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To establish practical, effective medical digital image filing systems, various problems remain to be solved. The authors focused on 2 such problems of great importance: image data compression and standard specifications for digital data storage. From a variety of image compression algorithms now available, 2D-Color Doppler image compression was clinically investigated using the Joint Photographic Expert Group (JPEG) method. In low grade compression, the images decompressed showed no significant alterations in image quality, however, in higher grades of compression attained through irreversible coding in the JPEG method, the images showed subtle but significant alterations: emergence of 2 kinds of artifact, i.e., borderline-artifact produced in the DCT procedures and pseudo color spots. The reproducibility of colors was found to be altered by changing the quantization table in the JPEG procedure. It was thought necessary to choose a proper quantization table and examine the DC coefficients (number of pixels) in the DCT procedure to attain practical 2D-Color Doppler image compression by the JPEG method. Although attempts in Japan are being made to establish common standards for electronic data storage, based on MEDIS, in an effort to promote standardization there are many problems to be solved before practical use is possible. To ensure common availability as required by the technical standards, it is necessary to organize minimum-required specifications into common standards and make them open to the public.
Maryland has a pioneering and sophisticated system of prehospital emergency medical care. Approximately 44,000 patients with chest pain and/or acute myocardial infarction were transported last year by emergency medical service (EMS) providers who also responded to approximately 5,000 out-of-hospital cardiac arrests. Funding has recently been prioritized to enable EMS providers to be trained and equipped with automated external defibrillators. Future consideration may be given to purchasing defibrillators with integrated 12-lead electrocardiographic capability. These devices have been shown to reduce the time required to initiate thrombolytic therapy once in the emergency department. There are presently no data in the United States that support the prehospital administration of thrombolytics.
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This paper describes the use of the Balanced ScoreCard (BSC) in the MIEMIS meso-model (Model for Investment and Evaluation of Medical Information Systems). The scope of the MIEMIS model is to integrate the evaluation process into the whole lifecycle of an information system using both a prospective and a retrospective approach. We conclude, that the MIEMIS-model has benefited from implementing the BSC into the model due to the fact, that the BSC can support the project management work. This approach helps ensuring, that the new information systems are fulfilled according to the plan and with a balance between the four perspectives (financial, customer/user, internal, and innovation/learning perspective) to avoid that the financial aspect is the driving force in developing and implementing a new information system, for example.
Health care reform in the United States will likely attempt to expand the health insurance coverage to uninsured groups, control costs, enhance quality, and expand access to care. Preventive services will be assigned to the medical care system, while new roles and responsibilities will be defined for public health agencies. The clinical preventive services likely required are examined in a population of 44,565 persons residing in Otsego County, New York. Expansion of preventive services to Medicaid requests and the uninsured will require considerable resource expenditure to correct the current deficit in preventive services received by these groups. Moreover, the uninsured and Medicaid recipients have high levels of risk behaviors, identifying a need for health education services effective to that population subgroup. The transfer of responsibilities for clinical preventive services to the medical care system may free up resources for public health agencies to focus on other initiatives such as disease surveillance, health education, and quality assurance. New interrelationships, some cooperative and some adversarial, are likely to emerge, due to a closer working relationship between the medical care system and public health agencies than previously seen in American health care.
MARS was a joint developmental effort between Maine Medical Center and Advanced Healthcare Systems, Inc. It has taken nearly three years to get the system (hardware, software, and staff) to a point where it can now meet daily production requirements. This project was truly unique, so there was no opportunity to learn from the experiences of others. The optical disk system has been an attractive solution to some of the problems experienced at Maine Medical Center. The result was worth the effort in terms of both dollars and other less quantifiable benefits that have had a positive impact on patient care.
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Causal probabilistic networks (CPNs) offer new methods by which you can build medical expert systems that can handle all types of medical reasoning within a uniform conceptual framework. Based on the experience from a commercially available system and a couple of large prototype systems, it appears that CPNs are now an attractive alternative to other methods. A CPN is an intensional model of a domain, and it is therefore conceptually much closer to qualitative reasoning systems and to simulation systems than to rule-based or logic-based systems. Recent progress in Bayesian inference in networks has yielded computationally efficient methods. The inference method used follows the fundamental axioms of probability theory, and gives a sound framework for causal and diagnostic (deductive and abductive) reasoning under uncertainty. Experience with the prototypes indicates that it may be possible to use decision theory as a rational approach to test planning and therapy planning. The way in which knowledge is acquired and represented in CPNs makes it easy to express 'deep knowledge' for example in the form of physiological models, and the facilities for learning make it possible to make a smooth transition from expert opinion to statistics based on empirical data.
The emergency medical services (EMS) system of the future has the opportunity to serve as a regional community health monitoring and referral system. Such a system would shift attention from care of the individual to cost-effective community health efforts using community resource integration, while emphasizing individual responsibility for health. This health care system model requires the establishment of a centralized monitoring agency, the "regional center." The regional center would coordinate the monitoring of regional EMS use and linkage of patients with essential health promotion and behavior change organizations. Many of these supporting organizations are in place but are functioning without the benefit of communitywide health monitoring or effective referral and follow-up links with other resources. Coordination through the EMS system and a regional center would permit these resources to be used in an efficient and accountable fashion. We propose a model in which the EMS system could contribute to coordinated regional health monitoring and maintenance, timely and appropriate health care legislation and regulation, and high-impact health care education and intervention in the setting of self-destructive individual behavior.
This paper describes the design and implementation of ADAMIS ('A database for medical information systems'). ADAMIS is a relational database management system for a general hospital environment. Apart from the usual database (DB) facilities of data definition and data manipulation, ADAMIS supports a query language called the 'simplified medical query language' (SMQL) which is completely end-user oriented and highly non-procedural. Other features of ADAMIS include provision of facilities for statistics collection and report generation. ADAMIS also provides adequate security and integrity features and has been designed mainly for use on interactive terminals.
This paper describes an informal but systematic method for how to test and verify a knowledge-based system in a large open-ended medical target domain. The system used is Guardian, an intelligent system for monitoring and diagnosis of post-cardiac surgery patients in an intensive-care unit. The knowledge base is tested and verified by running the system on a series of realistic test scenarios, both with an embedded simulator and with an external simulation system. The same scenarios are presented to human test subjects, making it possible to compare and analyze the performance of the knowledge-based system with that of human physicians. The use of simulators instead of clinical data also means that it is possible to test crucial scenarios which occur seldom in medical practice. Our results show that a system like Guardian might indeed be useful in medical care.
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The life-support system described provides on-site emergency medical care for a designated group of people. It consists of a fixed subunit, a back-up emergency department; a temporary subunit, a life support station, and a mobile subunit, an ambulance and mobile medical personnel. A proposal for a life-support system for indoor conventions is presented with specifications of personnel, communications, supplies, registrant education and life-support team function. Results, critique, and discussion of a life-support station at the 1974 Annual ACEP/EDNA Scientific Assembly are presented.
The transfer of medical records from a paper system to a computer-based system is inevitable. However, the widespread acceptance of electronic medical records has been delayed by problems such as high cost, inefficiency, data entry errors and poor physician acceptance. We have developed a database system that has overcome these difficulties and now serves as an electronic medical record. Our system has been in use for a year and a half, and currently contains information on over two thousand patients. The database provides an electronic radiation oncology chart containing patients' demographic information, technical treatment data and dictated reports. All dictated notes are captured, including consultation notes, treatment summaries, on-treatment visits, letters and follow up reports. The system provides data validation upon entry, required few additional software or hardware purchases, and allows for efficient retrieval of data. Unlike other database systems which require the hiring of data entry clerks to input the data, ours combines transcription and data entry. The database runs on a local area network of computers and uses a commercially available relational database package. It makes extensive use of mouse interface features such as pull-down menus, pop-up lists, buttons, multi-page forms, and scrolling fields, making the system easy to use with minimal training. Many custom features are built in, such as help screens, control functions, audit trails, and a system that keeps track of each patient's referring and other relevant physicians. For research purposes, the system has the capability to perform survival analyses on arbitrary user-defined subsets of patients. Data may also be exported transparently to statistical packages for other types of analyses.
To determine the characteristics and effects of quality assurance programs in emergency medical service (EMS) systems in Michigan, medical directors of all EMS medical control authorities in Michigan were mailed a survey consisting of 14 closed-ended and open-ended questions including 2 using a subjective continuum scale; the study included phone follow-up of nonrespondents. Twenty-nine (56%) of 52 authorities surveyed responded; 28 reported that they conducted quality assurance activities. Physicians were the most commonly reported reviewers and emergency medical technicians were the practitioners most frequently reviewed. Although 26 (92%) respondents reported that their quality assurance program made a difference in the quality of care delivered, lack of standards and resources were most frequently listed as program weaknesses. Survey findings prompted the EMS Division of the Department of Public Health, State of Michigan, to address quality assurance in statewide seminars and to develop guidelines for statewide implementation.
CADIAG-1 and CADIAG-2 are medical expert systems with applications in rheumatology, gastroenterology, and hepatology. CADIAG-1 is based on a symbolic logic representation of medical relationships between symptoms, signs, or findings and diseases. Definite relationships (obligatory occurrence, confirming, and excluding) as well as uncertain relationships (facultative occurrence and not confirming) are applied to confirm or exclude diagnoses and to establish diagnostic hypotheses. CADIAG-2 employs fuzzy set theory and fuzzy logic to formalize medical entities and relationships. The medical concept of confirming or excluding diagnoses is identical to that of CADIAG-1, but diagnostic hypotheses are generated differently. Here, a documentation of medical relationships allowing gradual transitions from "always" to "never" for the frequencies of occurrence of symptoms with and from "strong" to "weak" for their strengths of confirmation for diseases leads to strongly or weakly supported diagnostic hypotheses in the actual case. Tests with 322 real patient cases from a rheumatological hospital, each including between 500 and 700 symptoms, signs, and findings, were carried out. The percentage of cases diagnosed correctly is about 80%. Problems and pitfalls that became apparent in the evaluation of the cases are shown and discussed.
The presented report describes the system of medical fitness examinations used for all employees of the GDR's transport system, and therefore also for the seafarers serving in the merchant, fishing and technical fleets, since 1979. The novelty in these tests is that, owing to classification of working places and jobs, the requirements and work loads associated with the working places and jobs can be combined with the health and fitness of the seamen so that his fitness for a particular job can be ascertained.