Modeling controlled vocabularies using OODBs and multilevel area diagrams

A Controlled Vocabulary (CV) is a software system of domain knowledge that consolidates and unifies the terminology of a large application domain. With a common, centralized CV, costly and time-consuming translations can be eliminated between pairs of organizations and pairs of software systems. Unfortunately, the more knowledge we put into a CV, the harder it is to understand and maintain it. In this dissertation, a comprehensive theoretical methodology for modeling CVs using Object-Oriented Database (OODB) technology is presented. We present two methods for representing a semantic network CV as an equivalent OODB, which we call an Object-Oriented Vocabulary Repository (OOVR). The first method, based on a structural analysis and partitioning of the CV, yields an OODB with a very concise schema, referred to as the OOVR schema. Due to its compact size, the schema can be displayed on one or a few computer screens and serves as an aid for comprehending and maintaining the CV. A program called the Object-Oriented Vocabulary Repository Generator (OOVR Generator) has been built to automatically generate an OOVR for a given semantic network CV. Our second methodology results in a larger schema, which, however, serves as an important tool for browsing and navigation through a CV. The OODB schemas created by both methodologies provide important abstract views of CVs. We have also defined a new type of semantic relationships called IS-A\u27 in the context of an OOVR representation. The IS-A\u27 relationships are defined on OOVR schemas to reflect certain important IS-A relationships in the underlying CV. The two OOVR representations exhibit several interesting theoretical characteristics which are formally proven in this dissertation. To provide an environment with several abstract views of a CV, we also define a paradigm called Multilevel Area Diagrams (MLADs). A MLAD is a collection of different partitions of increasing detail and decreasing abstraction derived from a CV. Users can browse at one level and then switch to another level to continue their navigation. Examples of browsing sessions are presented to show that the MLAD paradigm provides processing capabilities beyond those of a traditional object-oriented representation of a vocabulary

Developing techniques for enhancing comprehensibility of controlled medical terminologies

A controlled medical terminology (CMT) is a collection of concepts (or terms) that are used in the medical domain. Typically, a CMT also contains attributes of those concepts and/or relationships between those concepts. Electronic CMTs are extremely useful and important for communication between and integration of independent information systems in healthcare, because data in this area is highly fragmented. A single query in this area might involve several databases, e.g., a clinical database, a pharmacy database, a radiology database, and a lab test database. Unfortunately, the extensive sizes of CMTs, often containing tens of thousands of concepts and hundreds of thousands of relationships between pairs of those concepts, impose steep learning curves for new users of such CMTs. In this dissertation, we address the problem of helping a user to orient himself in an existing large CMT. In order to help a user comprehend a large, complex CMT, we need to provide abstract views of the CMT. However, at this time, no tools exist for providing a user with such abstract views. One reason for the lack of tools is the absence of a good theory on how to partition an overwhelming CMT into manageable pieces. In this dissertation, we try to overcome the described problem by using a threepronged approach. (1) We use the power of Object-Oriented Databases to design a schema extraction process for large, complex CMTs. The schema resulting from this process provides an excellent, compact representation of the CMT. (2) We develop a theory and a methodology for partitioning a large OODI3 schema, modeled as a graph, into small meaningful units. The methodology relies on the interaction between a human and a computer, making optimal use of the human\u27s semantic knowledge and the computer\u27s speed. Furthermore, the theory and methodology developed for the scbemalevel partitioning are also adapted to the object-level of a CMT. (3) We use purely structural similarities for partitioning CMTs, eliminating the need for a human expert in the partitioning methodology mentioned above. Two large medical terminologies are used as our test beds, the Medical Entities Dictionary (MED) and the Unified Medical Language System (UMLS), which itself contains a number of terminologies

On-demand computerised decision support in paediatric emergency medication administration

Medication errors are common and contribute significantly to avoidable morbidity and mortality. These errors are more common in paediatrics than in adult medicine and yet more common in emergencies than in non-urgent scenarios. Emergency medication use in paediatrics is a complex process, often performed by a multidisciplinary team. This practise spans paediatric emergency weight estimation, medication ordering and the preparation, labelling and finally administration of drugs to critically ill children. Discrepancies during any one of these stages may be the cause of a medication error. This thesis describes the feasibility testing and iterative development of On-Demand Computerised Decision Support (ODCDSS), a digital medication safety system designed to support emergency doctors and nurses at all stages of medication use during paediatric resuscitation. This thesis decouples paediatric weight estimation and medication administration, with each being examined separately. First, opportunities to incorporate digitally-supported weight estimation methods into a comprehensive decision support system are explored. This includes efforts to improve well-established but inaccurate methods such as age-based weight estimation, and an exploration into whether emerging technologies such as three- dimensional imaging could bring greater accuracy than current methods. To validate the design rationale behind ODCDSS, simulated resuscitations are examined using a human factors approach. Human Reliability Analysis (HRA) is 2 used to show both that the incidence of medication error is dangerously high and that many errors are clinically significant, as well to identify the individual process steps that contribute to these errors. This thesis is the first to describe the design and development of ODCDSS. The effectiveness of this experimental prototype was tested in a simulated crossover study which determined that using ODCDSS significantly reduced the odds of a clinically significant medication error occurring. The use of ODCDSS, however, was not error free, and HRA was re-applied to determine precisely where the prototype system required design refinement.Open Acces

Efficient Decision Support Systems

This series is directed to diverse managerial professionals who are leading the transformation of individual domains by using expert information and domain knowledge to drive decision support systems (DSSs). The series offers a broad range of subjects addressed in specific areas such as health care, business management, banking, agriculture, environmental improvement, natural resource and spatial management, aviation administration, and hybrid applications of information technology aimed to interdisciplinary issues. This book series is composed of three volumes: Volume 1 consists of general concepts and methodology of DSSs; Volume 2 consists of applications of DSSs in the biomedical domain; Volume 3 consists of hybrid applications of DSSs in multidisciplinary domains. The book is shaped decision support strategies in the new infrastructure that assists the readers in full use of the creative technology to manipulate input data and to transform information into useful decisions for decision makers

Mobile application to support pediatric medical practice

Dissertação de mestrado em Engenharia InformáticaThe objective of this project is to develop a mobile application in order to aid pediatricians performing their work. The necessity of this application was initially identified by a pediatrician working in Santo António Hospital of Oporto, after also verifying the interest of some of his coworkers. The bibliography also states some situations where mobile applications may be helpful, such as: errors in the administration of drugs or the difficulty pediatricians face in performing needed mathematical operations. It is made a review of pediatric applications, mobile mostly, in order to know what kinds of applications are already available for pediatricians. It is presented the analysis of 5 distinct applications, from medical calculators for emergency situations to decision support systems that given a set of clinical characteristics it is provided a list of diagnosis to consider. Following it is done a study of requirements elicitation and prioritization. Its objective is to know the techniques and tools already studied in the bibliography, as well as to identify the most appropriate ones for this project. Several elicitation and prioritization techniques were used in this project. It is also used a tool to register the requirements. In order to develop a mobile application that may run on the majority of smartphones in the market, it is made an analysis of the smartphone operating systems market share, as well as of market share projections for the next few years. After identifying the target operating systems for the app it is made a study of the mobile cross-platform development frameworks. The framework choice considered the elicited requirements and the operating systems with the greatest market share. After a learning period of the involved technologies, the pediatric app is developed using the gathered requirements and following the results of the requirements prioritization. The development of the application was always followed by a pediatrician, and as a result the application was tested and refined during that time. Finally, the application is released as well as a questionnaire to evaluate it.Este projecto tem o objectivo de criar uma aplicação para os dispositivos móveis que auxilie os médicos pediatras no exercício das suas funções. A necessidade desta aplicação foi inicialmente identificada por um médico pediatra que trabalha no Hospital de Santo António do Porto, após também verificar o interesse de alguns colegas de trabalho. A bibliografia também evidencia algumas situações em que as aplicações móveis podem dar o seu contributo, assim como: erros na administração de medicamentos ou dificuldades na realização de operações matemáticas necessárias. É feita uma análise a aplicações móveis na sua maioria, vocacionadas para pediatria por forma a conhecer o trabalho já realizado nesta área. É apresentada a análise de 5 aplicações diferentes, que vão desde calculadoras médicas para situações de emergência até sistemas de suporte à decisão em que é apresentada uma lista de possíveis diagnósticos dado um conjunto de características do paciente. De seguida é feito um estudo sobre a elicitação e priorização de requisitos. Este estudo teve por objectivo conhecer as técnicas e ferramentas já estudadas até ao momento, assim como identificar e aplicar as que melhor se adequam a este projecto. São aplicadas várias técnicas tanto de elicitação como de priorização de requisitos. É também utilizada uma ferramenta para o registo dos requisitos. Para desenvolver uma aplicação móvel que atinja a grande maioria dos dispositivos móveis, é realizada uma análise ao market share dos sistemas operativos móveis, assim como a previsões para os próximos anos. Depois de identificados os sistemas operativos preferenciais para o desenvolvimento da aplicação é feito um estudo das frameworks de desenvolvimento de aplicações móveis multiplataforma. A escolha da framework teve em conta os requisitos adquiridos e os sistemas operativos com mais peso no mercado. Passado um período de aprendizagem das tecnologias envolvidas neste projecto, é desenvolvida a aplicação em causa, utilizando os dados recolhidos na elicitação de requisitos e seguindo a ordem resultante da priorização dos requisitos. O desenvolvimento da aplicação foi sempre acompanhado por um médico pediatra, sendo a aplicação testada e refinada ao longo desse período. Por fim, a aplicação é lançada assim como um questionário que pretende avaliar a mesma

Willingness to Influence Indication-Based Off-Label Prescribing: an Investigation of Hospital Pharmacists

Off-label prescribing is a comand legal practice in the United States. However, off-label prescribing occurs oftentimes with inadequate evidence of effectiveness. Such practice, especially when prescribing for disease conditions different from approved clinical indications (indication-based off-label prescribing), brings about controversy and raises different issues with various stakeholders. Although indication-based off-label prescribing offers advantages in terms of providing innovative therapy, it raises concerns because the safety and efficacy of such use may not be evaluated adequately. Thus, the objective of the study was to examine whether pharmacists are willing to influence physicians while evaluating an indication-based off-label medication order. Based on the extended social power typology originally proposed by French and raven (1965), the study examined the role of relative expert power, perceived appropriateness, and perceived negative relational consequences on pharmacist\u27s willingness to influence using rationality tactic. Pharmacists practicing in hospitals were recruited from the membership rolls of state affiliates of the American Society of Health-System Pharmacists (ASHP). The state affiliates were requested to distribute to their members an invitation to participate that contained a link to the survey instrument. The study employed a 2 x 2 experimental design in which relative expert power and appropriateness were manipulated using a hypothetical vignette. Respondents who reported practicing in a hospital were randomly assigned to one of the four experimental groups. Responses from 267 pharmacists were available for analysis. After consistency inspection, 242 pharmacist respondents were included in the analysis to examine the various propositions. Results of the analysis shothat, in general, pharmacists were willing to influence physicians to ensure rationality of indication-based off-label prescribing. Although small in magnitude, pharmacists did express concern about negative impact on inter-professional relationship quality that might arise due to influence attempts. Indeed, the effect of perceived expert power differential between the physician and pharmacist and the effect of perceived appropriateness of the off-label medication order on willingness to influence were strongly (p\u3c0.05) moderated by perceived impact on relationship quality. In addition, the perceived expert power differential was associated with pharmacists\u27 willingness to influence. Pharmacists\u27 willingness to influence increased as perceived appropriateness decreased

Conveying meaning through design in a safety critical medical system

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel UniversityMedication errors account for a significant number of medical errors. Giving medications to patients is an activity that carries a high risk of error. In an effort to improve patient safety in this area several approaches have been employed. Many of these have taken a systems approach in that they consider how organisational factors such as medicines management, staffing levels, ward layout, shift patterns and staff training have contributed to the errors. None of these studies describe errors in detailed form at task level. This Thesis addresses the gap in knowledge by presenting a systematic analysis of the component tasks of hospital drug administration where none exists and goes on to describe novel design artefacts that assist the identification of drugs. The thesis highlights how hierarchical task analysis, a human factors technique, can be applied to the hospital drug administration task. Task analysis techniques have been used in many high-risk domains in industry as a means of analysing human activity in complex systems but remains an underused technique in health care. Used with the Systematic Human Error Reduction and Prediction Approach (SHERPA), hierarchical task analysis provides an effective way of predicting where errors in the drug administration task are likely to occur. SHERPA uses a taxonomy of human error modes to highlight types of error and makes suggestions to reduce these errors. Medication errors take many forms however it was decided to focus on the immediate interaction between the nurse and the patient. The measures considered to potentially have a significant influence were adding conspicuous labelling to medication packages. These were enhanced by icons intended to represent categories of drugs. Constructing a three dimensional representation of the icon design was considered to provide nurses with an additional channel of information. Technological solutions were proposed and a patient identity bracelet that uses a programmable chip to link the patient to their prescribed medication was viewed as having a huge potential to simplify the checking aspect of administering medications in which the nurse compares a medication order which is often badly written with available drug stock. The device prevents nurses giving medications to the wrong patient. It also prevents them administering an overdose.Anthony Anson medical fun

Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems

In the foreseeable future, it is likely that the familiar, paper-based patient medical files will become a thing of the past. On April 26, 24, President George W. Bush announced a plan to ensure that all Americans\u27 health records are computerized within ten years and to establish a National Health Information Network. Many advocates are enthusiastically promoting the adoption of health information technology (HIT) and electronic health record (HER) systems as a means to improve U.S. health care. HER systems often not only serve as record-keeping systems, but also have multiple capabilities, including drug ordering, decision support, alerts concerning patient allergies and potential drug interactions, reminders concerning routine tests, and various treatment management and data analysis tools. Because these capabilities require sophisticated software, significant risks of software failure exist, which can lead to life-threatening medical errors. Thus far, scholars have not provided a comprehensive assessment of the benefits and risks of this complex technology and evaluated the need for careful regulatory oversight akin to that required, in principle, by the FDA for life-critical medical devices. This paper begins to fill that gap. It analyzes HER systems from both legal and technical perspectives and focuses on how the law can be used as a tool to promote HIT. It is the first law journal article to provide an extensive proposal for regulations to maximize the technology\u27s benefits and reliability. We argue that the advantages of HER systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering and medical informatics practices. To ensure that these goals are achieved, regulatory intervention is needed. The paper carefully delineates recommendations that address the questions of who should regulate HER systems and how they should be regulated, including their approval and continual monitoring. It also proposes requirements for several significant features, including decision support mechanisms, audit trails, and interoperability. Because HER systems are safety-critical, the public\u27s health and welfare will depend upon their effective oversight

Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems

In the foreseeable future, it is likely that the familiar, paper-based patient medical files will become a thing of the past. On April 26, 24, President George W. Bush announced a plan to ensure that all Americans\u27 health records are computerized within ten years and to establish a National Health Information Network. Many advocates are enthusiastically promoting the adoption of health information technology (HIT) and electronic health record (HER) systems as a means to improve U.S. health care. HER systems often not only serve as record-keeping systems, but also have multiple capabilities, including drug ordering, decision support, alerts concerning patient allergies and potential drug interactions, reminders concerning routine tests, and various treatment management and data analysis tools. Because these capabilities require sophisticated software, significant risks of software failure exist, which can lead to life-threatening medical errors. Thus far, scholars have not provided a comprehensive assessment of the benefits and risks of this complex technology and evaluated the need for careful regulatory oversight akin to that required, in principle, by the FDA for life-critical medical devices. This paper begins to fill that gap. It analyzes HER systems from both legal and technical perspectives and focuses on how the law can be used as a tool to promote HIT. It is the first law journal article to provide an extensive proposal for regulations to maximize the technology\u27s benefits and reliability. We argue that the advantages of HER systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering and medical informatics practices. To ensure that these goals are achieved, regulatory intervention is needed. The paper carefully delineates recommendations that address the questions of who should regulate HER systems and how they should be regulated, including their approval and continual monitoring. It also proposes requirements for several significant features, including decision support mechanisms, audit trails, and interoperability. Because HER systems are safety-critical, the public\u27s health and welfare will depend upon their effective oversight