The Separation of Reviewing Knowledge from Medical Knowledge

J. van der Lei; M. A. Musen

doi:10.1055/s-0038-1634593

Methods of Information in Medicine, Table of Contents

Methods Inf Med 1995; 34(01/02): 131-139
DOI: 10.1055/s-0038-1634593

Original article

Schattauer GmbH

The Separation of Reviewing Knowledge from Medical Knowledge

J. van der Lei

¹Department of Medical Informatics, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands

,

M. A. Musen

²Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA, USA

› Author Affiliations

Abstract

Abstract:

The developers of reviewing systems that rely on computer-based patient-record systems as a source of data need to model reviewing knowledge and medical knowledge. We simulate how the same medical knowledge could be entered in four different systems: CARE, the Arden syntax, Essential-attending and HyperCritic. We subsequently analyze how the original knowledge is represented in the symbols or syntax used by these systems. We conclude that these systems provide different alternatives in dealing with the vocabulary provided by the computer-based patient records. In addition, the use of computer-based patient records for review poses new challenges for the content of that record: to facilitate review, the reasoning of the physician needs to be captured in addition to the actions of the physician.

Keywords:

Computer-based Patient Record - Knowledge - Critiquing Systems - Arden Syntax

Full Text

References

References
1 Blum BI, Duncan K. A History of Medical Informatics. New York: ACM Press; 1990
2 Schwartz W. Medicine and the computer: The promise and problems of change. N Engl J Med 1970; 283: 1257-64.
3 Greenes RA, Shortliffe EH. Medical Informatics: An emerging academic discipline and institutional priority. JAMA 1990; 263: 1114-20.
4 Shortliffe EH, Perreault LE. eds. Medical Informatics: Computer Applications in Health Care. Reading, MA: Addison-Wesley; 1990
5 McDonald CJ, Tierney WM. Computerstored medical records: Their future role in medical practice. JAMA 1988; 259: 3433-40.
6 Shortliffe EH, Tang PC. Patient records and computers. Ann Intern Med 1991; 115: 979-81.
7 McDonald CJ, Barnett GO. Medical-record systems. In: Shortliffe EH, Perreault LE. eds. Medical Informatics: Complller Applications in Health Care. Reading, MA: Addison-Wesley; 1990: 181-218.
8 Institute of Medicine, Committee on Improving the Patient Record. The Computer-Based Patient Record: An Essential Technology for Health Care. Washington, DC: National Academy Press; 1991
9 Van der Lei J, Duisterhout JS, Westerhof HP. et al. The introduction of computerbased patient records in the Netherlands. Ann Intern Med 1993; 119: 1036-41.
10 Branger PJ, Van der Wouden JC, Schudel BR. et al. Electronic data interchange between providers of primary and secondary care. Br Med J 1992; 305: 1068-70.
11 Johnston ME, Langton KB, Haynes RB, Mathieu AM. Effects of computer-based clinical decision support systems on clinical performance and patient outcome. Ann Intern Med 1994; 120: 135-42.
12 Clayton PD, Pryor TA, Wigertz OB. Issues and structures for sharing knowledge among decision-making systems: The 1989 Arden Homestead Retreat. In: Kingsland LC. ed. Proceedings of the 13th annual Symposium on Computer Applications in Medical Care. New York: IEEE Computer Society Press; 1989: 116-21.
13 Musen MA. Dimensions of knowledge sharing and reuse. Comp Biomed Res 1992; 25: 435-67.
14 Koran LM. The reliability of clinical methods, data and judgments. N Engl J Med 1975; 293: 642-6 695-701.
15 Komaroff AL. The variability and inaccuracy of medical data. Proc IEEE 1979; 28: 1196-207.
16 Hsia DC, Krushat WM, Fagan AB, Tebbutt JA, Kusserow RP. Accuracy of diagnostic coding for Medicare patients under the prospective-payment system. N Engl J Med 1988; 318: 352-5.
17 McMahon LF, Smits HL. Can Medicare prospective payment survive the ICD-9-CM disease classification system. Ann Intern Med 1986; 104: 562-6.
18 Burnum JF. The misinformation era: The fall of the medical record. Ann Intern Med. 1989; 110: 482-4.
19 Van der Lei J, Musen MA, Van der Does E, Man in ’t Veld AJ, Van Bemmel JH. Comparison of computer-aided and human review of general practitioners’ management of hypertension. Lancet 1991; 338: 1505-8.
20 Barnett GO, Jenders RA, Chueh HC. The computer-based clinical record: Where do we stand. Ann Intern Med 1993; 119: 1046-8.
21 Barnett GO. The application of computerbased medical-record systems in ambulatory practice. N Engl J Med 1984; 310: 1643-50.
22 Van der Lei J, Musen MA. A model for critiquing based on automated medical records. Comp Biomed Res 1991; 24: 344-78.
23 Warner HR. Computer-Assisted Medical Decision Making. New York: Academic Press; 1978
24 Weed LL. Representation of medical knowledge in PROM IS. In: Blum BI. ed. Computers and Medicine: Information Systems for Patient Care. New York: Springer Verlag; 1984: 83-108.
25 Musen MA, Van der Lei J. Knowledge engineering for clinical consultation programs: Modeling the application area. Meth Inform Med 1989; 28: 28-35.
26 Newell A. The knowledge level. Artif Intelligence 1982; 18: 87-127.
27 Musen MA. Automated Generation of Model-Based Knowledge-Acquisition Tools. London: Pitman; 1989
28 McDonald CJ. Action-Oriented Decisions in Ambulatory Care. Chicago: Year Book Medical Publishers; 1981
29 McDonald CJ, Hui SL, Smith DM. et al. Reminders to physicians from an introspective computer medical record. Ann Intern Med 1984; 100: 130-8.
30 Hripcsak G, Clayton PD, Pryor TA, Haug P, Wigertz OB, Van der Lei J. The Arden syntax for medical logic modules. In: Miller RA. ed. Proceedings of the 14th annual Symposium on Computer Applications in Medical Care. New York: IEEE Computer Society Press; 1990: 200-4.
31 Miller PL. Expert Critiquing Systems: Practice-Based Medical Consultation by Computer. New York: Springer-Verlag; 1986
32 Van der Lei J, Van der Does E, Man in’t Veld A, Musen MA, Van Bemmel JH. Response of general practitioners to computergenerated critiques of hypertension therapy. Meth Inform Med 1993; 32: 146-53.
33 De Smet PAGM. The Dutch approach to computerized drug information: Conceptual basis and realization. J Soc Adm Pharm 1988; 5: 49-58.
34 Musen MA, Weickert KE, Miller ET, Campbell KE, Fagan LM. Development of a controlled medical terminology: Knowledge acquisition and knowledge representation. Proceedings of the IMIA Working Group 6 Conference on Natural Language Processing. Meth Inform Med 1995; 34: 85-95.
35 Weed LL. Medical Records, Medical Education, and Patient: The Problem Oriented Record as a Basic Tool. Cleveland, OH: Case Western Reserve Press; 1971