ISYS and The Ultimate Medical Examination

The term ‘Forensic Medicine’ conjures up images of television programmes such as State Coroner, CSI, Murder Call and Quincy ME. We imagine a constant stream of medical conundrums as coronial investigators set out to discover all the tiny pieces of a puzzle that help with, or completely solve, the crime.

While the primary role of the NSW Institute of Forensic Medicine is to examine the deceased and make reports to the coroner, the institute also contributes to various other facets of medical research. Describing post mortems as “the ultimate medical examination”, Dr Joe Duflou of the NSW Institute of Forensic Medicine says that there is a lot more to be learned from a person than simply the cause of death. “When examined, the dead provide all sorts of information about their lives and other diseases, as well as what directly caused their death.”

For example, a person who dies in a car accident may, on examination, show signs of heart disease, may have diabetes or have early indications of cirrhosis. The size, height, weight of the body, dimensions of organs and every physical detail is recorded in the post mortem.

The information collected creates a huge pool of high quality epidemiological data – epidemiology being the study of diseases within a community. This information can be very important and the institute is responsible for providing all sorts of useful statistics and data on diseases, accidents, deaths by misadventure and murders.

The institute uses ISYS to index its post mortem reports. ISYS is set up on the Institute network and indexes every post mortem record since 1991. Roughly 2,500 reports are generated every year and the Institute performs an ISYS update every night and re-indexes once a week. Pathologists, laboratory technicians, support staff and grief councilors all use ISYS but at the NSW Institute of Forensic Medicine, ISYS is primarily used for research.

With hit highlighting and hit-to-hit navigation, ISYS acts as a powerful research tool that takes you to the exact point where a word or phrase occurs. ISYS also finds every reference to your query, providing every part of every document that refers to what you are looking for, in a second.

The staff at the institute have unlimited applications for their information. “Databases are generally designed with only one purpose in mind,” said Dr Duflou. “With ISYS, you can find anything you need and you’re not restricted to predetermined field searches.”

“The information contained in each post mortem report contributes in any number of ways to overall statistics. The trouble is that you could never design a database that would provide an efficient use of all the information, “ said Dr Duflou. “ Databases are designed for prospective research. You come up with an idea, something you want to know, and you design a database to collect relevant information for it. It could take five years or so before you get good results and at the end of that time you realize that you’d also like figures on something else, but you haven’t collected the data on that so you have to start again or give up on your new idea.”

“ISYS is perfect for retrospective research. Every post mortem report contains case histories; findings; of lab results; cause of death; any other diseases present and other information that might be relevant, all in a standard WordPerfect document. When we index these reports with ISYS, we can suddenly get a bright idea and search the last five years for a word, disease, age or anything else and get immediate findings.”

Dr Duflou says that many places use medical coding systems to maintain data. “These systems are good but cumbersome. Every disease condition needs a code and the information has to be very structured. With ISYS we can just index the entire report and access whatever information we need, whenever we need it. Information is not of much value unless you can analyze it and ISYS lets us access the information in whatever way we wish.”

The institute is also able to provide statistics on how well the community is combating a disease. For example, all suspected cot death post mortems are performed at either Westmead Hospital or the Institute. In the last few years, there has been a drop in SIDS (Sudden Infant Death Syndrome) of over 50 percent.

The Institute can be asked to provide statistics on all sorts of things at very short notice. Questions may be asked about road tolls, anorexia or heroin deaths. If the figures suddenly increase dramatically, the reason for the jump can be investigated and combated.

Dr Duflou spends a lot of his time involved with aviation pathology, where it is critical to find not only the pilot’s cause of death but also whether there were any contributing factors. He may be asked to provide statistics on the percentage of aircraft incidents attributable to pilot incapacitation (where the pilot died). This can be answered in no time with an ISYS query.

Another area where the ISYS search capability is very useful is with violent crime. Because the Institute has electronic records going back as far as 1991, investigative bodies are able to request information on past crimes and with ISYS an answer is easily provided. Where a murder has taken place, the institute is often asked whether there has been a previous case that matches the recent one. Sometimes an incident from years ago can be isolated and a repeat offender or serial killer’s method identified.

Grief Councilors at the NSW Institute of Forensic Medicine also use ISYS for rapid access to case results during telephone discussions with deceased’s relatives. ISYS lets them call up information quickly when questions are asked and the hit-to-hit navigation lets them skip through documents to the relevant areas without lengthy delays at a very emotional time.