Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium最新文献

{"title":"New computer-based tools for empiric antibiotic decision support.","authors":"H Warner,&nbsp;S R Blue,&nbsp;D Sorenson,&nbsp;L Reimer,&nbsp;L Li,&nbsp;M Nelson,&nbsp;M Barton,&nbsp;H Warner","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Since 1995 we have been developing a decision-support model, called Q-ID, which uses a series of infectious disease knowledge bases to make recommendations for empirical treatment or to check the appropriateness of current antibiotic therapy. From disease manifestations and risk factors, a differential diagnosis for the patient is generated by a diagnostic medical expert system. The resulting probability of each: disease is multiplied by the expected benefit in improved mortality and morbidity from optimal antibiotic treatment of each disease. To generate empirical treatment recommendations, site-specific data on sensitivity to antibiotics of each organism is used as an estimate of the likelihood of achieving maximum benefit for each disease on the patient's differential. Combining this data with drug and patient specific factors, the model recommends the antibiotic(s) most likely to produce the optimal benefit in this patient with the least risk and expense. In this paper the model is described, excerpts from each of the knowledge bases are presented, and performance of the model in a real case is shown for illustration.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"238-42"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233327/pdf/procamiaafs00001-0276.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20288991","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":"Acceptance of a speech interface for biomedical data collection.","authors":"M A Grasso,&nbsp;D Ebert,&nbsp;T Finin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Speech interfaces have the potential to address the data entry bottleneck of many applications is the field of medical informatics. An experimental study evaluated the effect of perceptual structure on a multimodal speech interface for the collection of histopathology data. A perceptually structured multimodal interface, using speech and direct manipulation, was shown to increase speed and accuracy. Factors influencing user acceptance are also discussed.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"739-43"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233555/pdf/procamiaafs00001-0773.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20290685","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":"Iterative usability testing: ensuring a usable clinical workstation.","authors":"J M Coble,&nbsp;J Karat,&nbsp;M J Orland,&nbsp;M G Kahn","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Once the users' needs are determined, how does one ensure that the resulting software meets the users' needs? This paper describes our application of a process, usability testing, that is used to measure the usability of systems as well as guide modifications to address usability problems. Usability testing is not a method to elicit opinions about software, but rather a method to determine scientifically a product's level of usability. Our application of usability testing is designed to determine the current usability level of a workstation designed for the clinician's use, determine specific problems with the Clinical Workstation's usability, and then evaluate the effectiveness of changes that address those problems.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"744-8"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233491/pdf/procamiaafs00001-0778.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20290686","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":"The importance of Java and CORBA in medicine.","authors":"D W Forslund,&nbsp;J L Cook","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>One of the most powerful tools available for telemedicine is a multimedia medical record accessible over a wide area and simultaneously editable by multiple physicians. The ability to do this through an intuitive interface linking multiple distributed data repositories while maintaining full data integrity is a fundamental enabling technology in healthcare. We discuss the role of distributed object technology using Java and CORBA in providing this capability including an example of such a system (TeleMed) which can be accessed through the World Wide Web. Issues of security, scalability, data integrity, and usability are emphasized.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"364-8"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233445/pdf/procamiaafs00001-0401.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20287533","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":"Text structures in medical text processing: empirical evidence and a text understanding prototype.","authors":"U Hahn,&nbsp;M Romacker","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We consider the role of textual structures in medical texts. In particular, we examine the impact the lacking recognition of text phenomena has on the validity of medical knowledge bases fed by a natural language understanding front-end. First, we review the results from an empirical study on a sample of medical texts considering, in various forms of local coherence phenomena (anaphora and textual ellipses). We then discuss the representation bias emerging in the text knowledge base that is likely to occur when these phenomena are not dealt with--mainly the emergence of referentially incoherent and invalid representations. We then turn to a medical text understanding system designed to account for local text coherence.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"819-23"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233262/pdf/procamiaafs00001-0853.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20287536","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":"Data collection and information presentation for optimal decision making by clinical managers--the Autocontrol Project.","authors":"A M Grant,&nbsp;Y Richard,&nbsp;E Deland,&nbsp;N Després,&nbsp;F de Lorenzi,&nbsp;A Dagenais,&nbsp;M Buteau","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The Autocontrol methodology has been developed in order to support the optimisation of decision-making and the use of resources in the context of a clinical unit. The theoretical basis relates to quality assurance and information systems and is influenced by management and cognitive research in the health domain. The methodology uses population rather than individual decision making and because of its dynamic feedback design promises to have rapid and profound effect on practice. Most importantly the health care professional is the principle user of the Autocontrol system. In this methodology we distinguish three types of evidence necessary for practice change: practice based or internal evidence, best evidence derived from the literature or external evidence concerning the practice in question, and process based evidence on how to optimise the process of practice change. The software used by the system is of the executive decision support type which facilitates interrogation of large databases. The Autocontrol system is designed to interrogate the data of the patient medical record however the latter often lacks data on concomitant resource use and this must be supplemented. This paper reviews the Autocontrol methodology and gives examples from current studies.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"789-93"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233326/pdf/procamiaafs00001-0823.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20287599","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":"Electronic forms: benefits drawbacks of a World Wide Web-based approach to data entry.","authors":"S N Luxenberg,&nbsp;D D DuBois,&nbsp;C G Fraley,&nbsp;R R Hamburgh,&nbsp;X L Huang,&nbsp;P D Clayton","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It has long been realized that, compared to paper-based records, electronic record systems provide many advantages in the healthcare environment, including increased availability, improved legibility, long-term accessibility, (potentially) greater completeness, data encoding, and automated decision support and analysis. In spite of these recognized benefits, collection of patient data at the point of service generally does not occur, in large part because each such effort usually requires application-specific software and hardware, and, most significantly, provider time. Given the presence of WWW browsers now available on nearly every desktop, the support and access concerns for data entry applications can be substantially lessened. Despite these advantages, there are also downsides to the use of the WWW for data entry, including user interface issues and security. At CPMC, we are currently using web-based forms to gather patient charge data from physical and occupational therapists. Benefits of this approach have included a 98.2% user compliance rate for at least weekly data entry, and the reduction of charge posting from an average of 24.3 days to 2.3 days following the date of service. Drawbacks to WWW-based applications have included increased security exposure and persistent human tendencies to enter data in batches rather than at the time of service. A final conclusion was that, in the absence of a strong central mandate, providers must perceive a clear benefit in order to be willing to learn and use a new technology.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"804-8"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233373/pdf/procamiaafs00001-0838.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20287602","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":"Decision-analytic valuation of clinical information systems: application to an alerting system for coronary angiography.","authors":"D S Bell","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Many patients who need coronary angiography fail to get it and they have decreased survival as a result. This study demonstrates the use of decision analysis to predict the survival value of an alerting system for necessary angiography.</p><p><strong>Methods: </strong>Data on the use of angiography and survival after myocardial infarction (MI) were taken from a published cohort study. The expected value of information (EVI) was calculated for alerts that angiography is necessary. Maximal EVI was estimated by assuming that alert advice is always followed. Sensitivity analysis relaxed that assumption. Hypothetical data were generated to demonstrate EVI analysis for narrower subcohorts.</p><p><strong>Results: </strong>A maximally effective alerting system would increase survival in this cohort by 2.2% over 1-4 years after MI. The system would therefore need to be applied to 46 people to prevent one death. Its effectiveness would decrease linearly with decreasing adherence to its advice. Given sufficiently detailed outcome and prevalence data, EVI analysis could also predict the survival value of the system's individual data elements.</p><p><strong>Conclusions: </strong>An alerting system that ensures necessary angiography post-MI should have a survival value comparable to the value of t-PA over streptokinase. EVI analysis provides a framework for predicting the overall effectiveness of information systems and for understanding the contribution of individual features to a system's effectiveness.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"173-7"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233285/pdf/procamiaafs00001-0211.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20287850","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":"Data privacy and confidentiality in the public arena.","authors":"M E Mills","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Public policy debates concerning the collection of healthcare information for use as aggregate databases to underpin healthcare planning are growing increasingly rankerous. Provider concerns for future patient relationships and public fear of damages resulting from information disclosure are driving the development of data collection policy. Through a special Task Force, the State of Maryland has addressed these issues and developed policy recommendations specific to data collection and use.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"42-5"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233391/pdf/procamiaafs00001-0081.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20288059","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 decentralized, community-based design for statewide immunization registries in Minnesota.","authors":"M LaVenture,&nbsp;N Wicklin,&nbsp;T Schillo,&nbsp;L Gatewood","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Incomplete immunization records and an increasingly complex immunization schedule make it difficult for parents and providers to know what shots their children or clients need. Complete and accurate immunization records are needed for day care, sports, camp, and school, but this is difficult--especially when previous immunizations have been received at different clinics. Population-based immunization registries help make complete and accurate records more easily available to parents and health care providers. Registries foster the timely sending of reminder notices for children who are due for immunizations and make it possible for providers to quickly assess immunization rates in their clinic. Public health officials use registries to determine immunization rates, to identify pockets of need where immunization rates are low and to target resources. In Minnesota, over 85% of immunizations are delivered in the private sector. Minnesota is also extensively covered by managed care organizations with an estimated 75% of the total population enrolled in some type of managed care. Strong local community public health agencies in each county also drive local solutions to community needs. These factors and others led to a de-centralized approach to the implementation of registries. The \"Minnesota Model\" is based on the development of community-based registries which link together local clinics, hospitals, health plans, public health departments, and schools in each region. Each community-based registry is designed to link to a state hub. This decentralized open architecture design is based on standards for data, not hardware or software. The building begins, not by implementing a state registry into which all immunizations are entered, but at the community level. Currently, 38% of Minnesota counties (representing 52% of statewide births) are involved in implementing a community-based registry, and 53% (representing 43% of statewide births) have initiated discussions with private providers. Only 9% of counties (5% of statewide births) have no current registry activity. This paper describes the steps which have been taken towards developing a decentralized statewide immunization information system for Minnesota, based on recommendations put forth by The State Immunization Practices Task Force Work Group on Immunization Registries.</p>","PeriodicalId":79455,"journal":{"name":"Proceedings : a conference of the American Medical Informatics Association. AMIA Fall Symposium","volume":" ","pages":"388-92"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233416/pdf/procamiaafs00001-0425.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20288070","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}