Things to Come: Postmodern Digital Knowledge Management and Medical InformaticsMatheson, Nina, W.
doi: 10.1136/jamia.1995.95261908pmid: 7743318
Abstract The overarching informatics grand challenge facing society is the creation of knowledge management systems that can acquire, conserve, organize, retrieve, display, and distribute what is known today in a manner that informs and educates, facilitates the discovery and creation of new knowledge, and contributes to the health and welfare of the planet. At onetime the private, national, and university libraries of the world collectively constituted the memory of society's intellectual history. In the future, these new digital knowledge management systems will constitute human memory in its entirety. The current model of multiple local collections of duplicated resources will give way to specialized sole-source servers. In this new environment all scholarly scientific knowledge should be public domain knowledge: managed by scientists, organized for the advancement of knowledge, and readily available to all. Over the next decade, the challenge for the field of medical informatics and for the libraries that serve as the continuous memory for the biomedical sciences will be to come together to form a new organization that will lead to the development of postmodern digital knowledge management systems for medicine. These systems will form a portion of the evolving world brain of the 21st century. This content is only available as a PDF. Author notes Presented as the ACMI Distinguished Lecture at the 18th annual Symposium on Computer Applications in Medical Care, Washington, DC, 1994. American Medical Informatics Association
A Patient's Perspective of Medical InformaticsMongerson,, Paul
doi: 10.1136/jamia.1995.95261909pmid: 7743319
Abstract From my viewpoint as a patient, 1. Medical knowledge has expanded to the point that individuals cannot adequately improve quality without the assistance of computer programs. 2. The medical profession must concentrate on why and how computer program projects must be used, not on why they cannot be used. 3. The successful application of computer programs to clinical medicine is dependent mainly on the efforts of individual institutions and people at the local level. This content is only available as a PDF. American Medical Informatics Association
Are Normative Expert Systems Appropriate for Diagnostic Pathology?Diamond, Lawrence, W.;Mishka, Vladimir, G.;Seal, Apollo, H.;Nguyen, Doyen, T.
doi: 10.1136/jamia.1995.95261910pmid: 7743320
Abstract Conceptual models for diagnostic reasoning proposed in the medical literature are presented to stimulate discussion about the issue of the appropriateness of probabilistic knowledge-based systems for medical diagnosis. Evidence is presented to corroborate the authors' view that diagnosis is a problem-solving task, rather than a decision-making task. In the authors' opinion, probabilistic reasoning is better suited to situations dealing with choices for clinical intervention, rather than to those dealing with determining the correct diagnosis. A critique is given of a diagnostic Bayesian expert system for lymph node pathology. In empirical studies, diagnostic Bayesian systems have been shown to typically list the correct diagnosis as the program's first choice 60% to 70% of the time. One reason for this undistinguished level of diagnostic performance is that Bayesian systems are not designed to represent and use knowledge the same way that an expert does. This content is only available as a PDF. American Medical Informatics Association
Managing the Electronic NIH-Guide for Grants and ContractsSmith, P., R.;Gottesman,, S.;Jones, William, K.
doi: 10.1136/jamia.1995.95261911pmid: 7743321
Abstract This article describes the implementation of a suite of computer programs to manage and provide access to a database containing the electronic documents that constitute the NIH-Guide that is distributed by the NIH on a weekly basis. The software consists of a management program that reads, processes, and stores the incoming documents and performs erratum updates on existing documents; an alerting program that sends selected information to users who have registered their information needs; a viewer that can be used on the local computer to read these documents; and a World-Wide-Web (WWW) server that can distribute the guide to computers that run WWW client software. The design of the documentation annotations, the management software, and the WWW server are expected to constitute valuable models for similar projects in the future. This content is only available as a PDF. American Medical Informatics Association
Lessons Learned from a Pilot Implementation of the UMLS Information Sources MapMiller, Perry, L.;Frawley, Sandra, J.;Wright,, Lawrence;Roderer, Nancy, K.;Powsner, Seth, M.
doi: 10.1136/jamia.1995.95261904pmid: 7743314
Abstract Objective: To explore the software design issues involved in implementing an operational information sources map (ISM) knowledge base (KB) and system of navigational tools that can help medical users access network-based information sources relevant to a biomedical question. Design: A pilot biomedical ISM KB and associated client-server software (ISM/Explorer) have been developed to help students, clinicians, researchers, and staff access network-based information sources, as part of the National Library of Medicine's (NLM) multi-institutional Unified Medical Language System (UMLS) project. The system allows the user to specify and constrain a search for a biomedical question of interest. The system then returns a list of sources matching the search. At this point the user may request 1) further information about a source, 2) that the list of sources be regrouped by different criteria to allow the user to get a better overall appreciation of the set of retrieved sources as a whole, or 3) automatic connection to a source. Results: The pilot system operates in client-server mode and currently contains coded information for 121 sources. It is in routine use from approximately 40 workstations at the Yale School of Medicine. The lessons that have been learned are that: 1) it is important to make access to different versions of a source as seamless as possible, 2) achieving seamless, cross-platform access to heterogeneous sources is difficult, 3) significant differences exist between coding the subject content of an electronic information resource versus that of an article or a book, 4) customizing the ISM to multiple institutions entails significant complexities, and 5) there are many design trade-offs between specifying searches and viewing sets of retrieved sources that must be taken into consideration. Conclusion: An ISM KB and navigational tools have been constructed. In the process, much has been learned about the complexities of development and evaluation in this new environment, which are different from those for Gopher, wide area information servers (WAIS), World-Wide-Web (WWW), and MOSAIC resources. This content is only available as a PDF. Author notes Supported in part by NIH Contract N01 LM13537 and NIH Grant G08 LM05366 from the National Library of Medicine, and by an equipment grant from the Sun Microsystems Corporation. American Medical Informatics Association
An Event Model of Medical Information RepresentationHuff, Stanley, M.;Rocha, Roberto, A.;Bray, Bruce, E.;Warner, Homer, R.;Haug, Peter, J.
doi: 10.1136/jamia.1995.95261905pmid: 7743315
Abstract Objective: Develop a model for structured and encoded representation of medical information that supports human review, decision support applications, ad hoc queries, statistical analysis, and natural-language processing. Design: A medical information representation model was developed from manual and semiautomated analysis of patient data. The key assumption of the model is that medical information can be represented as a series of linked events. The event representation has two main components. The first component is a frame or template definition that specifies the attributes of the event. The second component is a structured vocabulary, the terms of which are taken as the values of the slots in the event template structure. Individual event instances are linked by specific named relationships. Results: The proposed model was used to represent a chest-radiograph report. Conclusions: The event model of medical information representation provides a mechanism for formal definition of the logical structure of medical data and allows explicit time-oriented and associative relationships between event instances. This content is only available as a PDF. Author notes Dr. Rocha is supported by a scholarship from the National Council for Scientific and Technological Development (CNPq), Secretary for Science and Technology, Brazil. American Medical Informatics Association