HxFE

A comprehensive computer program to elicit, store & update patients' medical information

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This article is a statement of a sad Medicare fact – a bureaucratic oversight that has lost a billion dollars of taxpayer money and may well have caused much disability and death. Incidentally, this same article also ‘advertises,’ or better, reports on a soon to be available and inexpensive remedy…

We recently saw, in Ontario Canada, how the government’s eHealth efforts captured and swallowed a billion tax dollars to little or no practical avail. Numbers of highly payed business consultants failed to get to first base in devising an electronic medical backbone for publicly owned universal Medicare. And they are still floundering.

Some 20 years before the Ontario ehealth fiasco, the author designed & built a computerized medical database for his own general medical practice for next to nothing. The program is called HxFE.

An attempt to ‘market’ HxFE in 1991 as a stand-alone program fell on deaf ears as Ontario’s Ministry of Health was almost totally computer illiterate and virtually no doctors had computers in their offices. They had no reason to as the ministry was still dealing with billings by paper. OHIP (Ontario Health Insurance Plan) used cards made of cardboard! At long last, should it not be patently obvious to any politician or sensible government bureaucrat that, basic to any proper ehealth network, is proper programming – individual medical data designed, if not coded, by doctors? Well, that’s not likely, but HxFE may well fill the bill. We hope!

HxFE is a compact ‘Med-tool’ that enables the comprehensive and systematic gathering of manageable masses of medical data. Taking a full medical history with HxFE can be done by a secretary, or even the patient, because it has a subtly built in mechanism that ensures accurate, honest reporting. So what exactly is HxFE? Hx stands for medical history; FE stands for functional enquiry (or system review). The latter is akin to the checklist that pilots tick off before takeoff. Once such an easy, readily accessible, electronic database is on record, documented, the patient is protected from the neglect of obscure subtle problems and the doctor is rendered more efficient, effective and safe in practice. Obviously, HxFE will save both time and money for any Medicare system. As a bonus, legal issues are more easily clarified and the conscientious and competent doctor is less likely to be the target of spurious lawsuits.

HxFE is comprised of five distinct, but integrated, parts: 1) a full survey of the patient’s present, here and now, health, including presenting problem and all currently diagnosed conditions, their status and treatment details; 2) a broad and deep survey and documentation of all past illnesses, injuries, surgery, obstetrical, paediatric, etc., events and their management – from prenatal moments, on and up through life, to the present; 3) next, is the patient’s key family history, which can give clues to genetic and acquired problems that may be lurking in the background; 4) then comes an extensive personal rundown that may portray susceptibility to stress or other factors; and finally, 5) a check-list, or the so-called ‘functional enquiry,’ into all organ systems that elicits critical signals, symptoms and signs, of possible impending or overlooked problems. The program is full of ‘tickler-flags’ that draw serious concerns to the doctor’s immediate attention. HxFE also has the easy capability of updating a patient’s status at any time by means of a tiny (10-line) addendum termed a POR or problem oriented record.

Preparations for HxFE began in the 1970’s with creation of a simple key-coded, extra-secure cardex system that links patients’ paper charts together by translating patients’ names into an alpha-code and then into secret numbers. This enables charts to be filed in blind sequence by random number instead of alphabetically. (A break-in of a psychiatrist’s office and theft of patients’ charts during Nixon’s Watergate mess ‘inspired’ this extra-secure filing approach.) In the early 80’s I took a second non-medical leap and programed HxFE per se into my CPM-based Kaypro strictly for personal office use. While it generated electronic patient files, its main purpose was to get a history printout promptly into patients’ paper charts. In the late 80’s I recoded HxFE in DOS-based QB-4.5, a modular format, still name key-coded but also data soundexed for yet more security. I naively tried to market it across Canada for private doctors’ offices – but it was frankly too far before its time. At that time HxFE was copyrighted. The attached picture shows how HxFE was originally packaged for sale on a single floppy disk. As MS Windows-3 came out, my amateur programming gradually fizzled out, but I kept using HxFE, even on top of Windows, in my own private office with salutary results (that is, with good clinical and economic benefits). Wrinkles were ironed out until I retired from practice in the late 90’s. During the 90’s, modified versions of HxFe were designed for more in-depth use by various specialities, but none were sold. Recently I coded HxFE in HTML and tried to create a Java engine for its Internet use, but my programming skills were no longer up to the task. (Incidentally, the original HxFE still runs perfectly well on PC’s with 32-bit processors, but the new 64-bit ones are beyond it.) HxFE has sat dormant since my retirement, but its time may have at last come.

Privacy + security? Individual patient data is ‘key-coded’ for easy, but limited, access. It is, in addition, ‘soundexed’ for secure electronic transmission. 

Finally, HxFE, with its small tidy program engine, can easily be embedded on a single chip in a wallet-sized health care card. “HxFE may just save your life!” Here is a snippet from the first part of HxFE:


HxFE Part 0 CHIEF COMPLAINT (CC) (or presenting problem)

The CC is usually asked directly by the doctor, so this section is optional.

Type in one single MAIN PROBLEM below. E.g., headache, fatigue, nausea, chest pain, etc.

Just one! You will get a chance for more later.

My #1 foremost complaint – right now – is —–

The next five questions help us to clarify this main symptom of concern.

 1. When did it first START or how long have you had it? Onset &/or duration —–

               2. Do you know its SOURCE or CAUSE(S)? ? My idea of its cause is —–

               3. Are there any COMPLICATIONS from it? ? I have noticed —–

               4. Have you found anything that makes it BETTER? ? Yes, please go on —–

                                                                                    WORSE? ? Yes, go on —–

                                                                                    Nothing affects it. ?

              5. Why have you come here NOW? Why not before this time, or later? —–

HISTORY of PRESENT ILLNESS (HPI): Please give a description and brief sequential outline

of the problem. HPI is usually taken by the doctor, so imagine an empathic one sitting right here.

Dr. it has been like this —–

HxFE Part 1 We now check ALREADY DIAGNOSED medical-surgical-psychiatric problems & conditions that you NOW have. Whether under treatment or not! Cite doctors diagnoses, e.g., arthritis, diabetes, psoriasis, etc., whatever it is you definitely have. Try to list the entities in order of importance. Indicate if stabilized and under control or not.

Diagnosis of condition 1 ––––– be sure to elaborate.

Same for condition 2 –––––

And also for condition 3 –––––

Any others? Keep going, include all. There is lots of room. –––––

I suffer from no already-diagnosed illness right now! ? Women: are you now pregnant? ?

What MEDICATIONS are you now taking? Please, list everything including vitamin supplements

and proprietary remedies. Try to cite generic or trade names. If unknown, approximate: ?P Rx.’

Medication 1 ––––– M2 ––––– M3 ––––– M4 ––––– M5…n ––––– everything you take!

your pharmacist (optional) Name ––––– Phone number –––––

Is there any other medical problem you just may have, or you are secretly worried about?

PLEASE TELL US –––––


Please note: Among other things a medical history is a quasi-legal document. That includes yours. ONCE DONE, NEVER ALTER YOUR ORIGINAL MEDICAL HISTORY! Nor change its date. Leave it intact, as is. By NOT so doing, your doctor could be mislead and Rx distorted. Any legal liability or claim could be voided.

HxFE is undergoing retooling for 64 bit systems. It soon will be ready for a variety of applications, including chips for wallet cards, retail sales to practicing physicians and downloads from the Internet Doctor (ID) for general public use. HxFE is a trademark & copyrighted as the flagship component of Med-tools a subsidiary of Praxis & 10 Talents (interactive software), Inc. That covers the waterfront, doesn’t it? /wfh