摘要:

AbstractInteractive laserdiscs are of limited value in large group learning situations due to the expense of establishing multiple workstations. The authors implemented an alternative to laserdisc video by using indexed digital video combined with an expert system. High-quality video was captured from a laserdisc player and combined with waveform audio into an audio–video-interleave (AVI) file format in the Microsoft Video-for-Windows environment (Microsoft Corp., Seattle, WA). With the use of an expert system, a knowledge-based computer program provided random access to these indexed AVI files. The program can be played on any multimedia computer without the need for laserdiscs. This system offers a high level of interactive video without the overhead and cost of a laserdisc player.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.95202544

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjective: To develop a representational schema for clinical data for use in exchanging data and applications, using a collaborative approach.Design: Representational models for clinical radiology were independently developed manually by several Canon Group members who had diverse application interests, using sample reports. These models were merged into one common model through an iterative process by means of workshops, meetings, and electronic mail.Results: A core merged model for radiologic findings present in a set of reports that subsumed the models that were developed independently.Conclusions: The Canon Group's modeling effort focused on a collaborative approach to developing a representational schema for clinical concepts, using chest radiography reports as the initial experiment. This effort resulted in a core model that represents a consensus. Further efforts in modeling will extend the representational coverage and will also address issues such as scalability, automation, evaluation, and support of the collaborative effort.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.95202547

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjectives: To investigate the issues raised in applying a preliminary version of the GALEN compositional concept reference (CORE) model to a series of radiographic reports, and to demonstrate that the same underlying concept model could be used in conjunction with both a detailed, fine-grained model of medical records based on that used in the PEN&PAD project and with other more conventional medical-record models.Design: Following analysis and representation of concepts from a set of reports, a single report was taken as a “case study.” This report was analyzed in detail in its entirety and represented using each of the medical-record models.Results: The reports were successfully represented within the limits of the study, but a number of significant issues were raised.Conclusion: The compositional approach plus the PEN&PAD medical-record model allowed detailed information in the radiographic report to be represented, including information about the inferences and the clinical process. The resulting representation was large, and more compact representations may be necessary for some systems. Alternative encapsulations of the information as might be used in such systems were successfully prepared. The compositional approach avoided many issues that often cause controversy in the design of traditional coding and classification systems, but it raised other issues, including the handling of ambiguity and underspecification, linkage to information not explicitly present in the report, and questions concerning the focus of individual concepts. All work is preliminary and definitive conclusions await further studies and systematic evaluation.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.95202545

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjective: Develop a continuous-speech interface that allows flexible input of clinical findings into a medical diagnostic application.Design: The authors' program allows users to enter clinical findings using their own vernacular. It displays from the diagnostic program's controlled vocabulary a list of terms that most closely matches the input, and allows the user to select the single best term. The interface program includes two components: a speech-recognition component that converts utterances into text strings, and a language-processing component that matches recognized text strings with controlled-vocabulary terms. The speech-recognition component is composed of commercially available speech-recognition hardware and software, and developer-created grammars, which specify the language to be recognized. The language-processing component is composed of a translator, which extracts a canonical form from both recognized text strings and controlled-vocabulary terms, and a matcher, which measures the similarity between the two canonical forms.Results: The authors discovered that grammars constructed by a physician, who could anticipate how users might speak findings, supported speech recognition better than did grammars constructed programmatically from the controlled vocabulary. However, this programmatic method of grammar construction was more time efficient and better supported long-term maintenance of the grammars. The authors also found that language-processing techniques recovered some of the information lost due to speech misrecognition, but were dependent on the completeness of supporting synonym dictionaries.Conclusions: The authors' program demonstrated the feasibility of using continuous speech to enter findings into a medical application. However, improvements in speech-recognition technology and language-processing techniques are needed before natural continuous speech becomes an acceptable input modality for clinical applications.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.95202546

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjective: Evaluate the performance of a continuous-speech interface to a decision support system.Design: The authors performed a prospective evaluation of a speech interface that matches unconstrained utterances of physicians with controlled-vocabulary terms from Quick Medical Reference (QMR). The performance of the speech interface was assessed in two stages: in the real-time experiment, physician subjects viewed audiovisual stimuli intended to evoke clinical findings, spoke a description of each finding into the speech interface, and then chose from a list generated by the interface the QMR term that most closely matched the finding. Subjects believed that the speech recognizer decoded their utterances; in reality, a hidden experimenter typed utterances into the interface (Wizard-of-Oz experimental design). Later, the authors replayed the same utterances through the speech recognizer and measured how accurately utterances matched with appropriate QMR terms using the results of the real-time experiment as the “gold standard.”Measurements: The authors measured how accurately the speech-recognition system converted input utterances to text strings (recognition accuracy) and how accurately the speech interface matched input utterances to appropriate QMR terms (semantic accuracy).Results: Overall recognition accuracy was less than 50%. However, using language-processing techniques that match keywords in recognized utterances to keywords in QMR terms, the semantic accuracy of the system was 81%.Conclusions: Reasonable semantic accuracy was attained when language-processing techniques were used to accommodate for speech misrecognition. In addition, the Wizard-of-Oz experimental design offered many advantages for this evaluation. The authors believe that this technique may be useful to future evaluators of speech-input systems.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.95202548

出版商:BMJ Group    

年代:1995

数据来源: BMJ

摘要:

AbstractObjective: With the advent of hospital payment by diagnosis-related group (DRG), length of stay (LOS) has become a major issue in hospital efforts to control costs. Because the Columbia-Presbyterian Medical Center (CPMC) has had above-average LOSs for many DRGs, the authors tested the hypothesis that a computer-generated informational message directed to physicians would shorten LOS.Design: Randomized clinical trial with the patient as the unit of randomization.Setting and Study Population: From June 1991 to April 1993, at CPMC in New York, 7,109 patient admissions were randomly assigned to an intervention (informational message) group and 6,990 to a control (no message) group.Intervention: A message giving the average LOS for the patient's admission or provisional DRG, as assigned by hospital utilization review, and the current LOS, in days, was included in the main menu for review of test results in the hospital's clinical information system, available at all nursing stations in the hospital.Main outcome Measure: Hospital LOS.Results: The median LOS for study patients was 7 days. After adjustment for covariates including age, sex, payor, patient care unit, and time trends, the mean LOS in the intervention group was 3.2% shorter than that in the control group (p= 0.022).Conclusion: Computer-generated patient-specific LOS information directed to physicians was associated with a reduction in hospital LOS.

ISSN:1527-974X    

DOI:10.1136/jamia.1995.95202549

出版商:BMJ Group    

年代:1995

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1995.95202550

出版商:BMJ Group    

年代:1995

数据来源: BMJ

ISSN:1527-974X    

DOI:10.1136/jamia.1995.95202551

出版商:BMJ Group    

年代:1995

数据来源: BMJ