A Paradigm Shiftin Health Care

InformationSystems:Clinical

Infrastructures forthe 21s* Century

ANNUAL SYMPOSIUM

A Conference of theAmerican Medical

Informatics Association

PROCEEDINGS

November 7-11, 1998

Buena Vista Palace

Orlando, FL

Edited by Christopher G. Chute,

M.D., Dr.P.H.

Program Chair

HANLEY & BELFU8, INC.

Medical Publishers

Philadelphia

Contents

Section I Colloquia

National Information Infrastructure Issues

Health and the National Information Infrastructure 2

D. E. Detmer, MD

The Next Generation Internet and Health Care: A Civics Lesson for the Informatics Community 8

E. H. Shortliffe, MD, PhD

Regional, National, and International Integration of Systems

G7: A Framework for International Cooperation in Medical Informatics 15

D. A. B. Lindberg, MD, and E. R. Siegel, PhD

Clinical Information Systems for Integrated Healthcare Networks 19

J. M. Teich, MD, PhD

Human Factors and the Millenium

Interface Design for Health Care Environments: The Role of Cognitive Science 29

V. L. Patel, PhD, and A. W. Kushniruk, MS

Information Retrieval at the Millenium 38

W. R. Hersh, MD

Reusable Methods and Bioinformatics

Modern Architectures for Intelligent Systems: Reusable Ontologies and Problem-Solving Methods 46

M. A. Musen, MD, PhD

Bioinformatics in Support of Molecular Medicine 53

R. B. Altman, MD, PhD

The State of Medical Terminologies

Clinical Data Exchange Standards and Vocabularies for Messages 62

S. M. Huff, MD

The Copernican Era of Healthcare Terminology: A Re-centering of Health Information Systems 68

C. G. Chute, MD, DrPH

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Section II Clinical Information Management

Electronic Patient Record Innovations

LifeLines: Using Visualization to Enhance Navigation and Analysis of Patient Records 76

C. Plaisant, PhD, R. Mushlin, PhD, A. Snyder, MD, J. Li, D. Heller, and B. Shneiderman, PhD

Clinical Data Entry 81

E. M. van Mulligen, PhD, H. Stam, and A, M. van Ginneken

User Interface Preferences in a Point-of-care Data System 86

R. B. Melles, MD, T. Cooper UI, MD, and G. Peredy, MD

Identification of Design Features to Enhance Utilization and Acceptance of Systems for Internet-based Decision

Support at the Point of Care 91

C, S. Gadd, PhD, P. Baskaran, MS, and D. F. Lobach, MD, PhD

Automated Clinical Decision Support

Potential for Meeting Clinician Information Requirements in an Intensive Care Unit (ICU) via the Web 96

A. G. Randolph, MD, MSc, and J. Kane, MD

Using Web Technology and Java Mobile Software Agents to Manage Outside Referrals 101

S. N. Murphy, MD, PhD, T. Ng, D. F. Sittig, PhD, and G. O. Barnett, MD

Clinical Event Management Using Push Technology: Implementation and Evaluation at Two Health

Care Centers 106

H. R. Warner, Jr., MS, S. Miller, MSN, K. Jennings, MSN, H. Lundsgaarde, PhD, P. Pincetl, MD, E. N.

Robinson, Jr., MD, J. Sommers, PhD, and C. Childress, MD

The Effect of Telemedicine on Neonatal Intensive Care Unit Length of Stay in Very Low BirthweightInfants

, Ill

M. C. Rendina*, MS

Web-Based Electronic Patient Records

Component Architecture for Web-Based EMR Applications 116

D. A. Berkowicz*, MD, MSc, G. O. Barnett, MD, and C. Chueh, MD

Architecture for a Web-Based Clinical Information System That Keeps the Design Open and the Access

Closed 121

J. J. Cimino, MD, S. Sengupta, PhD, P. D. Clayton, PhD, V. L. Patel, PhD, A. W. Kushniruk, MS, and X. Huang,MS

Use of the WWW for Distributed Knowledge Engineering for an EMR: The KnowledgeBank Concept 126

B. Middleton, MD, MPH, MSc, J. Anderson, RN, J. Fletcher, MSc, F. E. Masarie, Jr., MD, and M. K. Leavitt,

MD, PhD

Development of a Web-Based Electronic Patient Record Extending Accessibility to Clinical Information and

Integrating Ancillary Applications 131

D. J. Wang, K. B. Harkness, MS, C. Allshouse, L. Elliot, S. Szekalski, and S. F. Mandell, MS

Student Paper Competition Finalist

xiv

Bringing Clinical Information to the Point of Need

Mobile Workers in Healthcare and Their Information Needs: Are 2-Way Pagers the Answer? 135

S. A. Eisenstadt, MS, M. M. Wagner, MD, PhD, W. R. Hogan, MD, M. C. Pankaskie, PhD, PharmD, F-C. Tsui,

PhD, and W. Wilbright, MD

Preferences of Interns and Residents for E-mail, Paging, or Traditional Methods for the Delivery of Different

Types of Clinical Information 140

M. M. Wagner, MD, PhD, S. A. Eisenstadt, MS, W. R. Hogan, MD, and M. C. Pankaskie, PhD, PharmD

Development of a Clinical Event Monitor for Use with the Veterans Affairs Computerized Patient Record

System and Other Data Sources 145

T. H. Payne, MD, and J. Savarino, PhD

The Effects of an Electronic Medical Record on Patient Care: Clinician Attitudes in a Large HMO 150

P. D. Marshall, MD, and H. L. Chin, MD

Representing Time in Clinical Systems

Knowledge-Based Visualization of Time-Oriented Clinical Data 155

Y Shahar, MD, PhD, and C. Cheng, MS

Mining Biomedical Time Series by Combining Structural Analysis and Temporal Abstractions 160

R. Bellazzi, PhD, P. Magni, C. Larizza, G. De Nicolao, A. Riva, and M. Stefanelli

The Evolution of an Integrated Timeline for Oncology Patient Healthcare 165

A. A, T. Bui, D. R. Aberle, MD, M. F. McNitt-Gray, PhD, A. F Cardenas, PhD, and J. Goldin, MD, PhD

Temporal Representation Design Principles: An Assessment in the Domain of Liver Transplantation 170

C. F. Aliferis, MD, PhD, and G. F. Cooper, MD, PhD

Coding and Retrieving Structured Clinical Data

MYCIN II: Design and Implementation of a Therapy Reference with Complex Content-Based Indexing 175

D. K. Kim, MS, L. M. Fagan, MD, PhD, K. T. Jones, D. C. Berrios, MD, MPH, and V. L. Yu, MD

Using Computer Modeling to Help Identify Patient Subgroups in Clinical Data Repositories 180

G. F. Cooper, MD, PhD, B. G. Buchanan, PhD, M. Kayaalp, MD, MS, M. Saul, and J. K. Vries, MD

Evaluating a Computerized Tool for Coding Patient Information 185

C. Bouchet, MD, F. Empereur, MD, and F. Kohler, MD, PhD

Self-contained Patient Data in ORCA to Cope with an Evolving Vocabulary 190

A. M. van Ginneken, MD, PhD, and P. W. Moorman, MD, PhD

Management Issues in Information Systems

Qualification of Discordant Responses in Utility Assessment 195

D. Steward, DVM, MSIE, andS. Davis, MD, MS

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Renewing Information Infrastructure at Hospital Das Clmicas 200

L. Moura, MSc, PhD, M. B. do Amoral, MD, PhD, A. Lira, MD, U. Tachinardi, MD, A. C. Teixeira, and J.

Yamamoto, PhD

Costs and Benefits of Connecting Community Physicians to a Hospital WAN 205

A. Kouroubali, J. B. Starren, MD, PhD, and P. D. Clayton, PhD

A Software Architecture to Support a Large-Scale, Multi-Tier Clinical Information System 210

J. A. Yungton, D. E Sittig, P. Reilly, J. Pappas, S. Flammini, H. C. Chueh, and J. M. Teich

Empowering Patients and Their Providers

Social Equity and Access to the World Wide Web and E-Mail: Implications for Design and

Implementation of Medical Applications 215

K. D. Mandl, MD, MPH, S. B. Katz, and I. S. Kohane, MD, PhD

Towards Improving the Accuracy of the Clinical Database: Allowing Outpatients to Review Their

Computerized Data .220

G. J. Kuperman, MD, PhD, A. Sussman, MD, L. I. Schneider, MD, J. M. Fiskio, and D. W. Bates, MD, MSc

Pre- and Post- Control Model Research on End-Users' Satisfaction with an Electronic Medical Record:

Preliminary Results 225

L. D. Gamm, PhD, C. K. Barsukiewicz, PhD, K. H. Dansky, PhD, J. J. Vasey, PhD, J. E. Bisordi, MD, and P. C.

Thompson

Moving Towards an Electronic Patient Record: A Survey to Assess the Needs of Community FamilyPhysicians 230

H. R. Strasberg, MD, F. Tudiver, MD, A. M. Holbrook, MD, PharmD, MSc, G. Geiger, MD, K. K. Keshavjee,MD, and S. Troyan

Issues in Clinical Systems Development

Physician Order Entry in U.S. Hospitals 235

J. S. Ash, PhD, MLS, MBA, P. N. Gorman, MD, and W. R. Hersh, MD

What Is an Electronic Patient Record? 240

D. Gordon, PhD, G. Geiger, MD, N. Lowe, MHSc, and J. Jickling, BScN

Methodology for Security Development of an Electronic Prescription System 245

J. Niinimdki, MD, M. Savolainen, MSc, and J. J. Forsstrbm, MD

CATCH/IT: A Data Warehouse to Support Comprehensive Assessment for Tracking Community Health 250

D. J. Berndt, PhD, A. R. Hevner, PhD, and J. Studnicki, ScD

Evaluating Clinical Systems

Evaluation of Online Documentation 255

C. M. Prophet, MA, RN, M. E. Krall, G. K. Budreau, MA, MBA,RN, T. D. Gibbs, MSN, RN, K. P. Walker, MBA,J. M. Eyman, MA, and M. J. Hafner

Physician Use of an Ambulatory Medical Record System: Matching Form and Function 260

N. Folz-Murphy, MS, M. Partin, PhD, L. Williams, RN, C. M. Harris, MD, and M. S. Lauer, MD

xvi

Automated Key Process Monitors for Patient Care Documentation 265

L. K. Heerman, RN, MS, T. D. East, PhD, A. Lugo, and R. L. Bradshaw, MS

Process Modelling and Simulation for Managing Clinical Care in the Community 270

S. Kay, MSc, PhD, N. R. Hardiker, RGN, MSc, S. Aldridge, PhD, B. C. Warboys, MSc, 1. Robertson, A.

Martinez-Garcia, MSc, M. Pentreath, and M. Pitt, MSc

Encoding Problem Lists and Other Clinical Data

Extracting Medical Knowledge for a Coded Problem List Vocabulary from the UMLS Knowledge Sources. . .

.275

J. W. Hales, PhD, K. M. Schoeffler, and D. P. Kessler

Just-in-Time Coding of the Problem List in a Clinical Environment 280

/. J. Warren, PhD, RN, J. C. Collins, C. Sorrentino, RN, and J. R. Campbell, MD

Strategies for Problem List Implementation in a Complex Clinical Enterprise 285

J. R. Campbell, MD

Modeling Utilization of Planned Information Technology 290

T. D. Stettheimer, MS, and A. D. Cleveland, PhD

Assessing Outcomes

Computerized Management of Diabetes: A Synthesis of Controlled Trials 295

E. A. Balas, MD, PhD, S. A. Boren, MHA, and G. Griffing, MD

"Virtual" Clinical Trials: Case Control Experiments Utilizing a Health Services Research Workstation 300

M. G. Weiner, MD, and A. L. Hillman, MD, MBA

Representing the Work of Medical Protocols for Organizational Simulation 305

D. B. Fridsma, MD

Linking Information Needs with Evaluation: The Role of Task Identification 310

C. R. Weir, PhD

Clinical Systems Innovations

Modifiable Templates Facilitate Customization of Physician Order Entry 315

M. J. Franklin, D. F. Sittig, J. L. Schmiz, C. D. Spurr, D. Thomas, E. M. O'Connell, and J. M. Teich

Clinical Application of the UMLS in a Computerized Order Entry and Decision-Support System 320

A, Geissbuhler, MD, and R. A. Miller, MD

Problem Focused Knowledge Navigation: Implementing the Problem Focused Medical Record and the

O-HEAP Note 325

K. C. Meyers, MD, H. J. Miller, MD, and F. Naeymi-Rad, PhD

Implementation of an On-Line Emergency Unit Nursing System 330

P. Q. Bourie, RN, V A. Ferrenberg, RN, M. McKay, J. D. Halamka, MD, MS, and C. Safran, MD, MS

*Student Paper Competition Finalist

xvii

Section III Health Information Networks

Telemedicine on the Internet

Patients' Acceptance of Internet-Based Home Asthma Telemonitoring 336

J. Finkelstein, MD, PhD, G. Hripcsak, MD, and M. R. Cabrera, MD

Creation and Maintenance of Helix, a Web-Based Database of Medical Genetics Laboratories, to Serve the

Needs of the Genetics Community 341

P. Tarczy-Homoch, MD, M. L. Covington, J. Edwards, PhD, P. Shannon, S. Fuller, PhD, and R. A. Pagon, MD

Nationwide Telecare for Diabetics: A Pilot Implementation of the HOLON Architecture 346

P. C. Jones, B. G. Silverman, PhD, M. Athanasoulis, D. Drucker, H. Goldberg, MD, J. Marsh, C. Nguyen, D.

Ravichandar, MS, L. Reis, MS, D. Rind, MD, and C. Safran, MD, MS

Baby CareLink: Development and Implementation of a WWW-Based System for Neonatal Home

Telemedicine 351

J. Gray, MD, MS, G. Potnpilio-Weitzner, RNC, P. C. Jones, Q. Wang, MD, M. Coriat, and C. Safran, MD, MS

Security for Clinical Records

Health Information Identification and De-Identification Toolkit 356

/. S. Kohane, MD, PhD, H. Dong, MS, and P. Szolovits, PhD

Vital Signs Services for Secure Telemedicine Applications 361

C, Sima, MS, MA, R. Raman, R. Reddy, W. Hunt, and S. Reddy

Protecting Clinical Data on Web Client Computers: The PCASSO Approach 366

D. R. Masys, MD, and D. B. Baker, PhD

Implementation of Organizational Practices to Protect Information in Health Organizations 371

A. J. Olsen, MBA, MA, D. Giuse, Drlng, R. B. Borden, RN, M. K. Miers, MS, MBA, M. G. Reeves, RRA, and

W. W. Stead, MD

Telemedicine and Health Information via Networks

Extending Contemporary Decision Support System Designs to Patient-Oriented Systems 376

G. C. Scott and L. A. Lenert, MD, MS

Designing HeartCare: Custom Computerized Home Care for Patients Recovering from CABG Surgery 381

P. F. Brennan, RN, PhD, B. Caldwell, PhD, S. M. Moore, PhD, RN, N. Sreenath, PhD, and J. Jones, MS

CARE-PARTNER: A Computerized Knowledge-Support System for Stem-Cell Post-Transplant Long-TermFollow-Up on the World Wide Web 386

/. Bichindaritz, PhD, M. F. Siadak, PA, J. Jocom, ARNP, C. Moinpour, PhD, E. Kansu, MD, G. Donaldson, PhD,N. Bush, PhD, M. Chapko, PhD, J. M. Bradshaw, PhD, and K. M. Sullivan, MD

Linking Multiple Heterogeneous Data Sources to Practice Guidelines 391

F. J. van Wingerde, drs, Y. Sun, MD, O. Harary, MPH, K. D. Mandl, MD, MPH, S. Salem-Schatz, ScD, C. J.

Homer, MD, MPH, and 1. S. Kohane, MD, PhD

xviii

Innovations in Health Information Networks

Remote Clinical Assessment for Acute Trauma: An Initial Experience 396

/ A. Aucar, MD, R. Eastlack III, MS, M. J. Wall, Jr., MD, K. R. Liscum, MD, T. S. Granchi, MD, and K. L.

Mattox, MD

Managing Care in an Integrated Delivery System via an Intranet 401

J. D. Halamka, MD, MS, M. Hughes, J. Mack, M. Hurwitz, F. Davis, D. Wood, K. Borten, and A. K. Saal, MD

HOLON: Extending Web Document Libraries via Objects in Order to Support the Health Information

Infrastructure 406

B. G. Silverman, PhD, P. Jones, MS, C. Safran, MD, MS, L. Reis, MS, D. Ravichandar, MS, C. Andonyadis, MS,

H. Goldberg, MD, and J. Marsh, MA

A Component-Based Problem List Subsystem for the HOLON Testbed 411

V Law, H. S. Goldberg, MD, P. Jones, and C. Safran, MD, MS

Section IV Training, Education, and Cognitive Science

Structural Informatics Applications

Delivering Labeled Teaching Images over the Web 418

H. P. Lehmann, MD, PhD, B. Nguyen, MEE, and J. Freedman, MS

The Digital Anatomist Structural Abstraction: A Scheme for the Spatial Description of Anatomical Entities .. .423

P. J. Neal, L. G. Shapiro, PhD, and C. Rosse, MD, DSc

Identification of Anatomical Terminology in Medical Text 428

C. A. Sneiderman, MD, PhD, T. C. Rindflesch, PhD, and C. A. Bean, PhD

Partonomies for Interactive Explorable 3D-Models ofAnatomy 433

R. Schubert and K. H. Hbhne

Modeling Patients and Patients' Preferences

Simulating Patients with Parallel Health State Networks 438

W. Sumner II, MD, M. Truszczynski, PhD, and V. W. Marek, PhD, DSc

A Qualitative Model for Computer-Assisted Instruction in Cardiology 443

N. Julen, PhD, P. Siregar, Ph,D., J-P. Sinteff, MSc, and P. Le Beux, MD, PhD

Improving Patient Outcomes by Including Patient Preferences in Nursing Care 448

C. M. Ruland*, PhD, RN

Child Health Records: Are They Valid and Useful to Children and Pediatric Practitioners? 453

C. S. Choi, MS, P. F. Brennan, PhD, RN, and C. Kalish, PhD

Teaching Medical Informatics

A Vertical Curriculum to Teach the Knowledge, Skills, and Attitudes of Medical Informatics 457

J. J. McGowan, PhD, W. Raszka, MD, J. Light, MLS, D. Magrane, MD, D. O'Malley, MLS, and T. Bertsch, MD

Student Paper Competition Finalist

xix

The Dependence of Educational Infrastructure on Clinical Infrastructure

C. Cimino, MD

,462

An Overview of the Medical Informatics Curriculum in Medical Schools 467

J. U. Espino and M. G. Levine

Public Health Informatics: A CDC Course for Public Health Program Managers , 472

P. W. O'Carroll, MD, MPH, W. A. Yasnoff, MD, PhD, and W. Wilhoite

Section V Expert Systems and Algorithms

Knowledge-Based Systems for Clinical Guidelines

P-CAPE: A High-Level Tool for Entering and Processing Clinical Practice Guidelines 478

R. D. Zielstorff, RN, MS, J. M. Teich, MD, PhD, M. D. Paterno, M. Segal, MS, G. J. Kuperman, MD, PhD, F. L.

Hiltz, PhD, and R. L. Fox, MS

Intention-Based Critiquing of Guideline-Oriented Medical Care 483

A. Advani, MD, MPH, K. Lo, MS, and Y. Shahar, MD, PhD

Hypertextual Navigation Operationalizing Generic Clinical Practice Guidelines for Patient-Specific TherapeuticDecisions 488

J. Bouaud, PhD, B. Se'roussi, MD, PhD, E-C. Antoine, MD, M. Gozy, MD, D. Khayat, MD, and J-F. Boisvieux,

MD, PhD

Long Term Changes in Compliance with Clinical Guidelines through Computer-Based Reminders 493

M. M. Morgan, J. Goodson, MD, and G. O. Barnett, MD

Information Systems Architectures

Scaling an Expert System Data Mart: More Facilities in Real-Time, 498

L. A. McNamee, B. D. Launsby, M. E. Frisse, MD, R. Lehmann, and K. Ebker, MS

A Graphical Tool for Ad Hoc Query Generation 503

K. Stoffel, J. D. Davis, G. Rottman, J. Saltz, J. Dick, W. Merz, and R. Miller

Large-Scale Database Scrubbing Using Object-Oriented Software Components 508

R. L. Herting, Jr., MD, * and M. R. Barnes, MD

Assessing an AI Knowledge-Base for Asymptomatic Liver Diseases 513

A. Babic, PhD, U. Mathiesen, MD, K. Hedin, MD, G. Bodemar, MD, PhD, and O. Wigertz, PhD

Automated Pattern Recognition

Guideline Generation from Data by Induction of Decision Tables Using a Bayesian Network Framework 518

S. Mani, MBBS, MS, and M. J. Pazzani, PhD

Improving Machine Learning Performance by Removing Redundant Cases in Medical Data Sets 523

L. Ohno-Machado, MD, MHA, PhD, H. S. Fraser, MRCP, MSc, and A. 0hrn, MSc

Student Paper Competition Finalist

XX

Comparison of Multiple Prediction Models for Ambulation Following Spinal Cord Injury 528

T. Rowland, MD, L. Ohno-Machado, MD, PhD, and A. 0hrn, MSc

A Comparison of Neural Network Models for the Prediction of the Cost of Care for Acute Coronary SyndromePatients 533

M. B. Ismael, MS, E. L. Eisenstein, DBA, and W. E. Hammond, PhD

Automated Clinical Classification

Modeling Treatment of Ischemic Heart Disease with Partially Observable Markov Decision Processes 538

M. Hauskrecht, PhD, and H. Eraser

Building Manageable Rough Set Classifiers 543

A. 0hrn, MSc, L. Ohno-Machado, and T. Rowland

Automated Knowledge Acquisition from Clinical Databases Based on Rough Sets and Attribute-Oriented

Generalization 548

S. Tsumoto, MD, PhD

New Advances and Validation of Knowledge Management Tools for Critical Care Using Classifier

Techniques 553

M. Frize, MD, L. Wang, C. M. Ennett, B. G. Nickerson, F. G. Solven, and M. Stevenson

Decision Support and Knowledge Systems

Evolution of a Knowledge Base for a Clinical Decision Support System Encoded in the Arden Syntax 558

R. A. Jenders, MD, MS, H. Huang, MPhil, G. Hripcsak, MD, and P. D. Clayton, PhD

Issues in Accommodating National Changes and Local Variation in a Computer-Based Guideline for Childhood

Immunization and in Related Knowledge Maintenance Tools 563

P. L. Miller, MD, PhD, S. J. Frawley, PhD, andF. G. Sayward, PhD

Automated Knowledge Extraction from the UMLS 568

Q. Zeng, MS, and J. J. Cimino, MD

A Computerized Reminder for Prophylaxis of Deep Vein Thrombosis in Surgical Patients 573

R. Patterson, MD

Expert Systems for Disease Prediction and Analysis

Can Low Accuracy Disease Risk Predictor Models Improve Health Care Using Decision Support Systems? ...577

D. K. Benn, DDS, PhD, D. D. Dankel II, PhD, and S. H. Kostewicz

A Fuzzy Classification System to Predict Renal Artery Restenosis after Angioplasty 582

/. Cherrak, M-C. Jaulent, PhD, and P. Degoulet

Bayesian Modeling for Linking Causally Related Observations in Chest X-Ray Reports 587

W. W. Chapman and P. J. Haug, MD

The Impact of Modeling the Dependencies among Patient Findings on Classification Accuracy and

Calibration 592

S. Monti, MS, * and G. F. Cooper

Student Paper Competition Finalist

xxi

Knowledge-Based Systems

MediAgent: A WWW-Based Scalable and Self-Learning Medical Search Engine 597

J. Tay, S. Ke, and K. C. Lun

A Declarative Explanation Framework That Uses a Collection of Visualization Agents 602

R. D. Shankar, MD, MS, S. W. Tu, MS, and M. Musen, MD, PhD

DXplain on the Internet 607

G. O. Barnett, MD, K. T. Famiglietti, R. J. Kim, E. P. Hoffer, MD, and M. J. Feldman, MD

Consumer Health Informatics: Knowledge Engineering and Evaluation Studies of Medical HouseCall 612

O. Bouhaddou, PhD, J. G. Lambert, MD, and S. Miller, RN, MS

Expert Systems Applications

Optimal Use of Communication Channels in Clinical Event Monitoring 617

W. R. Hogan, MD, and M. M. Wagner, MD, PhD

Differential Diagnoses of the Heart Disease Program Have Better Sensitivity Than Resident Physicians 622

H. S. F. Fraser, MRCP, MSc, W. J. Long, PhD, and S. Naimi, MD

Therapy Planning as Constraint Satisfaction: A Computer-Base Antiretroviral Therapy Advisor for the

Management of HIV 627

D. S. Smith, MD, J. Y. Park, andM. A. Musen, MD, PhD

Diagnosing Community-Acquired Pneumonia with a Bayesian Network 632

D. Aronsky, MD, and P. J. Haug, MD

Section VI Information Retrieval and Digital Libraries

Systems to Access and Integrate Health Information

Towards Interoperability of Information Sources within a Hospital Intranet 638

S. Aymard, D. Fieschi, F. Volot, M. Joubert, and M. Fieschi

Peer Reviewing and Curating the Health Care Information Infrastructure: Experiences and

Recommendations 643

M. P. D'Alessandro, MD, A. M. Westenfield, MD, D. M. D'Alessandro, MD, P. R. Pomrehn, MD, and J. R.

Galvin, MD

MCM Generator: A Java-Based Tool for Generating Medical Metadata 648

F. Munoz and W. R. Hersh, MD

HCFA Documentation Guidelines and the Need for Discrete Data: A Golden Opportunity for Applied Health

Informatics 653

M. I. Taragin, MD, MPH, M. Lauer, MD, M. Savir, MD, E. Sivan, D. Siesel, and B. Aufgang

xxii

Section VII User Interface Issues

Innovations in Information Retrieval

Information Needs Research in the Era of the Digital Medical Library 658

E. C. Lomax, MLS, and H. J. Lowe, MD

Developing Search Strategies for Detecting High-Quality Reviews in a Hypertext Test Collection 663

M. P. lacks, MD, and W. R. Hersh, MD

Versatility of a Multilingual and Bi-Directional Approach for Medical Language Processing 668

A-M. Rassinoux, PhD, C. Lovis, MD, R. H. Baud, PhD, andJ-R. Scherrer, MD

SAPHIRE International: A Tool for Cross-Language Information Retrieval 673

W. R. Hersh, MD, and L. C. Donohoe, MLIS

System Architectures and User Interfaces

The Integration of a Novice User Interface into a Professional Modeling Tool 678

S. Ramakrishnan, MS, C. E. Hmelo, R. S. Day, W. E. Shirey, and Q. Huang

Contextual and Temporal Clinical Guidelines 683

A. Guarnero, M. Marzuoli, G. Molino, P. Terenziani, M. Torchio, and K. Vanni

Electronic Surveillance of Disease States: A Preliminary Study in Electronic Detection of Respiratory Diseases

in a Primary Care Setting 688

J. Hung, J. Posey, MD, R. Freedman, PhD, and T. Thornton, MD

Design of a Modular, Extensible Decision Support System for Arrhythmia Therapy 693

C. H. F. Cheng, G. D. Sanders, PhD, K. M. McDonald, MM, P. A. Heidenreich, MD, M. A. Hlatky, MD, and

D. K. Owens, MD, MSc

User Interface Innovations

TraumaTalk: Content-to-Speech Generation for Decision Support at Point of Care 698

G. Bierner, MSE

A COSTAR Interface Using WWW Technology 703

U. Rabbani, M. Morgan, and G. O. Barnett, MD

A Graphical User Interaction Model for Integrating Complex Clinical Applications: A Pilot Study 708

D. F. Sittig, PhD, J. A. Yungton, G. J. Kuperman, and J. M. Teich

Hospitexte: Towards a Document-Based Hypertextual Electronic Medical Record 713

J. Charlet, PhD, B. Bachimont, PhD, V. Brunie, MSc, S. El Kassar, MSc, P. Zweigenbaum, PhD, and J-F.

Boisvieux, MD, PhD

xxiii

Section VIII Standards and Policies

XML as a Health Data Interchange Standard

SGML and XML as Interchange Formats for HL7 Messages 720

R. H. Dolin, MD, W. Rishel, P. V Biron, MLIS, J. Spinosa, MD, PhD, and J. E. Mattison, MD

Extensible Markup Language (XML) in Health Care: Integration of Structured Reporting and Decision

Support 725

C. E. Kahn, Jr., MD, and N. B. de la Cruz, PhD

An XML Portable Chart Format 730

H. C. Chueh, MD, MS, W. F. Raila, D. A. Berkowicz, MD, and G. 0. Barnett, MD

Using the Extensible Markup Language (XML) in Automated Clinical Practice Guidelines 735

A. K. Dubey* MD, and H. C. Chueh, MD

Standards for Clinical Data

Compositional Concept Representation Using SNOMED: Towards Further Convergence of Clinical

Terminologies 740

K. A. Spackman, MD, PhD, and K. E. Campbell, MD, PhD

Setting Standards for Nursing Data Sets in Information Systems 745

C. B. Averill, MS, R. Zielstorff, PhD, RN, C. Delaney, PhD, RN, B. Carty, Ed.D„ RN, and M, J. Ferrell, PhD,

RN

Updating a Bibliography Using the Related Articles Function within PubMed 750

X. Liu, and R. B. Altman, MD, PhD

A Tagging System for Section Headings in a CEN Standard on Patient Record 755

A. Rossi Mori, DOTT, F. Consorti, and E. Galeazzi

Medical Vocabulary Applications

Morpho-Semanlic Parsing of Medical Expressions 760

R. H. Baud, PhD, C. Lovis, MD, A-M. Rassinoux, PhD, and J-R. Scherrer, MD

A Randomized Controlled Trial of Automated Term Composition 765

P. L. Elkin, MD, K. R. Bailey, PhD, and C. G. Chute, MD, DrPH

Converting an Integrated Hospital Formulary into an Object-Oriented Database Representation 770

H. Gu, MS, L. Liu, M. Halper, J. Geller, and Y, Perl

Evaluating Lexical Variant Generation to Improve Information Retrieval 775

G. Divita, MS, A. C. Browne, and T. C. Rindflesch, PhD

Progress Toward Standard Medical Vocabularies

Discovering the Modifiers in a Terminology Data Set 780

A. T. McCray, PhD, and A. C. Browne

""Student Paper Competition Finalist

xxiv

A "Lexically-Suggested Logical Closure" Metric for Medical Terminology Maturity 785

K. E. Campbell, MD, PhD, M. S. Tuttle, and K. A. Spackman, MD, PhS

Reproducibility of Interpreting "And" and "Or" in Terminology Systems 790

E. A. Mendonca, MD, J. J. Cimino, MD, K. E. Campbell, MD, PhD, and K. A. Spackman, MD, PhD

A Clinical Terminology in the Post Modern Era: Pragmatic Problem List Development 795

C. G. Chute, MD, P. L. Elkin, MD, S. H. Fenton, and G. E. Atkin

Unified Medical Language System Progress

A Proposal for Incorporating Health Level Seven (HL7) Vocabulary in the UMLS Metathesaurus 800

S. M. Huff, MD, W. D. Bidgood, Jr., MD, J. J. Cimino, MD, and W. E. Hammond, PhD

Validation of Clinical Problems Using a UMLS-Based Semantic Parser 805

H. S. Goldberg, MD, C. Hsu, V. Law, and C. Safran, MD, MS

An Ontological Analysis of the UMLS Metathesaurus 810

D. M. Pisanelli, A. Gangemi, and G. Steve

Beyond Synonymy: Exploiting the UMLS Semantics in Mapping Vocabularies 815

O. Bodenreider, MD, PhD, S. J. Nelson, MD, W. T. Hole, MD, and H. F. Chang, MS

Issues in Knowledge Representation

The Digital Anatomist Foundational Model: Principles for Defining and Structuring its Concept Domain 820

C. Rosse, MD, DSc, L. G. Shapiro, PhD, and J F. Brinkley, MD, PhD

The Potential of the Digital Anatomist Foundational Model for Assuring Consistency in UMLS Sources 825

J. L. V. Mejino, Jr., MD, and C. Rosse, MD, DSc

Part-Whole Reasoning in Medical Ontologies Revisited: Introducing SEP Triplets into Classification-Based

Description Logics 830

S. Schulz, Drmed, M. Romacker, and U. Hahn

Knowledge Discovery and Data Mining to Assist Natural Language Understanding 835

A. Wilcox, MA, and G. Hripcsak, MD

Clinical Terminologies

Clinical Administration Procedures in the Read Thesaurus: Extending the ENV 1828 Model to Support

Regional Terminology Requirements 840

D. Robinson, MBBS, MSc, C. Price, MPhil, and P. J. B. Brown, MRCGP

Validating Clinical Terminology Structures: Integration and Cross-Validation of Read Thesaurus and

GALEN 845

J. E. Rogers, MRCGP, C. Price, A. L. Rector, W. D. Solomon, and N. Smejko

XXV

Synchronization of Diverging Versions of a Controlled Medical TerminologyD. E. Oliver, MD

850

An Evaluation of Natural Language Processing Methodologies 855

C. Friedman, PhD, G. Hripcsak, and I. Shablinsky

Issues in the Development of Standard Terminologies

Automatic Extraction of PIOPED Interpretations from Ventilation/Perfusion Lung Scan Reports 860

M. Fiszman, MD, P. J. Haug, MD, and P. R. Frederick, MD

The Need for a Concept-Based Medication Vocabulary as an Enabling Infrastructure in Health Informatics.. .

.865

W. D. Sperzel, MD, MS, C. A. Broverman, PhD, J. E. Kapusnik- Uner, PharmD, and J. M. Schlesinger

Computer-Facilitated Collaboration: Experiences Building SNOMED-RT 870

D. H. Levy, MD, R. H. Dolin, MD, J. E. Mattison, MD, K. A. Spackman, MD, PhD, and K. E. Campbell, MD,PhD

Data Dictionaries at Giessen University Hospital: Past - Present - Future 875

T. Bilrkle, PhD, H-U. Prokosch, A. Michel, and J. Dudeck

Section IX Images and Other Nontextual Data

Accessing and Interpreting Digital Images

Towards Knowledge-Based Retrieval of Medical Images: The Role of Semantic Indexing, Image Content

Representation, and Knowledge-Based Retrieval 882

H. J. Lowe, MD, I. Antipov, W. Hersh, MD, and C. Arnott-Smith, MA, MILS

Unified Modeling Language and Design of a Case-Based Retrieval System in Medical Imaging 887

C, Le Bozec, MD, M-C. Jaulent, PhD, E. Zapletal, and P. Degoulet, MD, PhD

Requirements for an On-Line Knowledge-Based Anatomy Information System 892

J. F. Brinkley, MD, PhD, and C. Rosse, MD, DSc

Automatic Semantic Interpretation ofAnatomic Spatial Relationships in Clinical Text 897

C. A. Bean, PhD, T. C. Rindflesch, PhD, and C, A. Sneiderman, MD, PhD

Medical Imaging Systems

Integration of DICOM Images into an Electronic Medical Record Using Thin Viewing Clients 902

B. K. Stewart, PhD, and S. G. Langer, PhD

System for Efficient and Secure Distribution of Medical Images on the Internet 907

J. Z Wang, MS, and G. Wiederhold, PhD

Digital Dynamic Telepathology: The Virtual Microscope 912

A. Afework, M.D. Beynon, F. Bustamanie, S. Cho, PhD, A. Demarzo, MD, R. Ferreira, R. Miller, MD, M.

Silberman, MD, J, Saltz, MD, PhD, A. Sussman, PhD, and H. Tsang

xxvi

Diagnostic Quality of Low-Resolution Images for Tele-Wbundcare 917

A. C. Roth, PhD, J. C. Reid, PhD, and M. Concannon, MD

Imaging and Reasoning

Incorporating Constraint-Based Shape Models into an Interactive System for Functional Brain Mapping 921

K. P. Hinshaw, MS, and J. F. Brinkley, MD, PhD

Vector-Field Classification in Magnetic-Resonance Angiography 926

M. A. Tovar, MS*

\

Locating Blood Vessels in Retinal Images by Piece-Wise Threshold Probing of a Matched Filter Response ... .931

A. Hoover, PhD, V. Kouzne^tsova, PhD, and M. Goldbaum, MD

i

A New Approach to Optimal Dynamic Therapy Planning 936

P. Magni, PhD

Section X Bioinformatics and Molecular Applications

Bioinformatics and Query Generation

Automatic Query Mapping among Genomic Databases: A Pilot Exploration 942

K-H. Cheung, MS, P. Nadkami, MD, P. L. Miller, MD, PhD, and D-G. Shin, PhD

MHCWeb: Converting aWWW Database into a Knowledge-Based Collaborative Environment 947

L. Hon, N. F. Abernethy, V. Brusic, J. Chai, and R. B. Altman

Integrating Molecular Diagnostic and Flow Cytometric Reporting for Improved Longitudinal Monitoring of

HIV Patients 952

A. L. Asare, H. Huda, J. C. Klimczak, DVM, MS, and C. W. Caldwell, MD, PhD

Data Mining by Clinicians 957

D. J. Nigrin, MD,*andI. S. Kohane, MD, PhD

Section XI Posters

WeblNQUIRER: Transition of an Educational Database to a Platform-Independent Environment 964

R. T. Aarhus, Jr., MS, MA, S. M. Downs, MD, J. W. Loonsk, MD, andD. S. Fritsch, PhD

Improved Access to Hematopathology Teaching Images 965

L. B. Afrin, MD

Virtual Cell: A New Approach for Undergraduate Biochemistry Practical Lessons 966

G. G. Amorim, F. S. Leao, J. L. L. Filho, PhD, and M. A. Novaes, PhD

Multi-Hospital Data Mart for Quality Improvement in Ambulatory Care 967

S. M. Anderson, MS, M. B. McDonell, MS, C. C. Canody, S. J. Schreiner, and S. D. Fihn, MD, MPH

"Student Paper Competition Finalist

xxvii

Using Co-Occurrence Data to Determine a Thesaurus Structure 968

J. E. Andrews, MLS, T. B. Patrick, PhD, D. E. Moxley, MLS, C. M. Meyer, MLS, M. Popescu, and M. C. Sievert,

PhD, MLS

Reducing Free Text Entries: A Continuous Quality Improvement Project 969

D. Aronsky, MD, K. Merkley, RN, P. J. Haug, MD, and B. C. James, MD, MS

Using Emergency Department Admission Rates to Guide Training and Guideline Development 970

P. Barr, MPH, N. Little, MD, and J. McClay, MS, MD

A System for Pilot Testing Clinical Knowledge Questions Using Pseudo-Anonymous Electronic Mail 971

D. S. Bell, MD, and C. M. Mangione, MD, MSPH

A Web-Based System for Diabetes Management: The Technical and Clinical Infrastructure 972

R. Bellazzi, PhD, A. Riva, PhD, S. Montani, C. Larizza, S. Fiocchi, MD, G. d'Annunzio, MD, R. Lorini, MD,

A. Monteforte, and M. Stefanelli

Preliminary Design of an Internet-Based Graphical Surveillance Information System 973

J. C. Benneyan, PhD, D. Satz, and S. Flowers

Strategy for Efficient Construction of Multimedia Case Simulations 974

E. S. Berner, EdD, P. Dev, PhD, N B. Smith, MD, and S. M. Harding, MD

Automated Text Markup for Information Retrieval from an Electronic Textbook of Infectious Disease 975

D. C. Berrios, MD, MPH, A. Kehler, PhD, D. K. Kim, V. L. Yu, MD, and L. M. Fagan, MD, PhD

ParcntLink: A Web-Based Communications Tool for Parents and Pediatricians 976

D. A. Bishku, MD, MSc, MPH, C. J. Homer, MD, MPH, K. D. Mandl, MD, MPH, and I. S. Kohane, MD, PhD

Web-Based Collaborative Building of Medical Knowledge Bases 977

K. Boegl, PhD, C. Chizzali-Bonfadin, PhD, and K-P. Adlassnig, PhD

Development of an Interdisciplinary Critical Care Problem List 978

P. Q. Bourie, RN, MS, D. M. Goldsmith, RN, MS, J. Einbinder, MD, J. Zelingher, MD, MSc, D. Z. Sands, MD,

MPH, J. McHale, RN, MS, M. Howenstein, RN, MS, J. Benyo, RN, and R. H. Chapman, RN, MS

HealthConnect: A Structured Communication System for Health Management 979

K. Bradshaw, K. D. Mandl, MD, MPH, and I. S. Kohane, MD, PhD

A Computerized Care Process Model (CCPM) for the Management of Community-Acquired Pneumonia 980

R. L. Bradshaw and T. D. East, PhD

Integrating Access to Patient Education Resources in a Health Sciences Center Using a Web-Based

Platform 981

B. E. Bray, MD, J. B. Olson, R. J. Boekweg, K. M. Hill, and J. A. Smith, PhD

Modular Text Processing System Based on the SPECIALIST Lexicon and Lexical Tools 982

A. C. Browne, MS, G. Divita, MS, V. Nguyen, MS, and V. C. Cheng, MS

Empirical Study on Artifact Detection in Monitoring Data 983

C. Cao, PhD, MSc, and N. Mcintosh, MD

xxviii

On-Line Resources for a WWW-Based Continued Education Curriculum on Behavioral Neurobiology 984

S. H. Cardoso, PhD, and R. M. E. Sabbatini, PhD

Telepharmacy: A New Application for Telemedicine 985

K. L. Carevic, PharmD, W. S. Harris, MD, N. A. Coblio, K. Mowrey, PharmD, and M. T. McCormick, MS

Interactive Knowledge Base for Interpretation of Serologic Tests for Hepatitis Accessible by WWW 986

C. Chizzali-Bonfadin, PhD, K-P. Adlassnig, PhD, K. Boegl, PhD, and W. Horak, MD

Quick Implementation of Web-Based Clinical Practice Guidelines through Instantaneous Links to Patient Data

and Action Steps 987

N. A. Coblio, M. R. Cox, R. A. Kamarowski, J. G. Seymour, M. T. McCormick, MS, and W. S. Harris, MD

Internal Medicine Report: Initial Evaluation of an Electronic Case-Based Educational Web Resource 988

S. J. Cohen, MD, D. C. Schaad, PhD, R. Murphy, S. Fuller, PhD, and F M. Wolf, PhD

What Must a Vocabulary Editing Interface Offer? 989

W. G. Cole, PhD, Y-J. Kim, MS Tuttle, and D. D. Sherertz

Use of the Computer To Uncover and Overcome Constraints on Knowledge and Action in Our Patient Care

System 990

T. M. Cowsert, PharmD, L. S. James, PharmD, N. Coblio, K. A. Mowrey, PharmD, M. T. McCormick, MS,

R. A. Kamarowski, J. G. Seymour, and W. S. Harris, MD

Medical Devices and Computer Networks: A Review of Communications Protocols 991

S. Dain, MD

Design of Platform Independent ICU Charting Environment Using HL7 and LOINC Messaging 992

D. P. Delaney, MD, J. D. Zibrak, MD, and C. Safran, MD, MS

Measuring the Benefits of an Electronic Medical Record System in Orthopedics 993

R. Dell, MD, B. Buchanan, MD, B. Steele, MD, and J. Schilz, MD

An Alert System for ED Laboratory Test Results 994

H. Dong, MS, D. Greenes, MD, G. Fleisher, MD, and I. Kohane, MD, PhD

Security Management Strategies for a Clinical Data Repository 995

R. Dulbandzhyan, D. Saperia, RD, MSD, J. Polacheck, RN, MS, R. Duncan, MD, and C. Plata, RRA

Planning and Building a Multi-Institutional Data Dictionary: The Problem List Solution 996

P. J. Dunbar, MB, ChB, P. Tarczy-Hornoch, MD, S. Fuller, PhD, J. P. LoGerfo, MD, K. N. Ibrahim, K. Stephens,D. S. Ketchell, ML, andH. I. Goldberg, MD

Automated Integration of a Diagnostic Decision Support System with a Large-Scale Clinical Information

System: Aspects of Feasibility 997

G. Elhanan, MD, and J. J. Cimino, MD

Investigation into the Strengths and Limitations of Artificial Neural Networks: An Application to an Adult ICU

Patient Database 998

C. M. Ennett, and M. Frize, Dr

On-Line Ratings of Mood 999

R. Ferziger, MD, R. J. Birnbaum, MD, PhD, H. B. Kowaloff, W. W. Slack, MD, and D. C. Jimerson, MD

xxix

Student Quality Assessments of Internet Resources for Clinical Problems 1000

V. Florance, PhD, and L. A. Metlay, MD

Developing and Implementing DIANA, the First Electronic Patient Record in Chile 1001

C. Gabella, MD, J. A. Riera, MD, R. Jorquera, MD, and R. Gonzalez, MD

An Audit Server for Monitoring Usage of Clinical Information Systems 1002

R. J. Gallagher, PhD, S. Sengupta, PhD, G. Hripcsak, MD, R. C. Barrows, Jr., MD, and P. D. Clayton, PhD

The Outpatient Referral Process: What Is Its Diagnosis and Treatment? 1003

T. K. Gandhi, MD, D. F. Sittig, PhD, J. Song, M. Franklin, M. Turetsky, J. M. Teich, MD, PhD, A. L. Komaroff,

MD, and D. W. Bates, MD

Applying Adaptive Component Architecture to the Design of a Clinical Information System 1004

J. R. Gerner, MS, and M. Ralich

Expert Notification System: Automated E-Mailing of Test Results to Ordering Physicians 1005

D. K. Giles, RRT, P. Piar, and C. M. Harris, MD

An Enterprise "Problem Picker" for Capturing Clinical Problem Data 1006

H. S. Goldberg, MD, V. Law, P. C. Jones, K. D. Keck, M. S. Tuttle, and C. Safran, MD

Capturing Clinical Narrative: What Factors Dictate the Decision to Type? 1007

D. M. Goldsmith, RN, MS, D. Z. Sands, MD, MPH, and C. Safran, MD

Virtual Curriculum 2000: The Design and Implementation of a Completely On-Line Adjunct to a Medical

School Curriculum 1008

J. W. Goldwein, MD, G. Jaspan, MSIS, M. Schenker, L. Hark, PhD, and G. Morrison, MD

System Utilization as a Measure of the Breadth of Diffusion 1009

D. Gordon, PhD, and J. Spink

Telemedicine: What's It Good For? Emerging Patterns in Telemedicine Utilization 1010

K. D. Harris, MPA

The Psychological Vital Sign: Implementation of a Computerized Psychological Distress Assessment Tool in

Primary Care 1011

R. R. Hausam, MD, M. Rigdon, PhD, N. S. Anderson III, PhD, R. D. Hill, PhD, L. Haas, PhD, C. Smoot, MS,and H. Wing, MBBS

A Review of the International Classification of Nursing Practice and Discussion of Its Relevance to Current

Efforts in the United States 1012

S. B. Henry, RN, DNSc, V. Elfrink, RN, PhD, B. McNeil, RN, PhD, and J. J. Warren, RN, PhD

DynamiQuesl: A System for Asking Clinical Examination Questions Based on Content Viewed 1013

W. Hersh, MD, and S. Malveau, MS

XXX

A Web-Based Model for Diabetes Education and Decision Support for the Home Care Nurse 1014

M. Hill, RN, and J. Kirby, RN

Dermatology CME for Rural Physicians: Use of Hybrid CDROM/WWW Technologies to Deliver an

Interactive Course 1015

T. B. Hoekman, PhD, V. Curran, MEd, W. Gulliver, MD, I. Landells, MD, and C. Michalski, PhD

The Partners for Child Passenger Safety Project: An Information Infrastructure for Injury Surveillance 1016

/. H. Holmes, PhD, F. K. Winston, MD, PhD, D. Durbin, MD, MS, E. Bhatia, MA, K. Arbogast, PhD, and

J. Werner, MS

Integration of Digital Images into Computer-Based Medical Training 1017

M. F. Holzer, D. Heiss, S. Endres, and M. R. Fischer

Computerized Data Mining for Adverse Drug Events in an Outpatient Setting 1018

B. Honigman, MD, D. W. Bates, MD, and P. Light

Episode Oriented Registration: Structuring Data-Entry into the Electronic Health Record 1019

P. E. F. Houwink, T. R. van Althuis, and H. P. Westerhof

A Needs Assessment of a Web-Based Smoking Cessation Program 1020

C. G. Huey, MD, MPH, L. Lucas, MD, K. B. Eden, PhD, and W. R. Hersh, MD

Query-by-Context: A Framework for Modeling and Navigating Multimedia Research 1021

R. M. Jakobovits, PhD, and J. F. Brinkley

A Model for Surveillance of Nosocomial Infections within a Hospital Information System 1022

J. Joch, T. Biirkle, and J. Dudeck

Web Browser as Medical Educator/Researcher Using HTML & JavaScript 1023

C. W. Johnson, PhD, G. Oser, PhD, and A. J. Abedor, PhD

The Development of a Web-Based Emergency Department Charting and Administrative System 1024

D. E. Johnson, MD, MS, and T. O. Stair, MD

Redefining a Thesaurus: Term-Centric No More 1025

D. Johnston, S.J. Nelson, MD, J-L. A. Schulman, A. G. Savage, and T. P. Powell

Modeling Standards of Care for an Online Environment 1026

J. Jones-Schenk, RN, MS, and J. Rossi, RN, MS

Correlation of Appropriateness Criteria Indexing Terms with the UMLS Metathesaurus 1027

C. E. Kahn, Jr., MD, and B. E. Kumahor

Three-Dimensional Growth and Optimization ofArterial Tree Models 1028

R. Karch, W. Schreiner, F. Neumann, and M. Neumann

Patient Headache Care Education System (PHCES) Using a Software Reuse Reference Model 1029

A. Khatri and D. C. Rine

An Analysis of MEDLINE Indexing of Medical Informatics Literature 1030

S. Krishna, EdS, J. E. Andrews, MLS, C. C. Craven, MLS, and T. B. Patrick, PhD

xxxi

Development of a Decision Support System for Detecting Critical Conditions during Anesthesia 1031

M. Krol, PhD, and D. L. Reich, MD

Designing Evaluation of Web-Based Information Resources: "Televaluation" of Patient Clinical Information

Systems 1032

A. W. Kushniruk, MSc, V. L. Patel, PhD, and J. J. Cimino, MD

Dentists' Use and Opinions of MEDLINE 1033

W. P. Lang, DDS, MPH, W. S. Borgnakke, DDS, PhD, P. S. Richards, DDS, MS, L. V Nyquist, PhD, B. L.

Shipman, AMLS, D. R. Bradley, MILS, J. G. Marshall, MLS, MHSc, PhD, and D. L. Ronis, PhD

Comparing Encounter and Demographics Data Elements among Different Healthcare Enterprises Using a

Common Data Dictionary 1034

L. M. Lau, MD, PhD, S. H. Lam, MD, andS. M. Huff, MD

CCS-SUS: The Brazilian Consortium of Software Components for Health Care 1035

B. de F. Leao, MD, PhD, E. B. Bandarra, MD, L. F. de Aratijo, P. J. Madril, L. Moura, PhD, and D. Sigulem,

MD, PhD

Critical Tedium: Data Quality Issues in Merging Two Structured Immunization Databases 1036

J. C. S. Liu, MD, andR. N. Shiffman, MD, MCIS

A Java-Based Interface for Medical Research Project Classification Using Metaphrase 1037

Q. Liu, J. D. Buntrock, D. L. Crowson, M. S. Tuttle, P. L. Elkin, MD, and C. G. Chute, MD, DrPH

Interfacing the Heart Disease Program to Coded Data 1038

W. J. Long, PhD, H. Fraser, and S. Naimi

Measuring the Accuracy of a Nomenclature Encoder Supporting Postcoordination 1039

Y. A. Lussier, PEng, MD

Using Neural Networks to Predict Patient Satisfaction 1040

J. Marshall, PhD

"Scan-a-Doc" Module as Part of an Expert System for UME Admissions 1041

W. T. McGowan III, PhD, C. J. Gleeson, PhD, and J. J. McGowan, PhD

Internet-Based Continuing Medical Education: Who Needs It Most? 1042

N. B. Mehta, MD, D. G. Litaker, MD, MSc, A. Fishleder, MD, and B. Nash, MD

Use of the Metathesaurus and SPECIALIST Lexicon of the Unified Medical Language System, Lexical

Matching and Domain-Specific Free-Text to Identify Undocumented Vocabulary 1043

E. M. Mills, DVM, PhD, J. R. Wilcke, DVM, MS, and H. S. Bender, DVM, PhD

Consumer Use of the Internet for Health Information: A Population Survey 1044

M. A. Nammacher, MD, and K. Schmitt, MS

Collecting Free Text and Dictation with a Coded Data Entry System 1045

S. P. Narus, PhD, and T. A. Pryor, PhD

Creating a Thesaurus from Text: A "Bottom-Up" Approach to Organizing Medical Knowledge 1046

S. J. Nelson, MD, T. Kuhn, D. Radzinski, PhD, D. D. Sherertz, M. S. Tuttle, and R. Spena, DSW

xxxii

Strategies for Information Management and Information Technology within Health Care: A ComparisonBetween Newly Adopted Strategies 1047R. E. Nikula and C. N0hr

Improving the SIMON Architecture for Critical Care Intelligent Monitoring 1048P. R. Norris, MS, B. M. Dawant, PhD, and K. Suwanmongkol

A Telemedicine Project in Brazil, Planning a Cost-Effective Solution 1049M. A. Novaes, PhD

Linking Health Education and Health Care Service Information via the WWW: The HealthAware Project .. . .1050L. Ohno-Machado, MD, MHA, PhD, A. Boxwala, J. Guillemin, K. Keefe, G. Sharp, T. Rowland, J. Ehresman,J. Tarn, L. Sato, and R. A- Greenes

The Virtual Dental Center: A Resource for Research and Education on theWWW 1051D. R. Palombo, DDS, M. M. Filho, DDS, MSc, R. M. E. Sabbatini, PhD, and C. L. Halstead, DDS, MSD

Protocols, Pathways, and Practice Guidelines: Defining Multiple Step Clinical Algorithms for Automated

Navigation 1052M. D. Paterno, R. D. Zielstorff, RN, MS, J. M. Teich, MD, PhD, M. Segal, MS, and R. Fox, MS

Varying Strategies to Improve Influenza Vaccination Compliance 1053A. M. Petronzio, MA, J. R. Gerner, MS, and J. M. Teich, MD, PhD

HealthNet: Improving Access to Knowledge Resources in a Community-Based Integrated DeliverySystem 1054D. Pine, MD, J. Bissen, RD, D. Abelson, MD, and S. Roller

Baby CareLink: Home Telemedicine for Families of NICU Patients 1055G. Pompilio-Weitzner, RNC, J. Gray, MD, MS, P. C. Jones, A. Levy, MS, S. Scholz, E. Sturges, and C. Safran,MD.MS

Parental Input into the Emergency Department Medical Record 1056S. C. Porter, MD, M. Silvia, G. R. Fleisher, MD, I. Kohane, MD, PhD, and K. D. Mandl, MD, MPH

Clinical Views: Object-Oriented Views for Clinical Databases 1057L. Portoni, C. Combi, and F. Pinciroli

Adding Java and CGI Functionality to an On-Line Atlas ofAnatomy for Medical Education 1058

R. P. Quaresma, R. M. E. Sabbatini, S. H. Cardoso, J. R. Ortale, E. A. Rodrigues, A. Kondo, and

G. L. P. Ubiali

Lean-Technology Enabled Telemedicine Scenarios 1059

S. Reddy, PhD, M. Niewiadomska-Bugaj, T. Pearson, Y. V. Reddy, R. Raman, V. Jagannathan, K. J. Cleetus,

K. Srinivas, B. Merkin, MD, and M. Kilkenny, MD

Computerized Sign-Out: A Web-Based Solution 1060

J. Reider, MD, and P. Norton

Just in Time (Point of Care) Computer Reminders to Improve Patient Care Documentation 1061

S. Renshaw, MS, S. H. Lam, MD, and V Haws, RN, MS

xxxiii

A Clinical Knowledge Repository Run by Medical Residents To Improve Evidence-Based Patient Care 1062

F. Rivera, MD, W. M. Detmer, MD, MSc, W. I. Thompson, MIS, E. Cutolo, MD, R. Shah, MD, E. Steigelfest, MD,

N. Coblio, M. T. McCormick, MA, J. G. Seymour, and W. S. Harris, MD

Representing Laboratory Test Findings: Relating the Read Thesaurus to LOINC and the CEN ENV 1614

Prestandard 1063

D. Robinson, MBBS, MSc, C. Price, MPhil, P. J. B. Brown, MRCGP, R. Jones, MRCP, MRCPath, and M.

O'Neil, MRCP

Clinicians' Response to Computerized Detection of Infections 1064

B. H S. C. Rocha, MD, PhD, J. C. Christenson, MD, R. S. Evans, PhD, and R. M. Gardner, PhD

Embedding the User's Electronic Medical Record in a Pocket Computer 1065

M. F. Rodriguez, MSBME

Automated Creation of Datamarts from a Clinical Data Warehouse, Driven by an Active Metadata

Repository 1066

C. L. Rogerson, PhD, P. H. Kohlmiller, and H. Stiitman, MD

Factors Influencing Successful Use of Information Retrieval Systems by Nurse Practitioner Students 1067

L. L. Rose, MS, RN, K. Crabtree, DNSc, ANP, and W. Hersh, MD

A Modular Coding Engine Based on the National Library of Medicine's Knowledge Source Server 1068

G. H. Roussel, MD, and J. W. Loonsk, MD

Retrieving Studies of Clinical Process Interventions: Methodological Issues and Early Results 1069

J. H. Sable, MD, C. K. Craven, MLS, and M. Sievert, PhD

Using Arden Syntax to Handle Alert Escalation 1070

J. T. Soger, PhD, R. G. Corman, D. N. Daine, MA, J Wu, PhD, M. G. Yang, MD, MS, and S. X. Wang, PhD

Moving Arden Syntax Outside of the (Alert) Box: A Paradigm for Supporting Multi-Step Clinical

Protocols 1071

R. M. Sailors, ME, R. L. Bradshaw, MS, and T. D. East, PhD

A Bedside Computer System for Nursing as a Part of a Hospital Information System 1072

T. Sakamaki, MD, T. Kimura, C. Aoyagi, H. Kobayashi, S. Kogure, and S. Oshima

Designing Educational Programs for the Internet Using the Internet Design Star 1073

C. L. Schell, MLS, MD, and R. Rathe, MD

Time-Oriented Multi-Image Presentation of Dynamic Case History 1074

N. Schklovsky-Kordi, MD, S. Goldberg, and B. Zingerman

Body Cell Mass as a Reference for Nutritional Support on the Internet 1075

P. R. Schloerb, MD, and J. F. Henning, RN

Optimization Targets for Computer Models of Blood Vessels 1076

W. Schreiner, R. Karch, F. Neumann, and M. Neumann

Controlled Evaluation of a Computer-Based Atlas of Histopathology 1077

S. Schulz, T. Auhuber, U. Schroder, and R. Klar

xxxiv

A Flexible WWW Query Interface for a Patient Data Warehouse 1078

K. W Scully, MS, R. D. Pates, PhD, J. Einbinder, MD, and R. E. Reynolds, MD

Internet Implementation of Nursing Process Using Standardized Coding 1111

A. Siders, RN, P. C. Jones, H. Marin, RN, PhD, R. Venkatraman, M. Cross, and C. Safran

Acquiring, Storing, and Retrieving Diverse Biomedical Data Using the World Wide Web: The SenseLab

Paradigm 1079

E. Skoufos, PhD, J. S. Mirsky, M. D. Healy, PhD, M. S. Singer, M. L. Hines, PhD, P. M. Nakardi, MD, P. L.

Miller, MD, PhD, and G. M. Shepherd, MD, DPhil

IDEAL: Integrating Computerized Educational Methods at the University of Washington HealthSciences Center 1080C. E. Solomon, MS, MA, and J. E. Barrett, EdD

Supporting the Use of the GALEN Intermediate Representation 1081

W. D. Solomon, J. E. Rogers, E. J. van der Haring, and P. E. Zanstra

Quality Criteria for Hypermedia Documents in Dental Education 1082

H. Spallek, DMD, PhD, P. Berthold, LDS, PhD, DMD, D. B. Shanley, FDS, MSD, and R. Attstrom, DMD, PhD

Development of a Structured Problem-List Management System atVanderbilt 1083

/. M. Starmer, MD, R. A. Miller, MD, and S. Brown, MD

Healthy Shot for Kids®: Finger Lakes Area Immunization Registry 1084

R. M. Tomalty andN. E. Hatch, MS

Telemedicine: Pilot Evaluation of User Satisfaction Survey Tool 1085

B. A. Tomasek, RN, MS, N. Sagoo, MS, and Y. Xiao, PhD

Discussion on the Use of Information Theory to Classify Medical Outcomes 1086

Y. Tong, M. Frize, Dr, and C. M. Ennett

Feasibility of Clinical Research on the Internet 1087

J. R. Treadwell, PhD, R. M. Soetikno, MD, MS, and L. A. Lenert, MD, MS

Methodology for Computer-Assisted Prediction of Growth Hormone Deficiency in Children 1088

C. L. Tsien, SM, D. J. Nigrin, MD, and I. S. Kohane, MD, PhD

The Doctor's Desktop: A Computer-Based Patient Record Application for the World Wide Web 1089

N. Udey, PhD, P. Sargious, MD, MPH, R. Talavera, MD, R. Pastorchik, D. Niebergal, and F. Chapman

Providing a Clinical Practice Guideline for Asthma Electronically at the Point of Use to Promote RegionalStandardization of Care 1090

H. R. Underwood, MD, MBA, J. L. Michener, MD, andD. F. Lobach, MD, PhD, MS

Development of a Multi-Year Population-Based Data Warehouse of Standardized Medical Costs: Methods

and Results 1091

P. E. Van Grevenhof, J. L. Wagner, PhD, J. M. Naessens, MPH, C. H. Darby, MS, J. M. Killian, E. R. Helgeson,and R. W. Evans, PhD

XXXV

Evaluating the Accuracy of and Time Spent in Analysis ofAcid-Base Reports by Three Methods: Is a

Computer-Aided Method Best? 1092

F. Vergara, MD

Implementation and Testing of a Respiratory Failure Care Process Model for Patients with Long-TermMechanical Ventilation 1093

C. /. Wallace, RN, MS, T. Oniki, MS, P. Bailey, RN, and T. P. Clemmer, MD

What in the Word? Development of a Structured Clinical Vocabulary Database 1094

R. D. Warlick, RN, MSN, and B. E. Tardiff, MD

Integrating Informatics into a Health Systems Nurse Specialist Curriculum 1095

/. J. Warren, PhD, RN, and J. A. Heermann, PhD, RN

ProMediWeb: Case-Based Learning in Medicine Using the WWW 1096

U. Weichelt, Tit. Baehring, M. Adler, and M. R. Fischer

Presenting Interactive Image Databases on the Web Using Java 1097

S. L Wertheim, PhD

Natural Language as a Tool in the Development of a Controlled Vocabulary 1098

A. Wilcox, MA, C. Friedman, PhD, and G. Hripcsak, MD

Evaluation of a Telcmcdicinc-Supported Rural Dialysis Clinic: Quality of Care, Acceptance, Return on

Investment, Quality of Life 1099

P. Winstead-Fry, PhD, J. J. McGowan, PhD, J. M. Rimmer, MD, M. Sussman, RN, and S, Parrish, RN

Dynamic 3-D Scene Navigation in Wcb-Bascd Anatomy Atlases 1100

B. A. Wong and J. F. Brinktey

An Experience in Merging Thesauri: Using Terms from Other Thesauri to Enhance MeSH 1101

C. H. Wu, MLS, S. Srinivasan, MA, and S. J. Nelson, MD

Design and Evaluation of a Real-Time Mobile Telemedicine System for Ambulance Transport 1102

K Xiao, PhD, D. Gagliano, M. LaMontc, MD, MSN, P. Hu, MS, W. Gaasch, MD, R. Gunawadane, MD, and C.

Mackenzie, MD

Visit Planning Assistant: Supporting the Delivery of Essential Services Based on Clinical Practice Guidelines

through a Browser-Based Object-Oriented Expert System over the Corporate Intranet 1103

L. Yin, PhD, N. Jarvis, MD, D. Abelson, MD, C. Kelly, MA, and A. Boerbon

VPA/Admin: A Knowledge Engineer's Tool to Efficiently Maintain the Integrity of Data Elements between

the Knowledge Base and the Database 1104

L. Yin, PhD

From Communication Server to Information Server: Simplifying the Concept 1105

A. W. Zaiss, U. Schroder, S. Bilchele, and R. Klur

Soft Search and Stepwise Selection: A New Strategy for LOINC Mapping 1106

X. Zhang, MD, MSc

xxxvi

A Data Collection and Data Processing System to Support Real-Time Trials of Intelligent Alarm

Algorithms 1107

Y. Zhang, and C. L. Tsien, SM

A Graphical User Interface for Content-Based Image Retrieval Engine that Allows Remote Server Access

Through the Internet 1108

L. Zheng, A. W. Wetzel, Y. Yagi, M. J. Becich

A Java Toolset for Writing Web-Based Clinical Case Exercises 1109

A. E. Zuckerman, MD, L. Jacques, MD, and S. Hoerlein, MD

Tuning an Existing Nomenclature for Specific Domain Corpora: A Syntax-Based Similarity Method 1110

P. Zweigenbaum, PhD, B. Habert, PhD, A. Nazarenko, PhD, and J. Bouaud, PhD

Section XII Theater-Style Demonstrations

The Regenstrief Medical Record System 1998: A System for City-Wide Computing 1114

C. J. McDonald, MD, J. M. Overhage, MD, PhD, W. M. Tierney, MD, P. R. Dexter, MD, J. G. Suico, MD,

A. Zafar, MD, B. Smith, RN, T. Hogan, RN, L. Blevins, J. Warvel, J. Warvel, J. Meeks-Johnson, L. Lemmon,

T. Glazener, A. Belsito, D. Lindbergh, B. Williams, P. Cassidy, D. Xu, M. Tucker, and M. Edwards

A Comprehensive Approach to Developing and Integrating Multilingual Classifications: GALEN's

Classification Workbench 1115

A. L. Rector, MD, PhD, R. Baud, W. Ceusters, W. Claassen, J-M. Rodrigues, J. Rogers, A. Rossi Mori, E. van

derHaring, W. D. Solomon, and P. Zanstra

Continuous-Speech Structured Reporting 1116

D. Rosenthal, PhD, and C. Friedman, PhD

ACT/DB: A Clinical Trials Database Being Refined on a Pilot Basis at Two Medical Centers 1117

C. A. Brandt, MD, MPH, P. Nadkarni, MD, L. Schacter, MD, PhD, D. Zelterman, PhD, Y. Li, MS, J. M. Fisk,

MD, E. K Shultz, MD, MS, and P. L. Miller, MD, PhD

TeleMed: Evaluation of Use in Rural Telemedicine 1118

D. W. Forslund, PhD, J. E. George, PhD, E. M. Gavrilov, PhD, S. Zink, PhD, and P. Zimnik, DO

Secure Collaborative Telemedicine Applications 1119

W. Hunt, MS, R. Raman, R. Reddy, V. Baker, I. Lapshin, S. Reddy, C. Sima, S. Kannan, T. Pearson,

M. Niewiadomska-Bugaj, V. Jagannathan, K. J. Cleetus, B. Merkin, M. Kilkenny, K. Vandevender, W. R. Beam,

and H. Patel

A Java-Based Tool for Entry of a Medical Problem List, Which Accesses a Remote Large-Scale Enterprise

Vocabulary Server 1120

P. L. Elkin, MD, M. S. Tuttle, K. Keck, G. E. Atkin, and C. G. Chute, MD, DrPH

The Vanderbilt Patient-Care Information System 1121

A. Geissbuhler, MD, D. Giuse, Dr Ing, J. Grande, R. A. Miller, MD, and W. W Stead, MD

An Integrated Multimedia Curriculum Database and Virtual Library on an Intranet 1122

S. S. R. Albright, E. Eaton, PhD, E. Almeida, and T. Alkasab

xxxvii

A Handbook Supported by a Web Site to Facilitate Distance Learning of Medical Informatics 1

J. S. Duisterhout, MS, B. Arends, J. C. Helder, PhD, R. J. A. Schijvenaars, MS, J. H. van Bemmel, PhD, and

M. A. Musen, MD, PhD

Self-Management for Pediatric Chronic Disease: A Description of the Watch, Discover, Think and Act Asthma

Education CD-ROM 1

R. Shegog, PhD, R. S. Gold, PhD, E. Pierrel, MA, L. K. Bartholomew, EdD, MPH, G. S. Parcel, PhD, M. M.

Sockrider, MD, DrPH, D. I. Czyzewski, PhD, M. Fernandez, PhD, N. Berlin, R. Combes, and S. L. Abramson,

MD, PhD

1998 Proceedings Authors 1

Subject Catalog 1

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