Informatics at RSNA 2003: evolution and maturation on all fronts.
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A searcher's inability to formulate an appropriate query can result in an overwhelming number of retrieved documents. Our approach to this problem is to use information about common types or categories of queries to (1) reformulate the user's initial query and (2) create an informative organization of the retrieved documents from the reformulated query. To achieve these goals, we first must identify which common categories or types of queries are the best abstraction of the user's specific query. In this paper, we describe a system that performs this first step of categorizing the user's query. Our system uses a two-phased approach: a lexical analysis phase, and a semantic analysis phase. An evaluation of our system demonstrates that its query categorization corresponds reasonably well to the query categorizations by medical librarians and physicians.
Traditional question-answering programs are difficult to write and require: question analysis, document identification, and text extraction. Thousands of new documents are created daily, making it difficult to determine which has useful data. MQAF facilitates the process by limiting the factors used in the process: a Lexicon (the UMLS), a medical term identifier (MetaMap), a Question Taxonomy, and a Medical Information website that is both evidence-based and kept up-to-date.
A program for matching between controlled medical vocabularies has been developed which adopts methods used in the domain of Information Retrieval. This program combines a stemmer based on fragments of words (digrams) with a similarity function. The proposed stemmer did not require any knowledge about word-formation rules and helped the identification of several kinds of word variants. The adopted similarity function assigned the highest score to the best candidate match in 99.0% of the cases.
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Picture archiving and communication systems (PACS) is a system integration of multimodality images and health information systems designed for improving the operation of a radiology department. As it evolves, PACS becomes a hospital image document management system with a voluminous image and related data file repository. A medical image informatics infrastructure can be designed to take advantage of existing data, providing PACS with add-on value for health care service, research, and education. A medical image informatics infrastructure (MIII) consists of the following components: medical images and associated data (including PACS database), image processing, data/knowledge base management, visualization, graphic user interface, communication networking, and application oriented software. This paper describes these components and their logical connection, and illustrates some applications based on the concept of the MIII.
Physician: "Condyloma, Toxoplasmosis, Blepharoplasty, and Fibroadenoma." Technoguru: "Pardon?" Physician (referring to "PCDR, Physician's Computer Desk Reference): "Carrier Sense Multiple Access, Spread Spectrum, Application Programming Interface, and Clustered Indexes." Technoguru: "Oh, now you're talking! How many do you want?" Until such time as computer scientists holding degrees in medicine become de rigueur, there will inevitably be conversations such as these. A pediatrician friend once told me that he could teach me in 30 days what I would need to know to handle 95 percent of the cases he sees. To handle the other 5 percent would still require 8 years of postgraduate medical education. The corollary for the application of technology is that I can teach you how to use a personal computer, and even to do a little programming, but to build a robust, mission-critical system for a production health care environment, well, back to school you go.
The advance of today's medicine could be linked very closely to the history of computers through the last twenty years. In the beginning the first attempt to build a computer was trying to help us with mathematical calculations. This has changed recently and computers are now linked to x-ray machines, CT scanners, and MRIs. Being able to share information is one of the goals of the future. Today's computer technology has helped a great deal to allow orthopaedic surgeons from around the world to consult on a difficult case or to become a part of a large database. Obtaining the results from a method of treatment using a multicentric information study can be done on a regular basis. In the future, computers will help us to retrieve information from patients' clinical history directly from a hospital database or by portable memory cards that will carry every radiograph or video from previous surgeries.
Semantic interoperability between knowledge bases in medicine, and knowledge base in genomics and molecular biology will lead to advances in fundamental research as well as to improved patient care. DNA chips strategy is used for transcriptome analysis in order to identify deregulated genes in physio-pathological conditions. The objective of the BioMedical Knowledge Extraction project (BioMeKe) is to develop a knowledge warehouse in the context of transcriptome analysis during liver diseases. Knowledge sources include ontologies, related terminologies and annotations linked towards public databases (e.g., SWISSPROT). BioMeKe has been developed to have access to information using systematic investigation upon a concept, gene, gene products, pathology, or any target keyword, and is based on the combination of several relevant resources: UMLS, GeneOntology, MeSH supplementary terms, GOA, and HUGO. Current efforts are focusing on exploiting this ontology-based Knowledge Extractor, to enrich the expression data on genes delivered by a liver specific DNA microarray for better assistance of analysis.
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Quasi-experimental study designs, often described as nonrandomized, pre-post intervention studies, are common in the medical informatics literature. Yet little has been written about the benefits and limitations of the quasi-experimental approach as applied to informatics studies. This paper outlines a relative hierarchy and nomenclature of quasi-experimental study designs that is applicable to medical informatics intervention studies. In addition, the authors performed a systematic review of two medical informatics journals, the Journal of the American Medical Informatics Association (JAMIA) and the International Journal of Medical Informatics (IJMI), to determine the number of quasi-experimental studies published and how the studies are classified on the above-mentioned relative hierarchy. They hope that future medical informatics studies will implement higher level quasi-experimental study designs that yield more convincing evidence for causal links between medical informatics interventions and outcomes.
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Over the next decade, the Internet and related technologies will revolutionize the administrative and clinical practices of ambulatory care, enhancing the ability of physicians to provide quality care, enabling "virtual care teams" to help patients deal effectively with acute episodes and chronic conditions, and reducing the cost of care. Like any major paradigm shift, this change will not happen overnight. Nor will it be without cost. The explosion of venture capital and meteoric rise of the Nasdaq in 1999 reflected the promise of the Internet to revolutionize many aspects of American business. The Nasdaq's equally rapid descent in 2000 reflected a growing realization that this change will not be free--that "creative destruction," to use Schumpeter's term, will inevitably require significant investment and produce substantial losses. This article takes a longer term view than the ups and downs in the stock market. We believe the forces unleashed by the Internet are inexorable and that 10 years from now we will look back at the millennium's first decade as a period when the practice of ambulatory medicine was transformed by communication technology.
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In order that medical informaticians can create Open Systems for health care, they need to have a common language. Efforts in the 1980s at the National Library of Medicine to create a Medical Informatics Vocabulary (MIVoc) have been useful for document indexing purposes, but need to be continued and extended. The Committee of European Normalization Technical Committee 251 has created a project team for MIVoc, and that team has used both automatic and manual methods and referenced many sources in producing a vocabulary that has support from numerous experts in Europe. MIVoc has both a glossary and a tree structure. The glossary has about 250 terms with detailed definitions that include various explanations and pointers. One critical pointer is the semantic link to other terms in MIVoc from a which a tree-structure is inferred. The success of MIVoc clearly depends on its being used, which in the long run depends also on the vocabulary being maintained.
Computer technology has changed our lives, even that of physicians. In a few years time, a physician can expect to have a new tool by the bedside: a hand-held computer small enough to put into a pocket and powerful enough for all everyday activities, including highly specialized and sophisticated activities such as prevention of adverse drug reactions. The Croatian Academic and Research Network (CARNet) was crucial in bringing the benefits of the information technology to the Croatian scientists. At the Split University School of Medicine, we started the Virtual Medical School project, which now also includes the Mostar University School of Medicine in neighboring Bosnia and Herzegovina. Virtual Medical School aims to promote free dissemination of medical knowledge by creating medical education network as a gateway to the Internet for health care professionals.
BACKGROUND AND OBJECTIVES: Little is known regarding the applied medical informatics and computing skills of family practice residents and faculty, yet such information is critical when planning a medical informatics curriculum. We conducted a survey at our institution to collect this information. METHODS: An applied medical informatics and computing skills survey was administered to 93 first-year medical students, 42 family practice residents, and 14 family medicine faculty. Responses were compared between groups before and after stratification by age and gender. RESULTS: A total of 92% of students, 100% of residents, and 79% of faculty responded. Faculty had the highest rate of computer ownership (91%), followed by students (86%) and family practice residents (79%). Students and interns had the highest overall confidence using computers, followed by faculty and then senior residents. Faculty, students, and junior residents were significantly more confident than senior residents in their ability to perform several specific tasks, such as conducting a MEDLINE search. Residents perceived lack of money and time as barriers to improving their skills. CONCLUSIONS: Current senior residents may require remedial training to graduate with the computer skills specified in curricular guidelines. While upcoming medical students and interns will demand more advanced training, faculty may not have the skills to provide it.