Evaluation of Vocabularies for Electronic Laboratory Reporting to Public Health AgenciesWhite, Mark D.; Kolar, Linda M.; Steindel, Steven J.
doi: 10.1136/jamia.1999.0060185pmid: 10332652
AbstractClinical laboratories and clinicians transmit certain laboratory test results to public health agencies as required by state or local law. Most of these surveillance data are currently received by conventional mail or facsimile transmission. The Centers for Disease Control and Prevention (CDC), Council of State and Territorial Epidemiologists, and Association of Public Health Laboratories are preparing to implement surveillance systems that will use existing laboratory information systems to transmit electronic laboratory results to appropriate public health agencies. The authors anticipate that this will improve the reporting efficiency for these laboratories, reduce manual data entry, and greatly increase the timeliness and utility of the data. The vocabulary and messaging standards used should encourage participation in these new electronic reporting systems by minimizing the cost and inconvenience to laboratories while providing for accurate and complete communication of needed data. This article describes public health data requirements and the influence of vocabulary and messaging standards on implementation.
Continuous Speech Recognition for CliniciansZafar, Atif; Overhage, J. Marc; McDonald, Clement J.
doi: 10.1136/jamia.1999.0060195pmid: 10332653
AbstractThe current generation of continuous speech recognition systems claims to offer high accuracy (greater than 95 percent) speech recognition at natural speech rates (150 words per minute) on low-cost (under $2000) platforms. This paper presents a state-of-the-technology summary, along with insights the authors have gained through testing one such product extensively and other products superficially.The authors have identified a number of issues that are important in managing accuracy and usability. First, for efficient recognition users must start with a dictionary containing the phonetic spellings of all words they anticipate using. The authors dictated 50 discharge summaries using one inexpensive internal medicine dictionary ($30) and found that they needed to add an additional 400 terms to get recognition rates of 98 percent. However, if they used either of two more expensive and extensive commercial medical vocabularies ($349 and $695), they did not need to add terms to get a 98 percent recognition rate. Second, users must speak clearly and continuously, distinctly pronouncing all syllables. Users must also correct errors as they occur, because accuracy improves with error correction by at least 5 percent over two weeks. Users may find it difficult to train the system to recognize certain terms, regardless of the amount of training, and appropriate substitutions must be created. For example, the authors had to substitute “twice a day” for “bid” when using the less expensive dictionary, but not when using the other two dictionaries. From trials they conducted in settings ranging from an emergency room to hospital wards and clinicians' offices, they learned that ambient noise has minimal effect. Finally, they found that a minimal “usable” hardware configuration (which keeps up with dictation) comprises a 300-MHz Pentium processor with 128 MB of RAM and a “speech quality” sound card (e.g., SoundBlaster, $99). Anything less powerful will result in the system lagging behind the speaking rate.The authors obtained 97 percent accuracy with just 30 minutes of training when using the latest edition of one of the speech recognition systems supplemented by a commercial medical dictionary. This technology has advanced considerably in recent years and is now a serious contender to replace some or all of the increasingly expensive alternative methods of dictation with human transcription.
A Semantic Lexicon for Medical Language ProcessingJohnson, Stephen B.
doi: 10.1136/jamia.1999.0060205pmid: 10332654
AbstractObjective: Construction of a resource that provides semantic information about words and phrases to facilitate the computer processing of medical narrative.Design: Lexemes (words and word phrases) in the Specialist Lexicon were matched against strings in the 1997 Metathesaurus of the Unified Medical Language System (UMLS) developed by the National Library of Medicine. This yielded a “semantic lexicon,” in which each lexeme is associated with one or more syntactic types, each of which can have one or more semantic types. The semantic lexicon was then used to assign semantic types to lexemes occurring in a corpus of discharge summaries (603,306 sentences). Lexical items with multiple semantic types were examined to determine whether some of the types could be eliminated, on the basis of usage in discharge summaries. A concordance program was used to find contrasting contexts for each lexeme that would reflect different semantic senses. Based on this evidence, semantic preference rules were developed to reduce the number of lexemes with multiple semantic types.Results: Matching the Specialist Lexicon against the Metathesaurus produced a semantic lexicon with 75,711 lexical forms, 22,805 (30.1 percent) of which had two or more semantic types. Matching the Specialist Lexicon against one year's worth of discharge summaries identified 27,633 distinct lexical forms, 13,322 of which had at least one semantic type. This suggests that the Specialist Lexicon has about 79 percent coverage for syntactic information and 38 percent coverage for semantic information for discharge summaries. Of those lexemes in the corpus that had semantic types, 3,474 (12.6 percent) had two or more types. When semantic preference rules were applied to the semantic lexicon, the number of entries with multiple semantic types was reduced to 423 (1.5 percent). In the discharge summaries, occurrences of lexemes with multiple semantic types were reduced from 9.41 to 1.46 percent.Conclusion: Automatic methods can be used to construct a semantic lexicon from existing UMLS sources. This semantic information can aid natural language processing programs that analyze medical narrative, provided that lexemes with multiple semantic types are kept to a minimum. Semantic preference rules can be used to select semantic types that are appropriate to clinical reports. Further work is needed to increase the coverage of the semantic lexicon and to exploit contextual information when selecting semantic senses.
The Determination of Relevant Goals and Criteria Used to Select an Automated Patient Care Information SystemChocholik, Joan K.; Bouchard, Susan E.; Tan, Joseph K. H.; Ostrow, David N.
doi: 10.1136/jamia.1999.0060219pmid: 10332655
AbstractObjectives: To determine the relevant weighted goals and criteria for use in the selection of an automated patient care information system (PCIS) using a modified Delphi technique to achieve consensus.Design: A three-phase, six-round modified Delphi process was implemented by a ten-member PCIS selection task force. The first phase consisted of an exploratory round. It was followed by the second phase, of two rounds, to determine the selection goals and finally the third phase, of three rounds, to finalize the selection criteria.Results: Consensus on the goals and criteria for selecting a PCIS was measured during the Delphi process by reviewing the mean and standard deviation of the previous round's responses. After the study was completed, the results were analyzed using a limits-of-agreement indicator that showed strong agreement of each individual's responses between each of the goal determination rounds. Further analysis for variability in the group's response showed a significant movement to consensus after the first goal-determination iteration, with consensus reached on all goals by the end of the second iteration.Conclusion: The results indicated that the relevant weighted goals and criteria used to make the final decision for an automated PCIS were developed as a result of strong agreement among members of the PCIS selection task force. It is therefore recognized that the use of the Delphi process was beneficial in achieving consensus among clinical and nonclinical members in a relatively short time while avoiding a decision based on political biases and the “groupthink” of traditional committee meetings. The results suggest that improvements could be made in lessening the number of rounds by having information available through side conversations, by having other statistical indicators besides the mean and standard deviation available between rounds, and by having a content expert address questions between rounds.
Contrasting Views of Physicians and Nurses about an Inpatient Computer-based Provider Order-entry SystemWeiner, Michael; Gress, Todd; Thiemann, David R.; Jenckes, Mollie; Reel, Stephanie L.; Mandell, Steven F.; Bass, Eric B.
doi: 10.1136/jamia.1999.0060234pmid: 10332656
AbstractObjective: Many hospitals are investing in computer-based provider order-entry (POE) systems, and providers' evaluations have proved important for the success of the systems. The authors assessed how physicians and nurses viewed the effects of one modified commercial POE system on time spent patients, resource utilization, errors with orders, and overall quality of care.Design: Survey.Measurements: Opinions of 271 POE users on medicine wards of an urban teaching hospital: 96 medical house officers, 49 attending physicians, 19 clinical fellows with heavy inpatient loads, and 107 nurses.Results: Responses were received from 85 percent of the sample. Most physicians and nurses agreed that orders were executed faster under POE. About 30 percent of house officers and attendings or fellows, compared with 56 percent of nurses, reported improvement in overall quality of care with POE. Forty-four percent of house officers and 34 percent of attendings/fellows reported that their time with patients decreased, whereas 56 percent of nurses indicated that their time with patients increased (P < 0.001). Sixty percent of house officers and 41 percent of attendings/fellows indicated that order errors increased, whereas 69 percent of nurses indicated a decrease or no change in errors. Although most nurses reported no change in the frequency of ordering tests and medications with POE, 61 percent of house officers reported an increased frequency.Conclusion: Physicians and nurses had markedly different views about effects of a POE system on patient care, highlighting the need to consider both perspectives when assessing the impact of POE. With this POE system, most nurses saw beneficial effects, whereas many physicians saw negative effects.
Use of Computer-based Records, Completeness of Documentation, and Appropriateness of Documented Clinical DecisionsTang, Paul C.; LaRosa, Michael P.; Gorden, Susan M.
doi: 10.1136/jamia.1999.0060245pmid: 10332657
AbstractObjective: To investigate whether using a computer-based patient record (CPR) affects the completeness of documentation and appropriateness of documented clinical decisions.Design: A blinded expert panel of four experienced internists evaluated 50 progress notes of patients who had chronic diseases and whose physicians used either a CPR or a traditional paper record.Measurements: Completeness of problem and medication lists in progress notes, allergies noted in the entire record, consideration of relevant patient factors in the progress note's diagnostic and treatment plans, and appropriateness of documented clinical decisions.Results: The expert reviewers rated the problem lists and medication lists in the CPR progress notes as more complete (1.79/2.00 vs. 0.93/2.00, P < 0.001, and 1.75/2.00 vs. 0.91/2.00, P < 0.001, respectively) than those in the paper record. The allergy lists in both records were similar. Providers using a CPR documented consideration of more relevant patient factors when making their decisions (1.53/2.00 vs. 1.07/2.00, P < 0.001), and documented more appropriate clinical decisions (3.63/5.00 vs. 2.50/5.00, P < 0.001), compared with providers who used traditional paper records.Conclusions: Physicians in our study who used a CPR produced more complete documentation and documented more appropriate clinical decisions, as judged by an expert review panel. Because the physicians who used the CPR in our study volunteered to do so, further study is warranted to test whether the same conclusions would apply to all CPR users and whether the improvement in documentation leads to better clinical outcomes.