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PubMed1994

OncoLink: a multimedia oncology information resource on the Internet.

This paper describes OncoLink, the first multimedia World-Wide-Web (WWW) and gopher server focusing on cancer information for both the health care professional and the patient. OncoLink provides an internetworked hypertext and multimedia resource linking people, computers and information together in an easy to use fashion. Our objective in developing OncoLink is to provide comprehensive and timely information about many aspects of oncology for both patients and healthcare providers. Specifically, OncoLink's purposes are: (1) the rapid dissemination of information relevant to treatment of cancer and concomitant problems; (2) education of health care personnel (at all levels) in the field; (3) education of patients and families of patients who have cancer; (4) posting of clinical trials and eligibility criteria; (5) the rapid collection and dissemination of quality, peer-reviewed information pertinent to oncology in general and specific subspecialties; (6) provide a well-organized, frequently updated hypertext system to access other quality cancer information resources on the Internet. OncoLink attempts to provide one-stop shopping for the patient, healthcare provider, researcher or Internet browser searching for cancer-related information. Since its inception on March 7, 1994, OncoLink has averaged more than 36,000 accesses per month from around the world. While also accessible by text-based gopher servers, preliminary observations infer increased use of multimedia and hypertext documents over traditional text-only resources. From the large following of users, it is clear that electronic dissemination of high quality, peer-reviewed cancer information is very popular. We conclude OncoLink is both useful and has wide interest in the international community.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks↗
PubMed1994

From terminology to terminology services.

Terminologies have traditionally been considered as static datasets held in books or databases. The GALEN Terminology Server presents a prototype for a new view of terminologies delivered as a set of functions and services provided to other applications. This facilitates their development and integration as part of a strategy for sharing and re-using information and knowledge. The essential features of the Terminology server are the functions which it can perform; questions which it can answer and statements which it can be told. The GALEN Terminology Server supports these operations through a modular architecture and uniform applications programming interface which allows client applications to ignore the internal structure and simply use the Server for terminological, coding, and linguistic functions.

Computer Systems↗
PubMed1994

Evaluation of UltraSTAR: performance of a collaborative structured data entry system.

The UltraSTAR structured data entry system is now in routine use for reporting ultrasound studies at Brigham and Women's Hospital, having been used for 3722 reports in its first ten months of service. Reports entered through GUI-based forms are uploaded via HL7 to a radiology information system and distributed through a hospital network. UltraSTAR introduces collaborative reporting, in which nonmedical and medical staff collaborate to produce a single report for each patient visit. Performance of UltraSTAR was measured as user satisfaction, data entry time, report completeness, free text annotation rate, and referring-physician satisfaction with reports. Results show high satisfaction with UltraSTAR among radiologists and acceptance of the system among ultrasound technicians. Data entry times averaged 5.3 minutes per report. UltraSTAR reports were slightly more complete than comparable narrative reports. Free text annotations were needed in only 25.2% of all UltraSTAR reports. Referring physicians were neutral to slightly positive toward UltraSTAR's outline-format reports. UltraSTAR is successful at structured data entry despite somewhat long reporting times. Its success can be attributed to efficiencies from collaborative reporting and from integration with existing information systems. UltraSTAR shows that the advantages of structured data entry can outweigh its difficulties even before problems of data entry time and concept representation are solved.

Attitude to Computers↗
PubMed1994

MD Concept: a model for integrating medical knowledge.

Many integrated clinical information systems depend on large knowledge bases containing dictionary of terms as well as specific information about each term and the relationships between terms. We propose a knowledge base model called MD Concept which is based on a semantic network and uses an object-oriented paradigm and relational tables. A prototype has been developed which integrates the Unified Medical Language System (UMLS) with other databases including the Systematized Nomenclature of Medicine (SNOMED II), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR) and a pharmaceutical database. We demonstrate how a user can easily navigate in this knowledge world using a browser.

Artificial Intelligence↗
PubMed1994

Using a computerized patient record to reengineer an outpatient clinic.

By employing process flow analysis and work redesign techniques during the design and implementation of a computerized patient record in the pediatric outpatient clinics at the University of Virginia Health Sciences Center, we have developed a database of clinical observations while simultaneously shortening the time that patients spend waiting in the pediatric clinics and decreasing the number of support staff employed within the clinics.

Ambulatory Care Information Systems↗
PubMed1994

A clinical database as a component of a diagnostic hematology workstation.

A clinical database was designed as part of a comprehensive workstation for diagnostic laboratory hematology. The database stores coded findings pertinent to hematologic disorders including inherited abnormalities, previous surgery, malignancies, current therapy, and laboratory test results. The workstation includes knowledge-based systems for peripheral blood analysis, flow cytometry studies, and bone marrow morphology. The peripheral blood system renders an interpretive report based on data from a complete blood count with manual review of a blood smear by a technologist. The flow cytometry module interprets the immunophenotyping and DNA content results, and correlates them with the clinical findings and the peripheral blood data. The bone marrow system bases its report on all of the available information including the morphologic review of the bone marrow specimen by a physician, the peripheral blood data, immunophenotype, and clinical/laboratory findings. Before generating an interpretive report, each of the knowledge-based systems automatically searches the clinical database for specific information pertinent to the findings in the case. Since the workstation must function in situations where access to distributed databases is not feasible or not yet practical, a data entry module with a graphical user interface has been created.

Artificial Intelligence↗
PubMed1994

Building Internet accessible medical education software using the World Wide Web.

We describe work to enhance existing software protocols and develop a suite of new software utilities based upon a set of standards known as the World Wide Web (WWW). Specifically, we have developed an effective X-windows based WYSIWYG WWW browser/editor and a prototype for integrated wide-area authentication and authorization support for delivery and maintenance of WWW service. These software development activities, along with parallel work in content development, are empowering individuals to better use the Internet as a resource to easily author, publish, and access materials. As an illustrative application, we describe one Web-based self-instructional unit designed to increase users' knowledge of hazardous substances in the environment. This on-line monograph was adapted from a series of paper-based case studies developed by the Agency for Toxic Substances and Disease Registry of the U.S. Department of Health & Human Services. The on-line version illustrates many of the innovative features provided by the Web, and demonstrates how such materials can significantly impact medical education at all levels.

Computer Communication Networks↗
PubMed1994

Regional health information networks: the Wisconsin Health Information Network, a case study.

It is projected that by the turn of the century, ninety percent of diagnostic procedures and seventy percent of therapeutic procedures will occur outside a hospital setting [2,3]. Additionally, according to a 1992 study by Arthur D. Little, during any given physician office visit, as much as 30 percent of the required diagnostic data and information required by the physician is unavailable [4]. Driven by ever increasing demands for convenience and accessibility, health care continues to evolve into an environment where the importance of data and its relative availability to the requester are diverging. This paper will present the concept of a regional or community health information network (RHIN or CHIN). Specifically, the Wisconsin Health Information Network (WHIN) will be used as a case study.

Computer Communication Networks↗
PubMed1994

A telemedicine distributed system for cooperative medical diagnosis.

Telemedicine is changing the classical form of health care delivery, dramatically increasing the number of new applications in which some type of distributed synchronous cooperation between health care professionals is required. This paper presents the design and development of a telemedicine distributed system for cooperative medical diagnosis based on two new approaches: 1) a distributed layered architecture specially designed to add synchronous computer supported cooperative work features either to new or existing medical applications; 2) the definition of a methodological procedure to design graphical user interfaces for telemedicine cooperative working scenarios. The cooperative work is supported by a collaborative toolkit that provides telepointing, window sharing, coordination and synchronization. Finally, we have implemented and installed the telemedicine system in clinical practice between two hospitals, providing teleconferencing facilities for cooperative decision support in haemodynamics studies. This specific implementation and a preliminary evaluation were accomplished under the Research Project FEST "Framework for European Services in Telemedicine" funded by the EU AIM Programme.

Computer Communication Networks↗
PubMed1994

Using the PEN&PAD information model to support hospital-based clinical care.

The PEN&PAD model for clinical record systems has been successfully used for medical records in both General Practice and hospital-based care. This paper describes experiences of using the model for developing computer-based nursing records. Results from this work show that there are some problems with directly applying the model to the nursing domain. Whilst the main purpose of the nursing record is to document and communicate a patient's care, it has several other, possibly incompatible, roles. Furthermore, the structure and content of the information contained within the nursing record is heavily influenced by the need for the nursing profession to visibly demonstrate the philosophical frameworks underlying their work. By providing new insights into the professional background of nursing records, this work has highlighted the need for nurses to clarify and make explicit, their uses of information, and also provided them with some tools to assist in this task.

Computer Systems↗
PubMed1994

Computer-based patient record: the essential data set approach.

The clamor for data to study the impact of care, to evaluate clinical performance and justify resource utilization is increasing. The data in demand normally should exist in the record of a clinical encounter. Advances in information technology and software techniques have provided us with tools to develop and implement computer-based patient record systems. The issues that constrain development are integral issues of clinical medicine, such as the variability in medical data, specialized practice of medicine, and differing demands of the numerous end-users of a medical record. This paper describes an approach to develop a computer-based patient record. The focus is on identification of the essential data set by infological data modeling and its implementation in a commercially available package for a physician's office.

Computer Systems↗
PubMed1994

The standard data model approach to patient record transfer.

This paper develops an approach to electronic data exchange of patient records from Ambulatory Encounter Systems (AESs). This approach assumes that the AES is based upon a standard data model. The data modeling standard used here is IDEFIX for Entity/Relationship (E/R) modeling. Each site that uses a relational database implementation of this standard data model (or a subset of it) can exchange very detailed patient data with other such sites using industry standard tools and without excessive programming efforts. This design is detailed below for a demonstration project between the research-oriented geriatric clinic at the Baltimore Veterans Affairs Medical Center (BVAMC) and the Laboratory for Healthcare Informatics (LHI) at the University of Maryland.

Computer Communication Networks↗
PubMed1994

An interactive learning environment for health care professionals.

This article summarizes experiences to date with building and deploying a clinical simulator that medical students use as part of a 3rd year primary care rotation. The simulated microworld helps students and health care professionals gain experience with and learn meta-cognitive skills for the care of complex patient populations that require treatment in the biopsychosocial-value dimensions. We explain lessons learned and next steps resulting from use of the program by over 300 users to date.

Computer Simulation↗
PubMed1994

A powerful macro-model for the computer patient record.

Especially in the Netherlands, the introduction of computer patient records (CPRs) in primary care has been relatively successful. Specialists usually maintain more extensive records than general practitioners and it has proven to be a great challenge to design a CPR that is useful and practical for specialized care. In this paper, we present the design of a CPR for use by specialists in an out-patient clinic. The philosophy underlying the design is that specialists may keep record in a relatively conventional way, while, at the same time, the system motivates them to add structure to their data. Data can be presented in various views, each suitable for one or more specific tasks. The potential to benefit from these views depends on the degree of structure in the recorded data. Since a CPR has to be faithful and permanent, explicit representation of observations, insights, and evolution of insight is also supported. The CPR system is in a final stage of implementation and will be evaluated in a clinical setting in summer 1994.

Computer Systems↗
PubMed1994

Generating patient-specific interactive natural language explanations.

Patient compliance is a significant problem and is strongly correlated with the patients' understanding of their condition and prescribed treatment. Since doctors typically do not have large amounts of time to educate patients, and impersonal, voluminous patient handouts are largely ineffective, we propose the use of a sophisticated computer-based information system to generate tailored, interactive handouts to communicate with patients. Our system uses text planning and user modeling techniques to generate natural language descriptions of migraine, its symptoms, triggering factors and prescriptions. The system is capable of handling follow-up questions requesting further information, and generating responses in the context of previously supplied information--a capability unavailable in previous patient information systems. The system tailors its interaction to: (i) the class of migraine patients, (ii) the individual patient, and (iii) the previous dialogue. Preliminary evaluation of the system indicates that patients find it useful and informative. More extensive evaluation is in progress.

Computer-Assisted Instruction↗