Computerized systems for indexing and retrieving information in physiology journals.
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Selective dissemination of information to individuals provides a new and promising method for keeping abreast of current scientific information. Since SDI services are directed to the information needs of each individual, they are a significant step beyond grouporiented services and products, which require considerable expenditure of effort by each user as he sorts useful information from trash. However, SDI systems do require a high degree of precision in matching scientists against documents. They must operate more efficiently and economically than many current systems which occasionally provide a useful item of information to users. To meet these stringent requirements for quality, precision, efficiency, and economy, more research must be devoted to comparing and improving indexing methods, which are the basic component of all information storage and retrieval systems. It is incredible that so much money has been spent on the development and operation of scientific information systems before basic data on the comparative performance of various indexing methods have been gathered, analyzed, and confirmed by multiple investigators. The design of an effective information system would seem to require this type of basic knowledge, just as basic properties of alternative materials must be known before an engineer can design a building, bridge, or factory. Yet, except for the few studies mentioned in the previous section, research on indexing methods has been greatly neglected. Bourne's comment about studies of indexing languages is still an appropriate description of the situation: "In almost all the experimental reports, the investigator worked with an indexing language different than that of other experimenters. Consequently, no one has ever had his test results verified, or expanded, or made more precise by another experimenter" (47). Most existing information systems are based on keyword indexing, with concepts broken into isolated terms during input operations and recombined to synthesize the original concept during search and retrieval. Such systems tend to involve imprecise indexing, with a high level of "noise" in retrieved documents, difficult search strategy involving extensive post-coordination, and lengthy, complex computer manipulations. This situation reflects the fact that many producers of indexed data originally focused the design of their systems on the production of a published product with entries printed under short, concise index headings. Production of magnetic tapes as a by-product of the publication process, and their use for retrospective searching or for SDI services, was a much later development, almost an afterthought. Yet use of these tapes is growing so rapidly that it may be time to redesign the tape-producing systems, with ease of tape use for SDI services and retrospective searching as the primary consideration, and with publication of abstract and index bulletins or title listings relegated to secondary importance (49). The use of keywords to index documents creates a high degree of disorganization in information search and retrieval operations: Information is scattered under the many different terms that can be used to index different aspects of a concept. If the large-scale, comprehensive abstracting and indexing services were based on enumerative classifications with assignment of documents to logical hierarchical categories at the time of initial indexing, then many of the specialized information centers (50) and the 1300 abstracting and indexing services (3) would be unnecessary, and much of the reindexing and reprocessing of documents, the repackaging and reworking of abstracts and index data, and the resulting overlap and duplication characteristic of current information processing could be terminated. Partly because of the disorganization resulting from keyword indexing, the cost of a 5-year retrospective search of information on just one data base on magnetic tapes is a major investment (16). The effort and cost required to find a few items of useful information scattered among 1,285,000 abstracts indexed on 116 full reels of magnetic tape (11 million characters per reel) which will be needed for the 5-year Eighth Collective Index to Chemical Abstracts (1967-1971) (51) staggers the imagination. In contrast, when HICLASS systems based on enumerative hierarchical classifications are used, concepts that might be useful for later retrieval are identified and related items of information are grouped together during the indexing process. These enumerative classifications, with single-hit matching, make it possible to index and retrieve ideas as intact units and to perform simple sequential searches of the very small segment of a file that deals with a given topic (31). The experiments at both the Science Information Exchange and the National Cancer Institute, as described in this article, demonstrate that automated HICLASS systems are feasible and can operate at a very satisfactory level of performance. Although considerable effort may be required for the development and constant updating of detailed enumerative classifications, HICLASS categories may facilitate organization of data at the time of input, improve the precision of matching documents with users, and greatly simplify search logic and computer manipulations. If so, then output savings and performance would more than justify input costs, and the development and use of enumerative classifications would be a better solution to information problems than the current keyword-and-coordination approach. It is time to think beyond the ease of the single input step in information systems and to take a hard look at ways of easing retrieval problems for the multitude of information systems that process the indexed data (52). Indexing effort is expended only once, whereas search and retrieval effort is required by every user of a system. If information were better analyzed and organized during input operations, if more basic research were devoted to the effect of indexing methods on the performance of information systems, and if more emphasis were placed on the quality and usefulness of retrieved information, then the magnitude of problems related to the storage and retrieval of scientific information might be considerably reduced.
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Intranet-technology is the application of Internet-Tools in local networks. With this technique electronic information systems for large hospitals can be realized very easily. This technology has been in routine use in 'Klinikum Grosshadern' for more than one year on over 50 wards and more than 200 computers. The following clinical application areas are described: drug information, nursing information, electronic literature retrieval systems, multimedia teaching und laboratory information systems.
We have developed a distributed image database system composed of the data in our medium-scale PACS that provides diagnostic-quality images and the data in our HIS. INFORMIX software was used to construct the distributed relational database. The data in HIS were retrieved using several programs written in COBOL. Image data in PACS were retrieved using ACR-NEMA protocols. The data retrieved from the HIS database involved medication, disease entities, laboratory test results, etc. Therefore, the image data on a given patient can be retrieved by specifying the name of the disease in our database system. Our method offers a practical one to make a global database system to maintain the integrity of the data in the HIS and the PACS. The combination of image data and disease made it quite easy to make a sample database for developing a computer-aided diagnostic system.
This article about the state of the art of hospital information systems and about future directions was written in 1984 by the late Peter Reichertz. It now serves as a companion paper to a paper with the same title, written by Reinhold Haux 20 years later (this issue). In that paper Reinhold Haux starts where Peter Reichertz ended. The original text of Peter Reichertz has been retyped and the figures redrawn. Possible errors may have resulted from this process.
OBJECTIVE: To construct a large-scale clinical repository that accurately captures a detailed understanding of the data vital to the process of health care and that provides highly efficient access to patient information for the users of a clinical information system. DESIGN: Conventional approaches to data modeling encourage the development of a highly specific data schema in order to capture as much information as possible about a given domain. In contrast, current database technology functions most effectively for clinical databases when a generic data schema is used. The technique of "generic data modeling" is presented as a method of reconciling these opposing views of clinical data, using formal operations to transform a detailed schema into a generic one. RESULTS: A complex schema consisting of hundreds of entities and representing a rich set of constraints about the patient care domain is transformed into a generic schema consisting of roughly two dozen tables. The resulting database design is efficient for patient-oriented queries and is highly flexible in adapting to the changing information needs of a health care institution, particularly changes involving the collection of new data elements. CONCLUSION: Conventional approaches to data modeling can be used to develop rich, complex models of clinical data that are useful for understanding and managing the process of patient care. Generic data modeling techniques can successfully transform a detailed design into an efficient generic design that is flexible enough to meet the needs of an operational clinical information system.
Several areas of HTML-applications using intranet-technology are presented, which are in routine use in our hospital: CBT for nurses and medical students, drug information, electronic literature retrieval systems and laboratory information systems. The basic concept is an integration of commercial databases and local information. All applications are hardware-independent with the same user-interface and all use client-server-technology. By a central update it is ensured that everybody gets the most recent information. As a result of these efforts synergy has developed. The training of the medical staff is supported which helps to improve the care of the patients.
Due to the ubiquitous and special nature of time, specially in clinical datábases there's the need of particular temporal data and operators. In this paper we describe S-WATCH-QL (Structured Watch Query Language), a temporal extension of SQL, the widespread query language based on the relational model. S-WATCH-QL extends the well-known SQL by the addition of: a) temporal data types that allow the storage of information with different levels of granularity; b) historical relations that can store together both instantaneous valid times and intervals; c) some temporal clauses, functions and predicates allowing to define complex temporal queries.
Searching through stacks of unbound journals is an inefficient method of information retrieval. I have developed an inexpensive and easily used filing system. This filing system provides an excellent medical-information retrieval system.
A thesaurus has been developed to serve as the integrating unit for the computerized information storage and retrieval system of the Vision Information Center. The Center maintains records of information in the visual sciences which are available to the user in the forms of computer-assisted instruction, literature retrieval, and patient records. The numerical coding system used in the thesaurus permits seven levels of specificity; this specificity is required for depth of indexing, as well as to limit the retrieval to those bibliographic citations which are relevant to a highly specific search request. The flexible design of the thesaurus facilitates frequent revision and addition of new terminology.
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In previous work, we proposed an approach called the Structural Difference Method (SDM) to correlating the anatomy of Homo sapiens with selected species, using the Foundational Model of Anatomy (FMA) as a framework and graph matching as a method, for determining similarities and differences between species. In this paper, we present the design of a comparative anatomy information system that utilizes the SDM and allows users to issue queries to determine the similarities and differences between two species. Our system will serve as a pilot project for cross-species anatomical information collection, storage, and retrieval. The underlying data structure of a mapping, and the syntax and semantics of the system's query language, are presented.
The rapid growth of diagnostic-imaging technologies over the past two decades has dramatically increased the amount of nontextual data generated in clinical medicine. The architecture of traditional, text-oriented, clinical information systems has made the integration of digitized clinical images with the patient record problematic. Systems for the classification, retrieval, and integration of clinical images are in their infancy. Recent advances in high-performance computing, imaging, and networking technology now make it technologically and economically feasible to develop an integrated, multimedia, electronic patient record. As part of The National Library of Medicine's Biomedical Applications of High-Performance Computing and Communications program, we plan to develop Image Engine, a prototype microcomputer-based system for the storage, retrieval, integration, and sharing of a wide range of clinically important digital images. Images stored in the Image Engine database will be indexed and organized using the Unified Medical Language System Metathesaurus and will be dynamically linked to data in a text-based, clinical information system. We will evaluate Image Engine by initially implementing it in three clinical domains (oncology, gastroenterology, and clinical pathology) at the University of Pittsburgh Medical Center.
The World Wide Web is a powerful new way to deliver on-line clinical information, but several problems limit its value to health care professionals: content is highly distributed and difficult to find, clinical information is not separated from non-clinical information, and the current Web technology is unable to support some advanced retrieval capabilities. A system called CliniWeb has been developed to address these problems. CliniWeb is an index to clinical information on the World Wide Web, providing a browsing and searching interface to clinical content at the level of the health care student or provider. Its database contains a list of clinical information resources on the Web that are indexed by terms from the Medical Subject Headings disease tree and retrieved with the assistance of SAPHIRE. Limitations of the processes used to build the database are discussed, together with directions for future research.
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.
This paper describes the implementation of the Stanford Public Information and Retrieval System (SPIRES) by the University of Michigan Medical School Learning Resources Center. SPIRES is a bibliographic data base management system which offers on-line search capabilities and retrieval of data in programmable formats. The Learning Resource Center utilizes SPIRES for the interactive retrieval of cataloging data, bibliographical compilations, and book catalog production.