PubMed Health⌕ Search

Biomedical subjects

P W Moorman

Publications and source records attributed to P W Moorman.

10 recordsLinked to original sources
PubMed1996

A multi-strategy approach for medical records of specialists.

Despite a number of well recognized shortcomings of paper medical records, the use of a Computer Patient Record (CPR) is not widespread among specialists. The complexity of specialized care combined with the diversity of their domains of expertise, make it a challenge to design a CPR that satisfies the needs of a specialist. Ideally, CPRs are tailored to the specific tasks of each user, and yet general enough to permit exchange and sharing of information. The basic philosophy behind our CPR is a 'mother' record, which is extended with specialized sub-records. Two different types of subrecords are discussed: one to accommodate standardized data entry in the context of a specialty or research protocol, and another for structured recording of accidental findings outside one's own domain of expertise. The CPR supports the entry of free text and does not impose structured data entry on the physician, but stimulates him to do so by confronting him with the benefits of a structured CPR.

Data Display↗
PubMed1995

Descriptive features of gastric ulcers: do endoscopists agree on what they see?

BACKGROUND: Little is known about the interobserver variation between endoscopists on descriptive morphologic features. METHODS: This study describes the agreement among 10 endoscopists on their description of 12 morphologic features, using 10 photographs of gastric ulcers, and on their eventual interpretation. The endoscopists used a form with predefined options for description. RESULTS: Kappa value was on average 0.36 for descriptive features and 0.31 for interpretation. The proportion of endoscopists agreeing on descriptive features was on average 84%, and 81% on interpretations. The chance of an endoscopist describing all 12 morphologic features of an ulcer on a photograph exactly the same as a colleague ranged from 4% to 46% (average 15%). A positive correlation between agreement in description and interpretation (0.75, p < 0.05) was found. CONCLUSIONS: These results indicate a poor agreement between endoscopists in their translation of visual observations into descriptive terms. The positive correlation between agreement in description and interpretation suggests disagreement in description as an important cause for disagreement in interpretation. We believe that the use of more explicit descriptive terms will improve agreement in description and in subsequent interpretation.

Diagnosis, Differential↗
PubMed1995

A multi-strategy approach for medical records of specialists.

Despite a number of well recognized shortcomings of paper medical records, the use of Computer Patient Records (CPR) is not widespread among specialists. The complexity of specialized care combined with the diversity of their domains of expertise make it a challenge to design a CPR that satisfies the needs of a specialist. Ideally, CPRs are tailored to the specific tasks of each user, yet general enough to permit the exchange and sharing of information. The basic philosophy behind our CPR is a "mother" record, extended with specialized sub-records. Two different types of subrecords are discussed: one to accommodate standardized data entry in the context of a specialty or research protocol, and another for structured recording of accidental findings outside one's own domain of expertise. The CPR does not impose structured data entry on the physician, but stimulates her to do so by confronting her with the benefits of a structured CPR.

Medical Records↗
PubMed1994

The contents of free-text endoscopy reports: an inventory and evaluation by peers.

Insight into the current status of endoscopy reports is needed for a discussion on the desirability and feasibility of (more) standardized endoscopy reporting. We collected, from ten endoscopists, 181 reports in two diagnostic and two indication categories. An inventory was made of the subjects dealt with in the reports, such as: indication, premedication, therapy plan, and descriptive aspects of ventricular ulcers and lower tract polyps. To assess endoscopists' opinions on their reports, 16 randomly selected reports were reviewed by the ten endoscopists, using the Delphi method. The reports varied enormously in content and detail; 19 of the 28 subjects were not explicitly described in more than 50% of the studied reports. Such variation in the contents of reports may decrease the quality of care. The large number of topics that endoscopists indicate to be missing in their reports (on average 14 topics per report) suggests that more detail should be given in endoscopy reports. The current method of reporting causes endoscopists to omit information that they consider important. Due to the low overall consensus among endoscopists on which specific topics to include (eight or more endoscopists agreed on 15% of topics) we conclude that general criteria for the contents of reports cannot yet be formulated. However, the fact that the endoscopists agreed with more than one-third of the remarks made by colleagues opens a perspective towards identifying criteria for the formalization of certain report categories.

Delphi Technique↗
PubMed1994

A model for structured data entry based on explicit descriptional knowledge.

Clinical narratives in patient records are usually recorded in free text, limiting the use of this information for research, quality assessment, and decision support. This study focuses on the capture of clinical narratives in a structured format by supporting physicans with structured data entry (SDE). We analyzed and made explicit which requirements SDE should meet to be acceptable for the physician on the one hand, and generate unambiguous patient data on the other. Starting from these requirements, we found that in order to support SDE, the knowledge on which it is based needs to be made explicit: we refer to this knowledge as descriptional knowledge. We articulate the nature of this knowledge, and propose a model in which it can be formally represented. The model allows the construction of specific knowledge bases, each representing the knowledge needed to support SDE within a circumscribed domain. Data entry is made possible through a general entry program, of which the behavior is determined by a combination of user input and the content of the applicable domain knowledge base. We clarify how descriptional knowledge is represented, modeled, and used for data entry to achieve SDE, which meets the proposed requirements.

Artificial Intelligence↗
PubMed1994

Are referring physicians satisfied with endoscopy reports?

To assess the opinions of referring physicians on the contents of endoscopy reports, 150 consecutive endoscopy reports were accompanied by a questionnaire. Of these, 102 reports were returned: response was 68%. Almost half of the reports were considered not fully satisfactory. However, endoscopy reports may be improved by including information such as indication, therapy plan and follow-up plan on a more regular basis, and add clarity whether findings may account for complaints of the patient. To tailor endoscopy reports to the needs of individual referring physicians, more explicit information of referring physicians is required. If endoscopists are responsible for the information they provide to the referrer, it is also their task to facilitate the explicit formulation of preferences by the referrer.

Attitude of Health Personnel↗
PubMed1993

Integrating QMR with a computer-based patient record.

Most diagnostic decision support (DDS) systems are used as stand-alone applications. At present, the physician can only benefit from the suggestions of a DDS system if he is sufficiently motivated to re-enter patient data and run a diagnostic case analysis. If data from a computer-based patient record (CBPR) could be made available electronically to a DDS system, the use of that DDS system may become much more practical. Integrating a CBPR with a DDS system requires a mapping between two different data structures and dictionaries. We have explored a strategy to create a mapping between our CBPR and QMR. Our research has provided more general insight in the potential and limitations of such a mapping.

Computer Systems↗
PubMed1992

Towards unambiguous representation of patient data.

In the early eighties, the goal set for the development of computer-based patient records was the creation of patient records that were analogous to the paper record. In the Netherlands, where the number of physicians using computer-based patient records is steadily increasing, this strategy has been proven successful. Although these "paper-like" computer-based patient records were suitable for patient care, they were much less suited for other purposes. Experiments showed that the use of data for other purposes than those for which they were recorded, can only be performed reliably when these data permit unambiguous interpretation. Due to a physician's limited time there is a constant tension between benefit and effort. Therefore, we should not expect the physician to provide the large amount of additional information, required for unambiguous interpretation of his record. Many of the inferences made by physicians are based on general knowledge and do not require specific, patient related information. We have focused our research on the potential of using knowledge about concepts in the patient record, to infer information, that is implicit in the patient data. The paper discusses considerations with respect to possible strategies to elicit a maximum of information with a minimum of effort from the physician.

Forms and Records Control↗
PubMedDate not supplied

Evaluation of reporting based on descriptional knowledge.

OBJECTIVE: In an attempt to enhance the completeness and clarity of clinical narratives, the authors developed a general formalism for the entry of structured data. The objective of this study was to gain insight into the expressive power of the formalism through its use for reporting in endoscopy. DESIGN: Each of ten endoscopists reported twice about eight endoscopy videotapes. They produced free-text reports first, and then structured reports using this formalism. Statements in the resulting reports were compared. RESULTS: In total, 6.8% of the endoscopists' statements could not be expressed in structured options. Most of these statements were not due to limitations of the formalism itself. Topics mentioned in the free-text reports were described more frequently in the structured reports and, in addition, the structured reports included a greater variety of topics. Overall, increases of 83% for topics not related to abnormal findings (366 in free-text reports and 671 in structured reports) and 45% for features of abnormal findings (406 in free-text reports and 586 in structured reports) were observed. Although there was an overall information gain, features of abnormal findings were, on average, described by only half of the endoscopists. CONCLUSION: The expressive power of this formalism is promising, but general, multipurpose usage of the acquired data requires that topics be described by a larger percentage of physicians. Since this formalism led to more complete and more uniform data, additional research is justified to study how spontaneous reporting can be augmented further. The few subjects that occurred less often in structured reports suggest a possible negligence effect of structured reporting.

Databases, Factual↗