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Development of a knowledge-based electronic patient record.

To help clinicians care for patients with HIV infection, we developed an interactive knowledge-based electronic patient record that integrates rule-based decision support and full-text information retrieval with an online patient record. This highly interactive clinical workstation now allows the clinicians at a large primary care practice (30,000 ambulatory visits per year) to use online information resources and fully electronic patient records during all patient encounters. The resulting practice database is continually updated with outcome data on a cohort of 700 patients with HIV infection. As a byproduct of this integrated system, we have developed improved statistical methods to measure the effects of electronic alerts and reminders.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Medicine in virtual environments.

Virtual Environments allow a human to interact with a (computer) system in such a way that a high level of presence in a computer-synthesised world is experienced. In principle, all human senses are involved with the interaction. Many applications may benefit from this type of human-machine interfacing, however, few have emerged so far for medicine. In this paper we elaborate on some realistic potential applications of Virtual Environment technology in the field of medicine. These applications can be found in education/training, therapy, surgery, rehabilitation, diagnosis, telemedicine and biomechanics. The value to be added to these applications by VE technology lies in the fact that patient data or patient models may be moderated to the physician in a more intuitive and natural manner. Despite these potentials, the short-term feasibility of these applications can be put into question for various reasons. Firstly, the current generation of display devices have a resolution that may show to be too low to achieve a sufficiently high degree of realism for medical applications. Secondly, there are no commercially-available actuators for tactile and force feedback which the physician desperately need for the simulation of the contact with the (virtual) patient. Thirdly, the enormous computing power required for these applications (still) needs a considerable investment. With these limitations in mind, we believe that we are at the cradle of a whole new generation of VE applications in medicine.

Computer Simulation↗
PubMed1995

[Virtual reality in medicine].

The methods of virtual reality (VR) will come to play a routine part in the work of hospitals. It is difficult to understand and explain what VR means in medicine and its scope in medicine. This paper distinguishes the four functional categories of Immersive VR, Desktop VR, Pseudo VR and Inverse VR. Immersive VR uses a head-mounted display and data gloves as input devices, while Desktop VR uses VR shutter glasses and a 3D input device such as the 3D mouse. Pseudo VR comprises interactive controllable animation. Inverse VR uses, for example, biosignals as an input device in order to support the computer user in the real world. This paper discusses the potential applications of the four categories of VR in medicine with reference to topical projects.

Computer Graphics↗
PubMed1995

[Computer-assisted intraoperative visualization of dental implants. Augmented reality in medicine].

In this paper, a recently developed computer-based dental implant positioning system with an image-to-tissue interface is presented. On a computer monitor or in a head-up display, planned implant positions and the implant drill are graphically superimposed on the patient's anatomy. Electromagnetic 3D sensors track all skull and jaw movements; their signal feedback to the workstation induces permanent real-time updating of the virtual graphics' position. An experimental study and a clinical case demonstrates the concept of the augmented reality environment--the physician can see the operating field and superimposed virtual structures, such as dental implants and surgical instruments, without loosing visual control of the operating field. Therefore, the operation system allows visualization of CT planned implantposition and the implementation of important anatomical structures. The presented method for the first time links preoperatively acquired radiologic data, planned implant location and intraoperative navigation assistance for orthotopic positioning of dental implants.

Computer Graphics↗
PubMed1995

[MR-pool: the "Vienna blend". An interactive computer-assisted teaching system for MRI].

Advances in the field of computer technology have facilitated the development of computer-assisted instruction. In this paper we present an interactive computer-based MR teaching system for education in radiology. Our program contains 120 teaching files. Various MR sequences can be displayed and compared to conventional X-ray images, CT, angiography and scintigraphy. Using a text field, additional clinical and diagnostic hints are offered. This teaching file can be easily upgraded and distributed on CD-ROM. Furthermore, we compare computer-assisted teaching in general to other conventional instruction media.

Austria↗
PubMed1995

[RADIOLIS. A radiologic instruction and training system for systematic evaluation of roentgen images exemplified by focal bone lesions].

RADIOLIS is an instructional software system for radiological training that guides the user through a systematic analysis of an image. The backbone of the analysis is a detailed and structured questionnaire which, as applied to our example, includes all relevant differential-diagnostic criteria for focal bone lesions. The variation range of the radiomorphologic characteristics in the questionnaire is introduced to the user with digitized X-ray images, making the simulation of an image analysis possible. In preparation, diverse teaching/learning methods reinforced by instructional psychology were incorporated during the system's development. At the core of the training system are an expandable image database and a database containing descriptions of image material formulated by radiology experts. The field of focal bone lesions, for instance, has already been integrated into RADIOLIS. A graphic user interface and an interactive dialogue enable both comfortable and simple use of the system and the user-specific structuring of the learning process.

Bone Neoplasms↗
PubMed1995

[New approaches to computer-assisted diagnosis of rheumatologic diseases].

UNLABELLED: Since the 1960s, several knowledge-based systems for computer-assisted diagnosis in radiology have been developed. The great majority of these tools has been implemented as off-line systems. This requires interaction with the system solely for the purpose of consultation and therefore interrupts the radiologist's work flow. This and inadequate man-machine interfaces may have inhibited the routine clinical use of such systems. The goal of this paper is to describe the current research toward the development of the on-line expert system Cadiag-4/Rheuma-Radio. The underlying fundamentals of the system design, including client/server architecture, communication interfaces, and fuzzy set theory and fuzzy logic as methods for knowledge representation and interference, are presented. METHODS: In radiology today, computers are routinely used to acquire radiological images in hospital and radiology information systems (HIS/RIS) and picture archiving and communication systems (PACS). In our approach, we make use of pre-existent sources of information to build an expert system that minimizes the interaction between radiologists and the computer. To handle uncertainty and vagueness of medical knowledge, fuzzy set theory and fuzzy logic are used. Given data of a specific case, a deductive inference procedure combines the observed radiological signs, establishes confirmed and excluded diagnoses as well as diagnostic hypotheses, and provides explanations for these conclusions. Furthermore, proposals for confirmation or exclusion of diagnostic hypotheses are offered. RESULTS: For evaluation purposes, an early prototype of Cadiag-4/Rheuma-Radio was tested on radiological disorders of the hip joint related to rheumatological diseases. Twenty radiological cases were used as test cases, reaching a diagnostic accuracy of about 80%. CONCLUSION: The first results are acceptable and encourage further work to cover the whole area of rheumatologically relevant radiological signs and diagnoses. Furthermore, research into the development of user-oriented data acquisition tools will be carried out.

Arthritis, Rheumatoid↗
PubMed1995

The UMLS Knowledge Source server.

The UMLS Knowledge Source server is an evolving tool for accessing information stored in the UMLS Knowledge Sources. The system architecture is based on the client-server paradigm wherein remote site users send their requests to a centrally managed server at the U.S. National Library of Medicine. The client programs can run on platforms supporting the TCP/IP communication protocol. Access to the system is provided through a command-line interface and through an Application Programming Interface.

Computer Communication Networks↗
PubMed1995

Collaborative health care information system development through sharable infrastructure, services, and paradigms.

The Decision Systems Group has focused for several years on software architectures and software engineering approaches to support collaborative development for health care information systems. The goal is to be able to more readily develop complex applications that require integration of a variety of information resources. Our efforts are aimed at four primary capabilities: (1) a software environment, Arachne, for developing applications by incorporation of components created by disparate developers, developing component classes, for providing cross-platform graphical user interface support with remote rendering, and incorporating evolving software engineering standards; (2) a library of domain-specific components for medical applications; (3) a user interaction paradigm that provides a framework for applications that integrate both clinical data and other information resources for education and decision support; and (4) improved understanding of the collaborative process per se and the development of methodologies to support it.

Information Systems↗
PubMed1995

A flexible approach to client-server computing.

The number of standards for client-server computing almost equals the number of client-server applications. Although there are some standardization efforts, there is hardly any experience with applying these solutions to (medical) practice. The layering approach of the integration architecture HERMES anticipates the inclusion of commercial standards (when available and evaluated); it currently supports already the development of client-server applications. The toolkit provides support for the development of the communication between client and server through a callback mechanism. Stubs created with the HERMES toolkit contain a number of built-in callbacks that manage sessions between clients and services. An important feature of HERMES is the ability to include existing legacy systems as if they are true open services. In this way, the growth path from stand-alone to client-server computing can be shortened and the implementation of the client-server architecture can begin immediately. Moreover, the existing legacy systems remain available as a stand-alone solution for daily practice. Clients and services are connected through the HERMES kernel. This kernel uses a database to find the best server match for a request from a client. Moreover, it completes requests with mandatory data and tries to optimize performance. Special features are included to minimize the memory burden of the session-oriented client-server model. Currently, a system for the outpatient clinic cardiology, occupational health care, and clinical data analysis is available.

Computer Communication Networks↗
PubMed1995

Integration is the art of decomposition.

A growing demand for integrating stand-alone information systems with an HIS can be observed. Different forms of integration can be distinguished: technical integration, user interface integration, and integration of the information service. The integration of the information service appears to be especially difficult. An integrated information service can only be achieved when the applications use each other's information services. We will discuss three approaches for letting applications belonging to another system utilize the necessary information service of a host system. The first approach makes use of the user interface, and the necessary information service has to be extracted from the service to a user. Another, often used, approach is the extension of the applications with coupling modules. The coupling modules communicate messages and translate them into the context of the application. The applications are modified scarcely and the coupling modules have to supply the necessary information services. When the coupling problem is more complex (e.g., a larger set of data is to be exchanged interactively), a growing effort will be needed for these adapting modules. A better approach is to split the application into building blocks. Applications are composed of building blocks. The application, which should deliver the integrated information service, is also composed of such building blocks. The building blocks are designed to offer information services that can be used by other systems as well. If we succeed in decomposing the applications into suitable building blocks, an integrated information service could be more easily achieved.

Hospital Information Systems↗
PubMed1995

CADMIO: computer aided design for medical information objects.

The growth of the computational capability and the tools of graphic software is nowadays available in an integrated manner into the development environments, thus permitting the realization of tool kits capable of handling information that is complex and of different kinds such as the typical medical information. This has given a great impulse to the creation of electronic medical folders joining together with new and stimulating functionality with respect to the usual paper document [1]. In the present work, we propose a tool capable of defining a multimedia electronic medical folder and representing its architecture through a layout that is formed on the basis of the particular data types to be handled. This tool is capable of providing an integrated view of data that, even though they are close in cognitive sense, are often stored and represented apart in the practice. Different approaches to the browsing feature are giving within the system, thus the user can personalize the way of viewing the information stored into the folder or can let the system guide the browsing.

Computer Graphics↗
PubMed1995

Integrated development of a knowledge-based CPR system for quality assurance in diabetes outpatient clinics.

Many approaches for the development of computer-based patient record (CPR) systems consider only implicitly the inferences a user wants to accomplish in using the system. However, the integration of knowledge-based support into the routine work flow requires an explicit model of the inferences during routine work. Such a model helps to structure the interface of the system and to identify those inference steps which could benefit from knowledge-based support. This paper describes the approach used in developing a CPR system taking into account its future role as a platform for the integration of knowledge bases into routine work.

Ambulatory Care Facilities↗
PubMed1995

A proposed architecture for ambulatory systems development.

We have developed an architecture and application framework known as the Ambulatory Services Architecture (ASA) for computerized management of patient records for ambulatory care. Our primary design goals included the development of an architecture that will be readily adaptable to advances in technology needed to enhance computerized patient record systems (e.g., multimedia, human-computer interfaces such as voice-to-text, and a fully distributed objects, etc.) and a data model and database implementation capable of providing the flexibility and extensibility needed to support a broad spectrum of specialty medical practices. This report describes the data model, access control, and the client/server components of the Ambulatory Services Architecture.

Ambulatory Care Information Systems↗
PubMed1995

Computer-based medical clerking.

All admissions to hospital begin with medical clerking. Thus, it is an essential element of any electronic patient record system. This paper describes some initial experiments to develop a computer-based clerking tool with which doctors can record their clinical observations. The clerking tool uses a structured data entry technique which is based upon an underlying semantic network of clinical terminology. This enables data to be captured and stored in a semantically structured manner, facilitating its use in computer-based record systems and also for audit, management, and decision support purposes. The prototype tool is described, and the evaluation and preliminary results obtained are reported. Initial results indicate that structured data entry is feasible for hospital-based clerking.

Admitting Department, Hospital↗
PubMed1995

Multimedia cardiac catheterization record document system.

In this paper, we present the design and implementation of a multimedia cardiac catheterization record (CCR) system. A traditional CCR contains medical report, electrocardiograms, X-ray images, and possibly video sequences for angiograms. The physicians found it difficult to access and manage these multimedia information easily. Current advances in multimedia technology has made possible the authoring, storage and presentation of these medical information in a systematic and easily-accessible way. This paper discusses the background and rationale that led to the design and implementation of a cost-effective multimedia medical document system framework and prototype.

Cardiac Catheterization↗
PubMed1995

The use of text encoding in the development of a terminology and knowledge system associated with the Norwegian version of the ICD-10.

In order to achieve a high quality on the coding work according to the ICD-10 in Norway, we have selected a new method for developing a Norwegian version. The objective is to arrive at a version which will ensure safe and easy coding. Standardization of nomenclature/terminology has been emphasized, leaving the users in no doubt as to what is the preferred terminology. Separate auxiliary applications for the ICD-10 are developed to make search operations more efficient in the coding work. For each code, a selected amount of supplementary information is given, enabling the user to check, on a medical basis, whether or not the selected code is the correct one. The ICD-10 will appear in SGML format, a markup language which, to our knowledge, has not been used for medical classification systems before. This format is well-suited for the development of multilingual classification systems, a fact which WHO should consider when they now start to develop the ICD-11.

Expert Systems↗