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One objective of this essay is to provide an understanding of the widely used categories of software as well as how one might select software for one’s own use. The most commonly used categories and considerations for software selection and use are discussed, with an emphasis on databases and database software.

This chapter will provide a more detailed look at clinical and anatomic database design for the following reasons. Personal computer software vendors’ marketing of database software appeals to nontechnical, computer-friendly professionals and desperate (and/or disparate) clinicians. Health care lags behind other industries in utilization of information technology. Financial executives often fail to understand the laboratorian’s or the clinician’s or the scientist’s need for information technology beyond billing for services. Financial executives generally control the information technology available to the laboratorian or the clinician or the scientist unless they build their own technology. Clinically meaningful information patterns that exist in the electronic laboratory record are obscured by current data management and presentation approaches.

Simulation is defined as a means of seeing how a model of a real system will respond to changes in its structure, environment, or underlying assumptions.^1 The value of a model simulation is that it allows exploration of proposed changes in a real, operating system without having to bear the risk and costs of change until the optimal system has been identified and tested. For the purpose of this chapter a system is defined as a combination of elements that interact to accomplish a specific objective. The two types of systems are manufacturing systems such as large production facilities, small jobs shops, machining cells, assembly lines, and so on and service systems such as healthcare facilities, amusement parks, restaurants, and banks.

Computer scientists and engineers, perhaps to make their activities more intelligible and more appealing to lay people, tend to use biological metaphors for the products of their activities. Prominent among these are artificial intelligence, neural networks, and genetic algorithms. All these are more or less expressions for categories of programs and the way they work. The intent (at least of some practitioners) is recreate the intelligence of a human in a machine. Whether this is possible or even desirable depends on how one looks at the processes of a machine and the processes of the human mind. History, folklore, and literature are full of accounts of attempts to create man or the intelligence of man in a robot or automaton: the Golem in Jewish folklore, the creature in Mary Shelley’s Frankenstein , and HAL, the computer in Arthur Clarke’s 2001: A Space Odyssey . It is interesting to reflect on how many of these efforts failed or went out of control because of the lack of a human moral sense in the creation. One of the very best and most scholarly and thoughtful works on the subject of “computer intelligence” is Jaki’s Brain, Mind and Computers .^1

The use of microscopic images in pathology dates back to the first users of the microscope. As early as the seventeenth century, Antoni van Leeuwenhoek measured the sizes of microscopic objects, including human erythrocytes, using reference objects such as hairs and grains of sand.^1 Drawings from observation and later from the camera lucida were the earliest means of recording microscopic images. With the development of photography in the nineteenth century, photomicrography came into use for the communication and archiving of microscopic images, and it has been the standard for well over a century.^2 The development of electronic imaging in the twentieth century had diverse roots in the fields of astronomy and medical radiology, the television and motion picture industries, the development of electronic copying, publishing, and printing technology, and of course the ascendance of the microcomputer. Only in the last decade has the technology for electronic acquisition, display, and storage of images become generally available, cost-effective and capable of sufficient resolution for effective routine use in pathology.

The practice of medicine has been subject to economic, social, scientific, and technological forces that have altered the practice of the profession over the last several decades. In many cases, pressures have been applied by forces that have seemingly contradictory goals. Economic forces applied by the evolution of managed care have led to a reorganization of the medical infrastructure in the United States, which have resulted in increasing numbers of patients for individual providers to care for and the unavailability of medical care to larger and larger segments of the population. Concurrently, medicine has been under constant pressure, from both inside and outside the profession to find a way to care for the medically underserved, not only those created by the economic restructuring, but those who were underserved in the past, such as the geographically remote. While the appeasement of contradictory forces and pressures on priorities in medicine at a national level are a laborious, complicated process involving many social, economic, and philosophical issues, medical practitioners are having to deal with the problem of providing care to more and more patients dispersed over a greater and greater geographic area on a daily basis. Pathology by its nature has been particularly prone to the pressures and problems of centralized care. Fortunately, advancements in the technology of telecommunications and computer science have offered practitioners an effective option in dealing with this problem.