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PubMedDate not supplied

Legal liability in the development and use of medical expert systems.

The application of medical expert systems is likely in some instances to result in patient injury litigation. Such legal action will be based on the same principles now applicable to medical practice and products liability. These principles define legally wrongful acts, product defects, and theories of recovery: negligence, breach of warranty and strict liability. The resolution of such litigation will depend on whether the clinician should have relied on the advice of the expert system when the advice and patient treatment is alleged to have been wrong, as well as the overall quality of the expert system, its functional design, and claims made for it. Clinical engineers who become involved with expert system development, selection or implementation should understand the risk management implications of this technology.

Expert Systems↗
PubMed1994

Subsumption principles underlying medical concept systems and their formal reconstruction.

Conventional medical concept systems represent generic concept relations by hierarchical coding principles. Often, these coding principles constrain the concept system and reduce the potential for automatical derivation of subsumption. Formal reconstruction of medical concept systems is an approach that bases on the conceptual representation of meanings and that allows for the application of formal criteria for subsumption. Those criteria must reflect intuitive principles of subordination which are underlying conventional medical concept systems. Particularly these are: The subordinate concept results (1) from adding a specializing criterion to the superordinate concept, (2) from refining the primary category, or a criterion of the superordinate concept, by a concept that is less general, (3) from adding a partitive criterion to a criterion of the superordinate, (4) from refining a criterion by a concept that is less comprehensive, and finally (5) from coordinating the superordinate concept, or one of its criteria. This paper introduces a formalism called BERNWARD that aims at the formal reconstruction of medical concept systems according to these intuitive principles. The automatical derivation of hierarchical relations is primarily supported by explicit generic and explicit partititive hierarchies of concepts, secondly, by two formal criteria that base on the structure of concept descriptions and explicit hierarchical relations between their elements, namely: formal subsumption and part-sensitive subsumption. Formal subsumption takes only generic relations into account, part-sensitive subsumption additionally regards partive relations between criteria. This approach seems to be flexible enough to cope with unforeseeable effects of partitive criteria on subsumption.

Subject Headings↗
PubMed1994

Medication cart-filling time, accuracy, and cost with an automated dispensing system.

Medication cart filling with an automated dispensing system was compared with manual cart filling with respect to personnel time, costs, and accuracy. At a 650-bed tertiary-care medical center, technician cart filling and pharmacist cart checking were timed for the existing manual system and for the Baxter ATC-212 automated dispensing system. Subsequently, carts filled with each system were checked for accuracy of dispensing. On the basis of drugs used in the automated system over three months, drug acquisition and dispensing costs were calculated for automated and manual cart filling; the costs of personnel time were also compared. Daily cart filling time for technicians was significantly less with the automated system. The savings of pharmacist time was not significant; pharmacists had to cut the strip-packaged drugs into individual doses as they checked patients' medications. For both systems, errors were found in fewer than 1% of the doses (0.84% for the manual system and 0.65% for the automated system). Drug costs were higher with the automated system; acquisition prices for the bulk drugs purchased for use in the dispensing machine were higher than the prices of the same products in unit dose packaging. Personnel time saved amounted to less than 0.5 full-time equivalent. With the automated system, overall time savings was not great enough to substantially affect pharmacy operations, and drug costs were higher.

Automation↗
PubMed1988

The medical care system of Hungary.

Medical care in Hungary has made significant progress since World War II in spite of other social priorities which have limited financial support of the health system. A shortage of hard currency in a high technological era is now having a particularly severe adverse impact on further development. Decentralized administration and local finance have, however, provided some room for progress. Preventive efforts are hampered by a deeply entrenched life style which is not conducive to improving the population's health status.

Aged↗
PubMed1999

New approach to the medical information system for quality management in patient care: development of Problem Mapping System.

A new type of medical information system named Problem Mapping System (P-Map) has been developed, which aids physicians with solving patients' problems. With this system, physicians can define the problems of in-patients, monitor their progress clearly, and share information efficiently. In P-map, a list of problems, such as disease names, can be set for each inpatient easily. The progress of each problem is clearly shown using progress lines on a time axis. Physicians can save the Subjective Objective Assessment Plan (SOAP) notes which are linked to each problem. At the final stage of patient care, a discharge summary can be made easily. With the aid of this system, the quality of patient care is improved due to the following: (1) physicians can make the best decision; (2) medical staff in the same team can provide the best medical treatment; (3) evaluation of each medical treatment is easy; (4) saved data can be used effectively for education and research; (5) the system can improve cooperation with other medical institutes by providing discharge summary information which can be distributed using e-mail; and (6) the system can improve patients' understanding for the purpose of informed consent by providing clear and well organized information to patients.

Computer Systems↗
PubMed1984

Do oral contraceptives reduce the incidence of rheumatoid arthritis? A pilot study using the Stockholm County medical information system.

The Stockholm County medical information system was used to select cases for a pilot study on the association between oral contraceptive (OC) use and the incidence of rheumatoid arthritis (RA). A selection procedure is described by which we obtained 76 cases of RA. These were compared in a case-control study with 152 healthy controls with regard to OC use prior to the onset of RA. For all women who had used OCs for more than one year the relative risk of RA was 0.70 (0.40, 1.24). The relative risk decreased with advancing age at onset of RA, being 0.40 (0.10, 1.65) for women with age at onset over 40. Although the material is small, and there are some inconsistencies in the results, our findings are compatible with the hypothesis that the use of OCs is associated with a reduced incidence of RA.

Adolescent↗
PubMed1991

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↗
PubMed1995

ARAMIS and toxicity measurement. (Arthritis Rheumatism and Aging Medical Information System).

Side effects of medications make up an important part of adverse outcomes experienced by patients with rheumatic diseases. Quantitative measures to assess toxicity, however, have not been available, and this lack has limited estimates of the magnitude of effects and of differences in side effects among different drugs. This paper describes the development of the Arthritis, Rheumatism and Aging Medical Information System (ARAMIS) Toxicity Index and the issues arising in construction of such an index, and reviews early results in comparing toxicities of antirheumatic drugs. Findings have had major value in revising therapeutic strategies for rheumatic diseases, particularly rheumatoid arthritis, and have set the stage for development of toxicity-therapeutic ratios for different drugs.

Adverse Drug Reaction Reporting Systems↗