific record modules available. The best place to record this other laboratory information is in the clinical text records. The following suggestions should help you to organize these laboratory results within the clinical text records and help make these results more retrievable. Clinical text records in MedARKS are organized by animal, date, and clinician initials, allowing each clinician in a practice to record separate clinical observations and treatments for the same animal on the same date. One solution for dealing with laboratory results is to add this information to the clinical text record written by the clinician responsible for collection of the sample producing those laboratory results. In one sense, this simplifies the records for an animal, since there is only one record per day for each animal. However, the daily record on the animal can rapidly become unreadable. For example, imagine a situation where you have an infected mass on an animal. It is quite likely that you will have both cytology and culture results, as well as an extensive clinical narrative record. Printing only the narrative portion of the animals record becomes impossible since it is mixed in with laboratory results. One solution to this problem has been to enter laboratory results under the initials of a technician. Now, if you want to access the clinical narrative, you filter the records based on clinician initials and obtain only that portion of the record. This is an acceptable solution to the problem of keeping laboratory results separate from the clinical text records, but you get into problems if your technician has any responsibility for writing narrative records (perhaps the technician is required to enter notes on any animals being hand-reared in the hospital). If this is the situation, you can no longer separate the narrative notes by the technician (e.g., how much milk was consumed at each feeding) from the laboratory results entered under the initials of the technician. Now imagine that your technician leaves and you hire someone new. Now you either have to remember that some laboratory results are under one set of initials and others are under a different set of initials, or your new technician is required to change his name so that the initials are the same as the old technician. There is a better method! We call this technique pseudoclinicians (and this is not meant to be an insult to any colleague). A pseudoclinician is simply a fake set of initials that you use for storing laboratory results. What is really exciting is that you can create an unlimited number of pseudoclinicians and use each one to store a different type of laboratory result. For example, if you want to look at all of the culture results for a particular case, you can use your filter for the appropriate set of pseudoclinician initials and you will only retrieve culture results. The rule that is recommended is that you include at least one non-alphabetic character in the initials to make it obvious that this is a pseudoclinician and to avoid the possibility of hiring an associate in the future that has the same initials as one of your pseudoclinicians. One popular scheme for creating pseudoclinicians is an asterisk followed by 2 letters that have some meaning (e.g., *CY = cytology results, *FC = fecal culture, *JC = Johnes culture, *CS= Culture/Sensitivity etc.). Let your imagination run wild!

Interface with the prescription and weight modules

From within clinical notes text records data entry, you are given direct access to both the prescription and body weight record modules. This ability was designed to make it more convenient for the clinician, when writing the medical text records, to add prescription and weight information on the currently active animal. When you enter records into these other modules from within clinical notes, there is an implicit understanding that you are entering data for the same animal you are working on within the clinical notes section. There is no need to enter accession number information (which saves you data entry time), but you do lose access to some of the powerful features of the prescription module by getting into the prescription module through this back door. For example, if you were writing the daily records that included vaccinations on the entire wolf pack, it will actually be more work to enter those prescription records through the clinical notes access. This is because one of the powerful features of the prescription module is the duplicate last prescription for a new animal option. Entering the vaccination record through the prescription module allows you to enter the vaccine record once and then duplicate that record for the rest of the pack. Entering the vaccine information through the clinical notes module forces you to enter the entire vaccine record on each pack member. Finally, if you need to write a group prescription, then you must enter the prescription through the prescription module. Accessing prescription records from within the clinical notes module only allows you to enter prescriptions on individual animals.

59

Interface with other modules from within Clinical Notes

Another feature of the newer versions of MedARKS is the ability to view records in any of the MedARKS modules (except pathology) from within the clinical notes data entry section. This allows you to obtain any pertinent clinical information you might require without having to leave the comfort of the clinical notes module. For example, if you had an animal that was losing weight over the past month and you wanted to check the most recent blood analysis results, parasitology findings, and what treatments you or the other clinician(s) have tried, you can access this information using the View other module records option. This button also allows you to read the ARKS3 text notes which (depending on your registrar) can provide such important information as the movements of that animal through various institutions and exhibits, behavioral observations, birthing data, and even Master Plan information for that particular animal. You cannot modify any of the data that is displayed from the other modules, but you can copy any information in that window to the temporary clipboard and then paste it into the medical text record. So, if the ARKS record contains a keeper observation that you would like to enter into the medical record, you do not need to retype that information. Instead, display the ARKS note, copy the relevant text (on page 81), return to the clinical note and paste the text into the record.

60

Pathology Records User-defined field

This is something completely new for MedARKS - a searchable data field where you get to decide on the information that will be stored in the field. In the past, when you had information that you wanted to standardize within your institution that was not part of a regular MedARKS record, you had to put that information into the comments. . A good example is the reason or purpose for an immobilization procedure, which many facilities routinely enter into the anesthesia comments. MedARKS will help you to standardize your text entries through the <F5> key and you have some ability to filter records, based on information in the comments, so it is possible to retrieve records based on this information. However, MedARKS does not prompt you for that information on every record, so it can be easy to forget to enter the information into the comments (unless you are well disciplined about your records). The user-defined field changes those rules. Now, if there is some piece of information that you want to routinely track on pathology cases (and even retrieve records based on this information), then you now have that ability. MedARKS will prompt you for that information on every record and maintain a list of default answers (a pick list). You even get to define the title for that data field when it is printed on reports. If you do not want to use this field, you can turn this entire data field off, and you will not be bothered with the user-defined field during data entry. The name of the field and the list of default answers are defined through the pathology module parameters.

SSP Necropsy, Sample collection and Research protocols

The pathology records module includes a file that is designed to help you manage the requests for samples, requests for body parts, research protocols, experimental treatment protocols and necropsy protocols that we all see quite commonly. In the past, it has been our responsibility to track all that information and fulfill the appropriate requests when possible. It can be quite a bit of work to track this information with a paper filing system since some requests are at the species level (e.g., the gorilla SSP), some are at the family level (e.g., Canid TAG) and other requests are for even larger taxonomic groups. Locating all the protocols that apply to a particular species when animal dies can be a time consuming task. The MedARKS pathology routines are designed to help you manage this information. As soon as you start a necropsy case (the species is known once you enter the accession number), the program automatically searches for all pertinent requests and protocols and then places a reminder into the MedARKS record and can even print you a copy of these requests. The protocol management system was originally designed to manage necropsy requests and protocols only, but it rapidly became clear that there was not a fundamental difference between a blood sample request and a necropsy tissue request (other than the fact that the animal is dead in one case). As a result, the protocol manager was generalized to enable MedARKS to assist you with managing requests for live animal samples. The main difference is that with live animals you have to remember to ask the protocol manager if there are any requests for samples from live animals. The protocol manager knows that there is a dead animal as soon as you start a necropsy record, so it can automatically remind you about dead animal requests. The only time that MedARKS can suspect that you are going to work on a live animal is when you run the anesthesia taxonomic (species) report. When you run this report, MedARKS will automatically check the protocol file and inform you when there are sample requests or other protocols that apply to live animals of the specified species. Any other time that you want to know about live animal protocols, you will need to go to the pathology utilities menu and run the protocol file report for a specific species and live animal protocols. Another important feature of the protocol manager is that its request files can be easily updated and that requests can be set to automatically expire. The protocol update file can be distributed by diskette, by E-mail or over the Internet. No more trying to reach the SSP coordinator at 7 p.m. to find out if the research protocol dated from June 1989 still applies. If that protocol is still active in the MedARKS protocol file then it should still be a valid request. Finally, the protocol manager allows you to create you own sample requests. The next time one of the zoo education department requests a piece of hide from a giraffe, dont just write a note to yourself that will be lost long before the next giraffe dies. Instead, add a sample request to the protocol file. Such a request is a simple addition; the recipient is the zoo education department and the request is for a piece of hide and the species is giraffe. Now, when the next giraffe dies, you

61

will automatically be reminded to collect that piece of hide (think of the brownie points you can earn!).

Importing Computerized Text into MedARKS:

Sometimes you get information from another source (outside laboratory or consulting pathologist) in the form of a computer file (e-mail message, web page or a word-processor file). When this is the case, you do not need to retype that text information to get it into MedARKS. Text information from other files can be loaded into the MedARKS system in 3 places - the necropsy report, the histopathology report and the clinical text record. There are actually 2 different methods to get this text information into MedARKS. Importing an ASCII file: MedARKS can import a pure text (ASCII) file directly into 2 places in the pathology record (necropsy text and histopathology text sections) and into the clinical notes text record. You use the same technique in all 3 places. So, how do you create a pure text file? It turns out to be very easy. Windows includes a program called Notepad that produces pure text files. So, any text that you copy into Notepad and save will be saved as a text file. In addition, Windows makes it easy to copy information between different programs. Consider the example where your consulting pathologist has sent you a histopathology report as an e-mail message. First open the e-mail message so that you can read the text of the message. Use your mouse to highlight the text that you need to get into MedARKS, then click on Edit and then Copy. You now have a copy of that text in the Windows clipboard. Next start the Notepad program (click on Start, then Programs, then Accessories and finally Notepad), and click on Edit and then Paste. You should now have your selected text in the Notepad Windows. Now click on File and then Save to save this text as a file; you can save the file anywhere, but importing is easiest if you save on a floppy disk. Use an 8 character (or less) file name since MedARKS is a DOS application. Finally, start the MedARKS program, go to the histopathology report section of the MedARKS record, press <Ctrl><L> and MedARKS will request the text file location and name (e.g., A:990135.txt). When you have entered the drive and file name information, press the <Enter> key and the text will be imported into the current MedARKS record. When the necropsy report and histopathology report are delivered as a single file, it is usually quicker to import the entire file and then delete the sections that are not applicable. The mouse and delete key can be used to quickly block out and delete text that does not apply to the section being edited. Some university laboratories (e.g. Michigan State University Animal Health Diagnostic Lab) offer their reports on a web site. The same instructions apply for a web page - copy the text to the Windows clipboard, paste into Notepad, save the text as a file and then import hat file into MedARKS. In fact, virtually any text file that you can view on your computer can be imported into MedARKS using these instructions. For those of you with historical pathology records saved as word processing files, those reports can be imported into MedARKS, using these instructions, considerable reducing the amount of effort required to get your historical pathology records into a computerized format. Pasting Directly into MedARKS from Windows 98: This method starts out the same as the first. First open the computer file containing the text that you need (e-mail message, web page or word processor file), so that you can read the text of the message. Use your mouse to highlight the text that you need to get into MedARKS, then click on Edit and then Copy so that you have placed a copy of that text in the Windows clipboard. Now start the MedARKS program and go to the location where you want to paste that text. If MedARKS is running in full-screen mode, press <Alt><Enter> to reduce MedARKS to a Window on your screen. Now click on the icon at the upper left corner of this MedARKS window. A drop-down menu will appear - choose edit and then paste from this menu. The text that is on the Windows clipboard will be typed into MedARKS at the current location of the MedARKS cursor. The process of loading text from the clipboard is not as fast as the MedARKS ASCII import process, but you do save the step of opening the Notepad program and saving the text as a file.

62

Exercises
Clinical Notes Module A. Its 4:30 pm and you've just finished another busy day of saving lives and preventing plague and pestilence. You sit down at your computer and want to enter the following information from one of today's (Oct 26, 1997) cases into the medical records. The events go like this: Keepers call on the radio for you to look at Ralph, a Major Mitchells Cockatoo, who is bleeding from a laceration on the lower abdomen. Upon arrival to the enclosure, you talk to the keepers. Apparently, Ralph was plucking feathers and tore the skin on the abdomen. On visual inspection you find that Ralph has a steady stream of blood coming from his lower abdomen. Keepers have him isolated and he has not been fed today, so you decide to immobilize him using Propofol. You draw blood in Heparin and serum tubes for CBC, serum profile, and banking. You are able to read the ID transponder 00-0014-3C4C. You complete your physical exam and found no other problems besides the laceration. At the request of the SSP, you measure the wing span. You perform surgery suturing the laceration and start him on Bactrim, 200 mg., PO BID. Recovery from anesthesia is normal and suture removal is scheduled in 14 days. Yikes! It's 6 pm and you wake up to find you've fallen asleep at your keyboard. You go pour yourself a cup of coffee, sit back down at your keyboard and are amazed to find that in your sleep, you have entered a completely fictitious event. You now erase the entry about the Major Mitchells Cockatoo and decide to call it a day. B. You are preparing a monthly activities report and want to include some data on the most common problems that you saw last month. C. You are preparing for a meeting with your director. Over the past 15 years you have impressing on him the need for a new quarantine facility. Now that you are using MEDARKS version 5, you can document this need. Generate a list of all animals that were in quarantine over the past 5 years. D. You are preparing for a hospital staff meeting tomorrow and wish to have a list of all active problems in the collection.

Pathology Module A. Its 6:00 pm, and as you get in your car to leave work early, you are notified that a Maned Wolf has just been found dead in its enclosure. You prepare to do the necropsy and want to know if there are any SSP requests for Maned Wolf tissues. B. You are putting together a report for the Director on cases of death by Eastern Equine Encephalitis at your institution. He is most interested in confirmed cases this year. C. Since the first of this year there seems to have been an increase in deaths in the Bongo Antelope. How many Bongo have died to since January 1, 1997. How does that number compare to deaths in 1996? D. You are immobilizing three female Gaur for reproductive examinations. You remember that Lee Raley is requesting Citrate Buffered whole blood on Gaur. But, you cannot remember if that request is valid this year? Is the request valid? How much blood does he need? How should it be shipped? Where do the samples need to be shipped? Who is covering the costs?

63

Appendix Hardware requirements and recommendations for MedARKS 5

Minimum Hardware Requirements: Central Processing Unit (CPU): 80386 (usually shortened to 386") Random Access Memory (RAM): 4Mb (Megabytes) Hard disk: 200Mb Monitor: Monochrome text Operating system: DOS 5 (or higher) Recommended Hardware: CPU: 486 or Pentium Advantage: Program will run substantially faster with a more powerful processor. The higher the clock speed, the faster the processor will run (i.e a 66MHz machine is better than one with a 33MHz CPU) RAM: 8Mb Advantage: Record retrievals will be faster with more extended memory and it will be possible to run MedARKS from inside Windows (for those who like the convenience to being able to switch between applications without shutting down what they are currently working on). More memory is even better, and 16Mb is required if you plan to use the Windows 95 operating system. Hard disk: 3-6Gb Advantage: You will have the hard disk space to keep your other programs (e.g. word processing) on the MedARKS machine. Monitor: Color VGA Advantage: The program will be easier to use (it will be much more obvious which is the highlighted choice in color) and there are some simple graphics available from inside MedARKS when VGA mode is available (e.g. plot changes in clinical pathology test results over time for an animal). Operating system: Windows 95or 98 Advantage: You are able to switch from MedARKS to another program and then back to MedARKS without having to exit from the program. Windows 95/98 offer better memory management than Windows 3. Mouse: Advantage: Choosing, from a menu or a drop-down list, becomes as simple as point and click. Text editing (cutting and pasting) is also much easier with a mouse. Other Useful Equipment: Zip Drive or Tape Backup Unit: The reason that most people do not have adequate backup files is simply because it takes too much time to copy those critical files to floppy diskettes on a regular basis. We can all find something we would rather do, other than sit in front of the computer swapping floppy diskettes in and out of the drive. With a tape backup unit, the process can be partially automated; you only need to remember to change tapes. The new versions of MedARKS also let you run the backup routine to a Zip drive. As a zip disk holds about 100 Mb, it will be a long time before your backup will not fit on a single disk, and not having to swap diskettes makes t he backup task easier to perform. At about $300 for a good tape unit and about $100 for a Zip drive, it is very cheap insurance for your medical record files. Uninterruptible Power Supply (UPS): If you have regular power failures or even severe drops in the voltage (brownouts), you are at risk for damaging your computer files. A surge protector prevents high voltage spikes

64

from damaging your computer, but provides no protection against the local voltage drop that occurs when the factory down the road suddenly demands significantly more electrical power (or perhaps even when your building air conditioning unit starts up). With a severe brownout, you notice the lights dim and your computer will usually reset itself, so you are not surprised that files can be damaged. However, even a brownout that does not dim the lights and doesnt reset your computer, can still damage open data files on your computer (files are opened whenever data entry is occurring or whenever record retrieval is happening). The UPS detects decreasing voltage and supplements the power from a rechargeable battery. In the event of a complete power failure, the UPS can provide power to keep your computer running for several minutes (or longer) which allows you to exit the current program (closing the files) and turn off the computer in an orderly fashion. While you can spend $1000 for an UPS that will keep your computer running for 60 minutes or more during a power failure and will automatically shutdown your computer system even when you are not present, you can get a good unit for only about $99. This unit will protect against brownouts and will provide several minutes of power in the event of a complete failure. Even the cheap models usually have an alarm that warns you when power is being drained from the battery; you will probably be surprised at how often the UPS warns you about a brownout that you would not have noticed otherwise. Local Area Network (LAN): For any veterinary practice where data entry time on the MedARKS computer becomes a scheduling problem, consider linking multiple computers together to allow shared access to the records and simultaneous data entry. A network can be as small as 2 computers or as large as several hundred. MedARKS is currently being used on LANs at about 30 zoos. The same memory and CPU recommendations apply to each workstation running MedARKS, but only the computer storing the program and data files requires a large hard disk. Running independent copies of MedARKS on separate computers with data entry restricted to particular record modules on each computer is no longer encouraged. The various record modules are becoming more closely integrated and there is a benefit to allowing the program to share information between the modules and this can only occur on a single machine or on a network.

65

Critical files in MedARKS 5

Where are the MedARKS version 5 files located on the hard disk and what are the critical files in these subdirectories? While MedARKS 5 can be installed to alternative directories, this document lists the directories and files that will be present when you have installed using the default values for the program installation. Subdirectories are indicated with the \ and their contents are listed under the subdirectory heading. If you are using Windows, find the drive with the NEWMED folder and double click on this folder to open the folder and start the process of viewing the contents. The NEWMED folder should only contain the MEDARKS folder. The MedARKS under the NEWMED folder will contain files (the program and related files) and the DATA folder. The DATA folder contains your MedARKS 5 records. Warning: If your directory structure is significantly different from what is defined below, you should consult with a local computer expert or MedARKS Technical Support before deleting or moving files. If you need to check which drive and directories your program is using, start MedARKS and go to the System Utilities, and then Edit/Display System Parameters. Two of the parameters define the drive and directory locations of the program and of the data files. MedARKS version 5.3 - Default Directory Structure and Critical Files \newmed \medarks DGE16.PLB FMEDARKS.BAT (copy of this file should also be in the root directory of this drive) FOXSQZ.PLB MEDARKS.ICO MEDARKS2.ICO MEDCOLOR.MEM MEDFILES.DBF MEDPRINT.DBF MEDPRINT.FPT MED_HELP.DBF MED_HELP.FPT MED_LINE.DBF MPRN.DAT PKUNZIP.EXE PKZIP.EXE SLICE.COM SMEDARKS.EXE SPELL.APP SP_WORDS.DBF \data ANESDATA.DBF (anesthesia records module) ANESDRUG.DBF (anesthesia records module) ANESTHES.DBF (anesthesia records module) ANESTHES.FPT (anesthesia records module) ANESTRAK.DBF (anesthesia records module) BANKCOMM.DBF (serum bank records module) BANKMAIN.DBF (serum bank records module) BANKMAIN.FPT (serum bank records module) CN_GROUP.DBF (clinical notes records module) CN__PROB.DBF (clinical notes records module) CN__TEXT.DBF (clinical notes records module) CN__TEXT.FPT (clinical notes records module) CPDELETE.DBF (clinical pathology records module) CP_FIXED.DBF (clinical pathology records module) CP_ORDER.DBF (clinical pathology records module) CP__COMM.DBF (clinical pathology records module)

66

CP__FLEX.DBF CP__MAIN.DBF CP__MAIN.FPT DRUGLIST.DBF DRUGLIST.FPT DRUGTYPE.DBF MED_INVS.DBF NOACCNUM.DBF NORMALS.DBF ORGANISM.DBF ORGCODES.DBF PARAEXAM.DBF PARAEXAM.FPT PARAPTRS.DBF PARA_DUE.DBF PATH_GRP.DBF PATH_SSP.DBF PATHDIAG.DBF PATHLIST.DBF PATHMAIN.DBF PATHMAIN.FPT PATHWGHT.DBF PROBLIST.DBF PROCLIST.DBF PROCLIST.FPT REPORTER.DBF REPORTER.FPT RX_SCHED.DBF RX__MAIN.DBF RX__MAIN.FPT RX__PTRS.DBF TESTLIST.DBF WGHTLIST.DBF

(clinical pathology records module) (clinical pathology records module) (clinical pathology records module)

(clinical pathology records module) (parasitology records module) (parasitology records module) (parasitology records module) (parasitology records module) (parasitology records module) (parasitology records module) (pathology module) (pathology module) (pathology module) (pathology module) (pathology module) (pathology module) (pathology module)

(prescription records module) (prescription records module) (prescription records module) (prescription records module) (clinical pathology records module) (weights module)

Other files that may be present: 1. Index files (*.?DX) are not critical files. They can all be erased and will be regenerated the next time you start the MedARKS 5 program. 2. Default settings for variable parameters that allow customization of record modules and program actions are held in the ????VARS.MEM files. The program will start without these files and the values for the variables can be set through the utilities found in each module. 3. File names starting with 8 digits and ending in TXT or TMP or DBF or FPT are temporary files created by FoxPro that were left behind when the program terminated unexpectedly - these files can be erased. When the program terminates normally, all temporary files are erased by FoxPro as part of the normal shutdown procedure. When the program terminates abnormally, these files get left behind and need to removed manually. 4. Deferred output file all start with OUTPUT. These files can be erased. Many of the data files in version 5 were created from a file with the same name in version 4, but have a modified file structure in the newer version. Do not mix version 4 and version 5 data files in the version 5 subdirectory. If you have upgraded to version 5.3, you should not even be using the old MedARKS version 4 program.

67

Suggested Backup Procedures for MedARKS

Who needs good backup copies of data files? Everyone does! Your computer files can be damaged or destroyed by accident (e.g., delete the wrong file), by deliberate mischief (e.g., a computer virus), by computer loss (e.g., theft or fire), by hard disk failure (all hard disks fail eventually and often without warning), by power surges (e.g., lightning strikes to the power grid), and by power failures. Finally, sometimes your files will be corrupted for no apparent reason (cosmic rays??). Some of these causes of file loss may seem unlikely, but institutions using ISIS software (and there are only a few hundred) have lost data for all of the above reasons - you are not immune to data loss. What is the bottom line? When you use a computer, it is virtually certain that, at some point in time, you will need to access a backup copy of a critical file. How seriously the file loss impacts you will depend on the backup protocol you have established and how well you have adhered to that protocol. Some zoos have lost years worth of computerized data with no means to recover that data without repeating all the data entry from paper copies (a prospect that most of us would not find inviting). The following are guidelines for equipment and procedures to establish good backups of your data files, so that when you need that backup, it will be available. Equipment: Tape units provide the most convenience for making backup copies of your computer files. Prices have dropped significantly over the past few years, and an excellent tape backup unit, capable of holding 1.6 gigabytes of information, can now be purchased for about $300 in the U.S.A. For most institutions, this will be sufficient space to make a backup of every file on their computer. Institutions with multiple computers (not on a network), can purchase the same tape backup unit as a portable device (for only a slightly higher cost) that attaches to the parallel port of any computer. With a single machine or a network, the backup procedure can be automated to occur at night when the computer is not being used, so that the computer is fully available during normal working hours. Most institutions will find the advantages of a tape backup to be well worth the small initial investment. Removable, high capacity disks (e.g., the Zip drive from Iomega) have the capacity to store around 100 megabytes of information, which can be sufficient for the backup of critical data sets. While more costly than a tape backup unit and more limited in capacity, these removable media drives do have the benefits of increased speed and of functioning as an extra hard disk when not being used to produce backups. These units are usually connected to the parallel port of the computer, allowing the drive unit to be easily moved and used to make backups on multiple computers. Floppy diskettes are a common method for producing a backup copy of your data. However, making backup copies using floppy diskettes is a much more time consuming and laborious process than with the previously mentioned equipment. The only advantage of the floppy diskette method is that virtually every computer is already equipped with a floppy drive, so the only further investment required are the floppy diskettes themselves. Automatic backup of large data files is not possible because of the limited capacity of floppy diskettes. However, for small size files and for institutions without access to superior backup methods, floppy diskettes will be the method used to ensure that important data is not lost. Procedures: Many institutions feel that their backup procedures for important data files are appropriate. Too often, these institutions have a major loss of data and only then discover that their backup procedures have not been adequate to protect their data files. Under these conditions, an immense investment in time and labor may be completely lost. The secret, to successful recovery from data loss, is redundancy. We used to recommend that institutions have 3 backup copies of MedARKS data, thinking that triple redundancy was adequate. However, there have been many instances where institutional data files have been damaged and all 3 backup data sets overwritten before the damage is discovered. The end result was a damaged data set and 3 copies of that damaged data set, with no means to recover the original data. The current backup procedure recommendations are: 1. Separate backup copies for each day of the week (five or seven sets depending on the whether the computer records are added every day or just Monday through Friday). Label the backup set (tape or disks) with the day of the week it is to be used and use it to make a backup copy on that day, unless one of the following special cases takes precedence. Two extra backups for one day of the week (e.g. Friday). The three redundant daily backup sets are rotated so that the

2.

68

3. 4.

oldest copy is used to make the new backup on the specified day (i.e., if you have 3 Friday tapes containing backup sets made a week apart, the backup made each Friday will write over the oldest of those 3 copies). Twelve monthly backup sets. On the first day of the month (or the first Monday of each month, whatever is most convenient), the daily backup set is not used for that day, and the monthly backup set is substituted instead. Yearly archives. Once a year, make a backup copy set that is then removed from the premises and stored safely in another location (archival storage of institutional records is actually part of the AZA accreditation inspection, so the archival backup copies can also serve an important function in meeting this requirement for accreditation).

Some backup software will allow what is termed an incremental backup. With this type of backup, only the files that have changed are copied to the backup set. While this sounds useful (backup data sets are smaller because only some files have changed), it is not recommended for MedARKS data. The various data files in MedARKS are tightly linked to each other and having backup sets that are not complete makes the restoration of a complete data set a much more difficult task. Restoring Data: In the event of data loss, start restoring with the most recent daily backup set and work back until an intact data file is found. To minimize data loss, only restore those files that need to be restored (e.g., if damage is only in the parasitology files, there is no need to restore data files for any of the other modules). When using the MedARKS backup/restore routine, it is easy to select the module (or modules) to be restored and MedARKS determines minimum number of files that must be restored. With a tape backup system you will need to manually select the appropriate files to restore to minimize data loss. If you have questions about the which files need to be restored, call MedARKS Technical support for assistance. In most cases where you have a good backup system in place, you will only lose a day or two of information, and only a relatively small amount of information will need to be entered again. When a data problem is not noticed for more than a week, the weekly and monthly backup sets can still allow data recovery to occur as much as a year after the damage has occurred. While losing an entire years worth of data may sound catastrophic, please recognize that the alternative is to lose everything. Whatever backup protocol you decide to use, remember that long-term redundancy is critically important. As soon as a data problem is suspected, put aside the existing backups until the problem is resolved.; continuing to use the existing backup data sets can compound the problem by destroying good backup data. For most of us, the MedARKS data files represent a significant investment in personnel and equipment resources, and spending a little more to safeguard that investment is just common sense.

69

Creating an icon for MedARKS in Windows 3

You must have at least 8 Mb of random access memory (RAM) to run MedARKS 5.xx from inside Windows 3.x. Remember that memory is not the same as hard disk space. Data is stored on the hard disk, but a program must fit into available memory to function. The amount of storage space (disk space) is irrelevant if there is not enough memory to run the program. The instructions that follow will help you to configure your computer to run MedARKS from inside Windows. 1. Checking the total amount of memory (skip if you are certain that you have 8 Mb or more of RAM). Make sure that Windows is running and go to the Program Manager window. If you are not sure how to get to this window, hold down the <Ctrl> key and press the <Esc> key. A small window, labeled Task List should appear in the center of your screen. One of the tasks will be Program Manager; double click on this choice to switch to the Program Manager window. Find either a window labeled Main or an icon with this label. If you have an icon, double click on the Main icon to open the Main window. Now double click on the icon labeled MS-DOS Prompt that is in the Main window. Now type mem /c (without the quotes) and press the <Enter> key. You will get a summary of the memory divided into rows and columns. Locate the intersection of the column labeled Total and the row labeled Total memory. The number shown should be roughly 8 million or higher. If the number is closer to 4 million, you probably only have 4 Mb of RAM. Type in exit to leave the MS-DOS prompt and return to Windows. Double click on the box in the upper left corner of the Main window to close this window (or press <Ctrl><F4>). Assuming that you found that you have sufficient memory, continue with the rest of these instructions. 2. Checking the CONFIG.SYS file. Find either a window labeled Accessories or an icon with this label. If you have an icon, double click on the Accessories icon to open the Accessories window. Now double click on the icon labeled Notepad that is in the Accessories window. Click on the choice File at the top left of the window to get a drop-down menu of choices. Click on Open and the Open window will appear. In the box labeled File Name:, type in C:\CONFIG.SYS (without the quotes) and click on the Ok button. You should now be looking at the contents of the Config.sys file. Look for the following items. a. The line containing EMM386.EXE. This is the memory manager supplied with Windows (if you know that you are using a different memory manager, do not worry about this line). On the same line as EMM386.EXE, should be the parameter NOEMS; if this is not present, add it to the end the EMM386.EXE line. b. The line containing Files=. The number to the right of the equals sign is the maximum number of files that may be open simultaneously. That number should be 120 or higher. If the number is less than 120, change it to 120. If the Files line is not present, add the line Files=120" (without quotes) to the bottom of the CONFIG.SYS file. c. The line containing Buffers=. There will be one or two numbers to the right of the equals sign; when 2 numbers are present, they are separated by a comma. The first number to the right of the equal sign is the number of file buffers available and that number should be about 40. If the number is much less than 40 (or much higher), change it to 40; ignore the second number if it is present. If the Buffers line is not present, add the line Buffers=40,0" (without quotes) to the bottom of the CONFIG.SYS file. d. Look for a line that contains the file name SHARE.EXE. If this file is being loaded within your system configuration (config.sys file), place an asterisk at the start of the line to disable the loading of the SHARE.EXE file. e. Look for a line that contains the file name SMARTDRV.EXE. If this file is being loaded within your system configuration (config.sys file), place an asterisk at the start of the line to disable the loading of the SMARTDRV.EXE file. If you modified the CONFIG.SYS file, click on File, and then Save, to save the new file. 3. Checking the AUTOEXEC.BAT file. Click on the choice File at the top left of the Notepad window to get a dropdown menu of choices. Click on Open and the Open window will appear. In the box labeled File Name:, type in C:\AUTOEXEC.BAT (without the quotes) and click on the Ok button. You should now be looking at the contents of the Autoexec.bat file. Look for the following items. a. Look for a line that contains the file name SHARE.EXE. If this file is being loaded within your autoexec.bat, place an asterisk at the start of the line to disable the loading of the SHARE.EXE file. b. Look for a line that contains the file name SMARTDRV.EXE. If this file is being loaded within your autoexec.bat file, place an asterisk at the start of the line to disable the loading of the SMARTDRV.EXE file. If you modified the AUTOEXEC.BAT file, click on File, and then Save, to save the new file.

70

Double click on the box in the upper left corner of the Accessories window to close this window (or press <Ctrl><F4>). 4. Optimize your memory. Restart your computer to bring into effect any changes made in the Config.sys and Autoexec.bat files. If you have DOS 6.0 (or higher), exit from Windows and run the Memmaker program from the DOS prompt to optimize your random access memory (RAM). 5. Virtual Memory Configuration. Restart Windows and from the Program Manager, select the following choices: a. Locate the Main Program Group icon and open the program group window by double clicking on it. b. Double click on the Control Panel icon to start this program. c. Double click on the 386 Enhanced icon to open the Enhanced window and click on the bar labeled Virtual memory. d. Click on the Change choice and make sure the virtual memory has the following settings: Drive: Choose any uncompressed disk (DoubleSpace and other disk compression technologies cause problems with virtual memory). Type: Permanent Size: About 4 to 6% of your hard disk space has been recommended, but less can be used if disk space is in short supply. Some versions of Windows will specify a maximum allowed size for virtual memory; use this amount when a recommended maximum is present. Disk and File access: If your computer will support 32-bit access, select these options. Click on Ok and save the changes to your virtual memory manager. Restart Windows to bring these changes into effect. 6. Create a PIF file. From the Program Manager, select the following choices: a. Locate the Main Program Group icon and open the program group window by double clicking on it. b. Double click on the PIF Editor icon to start this program. Fill in the fields as follows: Program Filename: This is the program that will start MedARKS. In this case, specify the FMEDARKS.BAT batch file that is provided with MedARKS. Window Title: Put MedARKS in this field. Optional Parameters: Leave this blank. Start-up Directory: This is the drive and path to locate the Fmedarks.bat file. This file is normally installed in the root directory of the drive containing the MedARKS program (the default is C:\). Video Memory: Check the Text option. Memory Requirements: Place a -1 (minus one) in the KB required and the KB desired fields. EMS Memory: Place a 0 (zero) in the KB required and the KB desired fields. XMS Memory: Place a 4096 in the KB required and the KB desired fields. You can vary these figures depending on the amount of memory on your computer. Other number that can be used are: 3072, 5120 and 6144. The larger the amount of XMS memory specified, the longer the program will take to load, but the faster the program will run once it is loaded. A memory specification of 4096 (4 Mb of RAM) seems to give a good balance between loading time and program performance. Display Usage: Mark the full screen option. Execution: Leave both options unmarked. Click on the Advanced options choice and make sure the Allow Fast Paste option is not marked. Now save the PIF file as Fmedarks.pif. The PIF file must have the same name as the program filename that was specified (i.e. the PIF file that starts Fmedarks.bat must be called Fmedarks.pif). The PIF file can be saved in the windows subdirectory or the same directory as the Fmedarks.bat file. 7. Creating a Program Item: The final step is to link the PIF file (just created in the above step) to an icon in a program group window. Return to the Program Manager window and open the Program Group to which you want to add the MedARKS icon (the Applications Program Group is one possibility). Now click on the File option of the Program Manager menu and click on the New choice of the drop-down menu. Mark the Program Item option and click on the Ok button. Fill in the fields as follows: Description: MedARKS 5 Command Line: fmedarks.pif Working Directory: This is the drive and directory containing the fmedarks.pif file (e.g. C:\WINDOWS).

71

Now click on Change Icon button. You will get a message indicating that no icons are available; click on the Ok button. A window labeled Change Icon will appear. Click on the browse button, switch to the \newmed\medarks subdirectory of the drive containing the MedARKS 5 program and choose the MEDARKS2.ICO file. Click on the Ok buttons until you are back to the Program Group window. The program group should now contain a new icon that should allow you to run MedARKS 5 from inside Windows.

72

Creating an icon for MedARKS in Windows 95

You must have at least 16 Mb of random access memory (RAM) to run MedARKS 5 from inside Windows 95. Remember that memory is not the same as hard disk space. Data is stored on the hard disk, but a program must fit into available memory to function. The amount of storage space (disk space) is irrelevant if there is not enough memory to run the program. The instructions that follow will help you to configure your computer to run MedARKS from inside Windows 95. 1. Click on the Start button, choose Programs and start your Windows Explorer program. 2. Click on the View choice (just below the top edge of the window), and click on the Details choice of the drop-down menu. 3. Click on the View choice again, and now click on the Options choice of the drop-down menu. In the option winodw, locate the Hide MS-DOS file extensions for file types that are registered check box and make sure this box is not checked. Also make sure the Show all files option is active. Click on Ok to close the Options window. 4. Locate the Newmed folder on the left side of the window, and click on the + to the left of the folder. 5. A MedARKS folder should now be showing under the Newmed folder. Click on this MedARKS folder icon and the folder should open (the contents of the folder will show on the right side of the window). 6. On the right side of the window, locate the Fmedarks.bat file, and click on the icon to the left of the file name. The file should now be highlighted. Now right click (click using the right button of the mouse) on the Fmedarks.bat file name and choose Create shortcut from the menu. A file called Shortcut to F... should now be highlighted on the right side of the Explorer window. 7. Right click on the Shortcut to F... file and choose Copy. 8. Close the Windows Explorer program (click on X box in upper right corner) 9. Right click on your desktop and choose the Paste shortcut from the menu. You should now have a highlighted icon labeled Fmedarks on your desktop. 10. Right click on this icon and choose the Properties option from the menu. A window called Fmedarks properties should appear. 11. Click on the Program tab (just below the top of the window). Make sure that the Close on exit check box is marked (click on the box if it is empty). Now click on the Change Icon button. Now click on the Browse button of the Change Icon window. Locate and open the Newmed folder, then open the MedARKS folder inside the Newmed folder. The MedARKS folder should contain two MedARKS icon files. Choose one of these icons and double click on the icon of choice. Now click on the Ok button of the Change Icon window. 12. Click on the Screen tab and make sure the following options are marked: Full-screen Initial Size - 25 lines Display toolbar - not checked Restore settings on startup - checked Fast ROM emulation - checked Dynamic memory allocation - checked 13. Click on the Misc. tab and set the following options: Allow screen saver - not checked Quickedit - not checked Exclusive mode - not checked Always suspend - not checked Warn if still active - checked Fast pasting - not checked 14. Click on the Apply button (lower right corner of window) and then the Ok button. 15. Right click on the Fmedarks icon and choose the Rename option. Type in MedARKS 5" and press the Enter key. You should now have a MedARKS icon on your desktop and double clicking on this icon should start the MedARKS 5 program.

73

Moving the ARKS files to the MedARKS computer

The MedARKS program requires access to some of the ARKS files to provide the clinician with basic animal inventory information. MedARKS has a utility that can ease the transfer of ARKS data files from the registrars computer to the hospital computer. This utility will create, on a floppy diskette, a batch file that will control the transfer of the ARKS files. Your responses to a series of questions will allow the program to customize the batch file for your institution. The ARKS files may be quite large, so before running this transfer utility, have several blank floppy diskettes available. Instructions: 1. From the MedARKS main menu, select option 9 (System Utilities) and then option 5 (ARKS Data File Transfer). 2. Enter the hard disk drive letter containing the ARKS files (the registrars computer). The default of C drive will be correct for most institutions. 3. Enter the floppy disk drive letter for the registrars computer. Again, the default of A drive will be correct for most institutions. 4. Enter the drive letter for the floppy disk drive on the MedARKS computer. 5. Enter the drive letter for the hard disk drive on the MedARKS computer that contains the ARKS files. 6. Choose whether to transfer the ARKS taxonomic file. This is a large file and only needs to be updated on the MedARKS machine when the registrar has added a new species to the taxonomic dictionary or if the copy on the MedARKS computer has been damaged and needs to be replaced. Most of the time, you do not need to transfer this file. 7. Indicate whether you have a split ARKS collection. If you are uncertain, ask your registrar. With split collections, you will need to run the transfer routine separately for each taxonomic group that has been split out of the ARKS system. For example, if the reptiles are maintained in a separate ARKS collection (HERPS), then to move the reptile ARKS files, you need to answer the split collection question with a Y and then indicate that you want to transfer reptile and amphibian data files. If all other taxonomic groups (mammals and birds) are managed as a single collection, they can moved by running this utility again and answer the split collection question with a N (move all the non-split taxonomic groups). Complete the transfer of ARKS files on each segment of a split collection before attempting transfer of the next taxonomic grouping. 8. Indicate whether you want printed instructions or not (a Y is suggested if this is your first ARKS file transfer). 9. You should now have a choice of 2 (versions 5.02 and 5.03) or 3 (versions 5.10 and higher) file transfer modes. The transfer modes are as follows: i. DOS backup routine: Avoid this choice. It was the original method, but newer versions of DOS have a different backup program and this transfer mode is not reliable. ii. Slice and Splice routine: This routine will slice the ARKS files into pieces that will fit onto floppy diskettes and then splice the parts back together on the MedARKS computer. iii. PKZIP routine: This is the best routine to use, but is only available starting with MedARKS version 5.10. The ARKS files will be compressed as they are copied to the floppy diskettes and uncompressed on the MedARKS machine. The compression will allow you to transfer the ARKS files using fewer diskettes. 10. Put the floppy diskette into the drive on the MedARKS computer and create the batch file. 11. Exit from MedARKS, take the diskette to the registrars computer, insert into the floppy drive and type (at the C: prompt): a:download (substitute b: if the diskette is in the B: drive). 12. The ARKS files will be copied onto a series of floppy diskettes (the number will depend on the size of your ARKS files, whether you are also copying the taxonomic file and whether you are compressing the files during the transfer). 13. Take the diskettes back to the MedARKS computer and insert the first diskette into the drive. To start the upload of the ARKS files, type (at the C: prompt): c:\newmed\medarks\upload (substitute another drive letter, if MedARKS is on another hard drive). 14. With split collections, repeat steps 1 to 13 for each set of ARKS collection files being transferred.

74

MedARKS Files/Support on the World Wide Web

The Internet has revolutionized the way things are done in the world and ISIS has kept pace with these changes through its Web site. You can now not only easily access the latest version/upgrade of MedARKS from the Web but also the instructions on how to update your version, and chapters on how to utilize each of the modules. There are even helpful hints on how to accomplish specific tasks in MedARKS and to help you make maximal usage of the program features. Accessing the ISIS Web site Go to the following Web address: http://www.isis.org/. This is the ISIS home page. Links to other pages of the ISIS web site and to related web sites are listed at the top of the ISIS home page. To access the "helpful hint" documents, click on the FAQ option at the top of the page and then click on the MedARKS link on the next page. You will now be looking at the list of available "helpful hint" documents. To download a MedARKS program upgrade file, other MedARKS file updates or MedARKS user guide documents, you will need to access the secure portion of the ISIS web site. To access this section of the ISIS web site, you will need your institutions mnemonic as well as the ISIS institution code number. Once you have this information (see your registrar), go to the ISIS home page and click on the Files option at the top of the screen. Entering your institutional mnemonic in the User Name field and your ISIS institution code in the Password field. A page with a listing of available ISIS updates and upgrades will pop up - choose the MedARKS link from this list. You will now be in the online MedARKS download files section. MedARKS download page content The page below shows the available options from the ISIS MedARKS download site. By clicking on the appropriate link, you will be taken to the pertinent section of the Web site and given instructions on how to complete your task. For example, if you were currently working with MedARKS version 5.30k and wanted to upgrade, you would click on the first option listed below (File required for upgrade.........version of MedARKS). This would take you to a series of pages including instructions on how to proceed with the upgrade, a listing of all of the various enhancements that had been made to MedARKS since your version, as well as the upgrade file itself. Contact MedARKS Technical Support (andy@isis.org) if you have questions or need help with any of the items on this page.

Available at this Download Site File required for upgrade from any version of MedARKS 5.3 or higher to the latest version of MedARKS Files required for upgrade from MedARKS 5.0 or 5.1 to the latest version of MedARKS Enhanced version of fmedarks.bat file - MedARKS startup program (31 December 1998 version) Latest version of chapters in the MedARKS manual Latest SSP/TAG protocols for the MedARKS pathology module (26 May 1998 version) Latest clinical pathology reference values for MedARKS (18 August 1998 version)

75

Accessing Library (Reference) Data Disks

Besides managing the medical records on an institutions collection, MedARKS also has the capability to access records in reference or library data sets. The medical advisors for a number of SSP's have established reference data sets. These reference disks contain the combined medical records from a number of institutions and often represent years of experience with a large number of individual animals. Originally, all reference data sets were available on floppy diskettes only, but newer versions of MedARKS can access library files written on a CD-ROM disk. There are three steps involved in accessing a library data set, although the first step is only performed the very first time that your copy of MedARKS accesses a reference data set. 1. Establish LIBRARY as a valid collection for your version of MedARKS. From the main menu, choose 9 (System Utilities), then 3 (Inventory/Collection Utilities) and then choice 1 (Add new collection). The current collections on your MedARKS system will now be displayed. If one of these collections is LIBRARY, you need to exit from this utility by pressing the <Enter> key twice and go to step 2 of these instructions (someone else has already made LIBRARY a valid collection). To continue with adding the library collection, press any key to continue with the utility program. The program should now be asking for the mnemonic of the collection; LIBRARY must be entered as the mnemonic (dont type the quotes). The full name of the collection is not important, except that it will appear on reports that are printed from the disk; Reference Data Set is one suggestion since it will let you know that the report was not printed from in-house records. Next you are asked for the ISIS institution code; leave this blank since reference disks are not records from a single institution. For the drive and path, just enter the appropriate floppy drive for your computer (A: or B:) and make sure the reference disk is in that drive. Accept the defaults for the next two questions. You should now have completed this step and added Library as a valid collection for your copy of MedARKS. Once this procedure has been completed successfully, you will not need to repeat this step - all reference data disks will run using this collection name. Library data disk recognition: The first time you access a library data disk you need to have MedARKS recognize the disk; thereafter you only need to put the disk into the drive and access the data. Go back to the MedARKS main menu and choose 7 (Inventory and Medical History Menu), then choose 5 (Library File Recognition). Answer the next few prompts and when you get back to the menu, you are ready to access the data on the disk. Access the reference data set records: Place the reference data disk in the appropriate floppy drive. From any of the main or secondary level menus, press <F2> and choose Library to switch to the reference data disk. A successful switch will be indicated by Library in the upper right corner of your screen. At this point, you can run any of the MedARKS reports using this data set. You might want to start by running the Collection Data - Taxonomic Group Report (from main menu choose 7, then 2) and set the Historical Collection List filter to generate a complete list of the animals on the disk.

2.

3.

76

Merging records on a medical history transfer disk into MedARKS 5.3

When you receive a floppy diskette that contains MedARKS medical records on an animal that was transferred to your institution, you can integrate those records into your own MedARKS records. All version 4 and version 5 diskettes can be used to update your MedARKS 5.3 files. The following instructions will allow you to update your MedARKS records from the transfer diskette. Remember, your registrar must have already entered the animal into ARKS and you must have updated your copy of the ARKS files (when kept on different computers) before you can perform this transfer. Updating your MedARKS version 5.3 files a) Start MedARKS 5.3x b) From the main (first) menu, press 7 and then 4. Enter password (if needed) and choose the second option (transfer from floppy disk to MedARKS) and enter the master password (if needed). c) You will be prompted for information regarding the drive containing the floppy diskette with the records and the accession number that your institution has assigned to the animal(s) on the diskette. Answer the prompts and the transfer of records should begin. Your MedARKS records should now contain historical medical records on the animal(s) transferred to your institution.

77

Contributing blood analysis results to the ISIS Physiological Reference Values Project
The Physiological Reference Values Project is attempting to define normal clinical pathology reference ranges for captive species by combining clinical pathology data from member institutions. This may not be the ideal method to establish reference ranges, but zoo clinicians often face the reality of dealing with a very small number of individuals at their institution for any particular species with a very limited number of samples collected from healthy individuals. Under these circumstances, reference ranges derived from pooled records represent the best information available for evaluating test results. All ISIS member institutions, that use MedARKS for clinical pathology record keeping, are encouraged to contribute this information to the centralized data file. The following instructions explain, in a step-by-step manner, how to transfer clinical pathology data from MedARKS version 5 (or above) to ISIS. Terms to be familiar with: click or mouse click: a single press and release of the left key on your mouse (with many mice, this is accompanied by an audible click of the button - hence the term). click on: place the mouse cursor on the specified item and click the left mouse key <Esc> key: the key, usually somewhere in the upper left corner of the keyboard, with this label; same as the Escape key. <Enter> key: the key on the right side of the keyboard. The key is most often labeled with Enter, but may also be labeled as Return or the key may be labeled simply with a left pointing arrow with an upward bend in the tail of the arrow. Arrow keys: The set of four keys with an up, down, left and right pointing arrow on the key. On some keyboards, these keys will serve double functions as numeric keys also. On this type of keyboard, there is usually a small set of lights in the upper right part of the keyboard and one will be labeled Num Lock or Numeric Lock. When the light is on, the double function keys will act like numeric keys and when the light is off, the keys take on their other function. Switch between the two modes using the Num Lock key on the keyboard; each press of this key switches the function of the keys. Clinical Pathology Data Transfer Instructions 1. Have an empty floppy diskette available. You can either delete all the files on the diskette or format the diskette to erase it. Start MedARKS and from the main menu choose 4, then 1, then 5 and finally 5 again to start the Hematology/Chemistry/Serology Data Transfer utility. Of course, you may make all the specified menu choices by clicking with the mouse on the choice, using the arrow keys to highlight the correct choice and pressing the <Enter> key or by simply press the appropriate number key. Enter the Master password (if you have one) and press the <Enter> key. You should now have a box, containing a list of 4 choices, on your screen. You can use the arrow keys to highlight a choice and press <Enter> to select that choice or simply click on the choice with your mouse. Each of the choices and their function is discussed below. Create transfer file...: This choice starts a utility program that reads through your MedARKS clinical pathology files looking for records that are marked for sending to ISIS. When an appropriate record is located, the information in your record is used to create a data transfer file on your hard disk. The transfer file contains test results and other sample information you have entered into MedARKS. When the utility is complete, you will have one or more transfer files (each transfer file can contain information on 1000 MedARKS records) that need to be sent to ISIS. When finished, this create transfer file utility will immediately start the copy file utility (see next paragraph) to let you copy the transfer file on your hard disk to a floppy diskette. Copy previously created ISIS transfer file ..: This utility can be started using this choice, but it will start automatically when the create transfer file utility is finished making transfer file(s). This utility will display a list of file names, file sizes (in bytes) and the file creation date. Any of the files listed can be selected and copied to a floppy disk. If you have just created the transfer file(s), those files with a creation date of today will be the files you need to copy. Select a

2.

3. 4.

78

file for transfer to the floppy diskette by highlighting it using the arrow keys and press <Enter> or click on the file name with your mouse. Insert the floppy disk into the appropriate drive and enter the floppy drive letter (A or B) when requested by the program. If the floppy disk is too full to contain the selected file, you will get a warning message. Replace the floppy disk with one that is empty and try to copy the file again. If the file is successfully copied to the floppy disk, the program will request permission to remove the file from your hard disk; it is safe to remove the file, since even if the file gets damaged it is possible to resend all your data to ISIS (see the instructions for the next choice). Once the transfer file(s) has been copied to the floppy diskette, mail that diskette to: Physiological Reference Values Project ISIS Offices, Building A 12101 Johnny Cake Ridge Road Apple Valley, MN 55124 U.S.A. Note: Anatomy of a file name: The ISIS transfer files can be recognized because they start with the last 8 digits of your ISIS institution code. The last 3 characters of the file name (after the period) represent the year the file was created (first character), the month (second character) the file was created (A=January; L=December) and the creation sequence (third character) for that month and year (A=first file, B= second file, ...). Mark all records ...: Normally, only the MedARKS clinical pathology records that have been edited or added are sent to ISIS in the transfer files. Occasionally, because of changes in the transfer utility or because of problems with previous transfer files, we will request that you resend all your data to ISIS. This utility will read your MedARKS clinical pathology files, locate all the records that have been sent to ISIS in the past and mark these records for sending to ISIS the next time you run the create transfer file utility. Count the records ...: Run this utility if you want to know how many records are currently marked for potential transfer to ISIS. For computer users with more experience, the data transfer files may be sent to ISIS electronically (rather than on a floppy diskette) attaching the file(s) to an E-mail message and sending them across the Internet to andy@isis.org. Institutions that contribute clinical pathology data to the ISIS data set will receive an updated version of the MedARKS compatible data file, containing the ISIS reference values for captive species, whenever this file is recalculated.

79

Suggestions for tracking experimental contraceptive methods with MedARKS

Many zoos use various reversible contraceptive methods in their animals, including the melengestrol acetate (MGA) implants (supplied by Dr. Ed Plotka), other synthetic progestins, and the zona pellucida vaccine. The experimental nature of these implants increases the clinicians responsibility for accurate records. The prescription module of MedARKS can be used to maintain drug records that will assist with annual reporting requirements and to calculate the duration of treatment, which can be used to determine when a contraceptive method needs to be renewed or removed. Record Entry: Records should be entered for all forms of reversible contraception (MGA, MGA+E2, Norplant, Depo-Provera, Zona Pellucida vaccine, birth control pills, Ovaban, Megace, etc.). The key features for entering reversible contraception methods are as follows, but, as always, make your records as complete as possible. Drug: MELENGESTROL ACETATE IMPLANT (or other contraceptive method) The drug dictionary file supplied with MedARKS 5.10 contains many of the common reversible contraceptives (like MELENGESTROL ACETATE IMPLANT). If your MedARKS dictionary does not contain the appropriate contraceptive method, you can add it to the dictionary when you record the prescription. Dose: Record the weight of the implant that is written on the outside of the implant container (or the appropriate dose for other methods) Duration: UFN (until further notice) for implants (use appropriate duration for other methods) Route: subcutaneous or intramuscular implant (or appropriate route for other methods) Prescribing Clinician: The initials of the clinician responsible for this contraceptive prescription. Lot/Bottle number: For MGA implants, record the number written on the outside of the implant container. For commercial products, record the manufacturers lot number. Purpose: For proper reporting, contraception should be entered as the purpose for the prescription. Scheduled Retreatment Date: For vaccines and drugs that are given at specific intervals or at a particular time of the year (e.g., Depo-Provera in seasonal breeders), the program can store a reminder to repeat the prescription on a specified date. Ending an Active Contraceptive Prescription: Prescriptions written with a duration of until further notice, remain active until terminated. With implants, prescription termination may be due to implant removal (for change of method, to allow reproduction, implant replacement, or other reasons) or implant loss (implant found or discovered missing at a routine examination). In any case, the Discontinue an Active Prescription menu choice in the prescription module will allow you to terminate the current contraceptive implant prescription. You will be requested for a date to terminate the prescription; use the date that implant was removed, known to be lost, or discovered to be missing. The duration of the prescription will be calculated by the program and stored in the record. Reporting: The Drug Usage Report can be used to obtain a list of the animals that have received contraceptive treatment by retrieving prescription records for a particular drug. For MGA implants, the implant number (lot number), the size (weight) of the implant, the duration of treatment and the prescribing clinician will be reported. Active contraceptive prescriptions are indicated and the duration for these active prescriptions reflects the current duration (days from the implant date to the reporting date). This allows you to easily monitor all animals with an active contraception prescription and schedule implant replacement or removal based on the duration of treatment. While not providing all the information requested for reports to the AZA contraception committee, the drug usage report is a good starting point for tracking down all the required information.

80

Text editing commands in MedARKS

The FoxPro text editor included with MedARKS 5 is fairly simple, but has the cut, copy and paste functions needed to make text editing easier. All these functions work on a block of text that has been selected or highlighted from the text entry. The following document outlines the methods used to edit text in MedARKS 5. Text Edit Functions: Selecting text: Mouse Method: Usually, the quickest method is to use the mouse. Position the mouse cursor on the first character to be selected, depress the left mouse button and while holding the left button down, drag the mouse cursor to one character past the last text character to be selected. Release the mouse button and the text should remain marked in a different color. This is selected text and the editing commands will apply to this block of text. Keyboard Method: You can also use the keyboard to select a block of text. Move your text cursor to the first character to be selected, hold down the shift key and use the arrow keys to move the text cursor just past the last character you want selected and release the shift key. Again, the selected text should be remain in a different color. The keyboard is most useful when combined with text positioning functions and can allow you to select very large blocks of text very quickly. Usage tip: Use the keyboard to select an entire record. Press the Ctrl-Home keys to jump to the beginning of the text. Now, while holding down the shift key, press the Ctrl-End keys. The entire text entry should now be selected. With large records, this is significantly faster than using the mouse. Select a single word: To quickly select a single word, place the mouse cursor anywhere on the word and double click. That word should become highlighted. Usage tip: This feature is useful for quickly replacing a single word. Double click on the word to be replaced and just type the replacement word.. Make sure you are in insert mode, otherwise, the first letter typed replaces the selected text and then you start typing over the next word in your text. Deselecting text: Press the left mouse key or one of the text position control keys (arrow, home, end, page up or page down keys) to deselect the text. Virtually any other key will have an effect on the selected text, so be careful. Copy selected text [Ctrl-C]: First select the text to be copied, then hold down the Ctrl key and press the C key. This will copy the selected text to a clipboard, where it will remain until you copy another block of text to the clipboard or you exit from MedARKS. From the clipboard, the text can be pasted back into the same text (perhaps you want to duplicate this entry further down the page) or into a new text record (duplicate the entry for another date or animal). Usage tip: The copy feature is particularly useful in MedARKS where you have performed the same procedure on a number of animals (e.g., quarantine examinations on a group of birds). Write the first text record in detail, select the entire text record and copy to the clipboard. Start the medical record on the next animal and paste in the record from the previous animal. Edit this record to reflect any differences between the 2 animals. Repeat these steps for all the animals that received examinations. In most cases, copying, pasting and minor editing will be much faster than writing an entire record for each animal. Paste text from clipboard [Ctrl-V]: Position the text cursor at the point where you want the clipboard text to appear. Hold down the Ctrl key and press the V key. Any text on the clipboard will be inserted at that point. Cut selected text [Ctrl-X]: This is very similar to the copy text function, except that the highlighted text is removed and then placed on the clipboard (rather than placing a copy of the text on the clipboard). Select the text, hold down the Ctrl key and press the X key. This will remove (cut) the selected text to the clipboard, where it will remain until you cut (or copy) another block of text to the clipboard or you exit from MedARKS.

81

Usage tip: The cut feature is most useful in MedARKS for moving a block of text. Perhaps you are most of the way through a clinical notes entry when you realize that it is the wrong animal. Simply select everything you have written, cut it to the clipboard, go to the correct animal and paste your text into this record. Delete selected text: Select the text to be removed and press the Delete key. The text is removed. This text is not copied to the clipboard and does not replace or remove any text that is already on the clipboard. Text Positioning Functions: You can move the text cursor by using the arrow keys or you can click anywhere in the text with the left mouse button. In addition, there are other keys or key combinations that will move the text position cursor. With the Control (Ctrl) key combinations, treat the Ctrl key like the shift key (i.e., hold the Ctrl key down and then press the second key in the combination). Home key: Move the cursor to the left margin of the current text line. Ctrl-Home key: Move cursor to the beginning of the text (top of the page) End key: Move cursor to the right edge of the text on the current line Ctrl-End key: Move cursor to the end of the text Up arrow key: Move cursor up to previous line. Down arrow key: Move cursor down to next line. Left arrow key: Move cursor to the left by one character. Right arrow key: Move cursor to the right by one character. Ctrl-right arrow key: Move cursor to the start of the next word. Ctrl-left arrow key: Move cursor to the start of the current word. Page up key: Move the text so the first line currently showing on the screen becomes the last line on the screen. Page down key: Move the text so the last line currently showing on the screen becomes the first line on the screen.

82

Common Problems and Questions Error message - Corrupted or missing memo file
As stated earlier, databases are quite susceptible to damage when data files are in use (on page 9) and the memo (text) file is the most susceptible to damage. When a memo file is damaged (corrupted) or deleted, this error message will appear when you start MedARKS. The program will automatically lock you out of the module impacted by the damaged file (i.e., if the damaged or missing file is part of the clinical notes module, then you will not be able to access the clinical notes module until the problem is resolved). The solution to this problem is to restore files from your last backup set. The MedARKS restore utility will allow you to selectively restore files so that you do not overwrite records in modules that have not been damaged (i.e., if the anesthesia module is disabled by a damaged file, you can choose to restore only the anesthesia module data files). If you are using a tape backup, the tape software will allow you to specify the files to restore. The data files associated with each module are listed on page 66 or call MedARKS Technical Support for assistance.

Can I run MedARKS on a network?

Yes. MedARKS is a multi-user product and is currently being used on LANs in more than 30 institutions. The process of installing and configuring MedARKS for the network is fairly simple, but MedARKS technical support can provide assistance if necessary.

83