Proceedings. Symposium on Computer Applications in Medical Care最新文献

{"title":"A distributed, scalable, community care network architecture for wide-area electronic patient records: modeling and simulation.","authors":"S Ghosh,&nbsp;K Han,&nbsp;R Reddy,&nbsp;S Reddy,&nbsp;S Kankanahalli,&nbsp;J Jagannathan,&nbsp;R Shank","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Principal systems issues relative to computerizing patient medical records that are yet to be addressed in the scientific literature include (1) the characteristics of networks, i.e. bandwidth and capacity, and their impact on the performance of the system, (2) the architecture and the underlying algorithm of the system, (3) the location and migration of medical records, (4) scalability of the system, and (5) the nature of the performance variation under heavy and light use of the network. Key parameters that affect performance include the number of patients, doctors, frequency of patient visits, and the number of electronic queries and record entries initiated during a patient-doctor interaction episode. This paper presents AMPReD, a Distributed, Scalable, Community Care Network Architecture that aims to provide Real-Time Access to Geographically-Dispersed Patient Medical Records. The AMPReD model includes stationary hospitals and medical clinics, mobile clinics, migrating doctors as well as patients, the communications network, and the patient medical record database. AMPReD's goals include (1) the accurate modeling of the propagation of medical records and (2) providing real-time access to patient medical records from anywhere in the system. To achieve these goals, an asynchronous, distributed algorithm must be developed that achieves concurrent access of multiple, autonomous databases. AMPReD is modeled and simulated for a representative community care network on a network of workstations configured as a loosely-coupled parallel processor, for different parametric combinations of number of doctors, patients, and number of queries or record entries generated corresponding to every patient-doctor interaction episode. AMPReD defines and obtains key performance measures including the idle times of the doctors, patient waiting times, the access times of queries as functions of their sizes, and the growth of the databases. In addition, AMPReD also measures the deviation of the actual time required for a patient-doctor interaction episode from the scheduled interaction interval, as a function of the network load. For the representative system selected, performance measures indicate that the network, utilizing 1/2T1 links, and the database system poses no bottleneck to the system even where the number of doctors and patients within a 30 minute interval are chosen at 192 and 200 respectively. A T1 is a standard, digital, transmission link that is rated at 1.44Mbits/sec.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"352-6"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579113/pdf/procascamc00009-0381.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rational reconstruction of INTERNIST-I using PROTEGE-II.","authors":"M A Musen,&nbsp;J H Gennari,&nbsp;W W Wong","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>PROTEGE-II is a methodology and a suite of tools that allow developers to build and maintain knowledge-based systems in a principled manner. We used PROTEGE-II to reconstruct the well-known INTERNIST-I system, demonstrating the role of a domain ontology (a framework for specification of a model of an application area), a reusable problem-solving method, and declarative mapping relations in creating a new, working program. PROTEGE-II generates automatically a domain-specific knowledge-acquisition tool, which, in the case of the INTERNIST-I reconstruction, has much of the functionality of the QMR-KAT knowledge-acquisition tool. This study provides a means to understand better both the PROTEGE-II methodology and the models that underlie INTERNIST-I.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"289-93"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579101/pdf/procascamc00009-0319.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost justification of a community health information network: the ComputerLink for AD caregivers.","authors":"F C Payton,&nbsp;P F Brennan,&nbsp;J B Silvers","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Recent studies examined the perceived benefits of the ComputerLink, a specialized computer network for caregivers of persons with Alzheimer's Disease. The ComputerLink existed as a special service within a free, public access community health information network. The issue of \"free\", however, is debatable. Though usage costs were not incurred by the AD caregivers who used ComputerLink, there are direct and indirect costs associated with these and other community networks. This study will focus on costs incurred at the individual level, recognizing that organizations and society also bear community network costs. At this level, the primary cost savings occur with the caregiver. The biggest factor determining net economic benefits is the extent to which this technology intervention delays or prevents institutionalization. Results of this analysis suggest that community health networks do return economic and social benefits to their users.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"566-70"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579157/pdf/procascamc00009-0595.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WHAM!: a forms constructor for medical record access via the World Wide Web.","authors":"A Hinds,&nbsp;P Greenspun,&nbsp;I S Kohane","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>WWW-EMRS is an architecture that provides a set of abstractions of electronic medical record systems (EMRS). This architecture has enabled us to implement interfaces to heterogeneous EMRS via the World-Wide Web that provide consistent visual presentations and functionality. We describe WHAM!, a program that allows rapid generation of customized interfaces to WWW-EMRS that therefore deliver the customized functions across multiple EMRS.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"116-20"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579067/pdf/procascamc00009-0147.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A web-based architecture for a medical vocabulary server.","authors":"J H Gennari,&nbsp;D E Oliver,&nbsp;W Pratt,&nbsp;J Rice,&nbsp;M A Musen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>For health care providers to share computing resources and medical application programs across different sites, those applications must share a common medical vocabulary. To construct a common vocabulary, researchers must have an architecture that supports collaborative, networked development. In this paper, we present a web-based server architecture for the collaborative development of a medical vocabulary: a system that provides network services in support of medical applications that need a common, controlled medical terminology. The server supports vocabulary browsing and editing and can respond to direct programmatic queries about vocabulary terms. We have tested the programmatic query-response capability of the vocabulary server with a medical application that determines when patients who have HIV infection may be eligible for certain clinical trials. Our emphasis in this paper is not on the content of the vocabulary, but rather on the communication protocol and the tools that enable collaborative improvement of the vocabulary by any network-connected user.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"275-9"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579098/pdf/procascamc00009-0305.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SmaCS: smart classification system for the design, maintenance and use of complex terminologies. Application in pediatric cardiology.","authors":"F van den Heuvel,&nbsp;T Timmers,&nbsp;J Hess","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The development of a generic Smart Classification System (SmaCS) for the design, construction, maintenance, and use of complex controlled terminologies is described. The ability of SmaCS to create and maintain terminologies that are combinations of structured terms and domain-specific knowledge is an important aspect of its design. SmaCS can therefore be used both for both controlled data-collection, using integrity rules included in the terminology, and intelligent data-retrieval. The design and implementation of SmaCS and application in the domain of pediatric cardiology are described.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"57-61"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579055/pdf/procascamc00009-0088.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary investigation of a Bayesian network for mammographic diagnosis of breast cancer.","authors":"C E Kahn,&nbsp;L M Roberts,&nbsp;K Wang,&nbsp;D Jenks,&nbsp;P Haddawy","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Bayesian networks use the techniques of probability theory to reason under conditions of uncertainty. We investigated the use of Bayesian networks for radiological decision support. A Bayesian network for the interpretation of mammograms (MammoNet) was developed based on five patient-history features, two physical findings, and 15 mammographic features extracted by experienced radiologists. Conditional-probability data, such as sensitivity and specificity, were derived from peer-reviewed journal articles and from expert opinion. In testing with a set of 77 cases from a mammography atlas and a clinical teaching file, MammoNet performed well in distinguishing between benign and malignant lesions, and yielded a value of 0.881 (+/- 0.045) for the area under the receiver operating characteristic curve. We conclude that Bayesian networks provide a potentially useful tool for mammographic decision support.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"208-12"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579085/pdf/procascamc00009-0238.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computerized practice guidelines for heart failure management: the HeartMan system.","authors":"A Margolis,&nbsp;B E Bray,&nbsp;E M Gilbert,&nbsp;H R Warner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this paper we discuss the initial stages of development and evaluation of the HeartMan system, a set of computerized practice guidelines for heart failure management. The concept of computerized guidelines as a hybrid of expert systems and practice guidelines methodologies and techniques is proposed. We show the results of the initial evaluation of the system, which are very promising, although the sample size is small, and the study is retrospective: Of 177 messages, 90% were considered appropriate, of which 97.5% would have been followed. Eight percent of the messages were classified as neutral, and 2% classified as inappropriate. The errors were correctable by changing the logic. The potential technical and sociological barriers to the complete development and clinical use of the system are discussed.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"228-32"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579089/pdf/procascamc00009-0258.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effective clinical uses of wide-area networks: electronic mail as telemedicine.","authors":"E R Worth,&nbsp;T B Patrick,&nbsp;J C Klimczak,&nbsp;J C Reid","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Electronic mail (E-mail) is widely used as a means of communication in the medical community. E-mail is clearly inexpensive when compared to two-way, fully interactive, real-time, video telemedicine. By content analysis of 200 consecutive messages, we show E-mail to be a low-cost use of computer networks, supporting a wide range of physician decision-making.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"814-8"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579207/pdf/procascamc00009-0843.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time wireless decision support alerts on a Palmtop PDA.","authors":"M M Shabot,&nbsp;M LoBue","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The authors devised a system which continuously analyzes data exported from a Clinical Information System for the occurrence of exceptional or life-threatening clinical events. A configurable rule-based system was created to detect and act on such events. When detected, the system formats an alerting message, dials a modem and transmits the message to a commercial satellite relay system. Ennunciated by an alerting beep and blinking LED on a PCMCIA receiver card, the alert message appears on the screen of a Palmtop Personal Digital Assistants (PDA) carried by designated clinicians.</p>","PeriodicalId":77331,"journal":{"name":"Proceedings. Symposium on Computer Applications in Medical Care","volume":" ","pages":"174-7"},"PeriodicalIF":0.0,"publicationDate":"1995-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579078/pdf/procascamc00009-0204.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"19543666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}