Medical systems and IT

Francisco José Nardi Filho

Main focusFind and understand papers which relate:

● medical or health knowledge bases

● medical training

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Keywords● HIT

○ Health information technology● RLS

○ Rapid learning system● EHR

○ Electronic health record● CDSS

○ Clinical decision support systems3

American Recovery and Reinvestment Act (2009)● $19 billion in incentives for hospitals to shift from paper to

EHR● $20 billion for the implementation of HIT alone● $17 billion in incentives for institutions who adopt HIT

before 2015

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Keywords● HIT

○ Health information technology● RLS

○ Rapid learning system● EHR

○ Electronic health record● CDSS

○ Clinical decision support systems5

EHR● Administrative ● Patient demographics● Progress notes● VItal signs● Medical histories

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Keywords● HIT

○ Health information technology● RLS

○ Rapid learning system● EHR

○ Electronic health record● CDSS

○ Clinical decision support systems7

CDSS● Knowledge-based CDSS

○ knowledge base■ rules and associations IF-THEN■ inference engine■ mechanism to communicate

● Covers the diagnosis of many different diseases

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Knowledge-based CDSS

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CDSS● Non-knowledge-based CDSS

○ machine learning■ support vector machines, artificial neural networks etc ■ find patterns in clinical data■ “black boxes”

● Focus on a narrow list of symptoms for a single or a few diseases

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CDSS● Non-knowledge-based CDSS

○ Woman○ Lives in Pernambuco○ Pregnant

■ Child's microcephaly risk

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Synthesis

Main focusFind and understand papers which relate:

● medical or health knowledge bases

● medical training

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1990 - Knowledge bases in medicine: a review

● CASNET● MYCIN● INTERNIST-I

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Main focusFind and understand papers which relate:

● medical or health knowledge bases

● medical training

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2009 - Development of Computer-Based Training to Enhance Resident Physician Management of Inpatient Diabetes

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Example

Keywords● HIT

○ Health information technology● RLS

○ Rapid learning system● EHR

○ Electronic health record● CDSS

○ Clinical decision support systems18

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2010 - Rapid-Learning System for Cancer Care

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Increase in data required for medical decision making relative to human cognitive capacity

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Synthesis

Health RLS challenges

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● data representation● standardized nomenclature● data formats● federated data access● data mining and evidence synthesis approaches● evidence retrieval● reporting● feedback on use of evidence

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Future studies

References

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● Abernethy, A. P., Etheredge, L. M., Ganz, P. A., Wallace, P., German, R. R., Neti, C., … Murphy, S. B. (2010). Rapid-learning system for cancer care. Journal of Clinical Oncology, 28(27), 4268–4274. http://doi.org/10.1200/JCO.2010.28.5478

● Cook, C. B., Wilson, R. D., Hovan, M. J., Hull, B. P., Gray, R. J., & Apsey, H. a. (2009). Development of computer-based training to enhance resident physician management of inpatient diabetes. Journal of Diabetes Science and Technology, 3(6), 1377–87. Retrieved from http://www.pubmed central.nih.gov/articlerender.fcgi?artid=2787038&tool=pmcentrez&rendertype=abstract

● Perry, C. A. (1990). Knowledge bases in medicine: a review. Bull Med Libr Assoc, 78(3), 271–282. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC225405/pdf/mlab00124-0071.pdf

● Weiss, S. M., Kulikowski, C. A., Amarel, S., & Safir, A. (1978). A model-based method for computer-aided medical decision-making. Artificial Intelligence, 11(1-2), 145–172. http://doi.org/10.1016/0004-3702(78)90015-2

● Yu, P. P. (2015). Knowledge Bases, Clinical Decision Support Systems , and Rapid Learning in Oncology. Journal of Oncology Practice, e206–11.doi:10.1200/JOP.2014. 000620