Biomedical subjects

T A Pryor

Publications and source records attributed to T A Pryor.

At least 19 recordsLinked to original sources

PubMed2003

Building a comprehensive clinical information system from components. The approach at Intermountain Health Care.

OBJECTIVES: To discuss the advantages and disadvantages of an interfaced approach to clinical information systems architecture. METHODS: After many years of internally building almost all components of a hospital clinical information system (HELP) at Intermountain Health Care, we changed our architectural approach as we chose to encompass ambulatory as well as acute care. We now seek to interface applications from a variety of sources (including some that we build ourselves) to a clinical data repository that contains a longitudinal electronic patient record. RESULTS: We have a total of 820 instances of interfaces to 51 different applications. We process nearly 2 million transactions per day via our interface engine and feel that the reliability of the approach is acceptable. Interface costs constitute about four percent of our total information systems budget. The clinical database currently contains records for 1.45 m patients and the response time for a query is 0.19 sec. DISCUSSION: Based upon our experience with both integrated (monolithic) and interfaced approaches, we conclude that for those with the expertise and resources to do so, the interfaced approach offers an attractive alternative to systems provided by a single vendor. We expect the advantages of this approach to increase as the costs of interfaces are reduced in the future as standards for vocabulary and messaging become increasingly mature and functional.

Computer Systems↗

PubMed1999

The HELP hospital information system: update 1998.

The HELP hospital information system has been operational at LDS Hospital since 1967. The system initially supported a heart catheterization laboratory and a post open heart Intensive Care Unit. Since the initial installation the system has been expanded to become an integrated hospital information system providing services with sophisticated clinical decision-support capabilities to a wide variety of clinical areas such as laboratory, nurse charting, radiology, pharmacy, etc. The HELP system is currently operational in multiple hospitals of LDS Hospital's parent health care enterprise--Intermountain Health Care (IHC). The HELP system has also been integrated into the daily operations of several other hospitals in addition to those at IHC. Evaluations of the system have shown: (1) it to be widely accepted by clinical staff; (2) computerized clinical decision-support is feasible; (3) the system provides improvements in patient care; and (4) the system has aided in providing more cost-effective patient care. Plans for making the transition from the 'function rich' HELP system to more modern hardware and software platforms are also discussed.

Computer Systems↗

PubMed1997

Inducing practice guidelines from a hospital database.

Improving health care quality requires the elimination of unnecessary variation in the care process. Decision support applications already exist that can foster adherence to standards. The challenge resides in developing standards consistent with good medical practice. In this paper we present our efforts in determining where sufficient clinical data are captured electronically to automatically define a care process, and what analyses can be done to identify additional data that would allow a care process to be defined. Data routinely collected by a hospital information system have been examined. The analysis tools utilized include logistic regression, a neural network, a Bayesian network, and a rule induction program.

Bayes Theorem↗

PubMed1996

Development and evaluation of a computerized admission diagnoses encoding system.

Hospital information systems designed to support the needs of health care professionals include patient data entered using both freetext and precoded storage schemes. A major disadvantage of freetext storage schemes is that data captured in this format can only be presented as is to the user for review tasks. In the view of many health care scientists, natural language understanding systems capable of identifying, extracting, and encoding information contained in freetext data may provide the necessary tools to overcome this weakness. This paper describes the development and evaluation of a such a system designed to encode freetext admission diagnoses. This system combines both semantic and syntactic linguistic analysis techniques. Evaluation results demonstrate the overall performance of this system to be reasonable, accurately encoding approximately 76% of admission diagnoses. Inefficiencies are primarily due to the inability of this system to generate encodings in roughly 15% of test cases. When encodings are produced, however, accuracy equals that of the current manual coding method. With further modification, this application can partially automate the coding process.

Algorithms↗

PubMed1995

Assessing the behavioral impact of a diagnostic decision support system.

This paper describes a prototype for research to evaluate the impact of diagnostic decision support systems on the behavior of physicians. Several indices that can be used to quantify the magnitude of impact are proposed. A large medical diagnostic knowledge base in internal medicine (the Iliad knowledge base) was used in this evaluation. The impact on behavior when different inference models are run against this knowledge base is evaluated for two different case domains and physician's specialties.

Analysis of Variance↗

PubMed1994

Interfacing a stand-alone diagnostic expert system with a hospital information system.

Few diagnostic decision-support systems are in routine clinical use, mainly because these systems typically require time-consuming manual data entry. This research investigated the feasibility of reducing manual data entry by integrating a stand-alone diagnostic expert system with an existing comprehensive hospital information system (HIS). A knowledge-based intervocabulary mapping technique was developed to map disparate vocabularies. The results of a retrospective study indicate that transferring clinical data from the HIS to the diagnostic expert system at the beginning of workup significantly reduces the manual data entry required for generating the correct diagnoses for patients.

Diagnosis, Computer-Assisted↗

PubMed1994

Rationale for the Arden Syntax.

The Arden Syntax, a language designed for writing and sharing task-specific knowledge for Medical Logic Modules (MLMs), has been recently accepted as a standard by the ASTM. The syntax is concerned with the critical task of sharing medical knowledge bases across many institutions. Because of the relative lack of agreement on vocabularies and data standards and because of the many other obstacles, the developers of the Arden Syntax took a pragmatic, straightforward approach that has borne fruit in a very short period of time. The syntax provides a vehicle for the health care community to begin sharing, so that we can see what works and what does not work, and we can begin to address the critical obstacles. In designing a language like the Arden Syntax, the authors make many decisions--but the final document gives only the result of these decisions without any explanation. By writing down the rationale behind the design of the syntax, we hope to aid users of the language, implementors of the language, and future designers of new languages.

Artificial Intelligence↗

PubMed1994

Decision support in medicine: examples from the HELP system.

Computerized health information systems can contribute to the care received by patients in a number of ways. Not the least of these is through interactions with health care providers to modify diagnostic and therapeutic decisions. Since its beginning, developers have used the HELP hospital information system to explore computerized interventions into the medical decision making process. By their nature these interventions imply a computer-directed interaction with the physicians, nurses, and therapists involved in delivering care. In this paper we describe four different approaches to this intervention. These include: (1) processes that respond to the appearance of certain types of clinical data by issuing an alert informing caregivers of these data's presence and import, (2) programs that critique new orders and propose changes in those orders when appropriate, (3) programs that suggest new orders and procedures in response to patient data suggesting their need, and (4) applications that function by summarizing patient care data and that attempt to retrospectively assess the average or typical quality of medical decisions and therapeutic interventions made by health care providers. These approaches are illustrated with experience from the HELP system.

Adult↗

PubMed1994

The use of medical logic modules at LDS hospital.

The development of medical knowledge bases for use in a clinical information system (HELP) has been an ongoing goal at LDS Hospital in Salt Lake City, Utah, for the past 25 years. In building our medical knowledge base we felt the need to implement a decision support syntax which could capture the logic of our experts in a way that was not only executable, but also easily read and shared by others. During these 25 years we defined several simple syntaxes to express this medical logic. Our current approach is to cooperate with international standards groups (ASTM) and use the Arden Syntax for medical logic modules. We are working with the 3M Corporation in the joint development of an Arden Compiler for HELP. We plan to use the Arden Syntax initially to support our alert/reminder system and computerized management protocols.

Artificial Intelligence↗

PubMed1994

HELP the next generation: a new client-server architecture.

A new client-server based system which is centered around a lifetime data repository (LDR) is under construction. The goal of the new system is to maintain the patient centered decision support aspects of the existing HELP* system while providing an open architecture that supports faster application development and allows execution of applications to be distributed across many computers. These goals are achieved by implementing the system with software components that are commercially available or by adhering to national and international standards for software integration. Keys to successful integration include the use of MS-DOS @, OS/2#, and UNIX Section as operating systems, Microsoft OLE 2.0 as a standard interface to the clinical database, the use of TUXEDO as a transaction/communication manager, and the use of ORACLE [symbol: see text] RDBMS as the underlying database management system.

Computer Communication Networks↗

PubMed1993

The Arden syntax for medical logic modules.

The Arden Syntax for sharing medical knowledge bases is described. Its current focus is on knowledge that is represented as a set of independent modules that can provide therapeutic suggestions, alerts, diagnosis scores, etc. The syntax is based largely upon HELP and the Regenstrief Medical Record System. Each module, called a Medical Logic Module or MLM, is made of slots grouped into maintenance, library, and knowledge categories. The syntax has provisions for querying a clinical database and representing time. Several clinical information systems were analyzed and appear to be compatible with the syntax. The syntax has been tested for syntactic ambiguities using the tools lex and yacc. Seventeen institutions are currently in the process of adopting the Arden Syntax for their decision-support systems. A subcommittee of ASTM has been formed to develop standards for sharing medical knowledge bases. The Arden Syntax has been published by ASTM as a initial standard for sharing medical knowledge.

Artificial Intelligence↗

PubMed1993

ASTM E31.15 on health knowledge representation: the Arden Syntax.

ASTM subcommittee E31.15 on Health Knowledge Representation was formed to promote standards for defining and sharing health knowledge bases. Its first standard, the Ardan Syntax, is focused on knowledge bases that can be represented as a set of independent modules called Medical Logic Modules (MLMs). The standard is in clinical use and has generated significant interest in industry and academics. The Extensions task group plans to extend the syntax where appropriate, to expand to other types of knowledge bases. The Validation/Verification task group is approaching the enormous problem of evaluating knowledge bases and the process of sharing them.

Artificial Intelligence↗

PubMed1993

Sharing MLM's: an experiment between Columbia-Presbyterian and LDS Hospital.

The use of Arden syntax for development of shareable medical logic modules (MLM's) has developed as an ASTM standard. To test the feasibility of sharing MLM's between institutions a study was conducted between Columbia-Presbyterian Medical Center and LDS Hospital. In this study seven MLM's clinically executing at Columbia-Presbyterian were used to test the sharing potential of the Arden syntax. The study was limited to measuring the modifications necessary to make executable at LDS Hospital the shared MLM's. Because of the site specific nature of the data variables, multiple modifications were required. Three classes of modifications were necessary. The simplest involved only data variable mappings. The other classes required either minor modifications to the logic or relatively major modifications. Over 50% of the modifications were in the minor or major classes. While the sharing of decision logic was possible and facilitated by the use of the MLM's at the two sites, the absence of standard medical vocabularies limited the utility of the MLM as a mechanism for directly sharing medical knowledge.

Hospital Information Systems↗

PubMed1992

The potential for medical informatics in the Eastern Mediterranean Region.

This article assesses the potential value of an integrated medical/ hospital information system (IMIS) for the members of the Eastern Mediterranean Region of the World Health Organization, and describes the preliminary results of a feasibility study questionnaire done in December 1989 at Salmaniya Medical Center (SMC) in the state of Bahrain.

Attitude of Health Personnel↗

PubMed1992

Pick from thousands: a collaborative processing model for coded data entry.

Methods for optimizing coded data entry in clinical systems are a frequent topic of system design. We have developed a new mechanism for this type of data entry that we call "Pick From Thousands" (PFT). It combines several known methods, including menu selection, keyword entry, and initial character matching, but adds a new string matching algorithm. The PFT method is more selective than initial character matching for a given number of keystrokes if entries in the coded list have more than one word. Collaborative processing between a PC workstation and the central HELP system computer is used to optimize ease of maintenance and increase the flexibility and performance of the system.

Algorithms↗

PubMed1992

Integrating Radiology and Hospital Information Systems: the advantage of shared data.

Information management is central to modern patient care. Computerization of information management has resulted in both departmental systems which serve information needs in locations such as the Radiology Department and in hospital-wide information systems which seek to integrate management of clinical data from many departments. For each of these systems to achieve the goal of maximizing both the effectiveness of health care workers and the quality of patient care, they need to share the data that they capture. Below we discuss a variety of applications, both currently available and in the realm of research protocols, that depend on a high level of communication between Radiology Information Systems and Hospital Information Systems. These examples suggest the benefits of integrating the medically relevant data collected by all of the computer-based information systems in the hospital setting.

Decision Making, Computer-Assisted↗

PubMed1991

Older age and elevated blood pressure are risk factors for intracerebral hemorrhage after thrombolysis.

Intracerebral hemorrhage is an important concern after thrombolytic therapy for acute myocardial infarction, but risk factors are controversial. Accordingly, we assessed risk factors in 107 treated patients of whom 4 had intracerebral hemorrhage. Intracerebral hemorrhage occurred at a mean of 25 hours (range 3.5 to 48) after therapy and was fatal in 2 patients. Significant differences were found between patients with and without intracerebral hemorrhage for age (77 +/- 7 vs 62 +/- 11 years, p less than or equal to 0.01), and initial (161 +/- 23 vs 135 +/- 23 mm Hg, p less than or equal to 0.03) and maximal (171 +/- 30 vs 146 +/- 20, p less than or equal to 0.02) systolic blood pressures. Initial and maximal diastolic blood pressures also tended to be higher (101 +/- 25 vs 86 +/- 16, p less than or equal to 0.07; 104 +/- 24 vs 90 +/- 13, p less than or equal to 0.06). Differences did not achieve significance for comparisons of gender, height, weight, site of infarction, time to therapy, specific thrombolytic agent used, concomitant therapy, interventions and partial thromboplastin time. It is concluded that age (greater than or equal to 70 years) and elevated blood pressure (greater than or equal to 150/95 mm Hg) are important risk factors for intracerebral hemorrhage. The overall balance of benefit and risk of thrombolysis should continue to be assessed by large mortality trials.

Age Factors↗

PubMed1991

Evaluation of an SQL model of the HELP patient database.

We tested a new model of the HELP patient database that makes use of relational tables to store patient data and provides access to data using SQL (Structured Query Language). The SQL database required more storage space and had many more physical records than the HELP database, but it was faster and more efficient in storing data than the standard HELP utilities. The HELP utilities used disk space more efficiently and were faster than the SQL tools when retrieving data for typical clinical reports. However, the SQL model provides networking capabilities, general report writing tools, detailed user documentation, and an ability for creating secondary indexes that offset its poorer performance.

Database Management Systems↗