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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

[Computer-assisted gnatho-prosthodontic diagnosis].

The program is very useful by its rapidity, reliability and releasing the dentist from calculating the multiple variants of some clinico-biological indices. The computer-assisted gnatho-prosthetic diagnosis also makes possible a more adequate therapeutical plan.

Denture Design

The Clintrac medical data system.

Basically, this is a clinical data entry program. Billing is added for convenience. It would be fine for a practitioner working in an institution with an existing billing department. You could certainly use it in a private office as an all-purpose workhorse, but you'd need to apply the criteria I listed in a recent article in this jouranl [1] to rate the accounts receivable section when it's complete. Dr. Bryner says he has done this and finds my criteria met by this package. The program shows much hard work and a good deal of promise. It strikes at the core of one of today's greatest frustrations. What's more, Dr. Bryner is dedicated to improving it as he goes along. The system is sold by Clintrac, Inc., 814 Main St., Yreka, CA 96097. The company is an IBM Business Partner. The current price is $14,000. It is only sold directly by the vendor, who has four employees and has sold four systems as of January 22, 1991. Extra costs are assessed for additional users ($1,500 each), specialty modules ($2,000 each), and support (12% of price per year). Updates are included in the support price. IBM is arranging to lease the system. The current version number is 2.0B.

California

A computerized purchase order management system.

Order processing and parts issuing are within the scope of an inventory management system and, as such, it was logical to incorporate the Purchase Order Management Menu into the biomedical engineering inventory management system. The Purchase Order Management function was implemented using the services of a biomedical engineering technician who is a staff member. Software development time (two months) was the only resource that was necessary to incorporate this function into the inventory system. This function, implemented on a PC, provided locally functions that had not been available on the mainframe-based hospital purchasing system. These functions directly addressed the needs of the users, who in this case are the staff members of the department of biomedical engineering at University Hospital, Stony Brook, New York.

Computer Systems

Using CAHD.

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Databases, Factual

Collaborations in art/science: Renaissance teams.

A Renaissance Team is a group of specialists who collaborate and provide synergism in the quest for knowledge and information. Artists can participate in Renaissance Teams with scientists and computer specialists for scientific visualization projects. Some projects are described in which the author functioned as programmer and color expert, as interface designer, as visual paradigm maker, as animator, and as producer. Examples are provided for each of these five projects.

Art

The Vesalius Project: interactive computers in anatomical instruction.

The goal of the Vesalius Project is a high-resolution, interactive 3-D atlas of human/animal anatomy, stored on a laser videodisc and displayed on graphics workstations--an an "electronic Gray's Anatomy." Students will use this computerized atlas interactively to learn the structure of the body and to understand their own bodies in health and disease. The Human Factors Research Laboratory at Colorado State University has designed and is conducting a comprehensive evaluation program for the project.

Anatomy