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PubMed1995

Implementation of the totally integrated hospital information system (Humane) in Osaka University Hospital.

On September 1, 1993, in the new Osaka University Hospital, we implemented a new hospital information system named "HUMANE" (Human oriented Universal Medical Assessment system by Network Environment). We had planned to organize a more effective and efficient medical care system in the new hospital and improve the medical services to patients. To succeed in constructing a totally integrated hospital information system, the original data must be entered. Most of it would be entered by doctors who are not accustomed to the operation of a computer system, thus the production of a good man-machine interface is indispensable. For this reason, we adopted a micro-medium-main frame link system for the system configuration. The interface program and the copy of the master data about each subsystem are located on the microframe. Although, all patient data is stored on the mainframe, most of the active patients' data is delivered to the mediumframe before the data is requested. This system design makes it possible to shorten the response time and to use a comfortable user interface. On the basis of this system configuration, we made subsystems that support hospital management, for example, an ordering system, a reporting system, a reservation system, a supporting system for hospitalization, a nurse supporting system, and so on. These systems promote automation control in each central service division; pharmacy, radiology, laboratory for clinical investigation and accounting section, resulting in man-power being saved. At the same time, medical service to patients is improved, because waiting time is shortened and redundant examinations or prescription are avoided.

Computer Systems↗
PubMed1995

CLECOS_P: clinical evolution control system on Parkinsonian patients undergoing neural transplantation.

The CLECOS_P system was conceived for registering and automating the processing of clinical evaluations performed on patients with Parkinson's disease who undergo functional neurosurgery and/or neural transplant. CLECOS_P represents the first time a computerized system is able to offer--with high precision and considerable time-savings--an integral analysis of the evolutive behavior of the universe in integrated variables at the core assessment program for intracerebral transplantations (CAPIT). CAPIT is used internationally for the evaluation and follow-up of patients with this pathology who have undergone neural transplant. We used the so-called MEDSAC methodology for the preparation of this system. The methodology that was used for the design of an intelligent system aimed at medical decision-making was based on the quantitative analysis of the clinical evolution. At the present moment, there are 20 patients controlled by this system: 11 bilaterally transplanted, 9 unilaterally (registered in ranks of 3 months before operation up to 1, 2, 3, 6, 9, 12, 18, and 24 months after operation). The application of CLECOS_P to these patients permitted the evaluation of 400 clinical variables, where a better evolutive characterization of the patients was obtained, thus getting most favorable results with personalized therapeutic methods aimed at raising their quality of life. CLECOS_P is used in a multi-user environment on a local area network running Novell Netware version 3.11.

Brain Tissue Transplantation↗
PubMed1995

Implementing security in computer based patient records clinical experiences.

In Norway, organizational changes in hospitals and a stronger focus on patient safety have changed the way of organizing and managing paper based patient records. Hospital-wide patient records tend to replace department based records. Since not only clinicians, but also other non-medical staff have access to the paper records, they also have easy access to all the information which is available on a specific patient; such a system has obvious 'side effects' on privacy and security. Computer based patient records (CPRs) can provide the solution to this apparent paradox if the complex aspects of security, privacy, effectiveness, and user friendliness are focused on jointly from the outset in designing such systems. Clinical experiences in Norway show that it is possible to design patient record systems that provide a very useful tool for clinicians and other health care personnel (HCP) while fully complying with comprehensive security and privacy requirements.

Clinical Laboratory Information Systems↗
PubMed1995

An integrated secure design of a medical database system.

An integrated secure design methodology for the enhancement of database security in a hospital environment is presented in this paper. The proposed design methodology is based on both the discretionary and the mandatory database security policies. In this way, the advantages of both approaches are combined to enhance medical database security. The experimental implementation of the methodology in a major Greek hospital is also presented. The implementation has shown that the combined discretionary and mandatory security enforcement effectively limits unauthorized access to the medical database, without severely restricting the capabilities of the system.

Computer Security↗
PubMed1995

Conflicting view support by medical information systems.

One of the advantages of current database systems is the capability to enforce global integrity constraints on a large amount of data. Input of contradicting data will be rejected by database systems in order to maintain correctness. On the other hand, in medical information systems it may be necessary to realize two or more databases in one system, where there are some controlled contradictions among these databases. For example, if a doctor wants to hide the real disease name from the patient in critical condition, the database viewed by the patient should be different from the real database, although each of these databases should be conflict free and large amounts of data are shared by both. This kind of problem was not discussed for commercial business-oriented databases. Data sharing and data security are important functions required for medical information systems. There are, however, cases when we need to show non-real data to some users. Security mechanisms usually prevent a user from retrieving critical data. If a request for retrieval of some data is rejected by the system, a user may find there is something secret being kept from him. In order to cope with these situations, we introduce the POSTGRES database system. POSTGRES is a generalized relational database system developed at the University of California. The form of POSTGRES rule is as follows: On event (To) object WHERE POSTQUEL-qualification Then Do [instead] POSTQUEL-command(s) The POSTGRES rule shows that event is retrieve, replace, delete, append, new (i.e., replace or append) or old (i.e., delete or replace). The concept of objects is introduced in object-oriented databases. In relational database systems, an object corresponds to each data value, an attribute, or a relation. The optional keyword "instead" indicates that the action indicated by POSTQUEL-command(s) is to be performed instead of the action which caused the rule to activate. This keyword plays very important role for our purpose. By preparing a standard story which is consistent with the patient's condition, the doctor can make a smooth explanation to the patient showing the stories instead of the critical data. So, if medical personnel and system designers prepare the standard stories or data for the explanation and store such data in the system, the users of medical information systems (doctors) can take the benefit of the data replacement. For such a purpose, medical personnel and system designers classify the patients' data according to their age, sex, occupational history, personal history, and diseases. Standard story or data should be prepared for each user class in advance. Using POSTGRES rule system in medical information systems, doctors can make a smooth explanation of a patientUs condition in serious cases, when hiding real data is required. The validity of POSTGRES rule system is proved where data exchange is needed for data protection. For example, when a doctor writes a prescription of a placebo through the ordering system, POSTGRES rule system will identify its existence. We believe that POSTGRES rule system can be applied to many fields in medical data processing.

Confidentiality↗
PubMed1995

The Scenario-Based Engineering Process (SEP): a user-centered approach for the development of health care systems.

The Scenario-based Engineering Process (SEP) is a user-focused methodology for large and complex system design. This process supports new application development from requirements analysis with domain models to component selection, design and modification, implementation, integration, and archival placement. It is built upon object-oriented methodologies, domain modeling strategies, and scenario-based techniques to provide an analysis process for mapping application requirements to available components. We are using SEP in the health care applications that we are developing. The process has already achieved success in the manufacturing and military domains and is being adopted by many organizations. SEP should prove viable in any domain containing scenarios that can be decomposed into tasks.

Artificial Intelligence↗
PubMed1995

PROTEGE-II: computer support for development of intelligent systems from libraries of components.

PROTEGE-II is a suite of tools that facilitates the development of intelligent systems. A tool called MAiTRE allows system builders to create and refine abstract models (ontologies) of application domains. A tool called DASH takes as input a modified domain ontology and generates automatically a knowledge-acquisition tool that application specialists can use to enter the detailed content knowledge required to define particular applications. The domain-dependent knowledge entered into the knowledge-acquisition tool is used by assemblies of domain-independent problem-solving methods that provide the computational strategies required to solve particular application tasks. The result is an architecture that offers a divide-and-conquer approach that separates system-building tasks that require skill in domain analysis and modeling from those that require simple entry of content knowledge. At the same time, applications can be constructed from libraries of component--of both domain ontologies and domain-independent problem-solving methods--allowing the reuse of knowledge and facilitating ongoing system maintenance. We have used PROTEGE-II to construct a number of knowledge-based systems, including the reasoning components of T-Helper, which assists physicians in the protocol-based care of patients who have HIV infection.

Clinical Trials as Topic↗
PubMed1995

User interface design and evaluation for electronic medical record system.

A user interface for an electronic medical record system (EMRS) is proposed. A pen-based device adopted for data input and the GUI windows layout simulate conventional paper forms, so that doctors can quickly grow accustomed to the EMRS. A comparison study shows the proposed interface does not significantly delay the examination, even when used in hospitals with many outpatients.

Ambulatory Care↗
PubMed1995

Designing interfaces for medical information management systems.

Poor interface design has adversely affected the integration of technology into medical environments. This paper discusses the importance of good interface design in medical information management systems. We will illustrate the advantages of approaching interface design in a user-centered manner, by describing the interface design process of the Curriculum Database for the Faculty of Medicine, Monash University. We believe that a consultative design process can make the difference between software success and failure.

Attitude to Computers↗
PubMed1995

Accessing oncology information at the point of care: experience using speech, pen, and 3-D interfaces with a knowledge server.

Oncologists' information needs arise at diverse times and settings. For example: "Is superior vena cava syndrome a medical emergency?" Our collaborative group is developing a system that supports an interface with combinations of spoken, gestural, and simulated three-dimensional manipulation to help an oncologist focus on the information need, not the system. The system requires a small amount of input from the oncologist, and then anticipates what information is pertinent to the patient at hand, based on the sources it has available. The system makes use of a "Knowledge Server" to find relevant information. The Knowledge Server uses selected data for the particular patient from a Computer-based Patient Record (CPR) to provide context for the information needs. The Knowledge Server leverages the Unified Medical Language System (UMLS) resources as well as relevant communications standards. A layered, interaction protocol is used to help manage the fulfillment of information needs. Each of the oncology knowledge sources is transformed into a uniform representation that utilizes both its formal schema (e.g., its table of contents) and its concepts and words indexed through the UMLS Metathesaurus. Our focus on the appropriate use of information from a CPR, and on anticipating oncologists' information needs, resulted from our study of several longitudinal patient scenarios. We believe that our use of scenario-based design techniques will help to ensure the system's success.

California↗
PubMed1995

Health graphics: reconciling theory and practice in the 21st century.

This presentation attempts to break away from traditional beliefs about the promises of computer graphics, particularly regarding their application for information management within the health care industry. A key question in graphical interface research for designers and practitioners is whether human information processing, including perceptual, cognitive, and decisional effectiveness, can and will improve with the use of innovative (e.g., color graphics) versus traditional modes (e.g., monochrome tables) of representation. A careful survey of the large existing bodies of empirical literature bearing on this question suggests that too much medical information processing has proceeded through the blind creation of new forms of computer graphical interface without a preliminary thinking about the cognitive aspects of the task at hand. Several research-based guidelines are drawn to provide both the practitioners and users with insights as to how one should best approach the selection of a particular graphical interface for use in a health administrative or clinical information system setting. The presentation also suggests directions for future research in the domain of health graphics for information management and clinical decision support.

Adult↗
PubMed1995

The clinician-information interface.

Technical advances now enable rapid data collection into sophisticated information systems, and the vision of the electronic patient record may soon be a reality. However, despite advances in the human-computer interface, little attention has been given to the structure of the clinical data to be collected in the electronic record. The 'clinician-information interface' embraces the cognitive, analytical, and decision processes that the clinician will need to undergo to capture clinical data in a structured, meaningful, and analyzable form. This paper discusses some of the issues which need to be addressed if the emerging opportunities for a detailed capture of clinical data are to be maximized.

Ambulatory Care↗
PubMed1995

Improved classification of psychiatric mood disorders using a feedforward neural network.

Our aim was to use a neural network model for classifying psychiatric mood disorders. In approaching this interdisciplinary task, the concern was not to build a more biologically plausible model, but to test the computational capabilities of an existent one. The multilayer perceptron was chosen as a model, trained and tested using both theoretical and real cases. The classification proved to be good, but we are aware of the fact that both training and testing should be performed in the future only on real data, as the way to get a true picture of the system's performance.

Adult↗
PubMed1995

Toward an improvement of life optimizing resource use.

In this paper an object-oriented system for the storing and the managing of epidemiological data in order to decrease the incidence of a given groups of diseases by means of health care strategy application and of the relative health care resource allocation is described. The system starts from the present epidemiological situation of the territory examined and from the real distribution on this territory of human and material health care resources. The health care manager inputs the available budget, some information regarding the population living on this area, other geographical and climatic informations, the values of certain epidemiological parameters of the diseases considered--the system has stored the mathematical and departmental models of these diseases--and the system allocates (using own allocation algorithms) human and material health care resources, optimizing the cost-benefit rate.

Algorithms↗
PubMed1995

A tool for matching physically impaired people with suitable technical aids: the merits and demerits of a laser disk consultation tool.

We are developing a tool for matching physically impaired people with suitable technical aids;w this tool will also provide specific and comprehensive information to users. According to the user's physical abilities and situations (indicated when using a "mouse"), specific instructions with dynamic images are displayed on the screen. The hardware of this system will be constructed with the laser¿disk system (Pioneer Laser Active, CLD¿A100). The software for drawing dynamic images is a two dimensional animation software (Animation Stand). The difficulties of developing this system are (1) Collecting every possible pattern without exclusion and constructing the comprehensive information frame for providing specific advises, and (2) Drawing a large number of dynamic animations. The merits of this tool are (1) High quality image and quick response time, (2) Excellent presentation ability, (3) A user friendly interface.

Activities of Daily Living↗
PubMed1995

Computer methods of assessment of patients state for practical use in clinical laboratory.

Results in the development of computer methods of assessment of patient state are presented as tasks of; diagnostics, gravity of disease assessment, selection of treatment based upon analysis of alternatives, forecast of the patient's state. Practice-oriented PC-based inquiry-consulting system is given as a result of this study. The system combines clinical data base and analysis functions, including the elements of artificial intelligence techniques in a user-friendly interface.

Algorithms↗
PubMed1995

Evaluation of a problem-based access knowledge system using triangulation methods.

A microcomputer-based system designed to provide nurses and physicians access to expert synthesized knowledge in the area of pulmonary arterial waveform troubleshooting has been developed and implemented. Evaluation using triangulation methods show that there was a substantive increase in knowledge in both nurses and physicians.¿.

Attitude of Health Personnel↗