Pain clinic EPR: requirements determination & configuration.

UNLABELLED: The focus of this study was to determine requirements for a general pain EPR (electronic patient record), design this EPR and develop a prototype for demo purposes in pain clinics in The Netherlands. The specifications for this EPR were derived from the 'Nijmegen Classification of Pain', analysis of patient paper records and in-depth interviews with six anaesthesiologists, three physiotherapists and two psychologists. For development a generic configuration tool was used. The actual EPR consisted of five components (two for the anaesthesiologists, one for the physiotherapist, one for the psychologist and one for the whole team). The five components comprised of numerous dialogues. The medical care process directed these dialogues. CONCLUSIONS: The different organisational settings and the variability in provided patient care compromised the development of an EPR for all pain clinics. Defining the granularity of the dialogues was influenced mainly by the factors mentioned previously. However, most respondents agreed on the importance of the following functional demands: registration speed, security, flexibility and supporting of communication between the care providers.

Towards a more rational use of psychoactive substances in clinical practice.

Complex knowledge and data intensive nature of the psychoactive drug selection and prescription process often makes for irrational and inconsistent use of psychoactive drugs in clinical practice. After describing the state of the art with respect to psychoactive drug prescription practices and selection processes, our aim is to analyze the advantages of computer support systems in assisting the clinician in his clinical decisions. Finally, we will review the neuropsychiatric expert systems developed for the neuropsychiatric domain. Suboptimal psychoactive drug therapy is common practice, which leads to hospital admissions, extended length of hospital stay, ineffective therapy and increased costs. Furthermore, the psychoactive drug selection process is a complex decision process, using up-to-date integrative knowledge of drugs from basic sciences to the clinical level. Due to the information load, the lack of appropriate up-to-date information at the point of clinical care and the problem of integrating and weighing all information relatively equally, it is questionable whether any clinician can manage such a complex situation with optimal effectiveness. As has been shown in a number of experiments, clinicians can benefit from computer-based systems that provide access to accurate, up-to-date information. We maintain that more rational use of psychoactive drugs in clinical practice is needed, and conclude that rational psychoactive drug prescription is a knowledge and data-intensive task requiring true expertise derived from clinical, pathophysiological and pharmacotherapeutic knowledge. We will be developing a Multidisciplinary Psychoactive Drug Selection advisor system, M-PADS, to support the integration of various types of biomedical information and deliver that integrated information supportive to evidence-based rational drug prescription in the practice of medicine for the drug treatment of individual patients.

Progress with formalization in medical informatics?

The prevailing view of medical informatics as a primarily subservient discipline in health care is challenged. Developments in both general informatics and medical informatics are described to identify desirable properties of modeling languages and tools needed to solve key problems in the application field. For progress in medical informatics, it is considered essential to develop far more formal modeling languages, modeling techniques, and tools. A major aim of this development should be to expel ambiguity from concepts essential to medicine, positioning medical informatics "at the heart of health care."

Requirements for medical modeling languages.

OBJECTIVE: The development of tailor-made domain-specific modeling languages is sometimes desirable in medical informatics. Naturally, the development of such languages should be guided. The purpose of this article is to introduce a set of requirements for such languages and show their application in analyzing and comparing existing modeling languages. DESIGN: The requirements arise from the practical experience of the authors and others in the development of modeling languages in both general informatics and medical informatics. The requirements initially emerged from the analysis of information modeling techniques. The requirements are designed to be orthogonal, i.e., one requirement can be violated without violation of the others. RESULTS: The proposed requirements for any modeling language are that it be "formal" with regard to syntax and semantics, "conceptual," "expressive," "comprehensible," "suitable," and "executable." The requirements are illustrated using both the medical logic modules of the Arden Syntax as a running example and selected examples from other modeling languages. CONCLUSION: Activity diagrams of the Unified Modeling Language, task structures for work flows, and Petri nets are discussed with regard to the list of requirements, and various tradeoffs are thus made explicit. It is concluded that this set of requirements has the potential to play a vital role in both the evaluation of existing domain-specific languages and the development of new ones.

Computerized charting of case reports.

Follow-up schemas are used in the planning of care delivery for patients who had a larynx tumour resection. Because of the diversity of this population, the idea has arisen that control schemas should be tuned to individual patient histories in order to optimize care delivery. To arrive at refined guidelines, detailed analysis of 300 case reports is planned. In this context a patient case report tool PCRT has been developed to support the analysis of computerized case reports. PCRT is based on an existing patient case report language and can generate case report charts using a newly developed charting method implemented with internet-based technology. This paper presents the charting method and explains the charting algorithm.

Formal description of disease courses.

Patient case analysis is an elementary and crucial process clinicians are confronted with daily. The importance and complexity is reflected in the need to discuss individual patient cases in clinicopathological conferences and the documentation of more than 70,000 patient cases in MEDLINE. This paper introduces DCGL, a technique to model disease course descriptions as present in medical literature. DCGL enables advanced computerised matching of generic disease course descriptions with individual patient case descriptions, a basic function in computerised patient case analysis.

Formal description of temporal knowledge in case reports.

Patient case analysis is an elementary and crucial process which clinicians are daily confronted with. The importance and complexity is reflected in the need to discuss cases in clinicopathological conferences and the documentation of more than 70,000 patient cases in MEDLINE. This paper introduces a generic patient case report language (PCRL) based on general medical temporal concepts to formalise temporal knowledge as present in case descriptions. The lack of such a generic technique is reflected by the fact that computers are very restrictive in accepting patient specific temporal information. Acceptance is almost always controlled and guided by specific predefined disease or treatment models. We strive for a case library consisting of unambiguous patient case descriptions formulated independent from future use.