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PubMed1995

Introducing the Internet.

The benefits to medical practitioners of using the Internet are growing rapidly as the Internet becomes easier to use and ever more biomedical resources become available on line. The Internet is the largest computer network in the world; it is also a virtual community, larger than many nation states, with its own rules of behaviour or "netiquette." There are several types of Internet connection and various ways of acquiring a connection. Once connected, you can obtain, free of charge, programs that allow easy use of the Internet's resources and help on how to use these resources; you can access many of these resources through the hypertext references in the on line version of this series (go to http:@www.bmj.com/bmj/ to reach the electronic version). You can then explore the various methods for accessing, manipulating, or disseminating data on the Internet, such as electronic mail, telnet, file transfer protocol, and the world wide web. Results from a search of the world wide web for information on the rare condition of Recklinghausen's neurofibromatosis illustrate the breadth of medical information available on the Internet.

Computer Communication Networks↗
PubMed2003

How well does decision support software perform in the emergency department?

OBJECTIVE: To determine how well general decision support systems perform given the data collected in an emergency department (ED). METHODS: A convenience sample of 25 patients was selected from those patients having a diagnostic question on presentation to the ED. All interactions with the patients were audiotaped and abstracted into a structured data form. All other data such as written notes, laboratory, and EKG results were also abstracted. All data were entered into two general diagnostic decision support programs (Quick Medical Reference (QMR Version 3.82, Knowledge Base 10-07-1998 Copyright University of Pittsburgh and The Hearst Corporation) and Iliad (Version 4.5 Copyright 1996 Applied Medical Informatics)). The diagnoses generated by the computer programs were compared with the final diagnoses of the ED attending. RESULTS: The final ED diagnosis was found in the differential diagnosis generated by Iliad and QMR 72% and 52% of the time respectively. The final ED diagnosis was found in the top 10 diagnoses 51% and 44% of the time and in the top five diagnoses 36% and 32% of the time for each program respectively. This approximates to the performance of these programs in other clinical settings. CONCLUSIONS: Diagnostic decision support software has the same success in finding the "correct" diagnosis in the ED as in other clinical settings where more extensive clinical data are available. The accuracy is not sufficiently high to permit the use of these programs as an arbiter in any individual case. However, they may be useful, prompting additional investigation in particularly difficult cases.

Decision Support Techniques↗
PubMedDate not supplied

An event model of medical information representation.

OBJECTIVE: Develop a model for structured and encoded representation of medical information that supports human review, decision support applications, ad hoc queries, statistical analysis, and natural-language processing. DESIGN: A medical information representation model was developed from manual and semiautomated analysis of patient data. The key assumption of the model is that medical information can be represented as a series of linked events. The event representation has two main components. The first component is a frame or template definition that specifies the attributes of the event. The second component is a structured vocabulary, the terms of which are taken as the values of the slots in the event template structure. Individual event instances are linked by specific named relationships. RESULTS: The proposed model was used to represent a chest-radiograph report. CONCLUSIONS: The event model of medical information representation provides a mechanism for formal definition of the logical structure of medical data and allows explicit time-oriented and associative relationships between event instances.

Computer Simulation↗
PubMedDate not supplied

Representing clinical guidelines in GLIF: individual and collaborative expertise.

OBJECTIVE: An evaluation of the cognitive processes used in the translation of a clinical guideline from text into an encoded form so that it can be shared among medical institutions. DESIGN: A comparative study at three sites regarding the generation of individual and collaborative representations of a guideline for the management of encephalopathy using the GuideLine Interchange Format (GLIF) developed by members of the InterMed Collaboratory. MEASUREMENTS: Using theories and methods of cognitive science, the study involves a detailed analysis of the cognitive processes used in generating representations in GLIF. The resulting process-outcome measures are used to compare subjects with various types of computer science or clinical expertise and from different institutions. RESULTS: Consistent with prior studies of text comprehension and expertise, the variability in strategies was found to be dependent on the degree of prior experience and knowledge of the domain. Differing both in content and structure, the representations developed by physicians were found to have additional information and organization not explicitly stated in the guidelines, reflecting the physicians' understanding of the underlying pathophysiology. The computer scientists developed more literal representations of the guidelines; addition were mostly limited to specifications mandated by the logic of GLIF itself. Collaboration between physicians and computer scientists resulted in consistent representations that were more than the sum of the separate parts, in that both domain-specific knowledge of medicine and generic knowledge of guideline structure were seamlessly integrated. CONCLUSION: Because of the variable construction of guideline representations, understanding the processes and limitations involved in their generation is important in developing strategies to construct shared representations that are both accurate and efficient. The encoded guidelines developed by teams that include both clinicians and experts in computer-based representations are preferable to those developed by individuals of either type working alone.

Brain Diseases↗
PubMedDate not supplied

Toward vocabulary domain specifications for health level 7-coded data elements.

The "vocabulary problem" has long plagued the developers, implementers, and users of computer-based systems. The authors review selected activities of the Health Level 7 (HL7) Vocabulary Technical Committee that are related to vocabulary domain specification for HL7 coded data elements. These activities include: 1) the development of two sets of principles to provide guidance to terminology stakeholders, including organizations seeking to deploy HL7-compliant systems, terminology developers, and terminology integrators; 2) the completion of a survey of terminology developers; 3) the development of a process for HL7 registration of terminologies; and 4) the maintenance of vocabulary domain specification tables. As background, vocabulary domain specification is defined and the relationship between the HL7 Reference Information Model and vocabulary domain specification is described. The activities of the Vocabulary Technical Committee complement the efforts of terminology developers and other stakeholders. These activities are aimed at realizing semantic interoperability in the context of the HL7 Message Development Framework, so that information exchange and use among disparate systems can occur for the delivery and management of direct clinical care as well as for purposes such as clinical research, outcome research, and population health management.

Computer Communication Networks↗