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Assessing and enhancing the value of the UMLS Knowledge Sources.

The goal of the UMLS Project is to give practitioners and researchers easy access to machine-readable information from diverse sources. Assessment of the first experimental versions of the UMLS Knowledge Sources is essential to measuring progress toward that goal and to identifying needed enhancements. As of July 30, 1991, copies of the first edition of the UMLS Knowledge Sources had been distributed to 143 individuals and institutions; 66 had provided initial feedback information. The information received indicates that the UMLS Knowledge Sources will undergo broad testing in the patient care, medical education, library service, and product development environments. Preliminary data support the hypothesis that expanded coverage of routine clinical concepts is needed. Key enhancements planned for 1992 and beyond include expanded coverage of ICD-9-CM and CPT.

National Library of Medicine (U.S.)

A graphical ICU workstation.

A workstation designed to facilitate electronic charting in the intensive care unit is described. The system design incorporates a graphical, windows-based user interface. The system captures all data formerly recorded on the paper flowsheet including direct patient measurements, nursing assessment, patient care procedures, and nursing notes. It has the ability to represent charted data in a variety of graphical formats, thereby providing additional insights to facilitate the management of the critically ill patient. Initial nursing evaluation is described.

Attitude of Health Personnel

Modelling work practices: input to the design of a physician's workstation.

To ensure tight coupling between users' work practices and the system's model of these practices, designers need methods to generate accurate descriptions of what users actually do. This paper illustrates how we model physicians' information needs and translate knowledge about these needs into design specifications.

Artificial Intelligence

Broadening our approach to evaluating medical information systems.

Evaluation in medical informatics tends to follow the paradigm of controlled clinical trials. This model carries with it a number of assumptions whose implications for medical informatics deserve examination. In this paper, we describe the conventional wisdom on evaluation, pointing out some of its underlying assumptions and suggesting that these assumptions are problematic when applied to some aspects of evaluation. In particular, we believe that these assumptions contribute to the problem of user acceptance. We then suggest a broader approach to evaluation, offering some conceptual and methodological distinctions that we believe will be of use to the medical informatics community in rethinking this issue.

Bias

Information retrieval using a "digital book shelf".

WALT (Washington University's Approach to Lots of Text), is a prototype interface designed to support information retrieval research. The WALT interface serves as a "front end" to a wide array of retrieval engines including those based on Boolean retrieval, latent semantic indexing, term frequency--inverse document frequency, and Bayesian inference techniques. The WALT interface is composed of seven distinct components: a document examination component known as the Document Browsing Area; four navigation components called the Book Shelf, the Book Spine, the Table of Contents, and the Path Clipboard; a term-based information retrieval component called Control Panel; and a relevance feedback component known as the Reader Feedback Panel. WALT's most unique feature may be it's use of "book shelf" and "book spine" metaphors both to facilitate navigation and to provide a histogram-based display showing documents deemed appropriate for answering user queries.

Books

The design of a user interface for a ventilator-management advisor.

The lack of user acceptance for many medical decision-support systems should force medical software developers to rethink strategies for user interaction with decision-support programs. Participatory design is an emerging method for the development for computer applications that emphasizes user involvement in both the design and implementation phases. We have applied participatory design to the development of a user interface for VentPlan, an application that assists physicians in the management of artificial respiration of critically ill patients. In this paper, we present a case history of the participatory design process and describe the resulting interface for the VentPlan program. As a result of applying participatory design ideas, we gained insight as to how to implement VentPlan more effectively.

Critical Care

Increasing physician acceptance and use of the computerized ambulatory medical record.

Because physicians have been reluctant to accept computerized medical records systems, we sought to identify the barriers to acceptance and redesigned our ambulatory records system accordingly. We identified several problems physicians encounter in using our computerized medical record system (COSTAR), including physicians' hesitation to use a computer in front of their patients, physicians' poor keyboard skills, and the structural organization of the computerized medical record. We formed a users group to educate users and the group has helped identify solutions to these problems. We equipped the exam room terminals with a user-friendly, patient-specific menu. We created a new physician interface for COSTAR that was organized to function similarly to a patient's chart and features user-friendly menus that provide cues to the unsophisticated user. Physician use of exam room terminals tripled after the installation of the exam room menu. The new physician interface doubled physician use of COSTAR's scheduling features. Acceptance of the new interface as gauged by a user survey was excellent, with the majority stating it improved their patient care.

Academic Medical Centers

A patient care workstation based on user centred design and a formal theory of medical terminology: PEN&PAD and the SMK formalism.

The PEN & PAD clinical workstation is for use by clinicians for direct patient care. It is based on a highly structured and detailed medical record but is intended to be simple and intuitive to use, allowing clinicians to summarise and view information in many ways, and quickly enter information through structured forms. It also provides mechanisms for tailoring the system to individual users without compromising its overall integrity. This has been achieved by following a process of user centred design and by developing a novel formalism, Structured Meta Knowledge, to represent the terminological knowledge, the medical record, and pragmatic knowledge about clinical practice.

Ambulatory Care Information Systems

An interactive report generator for bone scan studies.

An interactive report generator for bone scintigraphy will be demonstrated. It comprises a controlled reporting vocabulary, an adaptive user interface, and a text generator. The controlled vocabulary represents the relevant concepts for bone scan reports: anatomical sites, scintigraphical phenomena, and diagnoses, and various attributes for these concept domains. Within the vocabulary selectional constraints are defined that restricts to meaningful combination of concepts. The interface provides intelligent views on the vocabulary, and presents only those terms that are relevant in a certain context. Through the interface the user may choose appropriate terms and combine them to complex findings. A German text generator for a restricted finding language transforms the entered data into morpho-syntactic surface structures and produces acceptable reports.

Bone and Bones

Incorporating client-server database architecture and graphical user interface into outpatient medical records.

Computerized medical record systems require structured database architectures for information processing. However, the data must be able to be transferred across heterogeneous platform and software systems. Client-Server architecture allows for distributive processing of information among networked computers and provides the flexibility needed to link diverse systems together effectively. We have incorporated this client-server model with a graphical user interface into an outpatient medical record system, known as SuperChart, for the Department of Family Medicine at SUNY Health Science Center at Syracuse. SuperChart was developed using SuperCard and Oracle SuperCard uses modern object-oriented programming to support a hypermedia environment. Oracle is a powerful relational database management system that incorporates a client-server architecture. This provides both a distributed database and distributed processing which improves performance.

Ambulatory Care Information Systems

VentPlan: a ventilator-management advisor.

VentPlan assists physicians, nurses, and respiratory therapists in the management of artificial respiration for critically ill patients in the intensive-care unit (ICU). VentPlan interprets clinical observations, monitored data, and arterial-blood-gas analyses to make recommendations for setting the ventilator. The VentPlan interface allows users to examine the physiologic model, to inspect details of the data on which the model is based, and to exercise the model to try out different ventilator settings before they implement a new setting. We also report here a preliminary evaluation of VentPlan's ability to predict the arterial oxygen and carbon-dioxide tensions following adjustments to the ventilator. We conclude that VentPlan's physiologic models are acceptably accurate for predicting the effects of small adjustments of the ventilator.

Critical Care

Application development in the DeSyGNER environment: dynamic assembly of independent information resources via direct manipulation authoring.

Dynamic assembly of applications from diverse and possibly disparate collections of information components is a key element for powerful information management environments. Traditional methods of application development hinder flexible integration of information components because they treat computer programs as single units of functionality; inter-application connections and sharing of intra-application information components are achieved only by special cooperation between program authors. We have created a multimedia applications development architecture called DeSyGNER (the Decision Systems Group Nucleus of Extensible Resources) that provides a generalized framework for the inter-connection of independently developed units into applications. By focusing on composition methods or paradigms for constructing applications from modular, reusable units, DeSyGNER fosters sharing and cooperation in application development.

Authorship

Medical Information Management System (MIMS) CareWindows.

The demonstration of MIMS/CareWindows will include: (1) a review of the application environment and development history, (2) a demonstration of a very large, comprehensive clinical information system with a cost effective graphic user server and communications interface.

Computer Communication Networks

Hypermedia in medical decision analysis: HyperDecision.

Early in the evolution of medical decision analysis, computers were employed to remove the tedium and insure the accuracy of repetitive calculations, a capacity they still serve today. However, user interfaces could be so complex as to be overwhelming, except for the capable few who designed them or used them often. HyperDecision is a hypercard-based decision analysis program with a simple user interface. A comprehensive tutorial and generic decision tree are integrated so that the fledgling user, whether medical student or seasoned clinician lacking evolved computer and/or decision analysis skills, can reap the benefits of computer support in their clinical practice. In the current political environment surrounding the practice of medicine, having easily accessible tools for both teaching and using medical decision analysis to evaluate and present the rational for medical decisions has taken on a new importance which the medical community must remain abreast of as we move toward the 21st century.

Computer-Assisted Instruction

The Physician's Workstation: an example of end user integration of information systems.

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these system are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development using rapid prototyping object-oriented programming tools of a Physician's Workstation which integrates information from five different applications running on three separate computer systems.

Computer Communication Networks

A tool for the computer-assisted creation of QMR medical knowledge base disease profiles.

QMR-KAT is a computer-based tool which assists physicians in the construction of the QMR medical knowledge base. Each QMR disease profile results from an in-depth analysis of the published medical literature, and from consultations with expert clinicians. QMR-KAT is an interactive knowledge acquisition program which facilitates the creation of new disease profiles, records the supporting evidence for each disease profile entry, and enforces consistency with the existing knowledge base. The program has been used in the creation of all new QMR disease profiles over the past two years. It has also been used to support a study on the reproducibility of knowledge base construction.

Artificial Intelligence