[Classification in medicine. An introductory reflection on its aim and object]. / Klassifikation in der Medizin. Eine einführende Betrachtung von Sinn und Zweck.

Human beings are born with the ability to recognize Gestalt and to classify. However, all classifications depend on their circumstances and intentions. There is no ultimate classification, and there is no one correct classification in medicine either. Examples for classifications of diagnoses, symptoms and procedures are discussed. The path to gaining knowledge and the basic difference between collecting data (patient file) and sorting data (register) will be illustrated using the BAIK information model. Additionally the model shows how the doctor can profit from the active electronic patient file which automatically offers him other relevant information for his current decision and saves time. "Without classification no new knowledge, no new knowledge through classification". This paradox will be solved eventually: a change of paradigms requires the overcoming of the currently valid classification system in medicine as well. Finally more precise recommendations will be given on how doctors can be freed from the burden of the need to classify and how the whole health system can gain much more valid data without limiting the doctors' freedom and creativity through co-ordinated use of IT, all while saving money at the same time.

Electronic Patient Information -- Pioneers and MuchMore. A vision, lessons learned, and challenges.

OBJECTIVES: This paper must fulfill three different tasks: First, to introduce the topic "Electronic Patient Information -- Pioneers and MuchMore", second, to introduce the invited authors of the symposium, and third, to serve as the author's academic farewell lecture as professor emeritus. RESULTS: The electronic patient record, with all its different kinds of patient information, can be structured in many ways. Here, an historical approach is presented with a primary focus on the development of an information system for in- and outpatients in Germany, especially in Frankfurt, but also in comparison with US systems. The "Stone Age" and "Bronze Age" of patient-related computer applications started with expensive and insufficient hardware, but some years later, the first systems for patient documentation, text generation, and data acquisition could be implemented. The "iron age" and "golden age" yielded until the mid-1970s, e.g. in Oakland, Boston, Salt Lake City, and Frankfurt, quite successful Hospital Information Systems with some special emphasis on natural language processing. The following dark years were filled primarily with administrative systems, but beginning in the early 1980s, an era of enlightenment started, e.g. with rather inexpensive and easy to use PC application, broadly distributed MUMPS systems, and improved thesaurus-based text analysis. Especially in modern times, the medical text processing and classifying has been extended and successfully applied. CONCLUSIONS: Somewhat in contrast to other approaches, in the future the use of medical linguistics for the development of a successful electronic patient record should be better supported. Electronic patient information should be available wherever and whenever needed. For this, intelligent and automated reporting and controlled data exchange is necessary. The computer should do all classification, coding, and administrative work, and the physician should get all relevant information necessary for decision making.

Concept-oriented standardization and statistics-oriented classification: continuing the classification versus nomenclature controversy.

Nowadays, most activities on controlled medical vocabularies focus on the provision of a sufficient atomic-level granularity for representing clinical data. Amongst others, clinical vocabularies should be concept oriented, compositional and should also reject "Not Elsewhere Classified". We strongly share the opinion that there is a need to deal with serious deficits of existing manually created vocabularies and with new demands for computer-based advanced processing and exchange of medical language data. However, we do not share the opinion that methodological requirements like observational and structural comparability needed for sound statistics should not be included in desiderata of controlled medical vocabularies. Statistical-oriented classifications are not developed for representing detailed clinical data but for providing purpose-dependent classes where cases of interest are assigned uniquely. Either statistical classifications are not included into the set of controlled medical vocabularies in the sense of Cimino, or his desiderata are misleading. We argue that statistical classifications should be linked to (formal) concept systems, but again this linkage does not change their different natures. With this article we continue the "classification versus nomenclature" controversy referring to Coté.

Multi-dimensional visualisation of laboratory findings and functional test results for analysing the clinical course of disease in medicine.

The illustration of a patient's history by a graphical primitive is discussed. Illustration technology is presented which simultaneously represents quantitative examination findings (e.g., laboratory values) and qualitative findings (e.g., from function diagnostics) by a single geometrical figure. Depending on the medical results, this figure takes on characteristic forms which can be identified as patterns typical for a specific disease. The procedure developed is integrated in a user interface which is implemented in the form of a computerized medical record for use on a pentop computer. This portable computer assists the physician during ward rounds, supplies additional, intelligence-based information, serves quality control, and streamlines working procedures making them more efficient.

Building two medical databanks.

Two medical databanks are described: one for poison control centres, and one for gastroenterology. They include a diagnostic system built up since 1961 with logistic and statistical trial solutions, barring symptoms and the addition of not-found symptoms in the first data processing of the files. Up to 40 questions are answered by the databank concerning poisons. Around 60,000 items of information are stored. The databank for gastroenterology took 50 man-years for its development. 1381 diagnoses and 35,750 symptoms are now stored, with 445 test cases. Answers for 22 questions are provided. The correct diagnosis is found in 84% and 87% respectively in the first line of the printout; nearly 90% seems possible.

[Statistical contribution on symptomatic dry eye]. / Statistischer Beitrag zur Symptomatik des trockenen Auges

Optical mark page reader forms to establish the case history were statistically evaluated with regard to the question 'Do you often have the feeling of having sand in the eye. Out of a total of 5,833 patients, 684 (11.7%) answered this question with 'yes'. Women stated with 15.1% relatively more often than men with 9.7% this clinical symptom. Of these 684 patients who subjectively complained of feeling of sand, 241 had an ophthalmological examination. In 92 patients (38.2%) the Bengal-Rosa 1% test was specifically performed due to the specific past history and the clinical symptoms stated on questions by the physician; in all cases signs of a keratoconjunctivitis sicca of different degree were found by slit-lamp microscopy, i.e., at least 4.5% keratoconjunctivitis sicca patients on our whole collective can be expected. The result of a thorough examination in these 92 patients (39 men and 53 women) with ophthalmologically confirmed keratoconjunctivitis sicca showed that in 25 (of 53) women there was an imbalance of the sex hormones. Besides degenerative diseases due to age, diseases of the connective tissue and those caused by an auto immune mechansim were found.

[Feeling of sand in the eyes and hormonal contraceptives (authors transl)]. / Sandgefühl der Augen und hormonale Kontrazeptiva

By questionnaire forms the relation between the admission of taking antibaby pills and the subjective feeling of having sand in the eyes was checked. Out of 2201 patients from our group, aged between 9 and 84 years, 372 (16.9%) took hormonal contraceptives, 1812 (82.3%) denied the taking of contraceptives and 17 (0.8%) could not say. From the 372 patients who took hormonal contraceptives 37 (10%) complained of having the feeling of sand in the eyes, the other 335 (90%) denied having a feeling of sand in the eyes. The frequency of a subjective feeling of sand in the eyes was in the individual age groups independent of the subjective statement, of "take hormonal contraceptives" (chi2-test; P greater than 10%).

[The information system of the Deutsche Klinik für Diagnostik (author's transl)]. / Das Informationssystem der Deutschen Klinik für Diagnostik

Data processing in medicine includes the administration, patient control and medical documentation. The introduction must be made step by step, lead to selective editing of information and promote the standardization process through the application of electronic data processing. Data acquisition can be done automatically by activating the computer or feeding from the information flow. Patient-linked information, including clear text, can be inverted, i. e. edited for retrieval by automatic description in a diagnosis orientated form.