RESUMEN
As part of an effort to develop a knowledge base to support searching online medical literature according to individual needs, we have studied the possibility of using the co-occurrence of MeSH terms in MEDLINE citations associated with the search strategies optimal for evidence based medicine to automated construction of a knowledge base. This study evaluates the relevance of the relationships between the semantic relationship pairs generated by the process, and the clinical validity of the semantic types involved in the process. From the semantic pairs proposed by our method, a group of clinicians judge sixty percent to be relevant. The remaining forty percent included semantic types considered unimportant by clinicians. The knowledge extraction method showed reasonable results. We believe it can be appropriate for the task of retrieving information from the medical record in order to guide users during a searching and retrieval process. Future directions include the validation of the knowledge, based on an evaluation of system performance.
Asunto(s)
Inteligencia Artificial , Almacenamiento y Recuperación de la Información/métodos , Sistemas de Registros Médicos Computarizados , Sistemas en Línea , Descriptores , Algoritmos , Enfermedades Cardiovasculares/terapia , Humanos , Internet , MEDLINE , Sistemas de Registros Médicos Computarizados/organización & administración , Semántica , Encuestas y Cuestionarios , Terapia Asistida por ComputadorRESUMEN
The large and rapidly growing number of information sources relevant to health care, and the increasing amounts of new evidence produced by researchers, are improving the access of professionals and students to valuable information. However, seeking and filtering useful, valid information can be still very difficult. An online information system that conducts searches based on individual patient data can have a beneficial influence on the particular patient's outcome and educate the healthcare worker. In this paper, we describe the underlying model for a system that aims to facilitate the search for evidence based on clinicians' needs. This paper reviews studies of information needs of clinicians, describes principles of information retrieval, and examines the role that standardized terminologies can play in the integration between a clinical system and literature resources, as well as in the information retrieval process. The paper also describes a model for a digital library system that supports the integration of clinical systems with online information sources, making use of information available in the electronic medical record to enhance searches and information retrieval. The model builds on several different, previously developed techniques to identify information themes that are relevant to specific clinical data. Using a framework of evidence-based practice, the system generates well-structured questions with the intent of enhancing information retrieval. We believe that by helping clinicians to pose well-structured clinical queries and including in them relevant information from individual patients' medical records, we can enhance information retrieval and thus can improve patient-care.
Asunto(s)
Biología Computacional , Almacenamiento y Recuperación de la Información , Humanos , Sistemas de Información , Servicios de Biblioteca , Sistemas de Registros Médicos Computarizados , Sistemas en Línea , Terminología como AsuntoRESUMEN
The vast amount of information collected and stored in clinical systems can be a significant challenge in the integration of digital libraries and electronic medical records, especially the selection of clinical data to be used in the search, retrieval, and summarization processes. In this study, we describe the use of information retrieval measures with natural language processor output to identify critical information in narrative reports. Our hypothesis is that clinical data that occur often in narrative reports are less important to clinicians than findings that occur rarely. We used the information retrieval methods to analyze one year of discharge summaries. We then conducted a performance study, using physicians as subject. Results show that the methods can be used for filtering critical information from reports. Further studies need to be done on evaluation of the method based on an evaluation of the system performance in the context of a digital library.
Asunto(s)
Almacenamiento y Recuperación de la Información , Bibliotecas , Sistemas de Registros Médicos Computarizados , Procesamiento de Lenguaje Natural , Alta del Paciente , Humanos , Curva ROCRESUMEN
This paper describes initial experience with the Web-based Patient Clinical Information System (PatCIS). The system was designed to serve as a framework for the integration of applications that help patients access their electronic medical record, add data to their record, review on-line health information, and apply their own clinical data (automatically) to guideline programs that offer health advice. The architecture supports security functions and records user activities, relieving application developers from concerns about safe information practices and the evaluation process. PatCIS is being used to study the social and cognitive impact of allowing patients to have access to their health records via the Web. To date, PatCIS has grown to include 15 clinical functions and 4 dynamic links to literature (called infobuttons). Eleven patients have been enrolled since April, 1999; five have been active users. Experience shows that the PatCIS architecture supports application integration while providing adequate security and evaluation functions. Initial caution with the patient enrollment process has limited recruitment and, consequently, usage. However, experience thus far suggests that PatCIS has good usability and utility. No adverse events, including undesirable impact on doctor-patient interactions, have been reported. There do not appear to be any technical impediments to scaling up the enrollment to continue to observe patient usage.
Asunto(s)
Internet , Sistemas de Registros Médicos Computarizados/estadística & datos numéricos , Pacientes , Seguridad Computacional , Sistemas de Computación , Sistemas de Información en Hospital , Humanos , Selección de Paciente , Proyectos PilotoRESUMEN
As part of preliminary studies for the development of a digital library, we have studied the possibility of using the co-occurrence of MeSH terms in MEDLINE citations associated with the search strategies optimal for evidence-based medicine to automate construction of a knowledge base. We use the UMLS semantic types in order to analyze search results to determine which semantic types are most relevant for different types of questions (etiology, diagnosis, therapy, and prognosis). The automated process generated a large amount of information. Seven to eight percent of the semantic pairs generated in each clinical task group co-occur significantly more often than can be accounted for by chance. A pilot study showed good specificity and sensitivity for the intended purposes of this project in all groups.
Asunto(s)
Procesamiento Automatizado de Datos , Almacenamiento y Recuperación de la Información/métodos , MEDLINE , Descriptores , Medicina Basada en la Evidencia , Medicina Familiar y Comunitaria , Humanos , Proyectos Piloto , Sensibilidad y Especificidad , Unified Medical Language SystemRESUMEN
OBJECTIVE: A type definition, as a component of the categorical structures of a concept-oriented terminology, must support nonambiguous concept representations and, consequently, comparisons of data that are represented using different terminologies. The purpose of the study was to evaluate the adequacy and utility of a proposed type definition for nursing activity concepts. DESIGN: Nursing activity terms (n = 1039) from patient charts and intervention terms from two nursing terminologies (Home Health Care Classification and Omaha System) were decomposed into the attributes of the proposed type definition-Delivery Mode, Activity Focus, and Recipient. MEASUREMENTS: Attributes of the type definition were coded as present or absent for each term by multiple raters. In addition, Delivery Mode was rated as Explicit or Implicit and Recipient was rated as Explicit, Implicit, or Ambiguous. The data were summarized using descriptive statistics. Inter-rater reliabilities were calculated for each attribute of the type definition. RESULTS: All attributes of the type definition were present in 73.9 percent of the chart terms, 91.3 percent of Home Health Care Classification intervention terms, and 63.5 percent of Omaha System intervention terms. While Delivery Mode and Activity Focus were almost universally present, Recipient was problematic. It was rated as ambiguous in 4.8 percent of the chart terms, 8.7 percent of Home Health Care Classification intervention terms, and 36.5 percent of Omaha System intervention terms. CONCLUSIONS: The study findings supported the adequacy and utility of the type definition. Further research is needed to refine the type definition and its use for representing nursing activity concepts within a concept-oriented terminological system.
Asunto(s)
Proceso de Enfermería/clasificación , Terminología como Asunto , Vocabulario Controlado , Estudios de Evaluación como Asunto , Servicios de Atención de Salud a Domicilio/clasificaciónRESUMEN
As part of preliminary studies for the development of a digital library, we have studied the possibility of using the UMLS Information Sources Map (ISM) database to provide the means to connect and map different terminologies, as well as to facilitate access to available information sources. The main issues discussed are the indexing of and connection to relevant online sources. We found the features of the ISM to be consistent with the need to support automated source selection and retrieval. However, attention should be paid to three aspects of the information: granularity, completeness, and accuracy. We found the ISM to be potentially useful; however, significant modifications will be required if the ISM is to be able to support automated source selection and retrieval.
Asunto(s)
Indización y Redacción de Resúmenes , Bases de Datos como Asunto/clasificación , Almacenamiento y Recuperación de la Información/métodos , Descriptores , Unified Medical Language System , Estudios de Evaluación como AsuntoRESUMEN
This paper discusses the advantages of developing software as pattern-based components. The design and implementation of a pattern-based suite of software components specially constructed for the electronic patient record is presented. The methodology and the lessons learned in the development of these components are discussed. Finally, some comments about the globalization and the need for more integration among component developers in a worldwide basis is discussed.
Asunto(s)
Programas Informáticos , Humanos , Sistemas de Registros Médicos Computarizados , Lenguajes de Programación , Diseño de Software , Interfaz Usuario-ComputadorRESUMEN
High quality terminologies are a fundamental requirement in a range of health care applications. To ensure high quality terminologies we should reflect about the understandability, reproducibility and utility criteria within a terminology. This paper describes efforts to improve the understandability of SNOMED. We describe the problem related to the grammatical conjunctions "and" and "or" and how we applied basic semantic rules defined by the SNOMED Editorial Board. The results show that the meaning of "and" and "or" in SNOMED can be made explicit in almost all cases and can be done in a reasonable, reliable, and reproducible manner.
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Vocabulario Controlado , Semántica , Terminología como AsuntoRESUMEN
Hycones II is a tool that facilitates the construction of hybrid connectionist expert systems to solve problems in classification. Hycones II provides a hybrid system that integrates frames with three types of neural network: the "combinatorial" neural model (CNM), the "Fuzzy ARTMAP" model, and the "Semantic ART" (SMART) model, a combination of the CNM and Fuzzy ART-MAP. We will compare the ability of these three models to solve diagnostic problems in two medical domains.
Asunto(s)
Inteligencia Artificial , Sistemas de Computación , Técnicas de Apoyo para la Decisión , Sistemas Especialistas , Redes Neurales de la Computación , Diagnóstico por Computador , Cardiopatías Congénitas/diagnóstico , Humanos , Enfermedades Renales/diagnóstico , Programas InformáticosRESUMEN
This paper describes HYCONES II, a tool to enable construction of tightly coupled Hybrid Connectionist Expert Systems to solve classification problems. HYCONES II integrates frames with neural networks in its hybrid knowledge base. Three neural network models (CNM, the Fuzzy ARTMAP, and the Semantic ART - SMART) are available to the knowledge engineer. SMART is a new model, introduced by this research group and based on a combination of two previous models. The validation section compares the performance of these three neural models to solve diagnostic problems in two medical domains. Finally, the present status of this project and its future developments are presented.
Asunto(s)
Diagnóstico por Computador , Sistemas Especialistas , Lógica Difusa , Redes Neurales de la Computación , Programas Informáticos , Algoritmos , Cardiopatías Congénitas/diagnóstico , Humanos , Semántica , Validación de Programas de Computación , Integración de SistemasRESUMEN
This paper describes HYCONES II--a tool to enable the construction of hybrid connectionist expert systems to solve classification problems. HYCONES II offers to the knowledge engineer a hybrid knowledge base that integrates frames with three different neural network models: the combinatorial neural model--CNM, the Fuzzy ARTMAP and the Semantic ART--SMART models. The latter is a new model, introduced by this paper, based on a combination of the two previous models. The validation section compares the performance of these three neural models to solve diagnostic problems in two medical domains. This paper also presents HYCONES II knowledge representation features, built in the symbolic component of its hybrid knowledge-base, to deal and represent fuzzy medical variables. Finally, the present status and future developments of the project are presented.