PubMed · 3441242
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H Hutten. 1987. Medical progress through software.. https://pubmed.ncbi.nlm.nih.gov/3441242/
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None of the coding schemes currently contained within the Unified Medical Language System (UMLS) is sufficiently expressive to represent medical progress notes adequately. Some coding schemes suffer from domain incompleteness, others suffer from the inability to represent modifiers and time references, and some suffer from both problems. The recently released version of the Systematized Nomenclature of Medicine (SNOMED III) is a potential solution to the data-representation problem because it is relatively domain complete, and because it uses a generative coding scheme that will allow the construction of codes that contain modifiers and time references. SNOMED III does have an important weakness, however. SNOMED III lacks a formalized system for using its codes; thus, it fails to ensure consistency in its use across different institutions. Application of conceptual-graph formalisms to SNOMED III can ensure such consistency of use. Conceptual-graph formalisms will also allow mapping of the resulting SNOMED III codes onto relational data models and onto other formal systems, such as first-order predicate calculus.
In 1972, Webber and his coauthors closed their landmark paper with some visionary remarks that have proved to be remarkably perceptive. They hypothesized that special telephone circuits or radiofrequency channels could be used to yield "images whose grey scale and resolution are satisfactory enough to be virtually indistinguishable from the original." Speaking of transmitting still-frame images in a reasonable length of time and at a reasonable cost, they were limited by the current state of technology, but not by failing to use available technology creatively. We now have the tools they lacked; we must analyze alternatives and apply them. First, define the clinical problem. Determine the minimum acceptable function level of the proposed teleradiology system. Then use your best judgement to sort our convenience, reliability, cost, and various other considerations in light of the needs of your practice. As you develop the scenario, frequently refocus on the problem to be solved. Very likely you will find, as you look closer at current options, that by using teleradiology you could increase the quality of service to your patients by extending your presence electronically to areas where constant physical presence is simply not possible, affordable, or convenient.