Bipolar disorder.
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Antidepressive Agents↗
Biomedical subjects
Amar K Das
Publications and source records attributed to Amar K Das.
Modeling electronic discharge summaries as a simple temporal constraint satisfaction problem.
OBJECTIVE: To model the temporal information contained in medical narrative reports as a simple temporal constraint satisfaction problem. DESIGN: A constraint satisfaction problem is defined by time points and constraints (inequalities between points). A time interval comprises a pair of points and a constraint. Five complete electronic discharge summaries and paragraphs from 226 other discharge summaries were studied. Medical events were represented as intervals, and assertions about events were represented as constraints. Through a consensus process, a set of encoding procedures and a list of issues related to encoding were generated. MEASUREMENTS: Instances of temporal disjunction and contradiction and distribution of temporal constraints were used. RESULTS: An average of 95 medical events (range, 46-151) and 234 temporal assertions (range, 118-388) were identified per complete discharge summary. Nondefinitional assertions were explicit (36%) or implicit (64%) and absolute (17%), qualitative (72%), or metric (11%). Implicit assertions were based on domain knowledge and assumptions, e.g., the section of the report determined the ordering of events. Issues included linking events, intermittence, periodicity, granularity, vagueness, ambiguity, uncertainty, and plans. ions such as intermittence were not represented explicitly. The temporal network was sparse: Only 0.80% (range, 0.42%-1.38%) of possible constraints were instantiated. No instances of discontinuous temporal disjunction were found in the complete summaries or the 226 paragraphs. One instance of temporal contradiction was found (intrareport rate of 0.2 with a 95% confidence interval of 0.005-1.114). CONCLUSION: A simple temporal constraint satisfaction problem appears sufficient to represent most temporal assertions in discharge summaries and may be useful for encoding electronic medical records.
Algorithms↗
Screening for depression in adults.
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Adult↗
Specifying design criteria for electronic medical record interface using cognitive framework.
As the healthcare industry transitions from paper to electronic medical records (EMRs), medical informatics researchers face the task of ensuring that the electronic presentation of the information remains usable and effective while capitalizing on the ability of EMRs to tailor information to different users. In our research, we focus on utilizing formal cognitive science methodology to guide the conversion of paper-based narrative discharge summaries to a more dynamic, structured electronic version. In this paper, we present the results of a cognitive analytic study (1) that determines a 'core' component in medical narratives and (2) that compares the use of structured and narrative texts by physicians with varying expertise. Specifically, we studied six psychiatrists at three levels of expertise- experts, intermediates, and novices. The subjects were given two clinical case scenarios with discharge summaries and asked to verbalize their thoughts as they read through the summaries. The interview transcripts were analyzed for recalls and inferences generated in the verbalization. Based on experts' verbalizations, the discharge summaries were organized into a more structured form and used in the interview of other subjects. Novice-level subjects had more recall with the structured than with the narrative format. More errors were also made in recall with the narrative than with the structured text. We discuss how these results are valuable in designing an EMR interface to reduce errors and to support users of different expertise.
Cognition↗
Computers in psychiatry: a review of past programs and an analysis of historical trends.
In a variety of clinical settings, computers are playing an increasing role in managing or retrieving clinical information. A recent survey of physician computer use suggests that psychiatrists, in comparison to other types of medical specialists, may be using computers less in routine care. In this paper, we present a literature review of 57 articles on computer programs in psychiatry that were published since 1966 in five major peer-reviewed journals. We divide the types of programs that have been developed into four categories: (1) diagnostic and decision support, (2) patient screening and therapy, (3) data collection and management, and (4) data modeling. Among the first three categories, we found trends in publications during the past three decades of research. We provide a discussion of representative computer programs. Our analysis of past programs reveals a number of design problems that may be a barrier to the more widespread use of computers in psychiatry.
Computers↗
SYNCHRONUS: a reusable software module for temporal integration.
Querying time-stamped data in clinical databases is an essential step in the actuation of many decision-support rules. Since previous methods of temporal data management are not readily transferable among legacy databases, developers must create de novo querying methods that allow temporal integration of a decision-support program and existing database. In this paper, we outline four software-engineering principles that support a general, reusable approach to temporal integration. We then describe the design and implementation of SYNCHRONUS, a software module that advances our prior work on temporal querying. We show how this module satisfies the four principles for the task of temporal integration. SYNCHRONUS can help developers to overcome the software-engineering burden of temporal model heterogeneity within decision-support architectures.
Algorithms↗