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Biomedical subjects

J W Hales

Publications and source records attributed to J W Hales.

At least 19 recordsLinked to original sources
PubMed2001

Making public health data available to community-level decision makers--goals, issues, and a case report.

Effective community health assessment and planning depends on the availability of appropriate public health data. Web-based technologies have created an unprecedented opportunity for making data available to community-level public health decision makers. An interactive data retrieval system targeted to the community-level user must provide an intuitive and easy-to-learn user interface with functionality and statistical complexity appropriate to the expected users while maintaining confidentiality of personal health information. The authors use the Missouri Information for Community Assessment Web site as an example to discuss goals and issues involved in the development of such systems.

Community Health Planning↗
PubMed2000

Prediction accuracy and financial savings of four screening tests for a sequential test of clinical performance.

BACKGROUND: Sequential testing of clinical performance is an effective strategy to reduce cost of testing. PURPOSE: To evaluate prediction accuracy and financial savings of 4 screening tests of clinical performance. METHODS: Screening tests were created from a 13-case examination taken by 434 medical students at 4 schools. Regression analysis determined prediction accuracy for 2 test outcomes. Financial savings were computed from published estimates. RESULTS: Zero false passes were obtained with the "Total Number of Cases Passed" screening test, but it saved only 27%. Sixty-two percent savings with 5% false passes occurred with the "Classification" screening test. The "Scale" and "Mini Test" screening tests would have excused 79% and 67% examinees with 5% and 1% false passes, respectively. CONCLUSIONS: Prediction accuracy varies with screening test and outcome measure. Sequential testing of clinical performance can save 40% to 60% with low false pass rates. However, programs need to consider loss of information for curriculum and individual feedback relative to financial savings.

Clinical Competence↗
PubMed2000

Medical informatics in healthcare organizations: a survey of healthcare information managers.

OBJECTIVE: To assess the medical informatics needs of healthcare organizations and the work roles for informaticists in those organizations. METHODS: A 128-item survey was developed and administered as a structured interview to thirty-two information managers in eighteen organizations. The survey included items about medical informatics training, prior work experience, skills for informaticists, and programming proficiency. RESULTS: There was a strong preference for informaticists with prior clinical work experience and an understanding of healthcare. Project management and data warehousing were highly rated skills. Informaticists were expected to know about healthcare processes, clinical guidelines, and outcome management. They were not expected to be expert programmers. CONCLUSION: There is a role in healthcare organizations for interdisciplinary workers who understand clinical medicine, healthcare management, information technology, and who can communicate and work effectively across these organizational boundaries.

Administrative Personnel↗
PubMed1999

A Web link management tool for optimizing utilization of distributed knowledge in health care applications.

The number of health-related Web sites on the Internet is increasing. Incorporating these sites into clinical decision support systems and other health care applications can significantly enhance the educational and instructional value of such systems. While search engines exist for finding sites and criteria are available for assessing site quality, few tools are available for managing Web-based health care information. Management of Web-based information is particularly challenging because the information is continually changing and new resources are continually being added. In this paper, we describe the development and use of a Web-link manager for health care applications. This system retains search strategies for repeated use, catalogues search results in a search results database, accommodates tracking of site review and use status, and provides periodic checking of link integrity for sites that are used in local applications. The Web-link manager is currently in use to manage the links used in a clinical decision support system that presents clinical practice guidelines interactively to clinicians at the point of care.

Computer Communication Networks↗
PubMed1998

Barriers to evaluation of clinical vocabularies.

BACKGROUND: The importance of standard vocabularies for representing clinical data is widely accepted. The selection of suitable vocabularies for a given task relies upon criteria for systematically differentiating vocabularies. However, methods and measures for comparing vocabularies are only now emerging. Substantial barriers inhibit progress in the development of these measures. METHOD: As part of a larger project, the authors are developing quantitative measures for characteristics of controlled vocabulary as identified in the literature. RESULTS: Seven barriers have been identified that inhibit the development of quantitative measures of the characteristics of controlled vocabularies: 1) application dependence; 2) empirical v. independent assessment; 3) dichotomous v. continuous measures of characteristics; 4) poor definition of characteristics; 5) number of characteristics; 6) multiple levels of significance of characteristics; and 7) interdependence of characteristics. CONCLUSION: Progress toward quantitative assessment of clinical vocabularies is dependent upon overcoming barriers to the development of appropriate measures. Such progress requires innovative solutions and collaboration among investigators.

Evaluation Studies as Topic↗
PubMed1998

Siegfried: System for Interactive Electronic Guidelines with Feedback and Resources for Instructional and Educational Development.

The proliferation of clinical practice guidelines (CPGs) has necessitated computerized solutions for guideline distribution and implementation. In this paper we describe a Web-based system that interactively presents CPGs at the point of care. Our system, known as Siegfried, provides a generalized solution for implementing CPGs by maintaining the guideline knowledge base separate from the application that presents the guidelines. As a result of this design, new CPGs can be easily added and existing CPGs can be expeditiously modified without additional programming. This system also solicits feedback from users regarding guideline recommendations and provides hypertext links to relevant Web-based instructional and educational resources.

Artificial Intelligence↗
PubMed1998

Extracting medical knowledge for a coded problem list vocabulary from the UMLS Knowledge Sources.

INTRODUCTION: The Unified Medical Language System (UMLS) Knowledge Sources embody a rich source of medical knowledge. We sought to extract a portion of this knowledge by incorporating information about relationships between UMLS concepts into an existing problem list vocabulary. METHODS: We matched terms from the coded problem list of The Medical Record (TMR), a computer-based patient record system, with those found in the UMLS Metathesaurus. Those UMLS concepts that participate in 'parent' relationships with the matched TMR concepts were translated back into TMR codes and the relationship information was retained for integration into the coded problem list of TMR. RESULTS: Of the coded problems currently in use in TMR, 67% (1627/2436) could be matched by normalized string matches to the UMLS Knowledge Sources. Of these matched TMR concepts, 91% (1488/1627) participated in at least one UMLS-identified parent relationship but only 28% of the matched concepts (454/1627) participated in parent relationships that already matched to a TMR code. As a result, although 67% of TMR codes were matched to UMLS concepts, only 19% of our original problem list (454/2436) could be augmented by relationship information contained in UMLS without improving the rate of matches or adding additional UMLS concepts as coded problems in TMR. CONCLUSION: This study illustrates the rapid decline in overall rates of matching that result from a multiplicative effect of successive matches of terms to concepts, concepts to relationships and concepts back to entry terms. This effect will hamper any effort to extract relationship knowledge from the UMLS for incorporation into an entry vocabulary that is not already one of the source vocabularies of the UMLS Metathesaurus.

Humans↗
PubMed1997

Medical data mining: knowledge discovery in a clinical data warehouse.

Clinical databases have accumulated large quantities of information about patients and their medical conditions. Relationships and patterns within this data could provide new medical knowledge. Unfortunately, few methodologies have been developed and applied to discover this hidden knowledge. In this study, the techniques of data mining (also known as Knowledge Discovery in Databases) were used to search for relationships in a large clinical database. Specifically, data accumulated on 3,902 obstetrical patients were evaluated for factors potentially contributing to preterm birth using exploratory factor analysis. Three factors were identified by the investigators for further exploration. This paper describes the processes involved in mining a clinical database including data warehousing, data query and cleaning, and data analysis.

Data Interpretation, Statistical↗
PubMed1997

Structuring clinical practice guidelines in a relational database model for decision support on the Internet.

The rapid proliferation of clinical practice guidelines (CPGs) has made computerization increasingly useful to clinicians. Computerization, however, requires transformation of the content and logic of each guideline into a computer-accessible form. In this project, we sought to use a relational database to construct a generalized guideline knowledge base for use with Internet-based decision support applications. We hypothesized that knowledge representation schemes could be developed to capture guideline content and logic within the constraints of a relational database model. In this paper we describe a database schema based on a relational model for computerizing CPGs using a hybrid of structured and procedural knowledge representation schemes. We developed and refined this model in the context of five diverse CPGs and found it accommodated all necessary representational requirements.

Algorithms↗
PubMed1997

Development and use of a Guideline Entry Wizard to convert text clinical practice guidelines to a relational format.

Computerization of clinical practice guidelines (CPGs) has been proposed as one solution to enhance the use of guidelines in influencing standard clinical care. However, the conversion of text guidelines to the format required by a computer program is a major barrier. Clinicians who best understand the content of CPGs are typically ill equipped to convert textual guidelines into a computer accessible format. The potential of knowledge acquisition tools to assist in this process has been documented in the literature. In this paper we describe an application prototype, the Guideline Entry Wizard, created to assist in the conversion of text CPGs to a structured format within a relational database. We have tested this application through the input of information from several CPG. The application is a prototype for a more advanced tool. We have used this prototype to enter several CPGs and have demonstrated its effectiveness in inputting guideline content into a knowledge base.

Artificial Intelligence↗
PubMed1995

Evaluation of an object-based data model implemented over a proprietary, legacy data model.

Most computerized medical information today is contained in legacy systems. As vendors slowly move to open systems, legacy systems remain in use and contain valuable information. This paper evaluates the use of an object model imposed on an existing database to improve the ease with which data can be accessed. This study demonstrates that data elements can be retrieved without specific programming knowledge of the underlying data structure. It also suggests that underlying data structures can be changed without updating application code. Programs written using the object model were easier to program but ran greater than one order of magnitude slower than traditionally coded programs. In this paper, the legacy information system is introduced, the methods used to implement and evaluate the object-based data model are explained, and the results and conclusions are presented.

Computer Systems↗
PubMed1995

Converting a legacy system database into relational format to enhance query efficiency.

The analysis of clinical data collected over time can provide important insight into the health care process. Unfortunately, much of the electronic clinical data that exists today is stored in legacy systems, making it difficult to access and share the information. An approach is needed to improve the accessibility of electronic data stored in legacy system databases. In this study, a legacy database is converted into a relational format in the personal computer environment. The impact of such a conversion on query performance is evaluated, and issues that need to be considered when converting a legacy system database are identified.

Computer Systems↗
PubMed1995

A clinical economics workstation for risk-adjusted health care cost management.

This paper describes a healthcare cost accounting system which is under development at Duke University Medical Center. Our approach differs from current practice in that this system will dynamically adjust its resource usage estimates to compensate for variations in patient risk levels. This adjustment is made possible by introducing a new cost accounting concept, Risk-Adjusted Quantity (RQ). RQ divides case-level resource usage variances into their risk-based component (resource consumption differences attributable to differences in patient risk levels) and their non-risk-based component (resource consumption differences which cannot be attributed to differences in patient risk levels). Because patient risk level is a factor in estimating resource usage, this system is able to simultaneously address the financial and quality dimensions of case cost management. In effect, cost-effectiveness analysis is incorporated into health care cost management.

Academic Medical Centers↗
PubMed1995

Factors impacting the success of computerized preadmission screening.

Many approaches to controlling costs under managed care rely on the ability to prospectively identify the type or level of service a patient requires at the time of presentation. Although computers may effectively predict these factors, the impact of such a computer system is greatly dependent on its integration into the admission process. Three factors that influence the effectiveness of predictive screening using a computer were identified. They are detection, intervention and compliance. The effect of these factors was then measured in a prospective randomized trial evaluating the effectiveness of computerized preadmission screening for predicting the appropriateness of inpatient care. This paper examines the three factors and their impact on the effectiveness of the system. A mathematical model that relates the factors to the overall effectiveness of computerized preadmission screening is proposed and considered in a more general context.

Diagnostic Tests, Routine↗
PubMed1993

Using the Internet Gopher Protocol to link a computerized patient record and distributed electronic resources.

At Duke University Medical Center, we are developing a prototype clinical application for automated patient care plans with integrated links to electronic documents and other electronic resources. These links are implemented using the Internet Gopher Protocol, an emerging standard for distributed document search and retrieval. Use of this protocol permits storage of electronic documents in an open, nonproprietary manner. This paper discusses the architecture of the link mechanism and presents some of the advantages and disadvantages of the proposed method.

Academic Medical Centers↗
PubMed1992

Integration of a stand-alone expert system with a hospital information system.

A stand-alone PC expert system for evaluating the appropriateness of inpatient admissions has been integrated with an existing hospital information system. The expert system supports preadmission screening for appropriateness of inpatient admissions. The HIS provides extensive clinical data in a coded electronic form, permitting high-level decision support. The integrated system was developed for a 20 week randomized clinical trial to evaluate the effects of preadmission screening on inappropriate inpatient admissions. Three factors of the integration are considered: programmatic integration of the expert system, seamless presentation of mixed platform applications, and integration of coded data from the stand-alone application into the HIS data structure.

Evaluation Studies as Topic↗
PubMedDate not supplied

Predicting discharge diagnoses using a computerized preadmission screening tool.

The authors integrated into an existing hospital information system a preadmission screening system, intended to reduce payment denials and reimbursement shortfalls that result from improperly classifying the billing status of patients. They report the results of efforts to validate the expert system upon which the preadmission screening system is based.

Diagnosis-Related Groups↗