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Integrated Advanced Medical Information Systems (IAIMS): payoffs and problems.

IAIMS (Integrated Advanced Information Management Systems) is an initiative to improve the access to information needed to provide patient care, health-oriented education, biomedical research, and management of large medical center environments. This paper will review the goals, history, and accomplishments of the IAIMS initiative. Shortcomings and frustrations, lessons learned, and the future of such initiatives will also be discussed.

Computer Systems↗

The neural implementation of multi-attribute decision making: a parametric fMRI study with human subjects.

Decision making is not a unitary entity but involves rather a series of interdependent processes. Decisions entail a choice between two or more alternatives. Within the complex series of decisional processes, at least two levels can be differentiated: a first level of information integration (process level) and a second level of information interpretation (control level), leading to a subsequent motor response or cognitive process. The aim of this study was to investigate the neural network of these decisional processes. In a single trial fMRI study, we implemented a simple decision-making task, where subjects had to decide between two alternatives represented on five attributes. The similarity between the two alternatives was varied systematically in order to achieve a parametric variation of decisional effort. For easy trials, the two alternatives differed significantly in several attributes, whereas for difficult trials, the two alternatives differed only in small details. The results show a distributed neural network related to decisional effort. By means of time course analysis different subprocesses within this network could be differentiated: regions subserving the integration of the presented information (premotor areas and superior parietal lobe) and regions subserving the interpretation of this information (frontolateral and frontomedial cortex, anterior insula, and caudate) as well as a region in the inferior frontal junction updating task rules.

Adult↗

Neural mechanisms for synthesizing sensory information and producing adaptive behaviors.

The ability to integrate information from different sensory systems is a fundamental characteristic of the brain. Because different bits of information are derived from different sensory channels, their synthesis markedly enhances the detection and identification of external stimuli. The neural substrate for such "multisensory" integration is provided by neurons that receive convergent input from two or more sensory modalities. Many such multisensory neurons are found in the superior colliculus (SC), a midbrain structure that plays a significant role in overt attentive and orientation behaviors. The various principles governing the integration of visual, auditory, and somatosensory inputs in SC neurons have been explored in several species. Thus far, the evidence suggests a remarkable conservation of integrative features during vertebrate evolution. One of the most robust of these principles is based on spatial relationships: a striking enhancement in activity is induced in a multisensory neuron when two different sensory stimuli (e.g., visual and auditory) are in spatial concordance, whereas a profound response depression can be induced when these cues are spatially discordant. The most extensive physiological observations have been made in cat, and in this species the same principles that have been shown to govern multisensory integration at the level of the individual SC neuron have also been shown to govern overt attentive and orientation responses to multisensory stimuli. Most surprising, however, is the critical role played by association (i.e. anterior ectosylvian) cortex in facilitating these midbrain processes. In the absence of the modulating corticotectal influences, multisensory SC neurons in cat are unable to integrate the different sensory cues converging upon them in an adult-like fashion, and are unable to mediate overt multisensory behaviors. This situation appears quite similar to that observed during early postnatal life. When multisensory SC neurons first appear, they are able to respond to multiple sensory inputs but are unable to synthesize these inputs to significantly enhance or degrade their responses. During ontogeny, individual multisensory neurons develop this capacity abruptly, but at very different ages, until the mature population condition is reached after several postnatal months. It appears likely that the abrupt onset of this capacity in any individual SC neuron reflects the maturation of inputs from anterior ectosylvian cortex. Presumably, the functional coupling of cortex with an individual SC neuron is essential to initiate and maintain that neuron's capability for multisensory integration throughout its life.

Adaptation, Physiological↗

Navigating the information technology highway: computer solutions to reduce errors and enhance patient safety.

Standardized, seamless, integrated information technology in the health-care environment used with other industry tools can markedly decrease preventable errors or adverse events and increase patient safety. According to an Institute of Medicine (IOM) report released in 1999, preventable errors have caused between 44,000 and 98,000 deaths per year. Following the report, President Bill Clinton requested that the Agency of Healthcare Research and Quality, a government agency, look into the issue and fund, at the local or state level, processes that can reduce errors. Funding subsequently was made available for research that utilizes best practice tools in clinical practice to increase patient safety. The Joint Commission on Accreditation of Healthcare Organization has placed a great deal of emphasis on strategies to reduce patient identification errors. Fragmented systems tout the individual as well as enhanced safety applications. These applications, however, are related to prevention in specific conditions and in specific health-care settings. Systems are not integrated with common reference data and common terminology aggregated at a regional or national level to provide access to patient safety risks for timely interventions before errors and adverse events occur. Standardized integrated patient care information systems are not available either on a regional or on a national level. This article examines tangible options to increase patient safety through improved state-of-the-art tools that can be incorporated into the health-care system to prevent errors.

Accreditation↗

PathSys: integrating molecular interaction graphs for systems biology.

BACKGROUND: The goal of information integration in systems biology is to combine information from a number of databases and data sets, which are obtained from both high and low throughput experiments, under one data management scheme such that the cumulative information provides greater biological insight than is possible with individual information sources considered separately. RESULTS: Here we present PathSys, a graph-based system for creating a combined database of networks of interaction for generating integrated view of biological mechanisms. We used PathSys to integrate over 14 curated and publicly contributed data sources for the budding yeast (S. cerevisiae) and Gene Ontology. A number of exploratory questions were formulated as a combination of relational and graph-based queries to the integrated database. Thus, PathSys is a general-purpose, scalable, graph-data warehouse of biological information, complete with a graph manipulation and a query language, a storage mechanism and a generic data-importing mechanism through schema-mapping. CONCLUSION: Results from several test studies demonstrate the effectiveness of the approach in retrieving biologically interesting relations between genes and proteins, the networks connecting them, and of the utility of PathSys as a scalable graph-based warehouse for interaction-network integration and a hypothesis generator system. The PathSys's client software, named BiologicalNetworks, developed for navigation and analyses of molecular networks, is available as a Java Web Start application at http://brak.sdsc.edu/pub/BiologicalNetworks.

Computer Graphics↗

Why seeing is believing: merging auditory and visual worlds.

Vision may dominate our perception of space not because of any inherent physiological advantage of visual over other sensory connections in the brain, but because visual information tends to be more reliable than other sources of spatial information, and the central nervous system integrates information in a statistically optimal fashion. This review discusses recent experiments on audiovisual integration that support this hypothesis. We consider candidate neural codes that would enable optimal integration and the implications of optimal integration for perception and plasticity.

Animals↗

[Description and integration of biomedical information resources by metadata].

With the development and utilization of computer techniques, Internet is playing an important role in information dissemination. There are abundant biomedical resources on the Internet. Accessing biomedical information is more dependent on the Internet than ever. It is important to explore new methods to describe and manage information resources. We have analyzed biomedical databases, search engines, web sites, and the metadata adopted by biomedical databases. The results show that biomedical information resources are characterized by electronic format, networking, dynamia, and dispersion. Describing a resource with metadata allows it to be understood by both humans and machines in ways that promote interoperability. Metadata interoperability has to be the underlying principle for networked information management. It directly impinges on information sharing, interchange, and accessibility across the boundaries of systems, languages, and geographic locations. We can use metadata to describe biomedical information and to integrate resources. It will benefit the people to access, select, and utilize biomedical information resources.

Computer Communication Networks↗

The quest for the Holy Grail of systems.

Software agents like Edify can be used to retrieve (and store) information from most online systems, without having to access each system's database. These techniques allow information integration (display) into Windows applications or in new reference and information retrieval applications or Web pages. These techniques can be used to bridge the gap until the Holy Grail of systems is built (and works).

Delivery of Health Care, Integrated↗

User interpretations of future information system use: a snapshot with technological frames.

Integrated information systems for managing patient data transform the nature of hospital work to the extent that the work practices, the responsibilities, even the professional identities are likely to undergo major changes. Therefore, during the organizational implementation of the IS, attention should be paid to the future users and how they understand and see what is going on. Here the focus is on these interpretation processes, analyzed as technological frames. That is, people develop different assumptions, expectations and knowledge concerning new technology. During this sense-making process they build their idea of that technology, its technological frame. We analyzed the pre-implementation frames that could be discerned in 24 interviews of hospital personnel. Main influences on the frames in this case were the work role in the organization, knowledge about the new system, and attitudes toward the old systems. The social context appeared to have a significant influence in the users' interpretation processes and the frames seemed to be congruent within one group. So far, the incongruence between groups appeared to have caused no major problems for the implementation.

Attitude to Computers↗

[Hospital information system--project of implementation of SAP information system at Sveti Duh General Hospital].

Nowadays, as medical and hospital institutions have been facing a growing need of a more efficient provision of healthcare services to patients, with simultaneous complete monitoring of the successfulness of business activities, integrated information systems appear as the logical choice for the support to hospital business processes. The integrated business information system implemented at Sveti Duh General Hospital is a comprehensive system that supports all hospital, clinical and administrative processes, while providing the basis for decision making regarding the patients and hospital management. The system also enables transfer of all data with specific medical business segments such as laboratory device management. The project for the implementation of the information system was realized in accordance with the requests from the Ministry of Health, applying the proven methodology for the execution of such complex projects. The project team consisted of a number of consultants from b4b Co. from Zagreb, as well as Hospital employees. The new information system is completely ready for going live; however, the necessary decisions have to be made first. The application of the system gives the medical staff more time for their professional work with patients, and through longterm collection and analysis of data on symptoms, illnesses and medical treatments, the information system becomes an important tool for the improvement of health and quality of healthcare system in general.

Clinical Laboratory Information Systems↗

Cue summation in spatial discriminations.

We investigated the extent to which discrimination performance improves when more than a single cue distinguishes two patterns. When two simple gratings differ slightly in spatial frequency, orientation, and/or contrast, the performance of most observers is better in multiple-cue conditions than in single-cue conditions and by an amount indicating Euclidean summation of information. These results are shown to be consistent with discrimination models that integrate information over different, spatially selective pathways. However, little summation is found when the task requires integration of cues across widely separated spatial frequency bands. This result implies that information is integrated only over pathways tuned to a common region of the spatial frequency domain.

Contrast Sensitivity↗

Recruitment of fusiform face area associated with listening to degraded speech sounds in auditory-visual speech perception: a PET study.

For the fast and accurate cognition of external information, the human brain seems to integrate information from multi-sensory modalities. We used positron emission tomography (PET) to identify the brain areas related to auditory-visual speech perception. We measured the regional cerebral blood flow (rCBF) of young, normal volunteers during the presentation of dynamic facial movement at vocalization and during a visual control condition (visual noise), both under the two different auditory conditions of normal and degraded speech sounds. The subjects were instructed to listen carefully to the presented speech sound while keeping their eyes open and to say what they heard. The PET data showed that elevation of rCBF in the right fusiform gyrus (known as the "face area") was not significant when the subjects listened to normal speech sound accompanied by a dynamic image of the speaker's face, but was significant when degraded speech sound (filtered with a 500 Hz low-pass filter) was presented with the facial image. The results of the present study confirm the possible involvement of the fusiform face area (FFA) in auditory-visual speech perception, especially when auditory information is degraded, and suggest that visual information is interactively recruited to make up for insufficient auditory information.

Acoustic Stimulation↗

Comment on internal feedback as a theory of judgment: a reply to Levin.

Levin's suggestion that internal feedback strategies be employed in judgmental and learning tasks is discussed. The predictions of an internal feedback notion are seen as inconsistent with Veit's ratio and difference task data. Scale-free frameworks and scale-convergence criteria used in previous research are described as useful techniques for separating integration from judgmental processes in information-integration as well as learning-task situations.

Feedback↗

Analysis of information needs of users of the Stanford Health Information Network for Education.

OBJECTIVE: To examine the information needs of users of the Stanford Health Information Network for Education (SHINE), an integrated information retrieval (IR) system. METHODS: A subset of queries from the SHINE log were categorized into one or more of 33 categories. RESULTS: Drugs and infectious disease accounted for 25% of categorizations, and otherwise the distribution of categorizations was quite broad. CONCLUSIONS: Attention should be paid to the selection of drug information resources in medical knowledge information retrieval systems. The distribution of query categorizations also suggests that IR systems include a wide range of knowledge resources.

California↗

Integrating order and distance relationships from heterogeneous maps.

There is no automatic mechanism to integrate information between heterogeneous genome maps. Currently, integration is a difficult, manual process. We have developed a process for knowledge base design, and we use this to integrate order and distance relationships between genetic linkage, radiation hybrid, and physical maps. Until now, the only way to develop a persistent, knowledge-intensive application was to either develop a new knowledge base from scratch or coerce the application to fit an existing knowledge base. This was not from lack of interest by the knowledge base or database community, but merely from a lack of theoretical tools powerful enough to tackle the problem. We import formalisms from knowledge representation, natural language semantics, programming language research, and databases. These form a strong, theoretical foundation for knowledge base design upon which we have implemented the knowledge base design tool called WEAVE.

Artificial Intelligence↗

An Integrated International Aerospace Medical Information System.

An Integrated International Aerospace Medical Information System (IIASMIS) is proposed. Such a system is needed to allow all appropriate resources to be brought to bear on the medical problems that must be solved for safe extended manned missions. Existing medical data bases are reviewed. The suggested approach involves the formation of an international working group that would determine the scope of the problem, identify the real needs, and design the top-level architecture of the system. Participants would develop national data bases independently. A prototype system would be developed and evaluated; upon satisfactory operation, it would be expanded to include all active partners.

Aerospace Medicine↗

Airway mechanosensors.

A mechanosensory unit is a functional unit that contains multiple receptors (or encoders) with different characteristics, including rapidly adapting receptors, slowly adapting receptors, and deflation-activated-receptors. Each is capable of sensing different aspects of lung mechanics. The sensory unit is both a transducer and a processor. Significant information integration occurs at the intra-encoder and inter-encoder levels. Within an encoder, the information is encoded as analog signals and integrated by amplitude modulation. Information from each single stretch-activated channel is processed through several levels of temporal and spatial summation, producing a generator potential that encodes averaged overall information within the encoder. This analog signal is transformed into a digital signal in the form of action potentials that are encoded as frequency (frequency modulation). These all-or-none propagated action potentials from different encoders interact through a competitive selection mechanism. Such inter-encoder interaction may occur at several levels, because of the fractal nature of the sensory unit. Inter-encoder interaction retains representative information but eliminates redundant information, resulting in the final output to the central nervous system, where multiple decoders specific for different variables decipher the encoded information for further processing.

Action Potentials↗