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PubMed1991

Integration of an object knowledge base into a medical workstation.

A simple, yet powerful, knowledge base and its development environment is described that can act as a "knowledge server", integrated into a medical workstation. In many areas, such an integration of a knowledge base with other modules and systems is required, but difficult or impossible to achieve with existing commercial development shells. Three applications of the knowledge base are described: a controlled vocabulary for the classification of Congenital Heart Diseases, an extended data model for cardiology, and management of syntax descriptions for the BMDP command language.

Artificial Intelligence↗

PubMedDate not supplied

Automated translation between medical terminologies using semantic definitions.

Automatic translation of medical terms from one controlled vocabulary into another is essential to the integration of diverse medical informatics systems. We have developed a strategy in which medical terms are represented in a standard format that provides semantic description of the terms. We demonstrate the representational power of our method by showing that a subset of medical terms (procedures) from diverse vocabularies can be described in this manner. We assess the potential usefulness of our approach for facilitating automatic translation by finding the closest match for MeSH cardiovascular procedures with ICD-9 procedures.

MEDLARS↗

PubMedDate not supplied

Information retrieval in medicine: state of the art.

Conventional information retrieval systems usually involve searching by terms from controlled vocabularies or by individual words in the text. These systems have been commercially successful but are limited by several problems, including cumbersome interfaces and inconsistency with human indexing. Research on methods that automate indexing and retrieval has been performed to address these problems. The three major types of automated systems are vector-based, probabilistic, and linguistic. This article describes these systems and provides an overview of the field of information retrieval in medicine.

Abstracting and Indexing↗

PubMed1989

Evaluating CD-ROM versions of the MEDLINE database: a checklist.

The emergence of CD-ROM (compact disc/read-only memory) versions of the MEDLINE database requires experienced MEDLINE searchers to examine assumptions about searching MEDLINE, since some expectations may not be fulfilled by this new technology. When applied to a particular CD-ROM MEDLINE product, the evaluation procedure involves testing assumptions concerning database contents; mechanics of searching; display, print, and download capabilities; and user-friendly features. The extent to which a CD-ROM product preserves and exploits important MEDLINE strengths should be assessed, e.g., the MeSH controlled vocabulary, the designation of major and minor MeSH emphasis, and the use of subheadings. Search software characteristics that affect ease of searching and quality of results also need to be examined, e.g., the ability to truncate search terms and the order of precedence in which Boolean operators are evaluated. A checklist to assist in the evaluation process is presented, including search examples for use in testing search functions.

Abstracting and Indexing↗

PubMed1989

The CRISP system: an untapped resource for biomedical research project information.

CRISP (Computer Retrieval of Information on Scientific Projects) is a large database maintained and operated by the National Institutes of Health (NIH). It contains comprehensive scientific and selected administrative data on research carried out by the U.S. Public Health Service (PHS) or supported by PHS grants and contracts. Developed originally to meet the needs of NIH, it is an excellent, largely untapped resource for health information professionals at large, revealing new trends, methods, and techniques, often before they appear in the published literature. CRISP uses its own controlled vocabulary, developed to permit indexing of new and active research areas. Queries can combine subject headings with a great variety of administrative data elements (e.g., research category or principal investigator's name). Output is available in a variety of formats and media. While information professionals cannot directly access the CRISP system, abridged CRISP records are merged into the FEDRIP (Federal Research in Progress) database, and FEDRIP is publicly accessible through DIALOG. CRISP records in toxicology are also furnished to the National Library of Medicine's TOXLINE database. This paper discusses the indexing, information retrieval, publication products, and search services of the CRISP system, and how users of medical information can benefit from it.

Abstracting and Indexing↗

PubMed1987

A proposal for more informative abstracts of clinical articles. Ad Hoc Working Group for Critical Appraisal of the Medical Literature.

Medical journals are a principal source of new knowledge for clinicians. Unfortunately, articles containing valid and valuable information are often buried among others of less value. Innovations are needed to assist clinicians in finding articles that are both scientifically sound and applicable to their practices. An easily implemented, although partial, solution is for authors of articles that have clinical implications to structure their abstracts so that key aspects of purpose, methods, and results are reported with a partly controlled vocabulary and in a standardized format. This would assist clinical readers to select appropriate articles more quickly, allow more precise computerized literature searches, and facilitate peer review before publication.

Abstracting and Indexing↗

PubMed1972

In-depth indexing of monograph literature for an on-line retrieval system: a pilot project.

One of the unique features of the State University of New York (SUNY) Biomedical Communication Network is the availability of depth-indexed monograph information for on-line retrieval. Approximately 8,000 titles from the Upstate Medical Center Library collection in Syracuse, New York, were indexed in depth, chapter-by-chapter, as to subject content using the control vocabulary Medical Subject Headings. Detailed indexing of monographic conference proceedings was considered of particular importance to the project. This attempt to make monograph literature more readily accessible to medical library patrons is interesting from both a philosophical and a technical point of view. This paper will discuss both of these aspects, giving an overall description of the nature of this innovative project.

Abstracting and Indexing↗

PubMed1995

End-user search behaviors and their relationship to search effectiveness.

One hundred sixty-one MEDLINE searches conducted by third-year medical students were analyzed and evaluated to determine which search moves were used, whether those individual moves were effective, and whether there was a relationship between specific search behaviors and the effectiveness of the search strategy as a whole. The typical search included fourteen search statements, used seven terms or "limit" commands, and resulted in the display of eleven citations. The most common moves were selection of a database, entering single-word terms and free-text term phrases, and combining sets of terms. Syntactic errors were also common. Overall, librarians judged the searches to be adequate, and students were quite satisfied with their own searches. However, librarians also identified many missed opportunities in the search strategies, including underutilization of the controlled vocabulary, subheadings, and synonyms for search concepts. No strong relationships were found between specific search behaviors and search effectiveness (as measured by the librarians' or students' evaluations). Implications of these findings for system design and user education are discussed.

Computer Literacy↗

PubMed1994

Getting the data in: three year experience with a pediatric electronic medical record system.

The Clinician's Workstation (CWS) has provided the full-functionality of an on-line electronic patient record for outpatient pediatric clinics over the past 3 years. The implementation of the CWS built upon a substantial effort in integration of data from various sources. This paper addresses the subsequent design issues which had to be resolved in order to enable both physician and transcriptionist-driven data entry and retrieval, notably selecting a feasible mixture of controlled vocabulary and free text. Some of the consequences of these design decisions on clinical care, clinical education, clinical and basic research are reviewed with examples from the last three years.

Computer Systems↗

PubMed1993

Structured data collection and knowledge-based user guidance for abdominal ultrasound reporting.

This paper describes a system for structured data collection and report generation in abdominal ultrasonography. The system is based on a controlled vocabulary and hierarchies of concepts; it uses a graphical user interface. More than 17,000 reports have been generated by 43 physicians using this system, which is integrated into a departmental information system. Evaluations have shown that it is a well accepted tool for the fast generation of reports of comparatively high quality. The functionality is enhanced by two additional components: a hybrid knowledge-based module for "intelligent" user guidance and an interactive tutoring system to illustrate the terminology.

Abdomen↗

PubMed1993

A conceptual model for clinical radiology reports.

The structural and informational content of clinical radiology reports was examined to develop a comprehensive representational schema of the concepts in the domain. The model involves several different conceptual levels, ranging from the high level description of the report to the lower level description of the clinical concepts contained in the reports and the specification of the terms used to express the concepts. The design of an adequate structured representation for the domain has important implications for the design of the electronic patient record, for the unification of different controlled vocabularies by enabling them to be mapped to one common representation, and for the facilitation of natural language processing of clinical reports so that coded data may be obtained.

Humans↗

PubMed1993

Image Engine: an object-oriented multimedia database for storing, retrieving and sharing medical images and text.

This paper describes Image Engine, an object-oriented, microcomputer-based, multimedia database designed to facilitate the storage and retrieval of digitized biomedical still images, video, and text using inexpensive desktop computers. The current prototype runs on Apple Macintosh computers and allows network database access via peer to peer file sharing protocols. Image Engine supports both free text and controlled vocabulary indexing of multimedia objects. The latter is implemented using the TView thesaurus model developed by the author. The current prototype of Image Engine uses the National Library of Medicine's Medical Subject Headings (MeSH) vocabulary (with UMLS Meta-1 extensions) as its indexing thesaurus.

Abstracting and Indexing↗

PubMed1995

A comparison of problem lists generated by physicians, nurses, and patients: implications for CPR systems.

Using a sample of 201 patients hospitalized for Pneumocystis carinii pneumonia, this study describes problem lists generated by physicians and examines the overlap among problem lists generated by physicians, nurses, and patients. The findings indicate that the majority of patients in this sample had at least one problem that occurred in more than one problem list. Problems that most frequently appeared in more than one problem list were those related to the medical diagnosis of Pneumocystis carinii pneumonia and its associated physiological symptoms. Problems which occurred uniquely in the nurse problem list were knowledge deficit and potential for injury. Thirty-four percent of the patients identified at least one psychosocial problem that did not occur in either the physician- or nurse-generated problem lists. The study findings demonstrate that while there is overlap among the problem lists in problems related to the principal medical diagnoses, the nurse- and patient-generated problem lists include unique problems which provide additional significant information related to patient status that has the potential to impact patient outcomes. These findings suggest that a unified, nonredundant, multidisciplinary problem list is warranted in order to provide a comprehensive view of the patient for computer-based patient record (CPR) systems. Appropriate data models and comprehensive controlled vocabularies are needed to support the multiple uses of the problem list for CPR systems.

Humans↗

PubMed1995

A shared computer-based problem-oriented patient record for the primary care team.

1. INTRODUCTION. A computer-based patient record (CPR) system, Swedestar, has been developed for use in primary health care. The principal aim of the system is to support continuous quality improvement through improved information handling, improved decision-making, and improved procedures for quality assurance. The Swedestar system has evolved during a ten-year period beginning in 1984. 2. SYSTEM DESIGN. The design philosophy is based on the following key factors: a shared, problem-oriented patient record; structured data entry based on an extensive controlled vocabulary; advanced search and query functions, where the query language has the most important role; integrated decision support for drug prescribing and care protocols and guidelines; integrated procedures for quality assurance. 3. A SHARED PROBLEM-ORIENTED PATIENT RECORD. The core of the CPR system is the problem-oriented patient record. All problems of one patient, recorded by different members of the care team, are displayed on the problem list. Starting from this list, a problem follow-up can be made, one problem at a time or for several problems simultaneously. Thus, it is possible to get an integrated view, across provider categories, of those problems of one patient that belong together. This shared problem-oriented patient record provides an important basis for the primary care team work. 4. INTEGRATED DECISION SUPPORT. The decision support of the system includes a drug prescribing module and a care protocol module. The drug prescribing module is integrated with the patient records and includes an on-line check of the patient's medication list for potential interactions and data-driven reminders concerning major drug problems. Care protocols have been developed for the most common chronic diseases, such as asthma, diabetes, and hypertension. The patient records can be automatically checked according to the care protocols. 5. PRACTICAL EXPERIENCE. The Swedestar system has been implemented in a primary care area with 30,000 inhabitants. It is being used by all the primary care team members: 15 general practitioners, 25 district nurses, and 10 physiotherapists. Several years of practical experience of the CPR system shows that it has a positive impact on quality of care on four levels: 1) improved clinical follow-up of individual patients; 2) facilitated follow-up of aggregated data such as practice activity analysis, annual reports, and clinical indicators; 3) automated medical audit; and 4) concurrent audit. Within that primary care area, quality of care has improved substantially in several aspects due to the use of the CPR system [1].

Ambulatory Care Information Systems↗

PubMed1996

An ontological perspective on surgical procedures.

We studied terminological phrases on surgical procedures-from coding systems, controlled vocabularies, textbooks, and medical records-by an ontological point of view. A surgical procedure can be accurately described only by a set of sentences, in textbooks or surgical reports; a terminological phrase is just a short synthesis of that description. We outline three points of view actually used to construct a phrase, based on i) relevant phases and variants; ii) focus on structures, functions and pathologies; iii) evolution of information and decisions during the process of care. For each of them we discuss potential principles and mechanisms, with the aim of deriving guidelines to generate homogeneous systematic names, to organize regularities in classifications and nomenclatures, to normalize expressions in formal languages.

Medical Informatics Computing↗

PubMed1996

A decision-supported outpatient practice system.

We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed.

Ambulatory Care Facilities↗

PubMed1996

Structured data entry in ORCA: the strengths of two models combined.

The capture of patient data in a structured format receives increasing attention. Data can be extracted from free text using natural language processing techniques, but it can also be collected in a structured fashion at the time of data entry. The latter has the advantage that completeness and unambiguity can be promoted by offering predefined terms and options for description of findings. The paper discusses two models for supporting structured data entry. In the direct model, there is an immediate relationship between the terms and options for data entry and the structure of the underlying database. In the indirect model, terms and options for data entry are based on a controlled vocabulary and not directly related to the structure in which actual data is represented. Both models have been utilized by ORCA (Open Record for CAre). We discuss the pros and cons of these two models in relation to the type of patient data and the task involved. It is concluded that a strategic combination of both models has more strengths and less weaknesses than the use of each model only.

Data Collection↗

PubMed1997

BIOETHICSLINE use by medical students: curriculum-integrated instruction and collection development implications.

BIOETHICSLINE uselogs were analyzed during months when second-year medical students were engaged in ethics coursework that included curriculum-integrated bibliographic instruction. Uselog data showed that peak activity occurred while students were preparing a required paper. Further uselog analysis indicated that students applied database features such as controlled vocabulary, the "explode" command, and a combination of multiple search concepts. In addition, the study examined journal use and interlibrary loan activity for a correlation with online search activity. Higher bioethics journal use and interlibrary loan statistics coincided with peak BIOETHICSLINE activity periods. Citation analysis of student bibliographies reflected the interdisciplinary nature of BIOETHICSLINE and the need for ethics, legal, and clinical information sources in a bioethics collection. This study suggests that the integration of bibliographic instruction and the coordination of collection development with students' curricular needs lead to increased and more competent use of information resources.

Bioethics↗