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Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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PubMed2002

RIS minus PACS equals film.

Web-based integration methods can be used to resolve a fundamental issue in the transition from film to a picture archiving and communication system (PACS): the identification of relevant prior studies only available on film. Even in the most ambitious conversions from a film-based environment to PACS, there are issues regarding prior studies not on PACS. Failure to compare with prior exams is one of the known risk factors for malpractice in radiology. While most commercial PACS systems today have some degree of RIS integration, knowledge of prior studies is usually limited to an awareness of studies in the PACS. On the other hand, most RIS systems today do not or cannot distinguish between studies on film and those in PACS. We made the observation, from a set theory perspective, that in general: Therefore we sought to create a system that would query both the RIS and PACS and reconcile the results using the above set operation. The query is initiated from a display station via the invocation of a Web browser installed on that station. The process of starting the browser is implemented using a scripting language provided by the workstation vendor, though the use of other mechanisms, such as the CCOW (Clinical Context Object Workgroup) or IHE (RSNA Integrated Healthcare Enterprise) interfaces, can be supported by this architecture. The medical record number, which identifies the current patient and is the primary parameter of the query, is passed as part of the URL (Universal Resource Locator) used to launch the browser. Once running, the browser connects to a Web server that hosts a JSP (Java Server Page) page that performs a DICOM query of the PACS and an HL7 query of the RIS, and then collates the results using the set operation described above. Both the DICOM and HL7 functionality are provided by Java-based toolkits developed in house. The results are returned to the client's browser as a standard HTML page with a tabular format detailing which studies are on PACS and which are available only on film. The responsiveness of the system in terms of time required to complete the two queries and display the results was measured. In addition, the number of diagnostic reports, whose retrieval was triggered by the results of the queries, was monitored to determine the overall performance and use of the system. This project demonstrates that, with minimal modification of commercial software, Web-based integration methods exist to enable patient-context sensitive queries from the diagnostic workstation that identify relevant prior studies that exist only on film and are unknown to the PACS. As a result radiologist workflow is enhanced by the elimination of the need to consult a physically separate system for this type of information. In addition, quality of service is improved by providing more accurate and easier identification of relevant prior studies.

Information Storage and Retrieval↗
PubMed2004

Health informatics.

Explore the source record for details and available documents.

Computational Biology↗
PubMed1995

Exploration and exploitation of clinical databases.

Clinical data repositories represent a potential gold mine of information and knowledge. Rapid access to such information can help bridge the gap between clinical care and research, support clinical and executive decision making, and improve the quality of care. A clinical database can be used in four ways: to display information about an individual patient (results reporting); to find data on a patient with similarities to one being seen (case finding); to describe a group of patients with at least one attribute in common (cohort description); and to analyze data patterns in terms of trends or relationships (predictive modeling). It seems unlikely that many important clinical questions will be subject to randomized clinical trials because of the ethics, logistics, and expense that would be involved. Evolving statistical and epidemiological methods allow us to approach these clinical data repositories with the purpose of building predictive models, but a clear understanding of the limitations of routinely collected clinical data and the inherent biases is necessary. The largest barrier to using routinely collected clinical data is not the limitations of the data themselves, but rather the lack of a data paradigm for the decision-maker. We present some of the problems and pitfalls in obtaining and using routinely collected data, based upon the use of ClinQuery at Boston's Beth Israel Hospital and the resources and traditions at the Mayo Clinic.

Databases, Factual↗
PubMed2006

Automated identification of adverse events related to central venous catheters.

Methods for surveillance of adverse events (AEs) in clinical settings are limited by cost, technology, and appropriate data availability. In this study, two methods for semi-automated review of text records within the Veterans Administration database are utilized to identify AEs related to the placement of central venous catheters (CVCs): a Natural Language Processing program and a phrase-matching algorithm. A sample of manually reviewed records were then compared to the results of both methods to assess sensitivity and specificity. The phrase-matching algorithm was found to be a sensitive but relatively non-specific method, whereas a natural language processing system was significantly more specific but less sensitive. Positive predictive values for each method estimated the CVC-associated AE rate at this institution to be 6.4 and 6.2%, respectively. Using both methods together results in acceptable sensitivity and specificity (72.0 and 80.1%, respectively). All methods including manual chart review are limited by incomplete or inaccurate clinician documentation. A secondary finding was related to the completeness of administrative data (ICD-9 and CPT codes) used to identify intensive care unit patients in whom a CVC was placed. Administrative data identified less than 11% of patients who had a CVC placed. This suggests that other methods, including automated methods such as phrase matching, may be more sensitive than administrative data in identifying patients with devices. Considerable potential exists for the use of such methods for the identification of patients at risk, AE surveillance, and prevention of AEs through decision support technologies.

Artificial Intelligence↗
PubMed1997

Medical narratives in electronic medical records.

In this article, we describe the state of the art and directions of current development and research with respect to the inclusion of medical narratives in electronic medical-record systems. We used information about 20 electronic medical-record systems as presented in the literature. We divided these systems into 'classical' systems that matured before 1990 and are now used in a broad range of medical domains, and 'experimental' systems, more recently developed and, in general, more innovative. In the literature, three major challenges were addressed: facilitation of direct data entry, achieving unambiguous understandability of data, and improvement of data presentation. Promising approaches to tackle the first and second challenge are the use of dynamic data-entry forms that anticipate sensible input, and free-text data entry followed by natural-language interpretation. Both these approaches require a highly expressive medical terminology. How to facilitate the access to medical narratives has not been studied much. We found facilitating examples of presenting this information as fluent prose, of optimising the screen design with fixed position cues, and of imposing medical narratives with a structure of indexable paragraphs that can be used in flowsheets. We conclude that further study is needed to develop an optimal searching structure for medical narratives.

Database Management Systems↗
PubMed2004

Bio-Mirror project for public bio-data distribution.

Timely worldwide distribution of biosequence and bioinformatics data depends on high performance networking and advances in Internet transport methods. The Bio-Mirror project focuses on providing up-to-date distribution of this rapidly growing and changing data. It offers FTP, Web and Rsync access to many high-volume databanks from several sites around the world. Experiments with data grids and other methods offer future improvements in biology data distribution.

Biology↗
PubMed1997

Evolution of the Intranet in the University Hospital of Gent.

The explosive development of the internet in recent years has lead to the production of massive collections of web-based tools and development know-how. Implementing an Intranet solution within a health care environment offers tremendous advantages for internal information management, distribution and collaborative computing. Easy adaptability, scalability and the low development cost allow easy integration into existing health care structures. A key aspect of the UZ Gent Intranet is its transparent interaction with the currently implemented HIS thus providing an open gateway to the future.

Belgium↗
PubMed1992

Prototyping an institutional IAIMS/UMLS information environment for an academic medical center.

The paper describes a prototype information environment designed to link network-based information resources in an integrated fashion and thus enhance the information capabilities of an academic medical center. The prototype was implemented on a single Macintosh computer to permit exploration of the overall "information architecture" and to demonstrate the various desired capabilities prior to full-scale network-based implementation. At the heart of the prototype are two components: a diverse set of information resources available over an institutional computer network and an information sources map designed to assist users in finding and accessing information resources relevant to their needs. The paper describes these and other components of the prototype and presents a scenario illustrating its use. The prototype illustrates the link between the goals of two National Library of Medicine initiatives, the Integrated Academic Information Management System (IAIMS) and the Unified Medical Language System (UMLS).

Academic Medical Centers↗
PubMed2005

BioMediator data integration: beyond genomics to neuroscience data.

The BioMediator system developed at the University of Washington (UW) provides a theoretical and practical foundation for data integration across diverse biomedical research domains and various data types. In this paper we demonstrate the generalizability of its architecture through its application to the UW Human Brain Project (HBP) for understanding language organization in the brain. We first describe the system architecture and the characteristics of the four data sources developed by the UW HBP. Second we present the process of developing the application prototype for HBP neuroscience researchers posing queries across these semantically and syntactically heterogeneous neurophysiologic data sources. Then we discuss the benefits and potential limitations of the BioMediator system as a general data integration solution for different user groups in genomic and neuroscience research domains.

Brain↗
PubMed2006

New trends in the virtualization of hospitals--tools for global e-Health.

The development of virtual hospitals and digital medicine helps to bridge the digital divide between different regions of the world and enables equal access to high-level medical care. Pre-operative planning, intra-operative navigation and minimally-invasive surgery require a digital and virtual environment supporting the perception of the physician. As data and computing resources in a virtual hospital are distributed over many sites the concept of the Grid should be integrated with other communication networks and platforms. A promising approach is the implementation of service-oriented architectures for an invisible grid, hiding complexity for both application developers and end-users. Examples of promising medical applications of Grid technology are the real-time 3D-visualization and manipulation of patient data for individualized treatment planning and the creation of distributed intelligent databases of medical images.

Artificial Intelligence↗
PubMed1997

The Stanford Health Information Network for Education: integrated information for decision making and learning.

Although multiple decision support systems have been built for physicians, efficient delivery of valid and complete medical knowledge remains an elusive goal. In this paper we describe a new project, the Stanford Health Information Network for Education (SHINE). SHINE unifies core medical resources in an intuitive interface to support clinical decision making. Included in the description is a novel paradigm for continuing medical education (CME).

California↗
PubMed1998

Implementing HL7: from the standard's specification to production application.

A C++ implementation of the HL7 health-care data interchange standard was developed by automatic methods applied to the authoritative specification of the standard. The reusable class library thus created presents an intuitive, flexible, and easy-to-use application programming interface to the HL7 protocol. This allows HL7 applications to be developed quickly while a high conformance to the standard is ensured.

Artificial Intelligence↗
PubMed2003

Identification of key concepts in biomedical literature using a modified Markov heuristic.

MOTIVATION: The recent explosion of interest in mining the biomedical literature for associations between defined entities such as genes, diseases and drugs has made apparent the need for robust methods of identifying occurrences of these entities in biomedical text. Such concept-based indexing is strongly dependent on the availability of a comprehensive ontology or lexicon of biomedical terms. However, such ontologies are very difficult and expensive to construct, and often require extensive manual curation to render them suitable for use by automatic indexing programs. Furthermore, the use of statistically salient noun phrases as surrogates for curated terminology is not without difficulties, due to the lack of high-quality part-of-speech taggers specific to medical nomenclature. RESULTS: We describe a method of improving the quality of automatically extracted noun phrases by employing prior knowledge during the HMM training procedure for the tagger. This enhancement, when combined with appropriate training data, can greatly improve the quality and relevance of the extracted phrases, thereby enabling greater accuracy in downstream literature mining tasks.

Abstracting and Indexing↗