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PubMedDate not supplied

Modeling the temporal complexities of symptoms.

OBJECTIVE: To analyze the temporal aspects of symptoms, including their temporal uncertainty, in order to develop a high-level conceptual data model representation of this domain. DESIGN: A basic tenet of existing temporal models is that events occur not only relative to a particular date or time, but also relative to the time of some other event. The time an event occurs, particularly when the event is a symptom being recalled by a patient or collected by a busy provider, is frequently incomplete or uncertain, and this uncertainty must also be represented in a temporal data model. The object-oriented modeling technique used in this study is becoming popular among U.S. medical informatics standards developers. RESULTS: A conceptual data model for the temporal aspects of symptom data, including temporal uncertainty, has been developed. The object-oriented modeling approach used enables the temporal objects and attributes defined in this model to be inherited by other medical objects, such as problems. CONCLUSIONS: The temporal comparators presented here have previously been defined, and may serve as the basis for standardizing the terms used to describe how one event temporally relates to another. In an attempt to achieve domain completeness, this study concentrated more on developing a model that is highly expressive than on developing one that is easily queried. This trade-off in representation versus "queryability" will require further analysis and may require modifications to the underlying model.

Algorithms↗
PubMed2005

Managing the alert process at NewYork-Presbyterian Hospital.

Clinical decision support can improve the quality of care, but requires substantial knowledge management activities. At NewYork-Presbyterian Hospital in New York City, we have implemented a formal alert management process whereby only hospital committees and departments can request alerts. An explicit requestor, who will help resolve the details of the alert logic and the alert message must be identified. Alerts must be requested in writing using a structured alert request form. Alert requests are reviewed by the Alert Committee and then forwarded to the Information Systems department for a software development estimate. The model required that clinical committees and departments become more actively involved in the development of alerts than had previously been necessary. In the 12 months following implementation, 10 alert requests were received. The model has been well received. A lot of the knowledge engineering work has been distributed and burden has been removed from scarce medical informatics resources.

Decision Support Systems, Clinical↗
PubMedDate not supplied

Toward a medical-concept representation language. The Canon Group.

The Canon Group is an informal organization of medical informatics researchers who are working on the problem of developing a "deeper" representation formalism for use in exchanging data and developing applications. Individuals in the group represent experts in such areas as knowledge representation and computational linguistics, as well as in a variety of medical subdisciplines. All share the view that current mechanisms for the characterization of medical phenomena are either inadequate (limited or rigid) or idiosyncratic (useful for a specific application but incapable of being generalized or extended). The Group proposes to focus on the design of a general schema for medical-language representation including the specification of the resources and associated procedures required to map language (including standard terminologies) into representations that make all implicit relations "visible," reveal "hidden attributes," and generally resolve ambiguous or vague references. The Group is proceeding by examining large numbers of texts (records) in medical sub-domains to identify candidate "concepts" and by attempting to develop general rules and representations for elements such as attributes and values so that all concepts may be expressed uniformly.

Computer Simulation↗
PubMed1993

Quality assurance for respiratory care services: a computer-assisted program.

At present, the principal advantage of computer-assisted quality assurance is the acquisition of quality assurance date without resource-consuming chart reviews. A surveillance program like the medical director's alert may reduce morbidity and mortality. Previous research suggests that inadequate oxygen therapy or failures in airway management are important causes of preventable deaths in hospitals. Furthermore, preventable deaths tend to occur among patients who have lower severity-of-illness scores and who are not in ICUs. Thus, surveillance of the entire hospital, as performed by the HIS medical director's alert, may significantly impact hospital mortality related to respiratory care. Future research should critically examine the potential of such computerized systems to favorably change the morbidity and mortality of hospitalized patients. The departments of respiratory care and medical informatics at LDS Hospital have developed a computer-assisted approach to quality assurance monitoring of respiratory care services. This system provides frequent and consistent samples of a variety of respiratory care data. The immediate needs of patients are addressed through a daily surveillance system (medical director's alert). The departmental quality assurance program utilizes a separate program that monitors clinical indicators of staff performance in terms of stated departmental policies and procedures (rate-based clinical indicators). The availability of an integrated patient database allows these functions to be performed without labor-intensive chart audits.

Hospital Bed Capacity, 500 and over↗
PubMed2002

Closing the loop between clinical practice, research, and education: the potential of electronic patient records.

OBJECTIVE: To discuss the possible contribution of electronic patient records in closing the loop among clinical practice, research and education. RESULTS AND CONCLUSIONS: Applying Information and Communication Technology (ICT) to a given medical domain is not merely adding a new technique. When introduced into an environment, ICT will initially often emulate or resemble the already existing processes. When workers and researchers in that domain begin to appreciate the potential of ICT, this initial stage is followed by more fundamental changes in that domain that take advantage of the potential of ICT. To understand the scope of the potential changes enabled by electronic records, three principle changes need to be understood. First, data recorded in computer memories can be readily retrieved and re-used for a variety of purposes. Second, once data are available in computer memories, the data can be transported easily. Third, as physicians (and patients) are using computers to record medical data, the same electronic record can be used to introduce other computer programs that interact with the user. New usage of data, however, generates additional requirements. Thus the experience in developing decision support systems and analyzing observational databases feeds back into the requirements for electronic medical records. Each patient-physician encounter, each investigation, each laboratory test, and each treatment in medical practice constitutes, in principle, an experiment. Ideally, we learn from each experiment. Electronic medical records will facilitate research that relies on data recorded in routine medical practice. The potential and challenge, however, of Medical Informatics lies in its ability to close the loop among clinical practice, research, and education.

Databases, Factual↗
PubMed2003

The Magdeburg Clinical Studies' Network for pediatric diseases.

New pharmaceutical technologies had created either enthusiastic hope for major improvements in the medical treatment or major doubts on the use of research data and wrongdoing in clinical trials. Clinical investigators have to consider methodological and scientific principles, to stick to ethical rules, national law and international guidelines. With the invention of General Clinical Research Centres the necessary infrastructure in hospitals with well-trained personnel and the availability of laboratory, clinical and supporting service has been created in the US. Taking GCRC as a model to improve the clinical research in pediatrics, a formal collaboration between the Department of Pediatrics and the Institute for Biometry and Medical Informatics was established at the Otto-von-Guericke-University Magdeburg in 2001. Both nation-wide quality assurance programmes in Pediatric Endocrinology and clinical trials according to the principles of good clinical practice ('GCP') were planned and currently performed. Thus with the resources of the Medical faculty and additional project bound finances the necessary infrastructure has been developed.

Clinical Trials as Topic↗
PubMed1994

From HIS to IAIMS: expanding the scope of information processing applications in a German university hospital.

Since the mid eighties the department of medical informatics at the University Hospital of Giessen (Germany) has been engaged in the development of a comprehensive hospital information system. The installation of a campus wide network has set the basis to provide not only clinical patient-oriented information, but also general information resources for research, medical education and administrative purposes, thus creating an environment which in the U.S. became known as an integrated academic information management system (IAIMS). The underlying concept of the whole approach is to provide one-stop information shopping capabilities at the clinicians and administrators desktop in order to meet the increasing information needs of health professionals with the emerging reality of the potential benefits of computer and communication technologies. This paper describes the various steps performed to realize this concept at Giessen University Hospital and the evaluation results derived from analysis of the acceptance of these new technologies among our hospital staff.

Computer Systems↗
PubMed2006

Extending temporal databases to deal with telic/atelic medical data.

OBJECTIVE: In this paper, we aim at defining a general-purpose data model and query language coping with both "telic" and "atelic" medical data. BACKGROUND: In the area of Medical Informatics, there is an increasing realization that temporal information plays a crucial role, so that suitable database models and query languages are needed to store and support it. However, despite the wide range of approaches in the area, in this paper we show that a relevant class of medical data cannot be properly dealt with. METHODOLOGY: We first show that data models based on the "point-based" semantics, which is (implicitly or explicitly) assumed by the totality of temporal database approaches, have several limitations when dealing with "telic" data. We then propose a new model (based on the "interval-based" semantics) to cope with such data, and extend the query language accordingly. RESULTS: We propose a new three-sorted model and a query language to properly deal with both "telic" and "atelic" medical data (as well as non-temporal data). Our query language is flexible, since it allows one to switch from "atelic" to "telic" data, and vice versa. CONCLUSION: In this paper, we demonstrate the feasibility of a database approach copying with both telic and atelic data as needed in several (medical) applications.

Artificial Intelligence↗
PubMed2006

Monitoring the integration of hospital information systems: How it may ensure and improve the quality of data.

Integration of hospital departmental information systems (HDIS) has become a common but difficult issue. In May 2003, the Department of Biostatistics and Medical Informatics implemented a Virtual Electronic Patient Record (VEPR) for the Hospital S. João (HSJ), a university hospital with over 1350 beds. The system integrates clinical data from 10 legacy HDIS plus the Hospital Administrative Database (HAD), aiming to deliver all patient information to health professionals. Currently, around 500 medical doctors use the system on a regular basis and the HSJ-VEPR retrieves an average of 3,000 new reports per day, in PDF or HTML formats. This paper describes and discusses the role of monitoring in the assurance and improvement of data quality. Three approaches were put in place: (a) monitoring the HSJ-VEPR concerning the frequency of clinical records retrieved from the DIS by checking if the daily number of reports sent by the HDIS fell in the normal range from similar week days; (b) monitoring inconsistencies in the patient's identification by cross-checking between HDIS and HAD; and (c) monitoring the integrity of clinical records delivered to medical doctors through the HSJ-VEPR by checking their digital signature. During 2005, the monitoring system detected 53 unusual frequency patterns of which 44 corresponded to real problems. Over a 6 months period, more than 400 alerts were generated concerning inconsistencies in the patient's identification found in laboratory reports. Nevertheless, a significant reduction in the number of these inconsistencies occurred - from 116 in July to 10 in December 2005--due to implementation of preventive measures by the DIS. Finally, report's integrity was checked each time the report was asked to be visualized i.e. in more than one hundred thousand times during a one year period. In conclusion, all information available in hospital information systems can and should be used to trigger alerts of malfunctions and inconsistencies, in order to improve data quality and ensure a better health care.

Hospital Information Systems↗
PubMed1998

ATRAS: a decision support application layered on the W3-EMRS architecture.

The creation of portable decision support systems (DSSs) remains an important goal in medical informatics. The Adrenal Test Retrieval and Analysis System (ATRAS) has been developed as an example of a simple yet highly effective decision support application which runs in a system-independent way. It is the first implementation of a decision support application layered on the World Wide Web Electronic Medical Record System (W3-EMRS) architecture, which allows for unified access to remote heterogeneous electronic medical record system (EMRS) databases.

Adrenal Cortex Hormones↗
PubMed1995

An overview of the CERC ARTEMIS project.

The basic premise of this effort is that health care can be made more effective and affordable by applying modern computer technology to improve collaboration among diverse and distributed health care providers. Information sharing, communication, and coordination are basic elements of any collaborative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and managed access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such a patient-centered perspective is in keeping with the real mission of health care providers. Today, an easy-to-use, integrated health care network is not in place in any community, even though current technology makes such a network possible. Large health care systems have deployed partial and disparate systems that address different elements of collaboration. But these islands of automation have not been integrated to facilitate cooperation among health care providers in large communities or nationally. CERC and its team members at Valley Health Systems, Inc., St. Marys Hospital and Cabell Huntington Hospital form a consortium committed to improving collaboration among the diverse and distributed providers in the health care arena. As the first contract recipient of the multi-agency High Performance Computing and Communications (HPCC) Initiative, this team of computer system developers, practicing rural physicians, community care groups, health care researchers, and tertiary care providers are using research prototypes and commercial off-the-shelf technologies to develop an open collaboration environment for the health care domain. This environment is called ARTEMIS--Advanced Research TEstbed for Medical InformaticS.

Computer Communication Networks↗
PubMed1997

Medico-economical use of the medical record or the bridge between minimal and detailed data.

Medico-economical use of the medical record: the title encloses two different notions which represent two different trends within medical informatics. The first trend is worried about weighting aspects of health resources consumption, mainly about hospital acute care; their key-words are "DRG (Diagnostic Related Groups), Case-Mix, reimbursement by pathology, measurement of indicators (severity or outcome), costs". The other trend is looking for deeper understanding of the medical process and for better diffusion of relevant information helping the day-to-day care process; they speak of "CPR (Computerized patient record), full text reports and corresponding retrieval, detailed data, medical records on Internet, large access to literature and databases". It is mandatory to realize a bridge between these two trends for facing the information technology revolution entering into a self-revolutioning medicine. The purpose of this paper is to begin this bridge by showing what the DRG people expect from the CPR people and what the latter should receive from the former.

Diagnosis-Related Groups↗
PubMed1998

A study on development of a home health care support information system.

As the need for home health care has been increasing with the rising number of the elderly in Japan, the application of medical informatics to home health care delivery is considered to be useful. Therefore, development of a home health care support information system was planned. The system can collect patient's PHD (Personal Health Data) such as data of ECG, complaints, etc. at patient's home and can send the PHD to medical facilities. We designed and constructed two subsystems on a trial basis. One subsystem has function of gathering, recording and transmitting vital signs of the aged such as ECG, physical activity rate, oxygen saturation rate in arterial blood. Another subsystem can collect and send image data of the old people at their home. Experiments for trial use of the system was conducted and it was recognized that the PHD can be smoothly collected and recorded at home of the elderly and can be sent to the medical facilities with good success by using the system.

Aged↗
PubMed1997

MedWeaver: integrating decision support, literature searching, and Web exploration using the UMLS Metathesaurus.

Integrating functions from disparate and widely-distributed information systems has been an interest of the medical informatics community for some time. Barriers to progress have included the lack of network-accessible information sources, inadequate methods for inter-system messaging, and lack of vocabulary translation services. With the advent of the World Wide Web (WWW) and the evolution of the National Library of Medicine's Unified Medical Language System (UMLS), it is now possible to develop applications that integrate functions from diverse, distributed systems. In this paper we describe one such system, MedWeaver, a WWW application that integrates functions from a decision support application (DXplain), a literature searching system (WebMedline), and a clinical Web searching system (CliniWeb) using the UMLS Metathesaurus for vocabulary translation. This system demonstrates how application developers can design systems around anticipated clinical information needs and then draw together the needed content and functionality from diverse sources.

Computer Communication Networks↗
PubMed1996

[Microprocessor cards and portable medical record].

The smart cards are considered as "intermittently connected devices" ensuring the security and the confidentiality of the data. This technique can be used in the healthcare domain for 2 types of applications: 1. patient cards for administrative functions (Social Security card, identification card) or medical purposes (general medical record or "niche" cards); 2. healthcare professionals cards for identification, authentification of the bearers. Electronic signature and cryptography algorithms reinforce the security of the transactions in medical informatics and telematics. In every case, the smart card must be considered as a mobile tool, intermittently connected with a larger, not limited information system.

Confidentiality↗
PubMed2005

Evaluating the web as a clinical knowledge base.

Medical diagnostic decision support systems are some of the most visible applications of medical informatics. Many of these systems, however, were created in the pre-WWW era, when access to clinical knowledge was much more limited than it is currently. Using the Google(tm) Java API1, we created a simple program to extract potential diagnoses from a general web search. Our system performed at a level comparable to other medical expert systems.

Algorithms↗