ABSTRACT
Standardized medical terminologies are gaining importance in the representation of medical data. In this paper, we present the evaluation of the SNOMED3.5 medical terminology to code concepts routinely used in chest radiology reports. Integration of this terminology mapper into a radiology reporting workstation that incorporates a speech recognition system and a natural language processor is also discussed. A total of 700 anatomical location terms (including synonyms) were tested and 72% of the terms had corresponding SNOMED terms. Of the 28% that did not result in a match, 16% were either morphological variants of SNOMED terms or could be found from a combination of terms from two or more SNOMED axes. Only 12% of the terms (primarily specialized radiology terms) were concepts not actually included in the SNOMED terminology.
Subject(s)
Medical Records Systems, Computerized/classification , Radiography, Thoracic/classification , Radiology Information Systems , Vocabulary, Controlled , Humans , Systems Integration , Terminology as Topic , User-Computer InterfaceABSTRACT
An effective, integrated telemedicine system has been developed that allows (a) teleconsultation between local primary health care providers (primary care physicians and general radiologists) and remote imaging subspecialists and (b) active patient participation related to his or her medical condition and patient education. The initial stage of system development was a traditional teleradiology consultation service between general radiologists and specialists; this established system was expanded to include primary care physicians and patients. The system was developed by using a well-defined process model, resulting in three integrated modules: a patient module, a primary health care provider module, and a specialist module. A middle agent layer enables tailoring and customization of the modules for each specific user type. Implementation by using Java and the Common Object Request Broker Architecture standard facilitates platform independence and interoperability. The system supports (a) teleconsultation between a local primary health care provider and an imaging subspecialist regardless of geographic location and (b) patient education and online scheduling. The developed system can potentially form a foundation for an enterprise-wide health care delivery system. In such a system, the role of radiologist specialists is enhanced from that of a diagnostician to the management of a patient's process of care.
Subject(s)
Delivery of Health Care/methods , Teleradiology , Appointments and Schedules , Computer Systems , Diagnostic Imaging , Family Practice , Humans , Hypermedia , Information Storage and Retrieval , Medicine , Online Systems , Patient Education as Topic , Patient Participation , Patient Satisfaction , Primary Health Care , Radiology , Remote Consultation , Software , Specialization , Systems Integration , User-Computer InterfaceABSTRACT
RATIONALE AND OBJECTIVES: The hypotheses of this study were as follows: (a) University subspecialty radiologists can provide consultations effectively to general radiologists as part of routine clinical operations; (b) these consultations will improve the quality of the final radiologic report; and (c) the consultations will improve the care process and may save money, as well. MATERIALS AND METHODS: For 2,012 consecutive computed tomographic or magnetic resonance (MR) imaging studies, the initial interpretations provided by radiology generalists were subsequently reviewed by specialists, with a final consensus report available. "Truth" was established by final consensus reports. To control for potential bias, 150 adult MR imaging and 250 pediatric radiologic studies were interpreted initially by specialists and then by generalists. Again, truth was established by final consensus reports. RESULTS: There was disagreement between generalist and specialist radiologist interpretations in 427 (21.2%) of the cases reviewed. These disagreements were stratified further by independent specialists, who graded them as important, very important, or unimportant. Differences were considered important or very important in 99% of the cases reviewed. CONCLUSION: Consultations by subspecialty radiologists improved the quality of the radiology reports studied and, at least in some cases, improved the process of care by eliminating unnecessary procedures or suggesting more specific follow-up examinations. The consultation services can be provided cost-effectively from the payer's perspective and may save additional costs when unnecessary procedures can be eliminated.
Subject(s)
Quality of Health Care , Remote Consultation , Teleradiology , Humans , Magnetic Resonance Imaging , Tomography, X-Ray ComputedABSTRACT
We show how to generate case-based explanations for non-case-based learning methods such as artificial neural nets or decision trees. The method uses the trained model (e.g., the neural net or the decision tree) as a distance metric to determine which cases in the training set are most similar to the case that needs to be explained. This approach is well suited to medical domains, where it is important to understand predictions made by complex machine learning models, and where training and clinical practice makes users adept at case interpretation.
Subject(s)
Artificial Intelligence , Decision Trees , Neural Networks, Computer , Case-Control Studies , HumansABSTRACT
A multi-tiered telemedicine system based on Java and object-oriented database technology has yielded a number of practical insights and experiences on their effectiveness and suitability as implementation bases for a health care infrastructure. The advantages and drawbacks to their use, as seen within the context of the telemedicine system's development, are discussed. Overall, these technologies deliver on their early promise, with a few remaining issues that are due primarily to their relative newness.
Subject(s)
Database Management Systems , Programming Languages , Telemedicine , Databases as Topic/organization & administrationABSTRACT
Process modeling is explored as an approach for prospectively managing the quality of a telemedicine/telehealth service. This kind of prospective quality management is more appropriate for dynamic health care environments compared to traditional quality assurance programs. A vector model approach has also been developed to match a process model to the needs of a particular site.
Subject(s)
Models, Theoretical , Quality Assurance, Health Care/methods , Telemedicine/standards , Humans , Models, Organizational , Software Design , Telemedicine/organization & administrationABSTRACT
Teaching files based on real patient data can enhance the education of students, staff and other colleagues. Although information retrieval system can index free-text documents using keywords, these systems do not work well where content bearing terms (e.g., anatomy descriptions) frequently appears. This paper describes a system that uses multi-word indexing terms to provide access to free-text patient reports. The utilization of multi-word indexing allows better modeling of the content of medical reports, thus improving retrieval performance. The method used to select indexing terms as well as early evaluation of retrieval performance is discussed.
Subject(s)
Abstracting and Indexing/methods , Medical Records , Subject Headings , Teaching Materials , Evaluation Studies as Topic , Humans , Information Storage and Retrieval , Radiography, Thoracic , Radiology Information SystemsABSTRACT
A prototype multimedia medical database is described for supporting thermal ablation therapy of brain tumors. Its design is motivated by the major need to manage and access multimedia information on the progress and reaction of tumors to various therapy protocols. The database links images to patient data in a way that permits the use to view and query medical information using alphanumeric, temporal, and feature-based predicates. Visualization programs permit the user to view or annotate the query results in various ways. These results support the wide variety of data types and presentation methods required by neuroradiologists to manage thermal ablation therapy data. The database satisfactorily meets the requirements defined by thermal ablation therapy. A similar approach is being undertaken for supporting different therapies of other types of tumors, thus showing the generality of our approach.
Subject(s)
Brain Neoplasms/surgery , Database Management Systems , Electrocoagulation/methods , Image Processing, Computer-Assisted/methods , Multimedia , Brain Neoplasms/diagnosis , Humans , Magnetic Resonance Imaging , Reproducibility of ResultsABSTRACT
A multimedia medical database model and prototype is described for supporting a timeline-based presentation of information. The database links image and text data in a way that permits users to look at medical information in a single unified view. Various visualization programs permit the user to view data in various ways, including full image views, graphs, and tables. Our technology is applied for proof-of-concept to two areas: thoracic oncology and thermal tumor ablation therapy of the brain. This effort is part of the multidisciplinary KMeD project in collaboration with medical research and clinical treatment projects at UCLA.
Subject(s)
Database Management Systems , Diagnosis, Computer-Assisted , Models, Theoretical , Multimedia , Therapy, Computer-Assisted , User-Computer Interface , Data Display , Hospital Information Systems , Humans , Image Processing, Computer-Assisted , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/therapy , Radiology Information Systems , Systems Integration , Time Factors , Tomography, X-Ray ComputedABSTRACT
A prototype multimedia medical database has been developed to provide image and textual data for thoracic oncology patients undergoing treatment of advanced malignancies. The database integrates image data from the hospital picture archiving and communication system with textual reports from the radiology information system, alphanumeric data contained in the hospital information system, and other electronic medical data. The database presents information in a timeline format and also contains visualization programs that permit the user to view and annotate radiographic measurements in tabular or graphic form. The database provides an efficient and intuitive display of the changing status of oncology patients. The ability to integrate, manage, and access relevant multimedia information may substantially enhance communication among distributed multidisciplinary health care providers and may ensure greater consistency and completeness of patient-related data.