Barriers to the clinical implementation of compositionality.
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BACKGROUND: Compositional mechanisms for the entry of clinically relevant controlled vocabularies have been suggested as a possible solution to providing adequate descriptive precision while keeping term vocabulary redundancy under control. As of yet, there are no widely accepted term navigators that allow physicians to enter problem lists utilizing controlled vocabularies with compositionality. METHODS: We report on the results of a usability trial of 5 physicians using our most recent attempt at developing the Mayo Problem List Manager. We tested the implementation of an automated term composition, and hierarchical term dissection. RESULTS: Participants found acceptable terms 96% of the time and found automated term composition helpful in 85% of the case scenarios. There was significant confusion about the terminology used to describe compositional elements (kernel concepts, modifiers, and qualifiers) however participants used the functions appropriately. Speed of entry was universally stated as the limiting factor. CONCLUSIONS: The variety of methods that our participants used to enter terms highlights the need for multiple ways to accomplish the task of data entry. Successful implementation of user directed compositionality could be accomplished with further improvement of the user interface and the underlying terminology. (+info)
Workflow analysis and evidence-based medicine: towards integration of knowledge-based functions in hospital information systems.
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The large extent and complexity of scientific evidence described in the concept of evidence-based medicine often overwhelms clinicians who want to apply best external evidence. Hospital Information Systems usually do not provide knowledge-based functions to support context-sensitive linking to external information sources. Knowledge-based components need specific data, which must be entered manually and should be well adapted to clinical environment to be accepted by clinicians. This paper describes a workflow-based approach to understand and visualize clinical reality as a preliminary to designing software applications, and possible starting points for further software development. (+info)
The Virtual Pelvic Floor, a tele-immersive educational environment.
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This paper describes the development of the Virtual Pelvic Floor, a new method of teaching the complex anatomy of the pelvic region utilizing virtual reality and advanced networking technology. Virtual reality technology allows improved visualization of three-dimensional structures over conventional media because it supports stereo vision, viewer-centered perspective, large angles of view, and interactivity. Two or more ImmersaDesk systems, drafting table format virtual reality displays, are networked together providing an environment where teacher and students share a high quality three-dimensional anatomical model, and are able to converse, see each other, and to point in three dimensions to indicate areas of interest. This project was realized by the teamwork of surgeons, medical artists and sculptors, computer scientists, and computer visualization experts. It demonstrates the future of virtual reality for surgical education and applications for the Next Generation Internet. (+info)
Data quality and the electronic medical record: a role for direct parental data entry.
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INTRODUCTION: The paper and electronic medical record (EMR) have evolved with little scientific inquiry into what effect the informant (clinician or patient) has on the validity of the recorded information. We have previously reported on an electronic interview program that facilitated parents' direct reporting of past medical history data. We sought to define additional data elements that parents could report electronically and to compare parents' electronically entered data to that charted by physicians using the current EMR system. METHODS: A convenience sample of parents was recruited to enter data on history of present illness (HPI) and review of systems (ROS) elements using an electronic interview. Data from the electronic parental interview and information abstracted from the physician EMR were compared to data derived from a face-to-face criterion standard interview. Validity, sensitivity and specificity of each mode of data entry were calculated. RESULTS: 100 of 140 eligible parents (71.4%) participated. Validity of information from the electronic interview was comparable to that charted by emergency physicians for HPI regarding fever and ROS questions. Sensitivity of parents' electronic interview was superior to physicians' charting for ROS elements specific to hydration status. CONCLUSIONS: Improved sensitivity for detection of historical risk factors for illness can be achieved by augmenting the pediatric EMR with a section for direct parental direct data input. Direct parental data input to the EMR should be considered to improve the quality of documentation for medical histories. (+info)
Examining the symptom experience of hospitalized patients using a pen-based computer.
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The purposes of this study were to test the feasibility of using a pen-based computer to capture self-reported symptom data, to evaluate the system, and to evaluate the importance of obtaining symptom data. The sample included 72 patients who were hospitalized for a variety of medical conditions. Self-reported symptom data was obtained with the automated Sign and Symptom Checklist. The feasibility of using an automated symptom checklist to capture self-reported symptom data was demonstrated. Patients' evaluations of the ease of use and the format of the system were primarily positive; mean ratings ranged from 4.58 to 4.70 on a 5-point scale. Patients indicated the importance of documenting symptoms, with a few suggesting that the use of an automated symptom checklist may increase communication between providers and patients. Study findings support the inclusion of self-reported symptom data in electronic health records and national health care databases. (+info)
Evaluating physician satisfaction regarding user interactions with an electronic medical record system.
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A limiting factor in realizing the full potential of electronic medical records (EMR) is physician reluctance to use these applications. There have been very few formal usability studies of experienced physician users of EMRs in routine clinical use. We distributed the Questionnaire for User Interaction Satisfaction (QUIS) to 75 primary care physicians who routinely use the Brigham and Women's Integrated Computing System (BICS). BICS scored highest in the area of screen design and lowest in the area of system capability. Overall user satisfaction was most highly correlated with screen design and layout, and surprisingly not with system response time. Human-computer interaction studies can help focus our design efforts as we strive to increase clinician usage of information technology. (+info)
Multiresolution browsing of pathology images using wavelets.
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Digitized pathology images typically have very high resolution, making it difficult to display in their entirety on the computer screen and inefficient to transmit over the network for educational purposes. Progressive zooming of pathology images is desirable despite the availability of inexpensive networking bandwidth. An efficient progressive image resolution refining system for on-line distribution of pathology image using wavelets has been developed and is discussed in this paper. The system is practical for real-world applications, pre-processing and coding each 24-bit image of size 2400 x 3600 within 40 seconds on a Pentium II PC. The transmission process is in real-time. Besides its exceptional speed, the algorithm has high flexibility. The server encodes the original pathology images without loss. Based on the image request from a client, the server dynamically generates and sends out the part of the image at the requested scale and quality requirement. The algorithm is expandable for medical image databases such as PACS. (+info)
A Java speech implementation of the Mini Mental Status Exam.
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The Folstein Mini Mental Status Exam (MMSE) is a simple, widely used, verbally administered test to assess cognitive function. The Java Speech Application Programming Interface (JSAPI) is a new, cross-platform interface for both speech recognition and speech synthesis in the Java environment. To evaluate the suitability of the JSAPI for interactive, patient interview applications, a JSAPI implementation of the MMSE was developed. The MMSE contains questions that vary in structure in order to assess different cognitive functions. This question variability provided an excellent test-bed to evaluate the strengths and weaknesses of JSAPI. The application is based on Java platform 2 and a JSAPI interface to the IBM ViaVoice recognition engine. Design and implementations issues are discussed. Preliminary usability studies demonstrate that an automated MMSE maybe a useful screening tool for cognitive disorders and changes. (+info)