Proceedings / AMIA ... Annual Symposium. AMIA Symposium

Publications in this journal

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  Available from: nih.gov

  Article: Use of the internet to study the utility values of the public.

  Leslie A Lenert, Ann E Sturley
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  ABSTRACT: One of the most difficult tasks in cost-effectiveness analysis is the measurement of quality weights (utilities) for health states. The task is difficult because subjects often lack familiarity with health states they are asked to rate and because utilities measures such as the standard gamble, ask subjects to perform tasks that are complex and far from everyday experience. A large body of research suggests that computer methods can play an important role in explaining health states and measuring utilities. However, administering computer surveys to a "general public" sample, the most relevant sample for cost-effectiveness analysis, is logistically difficult. In this paper, we describe a software system designed to allow the study of general population preferences in a volunteer Internet survey panel. The approach, which relied on over sampling of ethnic groups and older members of the panel, produced a data set with an ethnically, chronologically and geographically diverse group of respondents, but was not successful in replicating the joint distribution of demographic patterns in the population.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
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  Available from: nih.gov

  Article: Tracking meaning over time in the UMLS Metathesaurus.

  Tammy Powell, Suresh Srinivasan, Stuart J Nelson, William T Hole, Laura Roth, Vladimir Olenichev
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  ABSTRACT: The Unified Medical Language System(R) (UMLS) Metathesaurus contains records arranged by concept or meaning. Each concept contains a unique identifier (CUI) that can be used to track the concept over time. Since the January 2001 release, the Metathesaurus has included the file MRCUI that contains mappings for CUIs that disappear. This paper describes the processes that facilitated this effort and the ongoing effort to find suitable mappings for concepts whose meanings no longer exist in the Metathesaurus. This study highlights the need to identify missed synonymy prior to a release. It also shows a need to work more closely with source providers to identify the closest match in the Metathesaurus when they eliminate terms from their vocabularies.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
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  Available from: nih.gov

  Article: An online heart simulator for augmenting first-year medical and dental education.

  Ryan Kelsey, Maria Botello, Bill Millard, John Zimmerman
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  ABSTRACT: In this study, we present the results of the development and implementation of an online simulator of human cardiac function. The program comprises a set of modular applets in the Java programming language that allow first-year medical and dental students at Columbia University to study the pressure-volume relationship in the left ventricle of the heart. The results of the student and faculty surveys administered suggest that student learning was augmented by the simulator and that students enjoyed the experience of studying with it.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
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  Available from: nih.gov

  Article: Comparing communication technology on Chinese, English, and Spanish diabetes web sites.

  Yanko F Michea, Karen Pancheri, Yang Gong, Elmer Bernstam
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  ABSTRACT: Technological and cultural factors influence access to health information on the web in multifarious ways. We evaluated structural differences and availability of communication services on the web in three diverse language and cultural groups: Chinese, English, and Spanish. A total of 382 web sites were analyzed: 144 were English language sites (38%), 129 were Chinese language sites (34%), and 108 were Spanish language sites (28%). We did not find technical differences in the number of outgoing links per domain or the total availability of communication services between the three groups. There were differences in the distribution of available services between Chinese and English sites. In the Chinese sites, there were more communication services between consumers and health experts. Our results suggest that the health-related web presence of these three cultural groups is technologically comparable, but reflects differences that may be attributable to cultural factors.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
• Article: GLEE--a model-driven execution system for computer-based implementation of clinical practice guidelines.

  Dongwen Wang, Edward H Shortliffe
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  ABSTRACT: We have developed the GLEE system for execution of guidelines encoded in the GLIF3 format. This system can be integrated with a local clinical information system through standard interfaces to EMRs and clinical applications. The execution model of GLEE takes the "system suggests, user controls" approach. A tracing system is used to record the state of guideline steps and their transitions. GLEE provides an internal event-driven execution model that can be hooked up with the clinical event monitor in a local environment. We discuss the execution flexibility provided by GLEE and issues related to its integration in a local environment. Potential use of GLEE includes clinical decision support, quality assurance, guideline development and medical education.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
• Article: Toward a cognitive taxonomy of medical errors.

  Jiajie Zhang, Vimla L Patel, Todd R Johnson, Edward H Shortliffe
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  ABSTRACT: One critical step in addressing and resolving the problems associated with human errors is the development of a cognitive taxonomy of such errors. In the case of errors, such a taxonomy may be developed (1) to categorize all types of errors along cognitive dimensions, (2) to associate each type of error with a specific underlying cognitive mechanism, (3) to explain why, and even predict when and where, a specific error will occur, and (4) to generate intervention strategies for each type of error. Based on Reason's (1992) definition of human errors and Norman's (1986) cognitive theory of human action, we have developed a preliminary action-based cognitive taxonomy of errors that largely satisfies these four criteria in the domain of medicine. We discuss initial steps for applying this taxonomy to develop an online medical error reporting system that not only categorizes errors but also identifies problems and generates solutions.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
• Article: Evidence for the rapid construction of preference during utility assessments.

  Jonathan Bennett, Robert F Nease, Walton Sumner
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  ABSTRACT: Subjects often construct preferences during the elicitation process. This could have implications for the processes automated utility assessments use to find indifference points. In particular, if subjects frequently shift preferences during elicitation processes, then reversible and irreversible procedures might reach different results. We analyzed series of choices made by two groups of subjects during computerized standard gambles for monocular and binocular blindness, comparing the utility assessed in a reversible search process with the utility that would have resulted from an irreversible search process. A minority of subjects reversed their choices during the assessments. The mean differences between these utilities and the predicted results of an irreversible search were quite small. Consequently, automated standard gamble surveys can terminate quickly, using irreversible searches, with little likelihood of skewing population results. Clinical decision support systems can use simple mechanisms to accommodate infrequent preference reversals, such as restarting a search.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
• Article: A framework for evidence-adaptive quality assessment that unifies guideline-based and performance-indicator approaches.

  Aneel Advani, Mary Goldstein, Mark A Musen
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  ABSTRACT: Automated quality assessment of clinician actions and patient outcomes is a central problem in guideline- or standards-based medical care. In this paper we describe a unified model representation and algorithm for evidence-adaptive quality assessment scoring that can: (1) use both complex case-specific guidelines and single-step population-wide performance-indicators as quality measures; (2) score adherence consistently with quantitative population-based medical utilities of the quality measures where available; and (3) give worst-case and best-case scores for variations based on (a) uncertain knowledge of the best practice, (b) guideline customization to an individual patient or particular population, (c) physician practice style variation, or (d) imperfect reliability of the quality measure. Our solution uses fuzzy measure-theoretic scoring to handle the uncertain knowledge about best-practices and the ambiguity from practice variation. We show results of applying our method to retrospective data from a guideline project to improve the quality of hypertension care.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
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  Available from: nih.gov

  Article: Fuzzy logic controller for weaning neonates from mechanical ventilation.

  G E Hatzakis, G M Davis
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  ABSTRACT: Weaning from mechanical ventilation is the gradual detachment from any ventilatory support till normal spontaneous breathing can be fully resumed. To date, we have developed a fuzzy logic controller for weaning COPD adults using pressure support ventilation (PS). However, adults and newborns differ in the pathophysiology of lung disease. We therefore used our fuzzy logic-based weaning platform to develop modularized components for weaning newborns with lung disease. Our controller uses the heart rate (HR), respiratory rate (RR), tidal volume (VT) and oxygen saturation (SaO2) and their trends deltaHR/deltat, deltaVT/deltat and deltaSaO2/deltat to evaluate, respectively, the Current and Trend weaning status of the newborn. Through appropriate fuzzification of these vital signs, Current and Trend weaning status can quantitatively determine the increase/decrease in the synchronized intermittent mandatory ventilation (SIMV) setting. The post-operative weaning courses of 10 newborns, 82+/-162 days old, were assessed at 2-hour intervals for 68+/-39 days. The SIMV levels, proposed by our algorithm, were matched to those levels actually applied. For 60% of the time both values coincided. For the remaining 40%, our algorithm suggested lower SIMV support than what was applied. The Area Under the Curve for integrated ventilatory support over time was 1203+/-846 for standard ventilatory strategies and 1152+/-802 for fuzzy controller. This suggests that the algorithm, approximates the actual weaning progression, and may advocate a more aggressive strategy. Moreover, the core of the fuzzy controller facilitates adaptation for body size and diversified disease patterns and sets the premises as an infant-weaning tool.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
• Article: Role grouping as an extension to the description logic of Ontylog, motivated by concept modeling in SNOMED.

  Kent A Spackman, Robert Dionne, Eric Mays, Jason Weis
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  ABSTRACT: Several clinical terminologies now utilize description logic to model the logical definitions of concepts. Recent editions of the Systematized Nomenclature of Medicine (SNOMED) have been developed using the description logic Ontylog. A significant design criterion for SNOMED is to keep concept expressions simple enough to be broadly usable by clinicians, while maintaining faithful representation of concept meaning. Motivated by this criterion, "role grouping" has been developed as an extension to the description logic Ontylog. This paper describes the problems that motivated the creation of role grouping, outlines the semantics of role grouping, illustrates the benefits of this construct with examples from SNOMED Clinical Terms, and provides an algorithm for determining normal forms for expressions involving role groups.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
• Source

  Available from: nih.gov

  Article: The USU medical PDA initiative: the PDA as an educational tool.

  Leon Moore, Bradley R Richardson, Robert W Williams
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  ABSTRACT: A medical personal digital assistant (PDA) initiative for healthcare students began in 2000 at the Uniformed Services University of the Health Sciences (USU). The University issued PDAs to Graduate School of Nursing (GSN) and School of Medicine (SOM) students. These devices were used to provide clinical reference material to the students, to facilitate clinical experience log collection, and the normal organizer functions of a PDA. Both medical and graduate nursing students were surveyed both before and during clinical training to determine the perceived usefulness of the PDA. A quantitative approach was utilized to emphasize the measurable variables.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
• Article: Asking questions: information needs in a surgical intensive care unit.

  Madhu C Reddy, Wanda Pratt, Paul Dourish, Michael Shabot
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  ABSTRACT: Even in the information-rich environment of hospitals, health-care providers face challenges in addressing their various information needs. Through a study of a patient-care team in a tertiary care Surgical Intensive Care Unit (SICU), we expanded our understanding of health-care providers' information needs in two important ways. First, the study focused on a patient-care team instead of individual health-care providers. Second, information needs were examined in a particular organizational setting, the SICU, which had not been previously studied. We found that organizational information was extremely important to SICU team members. Furthermore, the first resource that team members utilized was not electronic or paper but rather human: another team member.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;
• Source

  Available from: nih.gov

  Article: Web-based informatics education: lessons learned from five years in the trenches.

  L K Goodwin
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  ABSTRACT: Duke University has a five-year history with high-quality and clinically oriented informatics web-based nursing informatics education. This paper highlights an overview of instructional methods used and pedagogical considerations for both students and faculty. To do the job well, faculty workload for web-based instruction has been more than double the time and effort required for teaching an on-campus course. Results suggest that virtual teamwork is difficult but possible for highly motivated students. Committed to excellence, Duke's program finds that most students do well in achieving their goals and achieving Duke's high standards of academic rigor, however some students are not successful with on-line courses.
  Proceedings / AMIA ... Annual Symposium. AMIA Symposium 02/2002;