An estimate by the U.S. Department of Health and Human Services (DHHS) has used an estimate that a fully developed HealthCare Information Infrastructure (HCII) could save the U.S. economy $100 billion between 1992 and the year 2000 [HHS93].
The traffic pattern of health information differs greatly from that of other applications using digital highways. Much of the traffic is local. A great deal of medical care is delivered in the final years of ones life, and at that time one does not move around much. There are of course cases where rapid access to ones medical record at a remote location can be crucial, and being able to obtain a good record in digital form can make a big difference. That the record should be good must be stated explicitly. Many medical records being kept today are not good. They are often partial, because care was delivered at multiple sites, they are medically incomplete, because they focused on billing and legal accountability, and they are hard to interpret, because of diversity in coding schemes and habits.
After a brief history, focusing on desirable structure of the medical record, we will summarize the functions of the medical record with respect to demands being made for the digital highways.
Private physicians have guidelines on the keeping of records on the patients they see, but there no oversight today. In a clinic or a group practice the records should be adequate so that a !!replacement> can provide care to a patient. Only the potential need to defend oneself legally is a direct inducement to keep careful records about ones' patients. Still many physicians keep careful records, following the habits acquired in medical school.
In 195x? Larry Weed presented a formal structure to collect medical records. The Problem Oriented Medical Record (POMR) became a model for the teaching of keeping patient records. The record for a patient visit is to consist of four entries for each problem:
Having a prognosis enables feedback to occur about one's prognosis and plans. Unfortunately, the prognosis entry is the least consistently applied aspect of the POMR. Without being explicit about the expectations for treatmet it is difficult assess if the plan is successful.
Alerting can be improved by exploiting the * prognosis entry in the !!POMR>. A result value that might be serious for one patient may be expected for another. Since any alert will cause concern, the limits for alert generation are often set quite wide. For instance a weight gain that is in the normal range for a teenager may indicate a pulmonary embolism in a older patient with a heart problem. The use of the patient medical record, and specifically prognosis field greatly increase the relevance of alerting. Alerts can also be generated when expected events do not occur: no laboratory result was received when expected, or the patient failed to make an expected appointment.
Security and protection of privacy is a major concern here. The insurance company must be assured that the care provider and the patient are who they claim to be. The provider wants to be assured that a the bills will be paid eventually, and the patients do not want the record of their problems to become public knowledge.
All terms are categorized into one or more of 132 semantic types. A total of 47 relationship types are
recognized among them. The semantics of UMLS are much richer than those of the * structural model
presented in Chap.
DATABASES.Technologies.structural-model, making
the definition of a suitable algebra that much harder. However, the primary link type is * ownership (or
'isa'), where a lower level term specializes a superior concept, and inherits by default the attributes of its
superior, as shown in .smoking. Negative feedback, as
implied there, is of course, crucial to achieving stability in control theory.
!!at Columbia [cimino in Scherrer:95 UMLS expanded for clinical processing has 108,000 strings with
145,000 relationships
A total of 15 other thesauri and vocabularies contributed information to UMLS. Major, active sources are
the * LoC list of Subject Headings (LCSH), and * MEDLINE, * MeSH \tm,.
Like any ontology, UMLS requires long-term knowledge maintenance. It is now updated annually, but
quarterly updates are contemplated. Some of the changes needed are to correct errors and omissions, but
others will acount for the *evolution in the use of the terms. The existence and utilization of a sharable
ontology brings the community and its use of terms together through practice. The latter is probably the
most important result in the long run. By having tools more people will share concepts and naturally evolve
towards common meanings for terms, just like the Kings James Bible provided a major impetus towards a
consistent spelling in the <<16th>> century. The focus of UMLS research is indeed now the development of
applications, to obtain user coherence and feedback. As such UMLS, in its domain, is a good precedent
setter for HPCC and the general effort to establish highways of the future. The medical domain does have
the advantage that its participants are well-educated and demanding of high quality services. Since
healthcare delivery is costly, even relatively modest benefits can have a high financial impact.
With portable media confidentiality remains a problem. Although the record does not go over multiple
Internet nodes, it is likely that
Figure:. Example of an 'isa' inheritance (not yet in)
Figure: Smoking: An illustration of negative
feedback in a chain of causal relationships(not yet in)
smoking . increased blood pressure . heart attack .
reduction of smoking
!also used were AI/RHEUM, Physicians Data Query (PDQ), DXplain, Quick Medical Reference (QMR),
Dorland's Illustrated Medical Dictionary, Online Mendelian Inheritance In Man (OMIM), ICD9-CM >HEALTH.Technologies.xxx
HEALTH.Alternatives
HEALTH.Alternatives paper
Paper allows for rapid scanning. Even if the information is electronically transmitted many health-care
providers routinely print everything out, scan the data, and then file or discard the paper.
HEALTH.Alternatives.portable-record
A portable record is one that is carried by the person from one health-care facility to another. The U.S.
military use such a record in paper form now, since it is more reliable than their communication systems and
can accommodate all the media being used. A modern record medium could be floppy or a CD-ROM disk.
Fot computer media standards for the format must be defined and and equipment supporting these standards
would have to be widely distributed.
Since the general medical establishment will not entrust the patient with their medical records, there remains
an important role for the interchange of medical records ovr the Internet. Organizations such as the Health
Care Information Corporation (HDIC), a California non-profit group, are working at establishing secure
Internet-based communication for such data.
HEALTH.Bio
\Bio HEALTH. Conclusion
The medical domain does have the advantage that its participants are well-educated, demand high
quality services, and that fractionally modest benefits can have a high financial impact.HEALTH. Lists
Health Care Support Systems
Name | organization | field | when | [ref] | | %source | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ABDA-Pharma | drug | [Miller92] | | | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ageline | AARP | sociology, psychology, services for elderly | [Miller92] | | | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
AI/RHEUM | clinical, immunology | [Miller92] | | | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
AIDSLINE | clinical, HIV | [Miller92]
[Cancer Weekly | NCI | clinical literature | [Miller92] | |
| CHEMLINE | | biochemistry | [Miller92] | |
| DxPlain | Mass.Gen.Hospital | diagnoses | |
| EMI | | environmental mutagens | | [Miller92] | |
| FEDRIP | federal research in progress | [Miller92] | |
| HEALTH | | health planning and administration | [Miller92] | |
| ICSD | inorganic crystal structures | [Miller92] | |
| ISHOW | | hazardous organics in water | [Miller92] | |
| JICST | MITI, Japan | medical science literature abstracts | [Miller92] | |
| Lithium Library | psycho<> drug | [Miller92] | |
| Martindale Online | drug | [Miller92] | |
| Medical Forum | AAMSI | clinical articles, discussions | |
| MEDLINE | NLM | clinical | [Miller92] | |
| OMIM | Johns Hopkins | genetic diseases | [Miller92] | |
| PDQ | Physician Data Query | clinical | [Miller92] | |
| PDR | drug refernce | [Miller92] | |
| PHARma projects | drug | [Miller92] | |
| PharmLINE | drug | [Miller92] | |
| QMR | CAMDAT Corp. | Quick Medical Reference | |
| SEDLINE | drug | [Miller92] | |
| TOXNET | NLM, NIOSH | toxic substances, several files | |
| |