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This paper presents the novel ranking algorithm of the Coach Metathesaurus browser which is a major module of the Coach expert search refinement program. An example shows how the ranking algorithm can assist in creating a list of candidate terms useful in augmenting a suboptimal Grateful Med search of MEDLINE.
We have developed a computer program called CaseLog, which serves as an exemplary, computer-based patient record (CPR) system. The program allows for the introduction of the students to issues unique to patient record systems. These include record security, unique patient identifiers, and the use of controlled vocabularies. A particularly challenging aspect of the development of this program was allowing for student entry of controlled vocabulary terms. There were four goals we wished to achieve: students should be able to find the terms they are looking for; once a term has been found, it should be easy to find contextually related terms; it should be easy to determine that a sought-for term is not in the vocabulary; and the structure of the vocabulary should be dynamically altered by contextual information to allow its use for a variety of purposes. We chose a semantic network for our vocabulary structure. Within the processing power of the equipment we were working with, we achieved our goals. This paper will describe the development of the vocabulary, the design of the CaseLog program, and the feedback from student users of the program.
Kaiser Permanente Mid-Atlantic States has developed a fully integrated outpatient information system which currently runs on an IBM ES9000 on a VM platform written in MUMPS. The applications include Lab, Radiology, Transcription, Appointments. Pharmacy, Encounter tracking, Hospitalizations, Referrals, Phone Advice, Pap tracking, Problem list, Immunization tracking, and Patient demographics. They are department specific and require input and output from a dumb terminal. We have developed a physician's work station to access this information using PC compatible computers running Microsoft Windows and a custom Microsoft Visual Basic 2.0 environment which draws from these 14 applications giving the physician a comprehensive view of all electronic medical records. Through rapid prototyping, voluntary participation, formal training and gradual implementation we have created an enthusiastic response. 95% of our physician PC users access the system each month. The use ranges from 0.2 to 3.0 screens of data viewed per patient visit. This response continues to drive the process toward still greater user acceptance and further practice enhancement.
This manuscript describes a method for using digital-video technology to create patient simulations in which the simulated patient is always active on the computer screen. We outline the technical method we have developed, and we present the lessons learned in applying the method to develop a prototype patient simulation.
Continuous speech recognition systems have the potential to facilitate clinical data entry, but evaluating them rigorously is difficult. We describe a tool to aid evaluators of such systems. The tool is a HyperCard stack with stimuli consisting of pictures, sounds and the minimum of words to evoke 20 QMR physical findings. Despite using up to four different stimuli to communicate each finding and piloting the material on six subjects, eight test subjects made a total of 66 errors (42%) in interpreting the 20 sets of stimuli, of which 22 errors (14%) were serious. These results are relevant to those designing interfaces for decision-support, tutorial and student testing systems.
This paper describes Image Engine, an object-oriented, microcomputer-based, multimedia database designed to facilitate the storage and retrieval of digitized biomedical still images, video, and text using inexpensive desktop computers. The current prototype runs on Apple Macintosh computers and allows network database access via peer to peer file sharing protocols. Image Engine supports both free text and controlled vocabulary indexing of multimedia objects. The latter is implemented using the TView thesaurus model developed by the author. The current prototype of Image Engine uses the National Library of Medicine's Medical Subject Headings (MeSH) vocabulary (with UMLS Meta-1 extensions) as its indexing thesaurus.
This paper describes the prototype of a coder/decoder based on the Open Document Architecture (ODA) standard for management of medical documents, as well as the working environment in which it has been developed. The prototype has been assessed in an X-Windows-equipped workstation with a relational database containing patient folders (text and still images) from the departmental information system of the liver transplantation unit.
There are unique features of family and general practice which lead to unique issues in medical informatics for family physicians. The nature of practice in office based community settings and the discipline of dealing with all ages, sexes, and health conditions over the lifetime of a patient and his/her family lead to models of the thinking that are different from those used in most other specialties. Research is urgently needed to verify the models of thinking that physicians use during patient care encounters and the associated nomenclatures and classifications which support them. User interfaces need to be optimized for accuracy and speed. Standards for medical records computing in family practice need testing and validation.
To test the ability of a computer-based interview to detect factors related to the risk of the human immunodeficiency virus (HIV) among potential blood donors, and to determine donor reactions to the use of the computer, we compared the rate of detection of HIV-related factors elicited by the computer interview with the rate elicited by standard American Red Cross procedures (written questionnaires and face-to-face interviews) for assessment of donor suitability. The study was performed at a Red Cross blood donor center and a hospital. A consecutive sample of 294 male and female blood donors 18 to 75 years of age participated in a randomized crossover trial in which the order of the two methods was reversed. Among 272 prospective donors who provided complete data, the computer identified 12 who reported either behavior associated with a risk of acquiring HIV or symptoms compatible with AIDS. None of these 12 was so identified by face-to-face interviews or written questionnaires. Only one used the confidential unit exclusion procedure to prevent use of his donated blood. Tests for antibody to HIV were negative in blood from all 272 subjects. The subjects enjoyed the computer interview and judged it to be more private than the standard method for donor assessment.
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The ever-increasing specialization of nursing care may require nursing professionals to provide nursing care outside of their specialty. Nurses will have to familiarize themselves with a new specialization area at short notice. Fortunately, expert-systems technology can prove particularly helpful in achieving this familiarity. As such, this technology can prove a valuable tool for education and training of nursing professionals and students. This article describes the unique edge that expert systems technology provides in this context. Using VP-Expert, an expert system shell, the authors present two examples to illustrate the development of a computer aided instruction system and the unique benefits such a system offers.
This paper summarizes the contributions made by all of the authors in Session (1) of the 1st TIDE Congress and highlights the potentialities for exploitation of research and developments in areas of technology relevant to aspects of interfaces relating to visual perception, facilitation of human communication, prosthetics and orthotics, robotics and signal processing. Means by which promising technological developments can be expedited for more widespread availability are discussed together with aspects of consumer involvement and teamwork through consortia of relevant expertise.
A system for combined analysis of resting, rhythm and exercise electrocardiograms has been developed. Also an "expert" module for rule-based processing with backward chaining for reasoning has been implemented. The system can be used for routine ECG analysis as well as for research and teaching in electrocardiography.
The purpose of this study was to examine the relationship of nurses' cognitive and demographic characteristics to their information retrieval speed, accuracy, and subjective screen satisfaction during on-line interactions with three different computer screens. One hundred ten randomly selected female clinical nurses interacted with computer screens of varying information densities. Age, spatial memory, and spatial visualization were significant predictors for nurses' practiced and overall performance speeds. Age was an important variable across screens; the cognitive variables, however, differed according to screen types. Age was a predictor of nurses' practiced accuracy, while both age and spatial visualization predicted overall accuracy scores. Perceptual speed was not a significant predictor in any equations, and none of the nurse characteristics predicted subjective screen satisfaction.
The development of Open Systems Architecture and the extensive networked interconnection of Health and Hospital Information Systems (HIS) offer great opportunities for improved care, but simultaneously these facilities pose a great danger to the overall security of the information held. The Geneva University Hospital which has built up it centralized informatics system over the last twenty years must now bring about the conditions for a migration towards open system, for although during the last ten years there have been declarations of intent, this architecture is still a long way from final implementation. Like others, the DIOGENE system (the Geneva HIS) has had to face difficult choices especially due to its own successful situation at the end of the eighties. This paper gives a brief explanation of the technical conditions needed in order to fully migrate towards an open system. The first choices towards obtaining optimum communication standards, operating systems and database management systems were the easiest. The real difficulties occurred when deciding on the choice for management tools in this open environment.
As dependence upon interorganizational and international health care informatics becomes absolute, and with increased vulnerability of information networks and applications and the cunning sophistication of computer criminals, it becomes imperative to implement tight information systems security to ward off any possible threat to these vital life-dependent information systems. In a rapidly decentralizing environment, the author proposes centralized security control, implemented in a Security Audit Center under the direct supervision of an Information Systems Security Manager who is a high-ranking organization staff member. Of the various components of the Security Audit Center, the most significant is the security audit expert systems which analyze audit data files according to security rules and present a precise status of systems security and realtime suspicion alert of the various breaches and intrusions.
The paper starts off by first briefly discussing the necessary ethical, legal and administrative/management controls that are required before the mechanisms of accountability controls can be implemented in automated clinical patient record systems. After these social aspects are discussed the technical aspects of the ALS are outlined. The security concepts of the ECMA framework are reviewed and used to explain the technical design of the ALS. A walk-through of the server in a typical patient record transaction is used to explain the operations of the server. The paper concludes with a general discussion of the usefulness of accountability mechanisms in making security in health care information work in practice.