Journal of the American Medical Informatics Association

Bakken, Suzanne; Campbell, Keith E.; Cimino, James J.; Huff, Stanley M.; Ed Hammond, W.

doi: 10.1136/jamia.2000.0070333pmid: 10887162

AbstractThe “vocabulary problem” has long plagued the developers, implementers, and users of computer-based systems. The authors review selected activities of the Health Level 7 (HL7) Vocabulary Technical Committee that are related to vocabulary domain specification for HL7 coded data elements. These activities include: 1) the development of two sets of principles to provide guidance to terminology stakeholders, including organizations seeking to deploy HL7-compliant systems, terminology developers, and terminology integrators; 2) the completion of a survey of terminology developers; 3) the development of a process for HL7 registration of terminologies; and 4) the maintenance of vocabulary domain specification tables. As background, vocabulary domain specification is defined and the relationship between the HL7 Reference Information Model and vocabulary domain specification is described. The activities of the Vocabulary Technical Committee complement the efforts of terminology developers and other stakeholders. These activities are aimed at realizing semantic interoperability in the context of the HL7 Message Development Framework, so that information exchange and use among disparate systems can occur for the delivery and management of direct clinical care as well as for purposes such as clinical research, outcome research, and population health management.

Nadkarni, Prakash M.; Brandt, Cynthia M.; Marenco, Luis

doi: 10.1136/jamia.2000.0070343pmid: 10887163

AbstractThe task of creating and maintaining a front end to a large institutional entity-attribute-value (EAV) database can be cumbersome when using traditional client-server technology. Switching to Web technology as a delivery vehicle solves some of these problems but introduces others. In particular, Web development environments tend to be primitive, and many features that client-server developers take for granted are missing. WebEAV is a generic framework for Web development that is intended to streamline the process of Web application development for databases having a significant EAV component. It also addresses some challenging user interface issues that arise when any complex system is created. The authors describe the architecture of WebEAV and provide an overview of its features with suitable examples.

Lin, Shang-Che; Roumina, Kavous; Fadlalla, Adam; Henricks, Walter H.

doi: 10.1136/jamia.2000.0070357pmid: 10887164

AbstractIntegrating data that reside in different systems remains an often laborious process, requiring either manual steps or complicated programming. This paper describes a method for state-mandated reporting of childhood blood lead testing results that makes use of object linking and embedding technology and readily available software products to pull together information from different legacy systems. A terminal session emulator employs object linking and embedding automation to extract host data, and Visual Basic routines specify the user interface and database manipulation. This system has significantly increased the efficiency and accuracy with which blood lead testing reports are provided to the local state health department. The system provides a model for a relatively easy solution for laboratories and other groups that need a way to integrate standard data sets that are distributed across legacy systems.

Lau, Francis; Hayward, Robert

doi: 10.1136/jamia.2000.0070361pmid: 10887165

AbstractObjective: To describe the experiences, lessons, and implications of building a virtual network as part of a two-year community health research training program in a Canadian province.Design: An action research field study in which 25 health professionals from 17 health regions participated in a seven-week training course on health policy, management, economics, research methods, data analysis, and computer technology. The participants then returned to their regions to apply the knowledge in different community health research projects. Ongoing faculty consultations and support were provided as needed. Each participant was given a notebook computer with the necessary software, Internet access, and technical support for two years, to access information resources, engage in group problem solving, share ideas and knowledge, and collaborate on projects.Measurements: Data collected over two years consisted of program documents, records of interviews with participants and staff, meeting notes, computer usage statistics, automated online surveys, computer conference postings, program Web site, and course feedback. The analysis consisted of detailed review and comparison of the data from different sources. nud*ist was then used to validate earlier study findings.Results: The ten key lessons are that role clarity, technology vision, implementation staging, protected time, just-in-time training, ongoing facilitation, work integration, participatory design, relationship building, and the demonstration of results are essential ingredients for building a successful network.Conclusion: This study provides a descriptive model of the processes involved in developing, in the community health setting, virtual networks that can be used as the basis for future research and as a practical guide for managers.

Lovis, Christian; Baud, Robert H.

doi: 10.1136/jamia.2000.0070378pmid: 10887166

AbstractObjective: The authors consider the problem of exact string pattern matching using algorithms that do not require any preprocessing. To choose the most appropriate algorithm, distinctive features of the medical language must be taken into account. The characteristics of medical language are emphasized in this regard, the best algorithm of those reviewed is proposed, and detailed evaluations of time complexity for processing medical texts are provided.Design: The authors first illustrate and discuss the techniques of various string pattern-matching algorithms. Next, the source code and the behavior of representative exact string pattern-matching algorithms are presented in a comprehensive manner to promote their implementation. Detailed explanations of the use of various techniques to improve performance are given.Measurements: Real-time measures of time complexity with English medical texts are presented. They lead to results distinct from those found in the computer science literature, which are typically computed with normally distributed texts.Results: The Boyer-Moore-Horspool algorithm achieves the best overall results when used with medical texts. This algorithm usually performs at least twice as fast as the other algorithms tested.Conclusion: The time performance of exact string pattern matching can be greatly improved if an efficient algorithm is used. Considering the growing amount of text handled in the electronic patient record, it is worth implementing this efficient algorithm.

Brown, Philip J. B.; Sönksen, Peter

doi: 10.1136/jamia.2000.0070392pmid: 10887167

AbstractObjectives: To measure the strength of agreement between the concepts and records retrieved from a computerized patient database, in response to physician-derived questions, using a semantic terminological model for clinical findings with those concepts and records excerpted clinically by manual identification. The performance of the semantic terminological model is also compared with the more established retrieval methods of free-text search, ICD-10, and hierarchic retrieval.Design: A clinical database (Diabeta) of 106,000 patient problem record entries containing 2,625 unique concepts in an clinical academic department was used to compare semantic, free-text, ICD-10, and hierarchic data retrieval against a gold standard in response to a battery of 47 clinical questions.Measurements: The performance of concept and record retrieval expressed as mean detection rate, positive predictive value, Yates corrected and Mantel-Haenszel chi-squared values, and Cohen kappa value, with significance estimated using the Mann-Whitney test.Results: The semantic terminological model used to retrieve clinically useful concepts from a patient database performed well and better than other methods, with a mean detection rate of 0.86, a positive predictive value of 0.96, a Yates corrected chi-squared value of 1,537, a Mantel-Haenszel chi-squared value of 19,302, and a Cohen kappa of 0.88. Results for record retrieval were even better, with a mean record detection rate of 0.94, a positive predictive value of 0.99, a Yates corrected chi-squared value of 94,774, a Mantel-Haenszel chi-squared value of 1,550,356, and a Cohen kappa value of 0.94. The mean detection rate, Yates corrected chi-squared value, and Cohen kappa value for semantic retrieval were significantly better than for the other methods.Conclusion: The use of a semantic terminological model in this test scenario provides an effective framework for representing clinical finding concepts and their relationships. Although currently incomplete, the model supports improved information retrieval from a patient database in response to clinically relevant questions, when compared with alternative methods of analysis.

Mattie, Mark E.; Staib, Lawrence; Stratmann, Eric; Tagare, Hemant D.; Duncan, James; Miller, Perry L.

doi: 10.1136/jamia.2000.0070404pmid: 10887168

AbstractObjective: Currently, when cytopathology images are archived, they are typically stored with a limited text-based description of their content. Such a description inherently fails to quantify the properties of an image and refers to an extremely small fraction of its information content. This paper describes a method for automatically indexing images of individual cells and their associated diagnoses by computationally derived cell descriptors. This methodology may serve to better index data contained in digital image databases, thereby enabling cytologists and pathologists to cross-reference cells of unknown etiology or nature.Design: The indexing method, implemented in a program called PathMaster, uses a series of computer-based feature extraction routines. Descriptors of individual cell characteristics generated by these routines are employed as indexes of cell morphology, texture, color, and spatial orientation.Measurements: The indexing fidelity of the program was tested after populating its database with images of 152 lymphocytes/lymphoma cells captured from lymph node touch preparations stained with hematoxylin and eosin. Images of “unknown” lymphoid cells, previously unprocessed, were then submitted for feature extraction and diagnostic cross-referencing analysis.Results: PathMaster listed the correct diagnosis as its first differential in 94 percent of recognition trials. In the remaining 6 percent of trials, PathMaster listed the correct diagnosis within the first three “differentials.”Conclusion: PathMaster is a pilot cell image indexing program/search engine that creates an indexed reference of images. Use of such a reference may provide assistance in the diagnostic/prognostic process by furnishing a prioritized list of possible identifications for a cell of uncertain etiology.

Schleyer, Titus K. L.; Forrest, Jane L.

doi: 10.1136/jamia.2000.0070416pmid: 10887169

AbstractThis paper describes the design, development, and administration of a Web-based survey to determine the use of the Internet in clinical practice by 450 dental professionals. The survey blended principles of a controlled mail survey with data collection through a Web-based database application. The survey was implemented as a series of simple HTML pages and tested with a wide variety of operating environments. The response rate was 74.2 percent. Eighty-four percent of the participants completed the Web-based survey, and 16 percent used e-mail or fax. Problems identified during survey administration included incompatibilities/technical problems, usability problems, and a programming error. The cost of the Web-based survey was 38 percent less than that of an equivalent mail survey. A general formula for calculating breakeven points between electronic and hardcopy surveys is presented. Web-based surveys can significantly reduce turnaround time and cost compared with mail surveys and may enhance survey item completion rates.

Wyatt, Jeremy C.

doi: 10.1136/jamia.2000.0070426pmid: 10887170

doi: 10.1136/jamia.2000.0070430pmid: N/A