Showing papers in "Journal of Medical Systems in 1989"

A new electronic medical nomenclature

Abstract: The author presents the complex scientific and technical foundation of the recently completed biomedical nomenclature. This nomenclature places all the terms into a single hierarchical order. Computer-compatibility is achieved by the numeric representation of the location (“address”) of the term on the hierarchical tree. These unique numeric representations serve as codes, making the system language-independent, with potential for usage in various languages, and rendering medical terminology computer-compatible.

Cognitive match interface design, a base concept for guiding the development of user friendly computer application packages

Abstract: The authors present a base concept which unites the various prescriptions for creating and implementing a user friendly computer system. Making the system operate and interact with the user in a manner which parallels the flow of the user's own thought processes is the key issue. The authors illustrate this concept with examples from a system they recently developed to create and store patient records for the health care industry. Additionally they outline a procedure for creating patient/client data storage systems.

Using mathematical programming to assess the relative performance of the health care industry

Abstract: Unlike conventional methods for evaluating program efficiency, a recently developed mathematical programming technique, Data Envelopment Analysis (DEA), is able to handle multiple inputs and outputs simultaneously without assigning arbitrary weights and does not require the use of homogeneous measurement units nor a prespecified functional relationship between inputs and outputs. Despite of its unfamiliarity to health care researchers and administrators, this technique is becoming increasingly popular as a means of evaluating relative performance in not-for-profit emities.

Evaluation of an advance surgical scheduling system

Abstract: Utilization of the surgical suite is of significant concern to administrators because of the high costs associated with this facility. Scheduling systems, which control the flow of patients into the surgical arena, are frequently cited as a primary means of improving resource utilization. The objective of the research reported herein was to test the hypothesis that the implementation of a centralized advance surgical scheduling system is associated with a significant improvement in operating room (OR) team utilization rate. Data were collected at a test hospital and at a control hospital for three months prior to implementation of a scheduling system at the test hospital, and for an additional three months starting nine months after implementation. The mean OR team utilization rate at the test hospital rose 12% from 0.68 prior to implementation to 0.77 postimplementation. The mean OR team utilization rate at the control hospital fell 8%, from 0.78 preimplementation to 0.73 postimplementation. The research hypothesis was supported using multiple regression, which controlled for various intervening variables that could affect utilization rate independently of the scheduling system. A literature review showed that experimental designs such as the one used in this study have not previously been used to evaluate scheduling systems in hospital settings, despite the increasing need to justify the purchase and implementation of such systems.

Computer based information systems in primary health care—why?

Abstract: The delivery of health care is information based. A host of computer-based information systems have been developed and implemented in the health care environment. The mere availability of the computer as a tool for information handling should, in itself, not be the cause for developing computer-based information systems. The earlier assumption of a cost-benefit impact with the development of such systems has not been effectively shown in all cases, and as seen in a report by van Bemmel, the recent trend is to apply other criteria in systems evaluation. Information is essential in health care related decision making. The properties of information are described to present a case for a computer-based information system to support primary health care delivery.

A clinical database management system for improved integration of the veterans affairs hospital information system

Abstract: The Department of Veterans Affairs (VA) Decentralized Hospital Computer Program (DHCP) contains data modules derived from separate ancillary services (e.g., Lab, Pharmacy and Radiology). It is currently difficult to integrate information between the modules. A prototype is being developed aimed at integrating ancillary data by storing clinical data oriented to the patient so that there is easy interaction of data from multiple services. A set of program utilities provides for user-defined functions of decision support, queries, and reports. Information can be used to monitor quality of care by providing feedback in the form of reports, and reminders. Initial testing has indicated the prototype's design and implementation are feasible (in terms of space requirements, speed, and ease of use) in outpatient and inpatient settings. The design, development, and clinical use of this prototype are described.

The natural language processing of medical databases

Abstract: The consideration of natural language as a domain for computer processing has has been one of the long-term projects in the history of data processing. Computers were developed in the late 40's and early 50's in the United States and from the very beginning there was a desire and intent that someday the computer would handle speech and be able to understand normal English literature and text with the coherency of a student or perhaps even an expert. Such breakthroughs have also been anticipated in the medical area. This paper will present a series of design specifications that facilitate the processing of natural language medical databases. Using these techniques it will be possible to expand the use of our traditional tools and exploit the effort that has been invested in these literary creations.

A parallel implementation of the ALOPEX process

Abstract: Optimization techniques have found many applications in science, engineering, and industry. In all applications, the best value of a “cost function” is sought in a well-defined domain; this cost function in general depends on many parameters. An iterative optimization technique has been developed (ALOPEX) that uses feedback in order to optimize the response of a system. The cost function for this process is problem dependent and therefore quite flexible. The method has been applied successfully to different optimization problems such as pattern recognition, receptive field studies in the visual system of animals, curve fitting, etc. We present two special purpose hardware implementations for ALOPEX. The first method takes time O(logN + logm) and uses O(mN2) processing elements. The second method takes O(logN + m) time and uses O(N2) processing elements. Our basic architecture is a binary tree with N2 leaves (equal to the length of the vectors) and therefore had depth O(logN). Different implications of the two approaches will be discussed including similarities with the biological visual process.

A microcomputer system for clinical signal analysis of vestibular laboratory

Abstract: A vestibular laboratory system was implemented for clinical testing and medical examination of patients with balance disorders. Programs for analysis of postural control and eye movements were made for a microcomputer. The microcomputer system can be used by a nurse without technical education. The system has now been used for two years at the laboratory.

Developing a DSS for a distribution facility: an application in the healthcare industry

Abstract: This article details a successful project in the design and implementation of a decision support system for practical use in a hospital setting. The approach used, the steps followed, the problems encountered, and the lessons learned are described and discussed with special emphasis on the managerial issues and management involvement during the decision support system life cycle.

DMSS: a computer-based diabetes monitoring system

Abstract: This paper describes a microcomputer-based decision support system (DSS) for diabetes monitoring. The system's basic functions include a patient management subsystem, an electronic logbook, a nutrition and exercise module, a dictionary for diabetes-related terminology, a diabetic-physician data transfer module and an on-line help capability. DMSS (Diabetes Monitoring Support System) provides a data capturing capability, trend analysis, and nutrition/exercise decision support to improve the monitoring and maintenance of diabetes. It was designed to be used by both a physician and a patient and can also serve as a useful teaching aid for a new diabetic. Its basic advantages lie in its comprehensiveness and flexibility. It is also user-friendly, easy to operate, and does not require any previous computer experience.

An online tests catalog for clinical laboratories

Abstract: An attempt to integrate an online catalog for clinical laboratory tests in a university hospital medical computing environment is presented here. The need for such a catalog is evident, due to the dynamic changes in the area, new tests, and new test methods. Physicians are able to access the catalog through department terminals. The catalog has been designed and implemented as a relational database, including seven tables. Context-sensitive help screens are available at any step, as well as specific instructions for each laboratory.

Informating, not automating, the medical record

Abstract: The author suggests that reference should be made in the future to the need to informate and not to automate the medical record. The reason for this recommended semantic change is first to avoid the mistaken notion that the computerization of medical records will reduce the number of personnel processing medical information. Instead, personnel will shift their attention from rote clerical activities to analytic activities made possible by the creation of new data bases by computers. These new data bases, a byproduct of informating the medical record, describe work processes and lend themselves to analytic activities which will enhance quality and efficiency in hospitals. The recent availability of report generators on commercial Laboratory Information Systems (LISs) mark their transition from automating to informating systems. One example of an ad hoc report used to enhance quality and efficiency in the clinical laboratories is the throughput report.

Diagnostic and treatment support for the NASA space program astronauts

Abstract: For over 9 years our research unit has been investigating medical databases that would be required to support astronauts on long-term missions. The configuration that has been developed will allow complete separation from earth-based experts and the capability of an on-board stand-alone system for knowledge engineering and medical decision support. Our data processing base of operation has advanced from the early stages on mainframe computers to the now ubiquitous microcomputer. Over this nine-year period we have seen several generations of improvements in every level of technology to the point where we can now package and deliver for space travel a rather broad-based decision support tool for astronauts that can provide the basic needs of medical treatment and diagnostic support which is vital for the proper execution of manned space missions.

Expert systems in laboratory medicine: a practical consultative application

Abstract: Today, more than ever, clinical pathologists will be required to act as consultants, while at the same time coping with ever-increasing workloads. We present a knowledge-based expert system for providing interpretive reports on over 100 specimens per day in a large commercial laboratory. The program's developmental history is reviewed, followed by a description of the program's structure and operation and how it is used and edited.

The implementation of a knowledge-based pathology hypertext under HyperCard

Abstract: A knowledge-based Hypertext of Pathology integrating videodisc-based images and computer-generated graphics with the textual cognitive information of an undergraduate pathology curriculum has been developed. The system described in this paper was implemented under HyperCard00 during 1988 and 1989. Three earlier versions of the system that were developed on different platforms are contrasted with the present system. Strengths, weaknesses, and future extensions of the system are enumerated. The conceptual basis and organizational principles of the knowledge base are also briefly discussed.

The relationship of age, level of formal education, and duration of employment toward attitudes concerning the use of computers in the workplace

Abstract: The introduction of computer technology in the Canadian health care environment necessitates an adaptation by hospital employees in order to perform their jobs. One thousand twenty-two hospital staff were surveyed immediately following their initial orientation to computers. The survey identified attitudes toward change, and the use of computers in the workplace. Demographic data and job classifications of all respondents were tabulated. Hypotheses were tested regarding the relationships between age, formal education, and duration of employment, and attitudes toward computers and change. Results indicated a generally positive response toward the use of computers in the workplace and to change in general. However, statistically significant results were obtained indicating that age, level of education, and length of employment affect the degree of positive response to both computers and change. The results suggest that demographic variables such as age, level of education, and employment duration must be taken into consideration when planning for the implementation of computer systems in the health care setting.

Automated processing of narrative medical text—a new tool for clinical drug studies

Abstract: The advent of automobiles and airplanes has revolutionized our traveling just as profoundly as computers are currently changing all aspects of information handling. Interestingly, the clinical practice of medicine may have been the last island of resistance for this new technology. This imperviousness was often misinterpreted 1 as a direct consequence of physician conservatism and/or excessive concern about medical confidentiality. The personal experience of this author is that the primary retarding reason has not been fully articulated. Medical communication, whether verbal expression or written notes or scientific manuscripts that consist of numeric data, is relatively easy to computerize. But free narrative text was widely viewed as incompatible with computer technology. The latter perception was probably the true barrier impeding clinical use of computers. Closer study of medical communication revealed two discrete difficulties. First, standardized terminology is a basic prerequisite for quantitative information transfer. Yet for the last three decades, American medicine has functioned without a standard terminology. Second, the richness of the English language in synonyms, near-synonyms, idioms, and metaphors increases the variability of stating the same facts, which in turn compounds the task of the computer. Linguistic nuances often play an important role in clinical communication. A medically intelligent automated text processor should conserve the intended meaning of the practitioner even if it is only implied. This is a difficult task. Despite intensive research in this field, 2-5 it is understandable how free medical narrative firmly resisted computerization.

A PC-based system for visual evoked potential studies

Abstract: An interactive PC-based computer controlled system is described that can be used for collection and analysis of data of Visual Evoked Potentials (VEPs). Visual stimuli are generated on a high-resolution color monitor driven by an Enhanced Graphics Adaptor (EGA). The VEP waveforms are digitized by an A/D converter at a sampling rate of 1 KHz and stored on a hard disk for further analysis. The analysis software includes both time and frequency analysis routines as well as some innovative techniques for the use of the VEPs as a diagnostic measure for various diseases.

A coded summation method to measure evoked responses of human beings

Abstract: Human Beings have several kinds of responses evoked by different kinds of stimuli. Examples include auditory evoked responses, visual evoked responses, and etc. Evoked responses appear in electroencephalograms (EEGs) and are measured by an EEG. These evoked responses have a smaller amplitude wave and an averaged summation method (ASM) is widely used to measure this phenomenon. The ASM, however, is not entirely suitable to measure a signal hidden behind nonstationary data with a high ratio. Because the number of average summation cycles has to increase in order to improve the signal-to-noise ratio, increased time is required to measure a signal. The nonstationarity of data also increases the danger that a measured signal has several distortions caused by nonstationarity. These facts indicate the necessity for a short period measurement to obtain an evoked response. At the same time, the short period measurement realizes a reduction of load for measured person.

A computerized kinematic diagnostic system

Abstract: This paper describes the instrumentation developed for a clinical system that measures upper extremity kinematics in normal and cerebral palsied children. The ability to diagnose cerebral palsy during early and midinfancy is influenced by the fact that movement and postural abnormalities become apparent only over time, and are not readily detectable until there is sufficient abnormality so that it can be viewed by gross inspection during clinical examination. The methodology presented here serves to discriminate normal from deviant movement at an earlier age than what is presently possible, and may also result in alternative therapeutic intervention.

The difference between interfaced and integrated systems

Abstract: The definitions of an "integrated system" and an "interfaced system" are unclear. Consequently, purchasers and developers of systems are often unable to judge the degree to which a system is integrated. This paper presents definitions of integrated systems and interfaced systems, describes the differences between the two, and reviews resulting conclusions.

Long-term data storage in a clinical laboratory information system

Abstract: The clinical laboratory is pressured on one side by physicians and regulators who want the laboratory to keep more detailed patient records available for longer periods and on the other side by physical space and cost constraints which favor rapidly transferring such records to Medical Records or a warehouse from which retrieval is slow and difficult. Various forms of inactive data storage and archiving in machine-readable form are available to address this dilemma, yet these solutions can create even more difficult problems. Two different approaches were developed within the framework of RelationaLABCOM to address both the intermediate and long-term storage of data. In this paper we examine the two methods as solutions to the problems, discuss their limitations, and determine why one is superceding the other in the installation base.

Statistical approaches to nonstationary EEGs for the detection of slow vertex responses.

Abstract: A slow vertex response (SVR) is an electric auditory evoked response used for an objective hearing power test One of the aims of an objective hearing power test is to find infants whose hearing is less than that of normal infants Early medical treatment is important for infants with a loss of hearing so that they do not have retarded growth To measure SVRs, we generally use the averaged summation method of an electroencephalogram (EEG), because the signal-to-noise ratio (SVR to EEG and etc) is very poor To increase the reliability and stability of measured SVRs, and at the same time, to make the burden of testing light, it is necessary to device an effective measurement method of SVR Two factors must be considered: (1) SVR waveforms change following the changes of EEGs caused by sleeping and (2) EEGs are considered as nonstationary data in prolonged measurement In this paper, five statistical methods are used on two different models; a stationary model and a nonstationary model Through the comparison of waves obtained by each method, we will clarify the statistical characteristics of the original data (EEGs including SVRs), and consider the conditions that effect the measurement method of an SVR

Medical education and the role of computers—as seen through the eyes of a medical student

Abstract: The medical education system that currently exists depends more and more on the memory of the physician-in-training as the medical database expands. While the brain has been engineered to reason and conceptualize, its capacity to memorize is limited and remains unchanged as the growth of medical knowledge continues. While we are exploring the frontiers of modern medicine, we must also explore new methods of training. An educational system that is efficient and practical must be developed, and the computer should assume a vital role in replacing the memorization of seldom used, but clinically important information. This would enable students to focus on clinical applications, and advance the development of reasoning skills that are essential in medicine: MEDICAL EDUCATION AND COMPUTERS.

Exclusive arrangments in the hospital industry

Abstract: There have been numerous antitrust cases concerning exclusive hospitals privileges. The plaintiff often alleges both that he was foreclosed from the market and that an illegal tying agreement exists. This paper which draws heavily from the cases concludes both that the relevant market for hospital based physicians is national and that the impact on competition is minimal. The hospital frequently initiates the exclusive arrangement which suggests that efficiency is enhanced. Our analysis also shows that the rying claims are generally unpersuasive. However, exclusive arrangements on occasion may be a device to exclude competitors. Finally, economic criteria are developed to help determine the desirability of particular exclusive arrangements.

Applications of staffing, scheduling, and budgeting methodologies to hospital ancillary units

Abstract: A computer-aided methodology for integrating the budgeting, staffing, and labor productivity systems of Ancillary Services using Respiratory Therapy as an example is presented. The data needed, staffing computations and schedules, and productivity analysis are presented and discussed. A summary of the predicted savings and other benefits for the application hospital are presented with comparisons to present productivity systems.

A computer aid for choosing HMOs: design of a new interface

Abstract: This paper reports on a new interface design. The presentation is similar to a newspaper style, allowing a familiar format and advertisement. In addition, the design includes steps to ease data collection, features to help users influence others in the organization, and a dynamic allocation of menu lists that reflect user's knowledge and previous interest.

Using demographic data for ambulatory health care planning: a dental health practice management model.

Abstract: The use of sociodemographic data in planning ambulatory health services is discussed and illustrated. Five global indices are identified as important for establishing contours of need within local community areas: social class, population heterogeneity, resident mobility, family organization, and general stress factors, Knowledge of sociodemographic distributions within a given community can serve as an adjunct for rational decision making in planning and placement of ambulatory health care services. It can also establish a means for evaluating whether extant health services reach their intended targets via comparisons to the social demography of patients receiving care in private practices or public clinics. Such analyses are germane to ambulatory health care practitioners in both the public and private sector.

Alternative test sequences for HIV screening of donated blood.

Abstract: Human Immunodeficiency Virus (HIV) infection is extremely rare among volunteer blood donors. The highly sensitive Enzyme Linked Immunoassay (ELISA) test and the highly specific Western blot confirmation constitute the test sequence now used to minimize the possibility of transfusion associated HIV infection and to minimize the loss of donors due to false positive test results. The estimated operating characteristies for the test sequence permit the estimation of true infection rates which may be higher or lower than “observed” rates among subcategories of blood donors with progressively lower prevalence rates. The probability that a positive test result indicates true infection also declines with decreasing prevalence. The potential benefits of changing the test sequence so that complete HIV screening is implemented only for donations which are hepatitis-free include a reduction in the costs of Western blot testing and donor counseling, a reduction in the number of donors who use the blood bank inappropriately for personal HIV testing, and a more explicit recognition of the false positive problem when counseling donors.