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Biomedical subjects

R M Sailors

Publications and source records attributed to R M Sailors.

4 recordsLinked to original sources

Testing and validation of computerized decision support systems.

Systematic, through testing of decision support systems (DSSs) prior to release to general users is a critical aspect of high quality software design. Omission of this step may lead to the dangerous, and potentially fatal, condition of relying on a system with outputs of uncertain quality. Thorough testing requires a great deal of effort and is a difficult job because tools necessary to facilitate testing are not well developed. Testing is a job ill-suited to humans because it requires tireless attention to a large number of details. For these reasons, the majority of DSSs available are probably not well tested prior to release. We have successfully implemented a software design and testing plan which has helped us meet our goal of continuously improving the quality of our DSS software prior to release. While requiring large amounts of effort, we feel that the process of documenting and standardizing our testing methods are important steps toward meeting recognized national and international quality standards. Our testing methodology includes both functional and structural testing and requires input from all levels of development. Our system does not focus solely on meeting design requirements but also addresses the robustness of the system and the completeness of testing.

Artificial Intelligence

Medical informatics academia and industry: a symbiotic relationship that may assure survival of both through health care reform.

There are often clear lines drawn identifying the demilitarized zone between medical informatics academics and industry. Academics were "pure" intellectuals sequestered in ivory towers that effectively shielded them from the realities of the world. Industry has historically focused on creating effective products that produce financial return to the corporation. Both the paradigms of academia and industry are quickly becoming dinosaurs in the era of health care reform where both medical informatics academia and industry are under increasing pressure to develop and prove that medical informatics has a positive impact on health care both in terms of the quality of care as well as cost. Unfortunately, neither academia or industry alone are going to be able to successfully complete this task. The purpose of this paper is to describe such a collaborative effort that has produced a computerized decision support system for the management of mechanical ventilation in patients with the Adult Respiratory Distress Syndrome (ARDS) that is now installed and supported on three different commercial CIS platforms. This collaborative effort has allowed us to successfully mount a large multi-center clinical trial designed to determine efficacy.

Clinical Protocols

A successful protocol for the use of pulse oximetry to classify arterial oxygenation into four fuzzy categories.

Pulse oximetry is widely used in critical care medicine to noninvasively estimate arterial hemoglobin oxygen saturation. Despite the obvious benefits of using pulse oximetry to detect life threatening desaturations, it is unknown how well pulse oximetry is able to predict the finer graduations of arterial oxygenation needed for clinical decision making. A computerized protocol was developed for the use of pulse oximetry to classify arterial oxygenation into four fuzzy categories and tested in a prospective clinical trial which compared the oxygenation category assigned by the protocol to one assigned by a respiratory therapist. In 3,742 classifications from 15 patients over a seven month period, the protocol showed 96% agreement with the therapists in the direction of therapy and 75% agreement with the oxygenation classes assigned by the therapists.

Clinical Protocols

A model-based simulator for testing rule-based decision support systems for mechanical ventilation of ARDS patients.

A model-based simulator was developed for testing rule-based decision support systems that manages ventilator therapy of patients with the Adult Respiratory Distress Syndrome (ARDS). The simulator is based on a multi-compartment model of the human body and mathematical models of the gas exchange abnormalities associated with ARDS. Initial testing of this system indicates that model-based simulators are a viable tool for testing rule-based expert systems used in health-care.

Computer Simulation