articles+ search results

Hospitals, United States, Computers standards, Information Systems standards, and Software standards

Humans, Pedigree, Data Collection, Database Management Systems, Genetic Diseases, Inborn, and Software

This work examines some of the problems encountered in developing small and large database application systems involving human genetics data collection efforts that include data on individuals as well as family pedigree data. Rapid prototyping of a database application requires software tools to produce the application with little or no programming. Features of MEGADATS-4 that provide for rapid prototyping and for producing stand-alone applications are examined.

Database Management Systems, Medical Informatics Applications, Programming Languages, Software Design, Information Systems, and Software

AIDA consists of a set of software tools to allow for fast development and easy-to-maintain Medical Information Systems. AIDA supports all aspects of such a system both during development and operation. It contains tools to build and maintain forms for interactive data entry and on-line input validation, a database management system including a data dictionary and a set of run-time routines for database access, and routines for querying the database and output formatting. Unlike an application generator, the user of AIDA may select parts of the tools to fulfill his needs and program other subsystems not developed with AIDA. The AIDA software uses as host language the ANSI-standard programming language MUMPS, an interpreted language embedded in an integrated database and programming environment. This greatly facilitates the portability of AIDA applications. The database facilities supported by AIDA are based on a relational data model. This data model is built on top of the MUMPS database, the so-called global structure. This relational model overcomes the restrictions of the global structure regarding string length. The global structure is especially powerful for sorting purposes. Using MUMPS as a host language allows the user an easy interface between user-defined data validation checks or other user-defined code and the AIDA tools. AIDA has been designed primarily for prototyping and for the construction of Medical Information Systems in a research environment which requires a flexible approach. The prototyping facility of AIDA operates terminal independent and is even to a great extent multi-lingual. Most of these features are table-driven; this allows on-line changes in the use of terminal type and language, but also causes overhead. AIDA has a set of optimizing tools by which it is possible to build a faster, but (of course) less flexible code from these table definitions. By separating the AIDA software in a source and a run-time version, one is able to write implementation-specific code which can be selected and loaded by a special source loader, being part of the AIDA software. This feature is also accessible for maintaining software on different sites and on different installations.

Drug Information Services, Netherlands, Hospital Information Systems, Pharmacy Service, Hospital, and Software

The CENTRASYS system for the Hospital Pharmacy, developed as part of a research project of the Department of Medical Informatics is described. The role of AIDA, a fourth-generation software package, as a prototyping tool is discussed. It is concluded that AIDA facilitates prototyping and is also very suitable as a vehicle for systems in operation. It is further concluded that prototyping is of great help in the developmental phase of a project, but that great care has to be taken during evaluation of the prototypes: minimize the number of test sites and try to avoid that users become dependent on the system, because every prototype needs further tuning before it really becomes an operational system.

Evaluation Studies as Topic, Hospital Information Systems, Pharmacy Service, Hospital, Primary Health Care, Software Design, and Software

A system for hospital pharmacies (CENTRASYS) and a system for primary health care (ELIAS), both developed using prototyping and a fourth-generation tool (AIDA), are introduced. Differences in development strategies are analyzed and conclusions are drawn with respect to the use of AIDA for management, development and operation of the systems. The use of AIDA increases development speed enormously, enabling a productivity of over 40 lines per day, which is more than twice the amount that is accepted as reasonable.

Animals, Cricetinae, Netherlands, Pilot Projects, Software Design, User-Computer Interface, Information Systems, Primary Health Care, and Software

In this article the development of a computer system for General Practice, ELIAS, is described. The use of the 4th-generation software toolkit AIDA proved to be very helpful in increasing the speed of development as well as the quality of the ELIAS software. The programming support that AIDA offered, not only in increasing the rate of development but also in the flexible way in which parts of the system and the database can be adjusted (in prototyping as well as in the operational system) and its self-documenting functions, contributed to the ease of development. The consistent lay-out of the frames and uniform screen-handling, the opportunity of data validation and the availability of help information at every item in screen frames--all facilitated by AIDA--rendered ELIAS a very user-friendly system.

Decision Making, Organizational, Models, Theoretical, United States, Computer Systems, Management Information Systems organization administration, and Public Health Administration organization administration

Human services agencies are closer than ever to fulfillment of their authoritative role. A critical step is transformation of the Reporting System to a Management Information System. This creates the information structure and mind set necessary to generate new, data-based ideas. There are too many obstacles to traditional MIS development approaches in agencies, however. New strategies such as selective use of end-user technology and prototyping can provide methods that overcome these obstacles.

Blood Glucose Self-Monitoring, Diabetes Mellitus blood, Diabetes Mellitus physiopathology, Diet, Diabetic, Exercise, Humans, Insulin physiology, Microcomputers, Numerical Analysis, Computer-Assisted, Prognosis, Blood Glucose metabolism, Diabetes Mellitus drug therapy, Expert Systems, Insulin administration dosage, and Therapy, Computer-Assisted

This paper describes the principles and prototyping of a computer-based system being developed to assist in the management of diabetes mellitus. Unlike other approaches based upon mathematical modelling or the use of computer algorithms, this system adopts one derived from artificial intelligence, seeking to incorporate the dynamics of glucose and insulin in a manner which reflects their clinical importance. The resultant logical model (qualitative algebra) defines the relationships between changes in insulin dose and site and time of injection and glycaemic response. In this manner the computer-based system, implemented in Prolog, can be used to provide advice concerning insulin therapy by means of making qualitative predictions of patient outcome of blood glucose profile resulting from alternative insulin regimens.

Adult, Decision Making, Computer-Assisted, Humans, Pulmonary Gas Exchange, Signal Processing, Computer-Assisted, Carbon Dioxide blood, Expert Systems, Respiratory Insufficiency therapy, Software, and Ventilators, Mechanical

The KUSIVAR is an expert system for mechanical ventilation of adult patients suffering from respiratory insufficiency. Its main objective is to provide guidance in respirator management. The knowledge base includes both qualitative, rule-based knowledge and quantitative knowledge expressed in the form of mathematical models (expert control) which is used for prediction of arterial gas tensions and optimization purposes. The system is data driven and uses a forward chaining mechanism for rule invocation. The interaction with the user will be performed in advisory, critiquing, semi-automatic and automatic modes. The system is at present in an advanced prototype stage. Prototyping is performed using KEE (Knowledge Engineering Environment) on a Sperry Explorer workstation. For further development and clinical use the expert system will be downloaded to an advanced PC. The system is intended to support therapy with a Siemens-Elema Servoventilator 900 C.

Efficiency, Models, Theoretical, Planning Techniques, United States, and Hospital Information Systems

One way automation can increase efficiency is through rapid prototyping, particularly of user interfaces. AI and logic programming, argues this author, offer good user interface tools and a suitable prototyping environment.

Magnetic Resonance Imaging, Tomography, Emission-Computed, Tomography, X-Ray Computed, Ultrasonography, Image Processing, Computer-Assisted methods, Software, Software Design, and User-Computer Interface

A comprehensive software package, called ANALYZE, has been developed (1) which permits detailed investigation and evaluation of multidimensional biomedical images. ANALYZE can be used with 3-D imaging modalities based on x-ray computed tomography, radionuclide emission tomography, ultrasound tomography, and magnetic resonance imaging. The software is written entirely in "C" and runs on standard UNIX workstations. The ANALYZE package features integrated, complimentary tools for fully interactive display, manipulation and measurement of multidimensional image data. The software architecture permits systematic enhancements and upgrades which has fostered development of a readily expandable package. It provides an effective shell for custom software prototyping and turnkey applications. This paper provides a general description of this software as well as specific details on the methodology employed to develop it, both conceptual and technical. Applications of the software are illustrated.

Amino Acid Sequence, Chemical Phenomena, Chemistry, Protein Conformation, Information Systems, and Proteins

An object-oriented database system has been developed which is being used to store protein structure data. The database can be queried using the logic programming language Prolog or the query language Daplex. Queries retrieve information by navigating through a network of objects which represent the primary, secondary and tertiary structures of proteins. Routines written in both Prolog and Daplex can integrate complex calculations with the retrieval of data from the database, and can also be stored in the database for sharing among users. Thus object-oriented databases are better suited to prototyping applications and answering complex queries about protein structure than relational databases. This system has been used to find loops of varying length and anchor positions when modelling homologous protein structures.

The aim of this study was to evaluate and improve the menu interface design of an existing expert system. The system provided expertise concerned with evaluating human response to environments and was implemented onto a computer with a simple tree menu system. Two laboratory based experiments were carried out in which alternative menu interface designs were developed rapidly and compared with the original design. User acceptance tests which incorporated objective and subjective measures were iteratively used to evaluate and improve the interface designs. The results of these experiments indicated that, for the particular system under study, a graphic based design which displayed 58 options divided into levels on a single screen was preferred by users over the original menu interface which displayed one menu at a time with seven options per screen. The final interface remains to be tested under field conditions.

Hospital Information Systems, Microcomputers, North Carolina, Software, Computer Communication Networks, Information Systems, Medical Records Systems, Computerized, and User-Computer Interface

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these system are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development using rapid prototyping object-oriented programming tools of a Physician's Workstation which integrates information from five different applications running on three separate computer systems.

Clinical Laboratory Information Systems, Critical Care, Decision Making, Computer-Assisted, Denmark, Diagnosis, Computer-Assisted, Expert Systems, Finland, Microcomputers, Monitoring, Physiologic, Sweden, Therapy, Computer-Assisted, User-Computer Interface, and Artificial Intelligence

A Nordic research and development programme, 'KBS in Medicine' (KUSIN-MEDICINE), was run in 1986-89. Its main goal was to acquire an understanding of applying knowledge-based techniques in medicine and of the limitations of present-day artificial intelligence (AI) methodologies. The programme comprised four experimental installation sites (Tampere in Finland, Uppsala and Linköping in Sweden, and Aalborg in Denmark) each prototyping in one or more medical domains. The programme was financed by the Nordic Fund for Technological and Industrial Development, by national funds for applied research and by a number of industries. Prototype decision support systems were produced in the following domains: intensive care (Tampere, Uppsala, Linköping, Aalborg), clinical chemistry (Tampere, Uppsala) and clinical neurophysiology (Aalborg in collaboration with Turku and Uppsala). These served to transfer this technology to industry and helped to identify limitations of this technology.

Computer Graphics, Computer Simulation, Computer User Training, Fourier Analysis, General Surgery methods, Magnetic Resonance Imaging, Radiotherapy methods, Tomography, X-Ray Computed, Ultrasonography, Diagnostic Imaging, Image Interpretation, Computer-Assisted, Models, Anatomic, and Software Design

A comprehensive software system called ANALYZE has been developed which permits detailed investigation and evaluation of 3-D biomedical images. The software can be used with any 2-D or 3-D imaging modality, including x-ray computed tomography, radionuclide emission tomography, ultrasound tomography, magnetic resonance imaging and both light and electron microscopy. The package is unique in its synergistic integration of fully interactive modules for direct display, manipulation and measurement of multidimensional image data. Several original algorithms are included which improve image display efficiency and quality. One of the most versatile and powerful algorithms is interactive volume rendering, which is optimized to be fast without compromising image quality. An important advantage of this technique is to display 3-D images directly from the original data and to provide on-the-fly combinations of selected image transformations and/or volume set operations (union, intersection, difference, etc.). The inclusion of a variety of interactive editing and quantitative mensuration tools significantly extends the usefulness of the software. Any curvilinear path or region-of-interest can be manually specified and/or automatically segmented for numerical determination and statistical analyses of distances, areas, volumes, shapes, densities and textures. ANALYZE is written entirely in "C" and runs on several standard UNIX workstations. It is being used in a variety of applications by over 40 institutions around the world, and has been licensed by Mayo to several imaging companies. The software architecture permits systematic enhancements and upgrades which has fostered development of a readily expandable package. ANALYZE comprises a powerful "visualization workshop" for rapid prototyping of specific application packages, including applications to interactive surgery simulation and radiation treatment planning. ANALYZE offers the potential to accurately and reproducibly examine, from images, the structure and function of any cell, tissue, limb, organ or organ system of the body, much like a surgeon or pathologist might do in real life, but entirely non-invasively, without pain or destruction of tissue. These capabilities promise exciting new insights into the basic processes of life, and major advances in health care delivery through improved diagnosis and treatment of disease.

Brain diagnostic imaging, Humans, Skull diagnostic imaging, Software, Image Processing, Computer-Assisted methods, and Radiography

Computer applications in radiology are evolving rapidly, tied to incremental improvements in hardware, software, and methods. In computer hardware, the emergence of dramatically improved graphic and computational performance for engineering workstations enables their use for visualization. Major changes in networking, storage, and display technology play a major role in influencing applications. The use of three-dimensional digitizers to perform localization of real three-dimensional points in conjunction with images and the rendering of objects using rapid prototyping methods, such as stereolithography, were recently reported. Major software advances have taken place through the availability of applications packages that are operated with menu-driven or point-and-click user interfaces, data flow languages, or complete turnkey applications. Imaging methods including CT, MR imaging, digital radiography, biomagnetism, and optical range sensing, which take advantage of advanced computer technology, are new this year. Image processing for multimodality fusion or image registration, visualization, reconstruction, and quantification of images, have been reported at a wide variety of conferences and in key publications. New computer methods to fabricate custom orthopaedic implants, and to improve imaging technology assessment were introduced.

Computer Graphics, Programming Languages, Hospital Information Systems, Medical Records Systems, Computerized, and User-Computer Interface

The PRIST-2 system has been designed as an interactive and high-productivity tool for the rapid prototyping and development of medical applications. Three major issues were addressed in this research project which derived from the evolution of a previous 4th generation software package, called PRIST (patient record information system tool): a high transportability on different hardware and operating systems, a conversational and interactive user-interface and user-independence Relational Data Base Management System (RDBMS). Although we developed PRIST-2 on the top of the ORACLE RDBMS, it does not depend on SQL commercial products because the ORACLE features have been directly used only for SQL relational data base management. The application design methodology implemented in the system architecture allows an interactive and formal description of the application constraints in terms of the semantic data model rather than in terms of the data structure. The translation of the conceptual constraints into SQL tables is performed by several pre-defined routines. In the PC based release (MS/DOS, OS/2, Xenix operating systems), the Graphic-User Interface (GUI) has been developed using Microsoft Windows Software Development Kit. The UNIX release will use a GUI developed on top of the X-Windows environment.

Adult, Breast Neoplasms pathology, Carcinoma pathology, Computer Systems, Decision Theory, Decision Trees, Diagnosis, Computer-Assisted, Expert Systems, Female, Humans, Programming Languages, Decision Support Techniques, Medical Informatics, and Software Design

The concept of object-oriented design and programming has recently received a great deal of attention from the software engineering community. This paper highlights the realisable benefits of using the object-oriented approach in the design and development of clinical decision support systems. These systems seek to build a computational model of some problem domain and therefore tend to be exploratory in nature. Conventional procedural design techniques do not support either the process of model building or rapid prototyping. The central concepts of the object-oriented paradigm are introduced, namely encapsulation, inheritance and polymorphism, and their use illustrated in a case study, taken from the domain of breast histopathology. In particular, the dual roles of inheritance in object-oriented programming are examined, i.e., inheritance as a conceptual modelling tool and inheritance as a code reuse mechanism. It is argued that the use of the former is not entirely intuitive and may be difficult to incorporate into the design process. However, inheritance as a means of optimising code reuse offers substantial technical benefits.

Drug Prescriptions, Medical Records Systems, Computerized, Nursing, Ambulatory Care, Artificial Intelligence, and Practice Guidelines as Topic

As we understand the process of ambulatory care better, the need to effectively implement standards of practice becomes more apparent. To facilitate successful use of practice guidelines, we have integrated an artificial intelligence system of Medical Logic Modules into our computerized medical record. A rule shell allows rapid development and prototyping of rules which can be practice reminders, information gathering utilities, or standing orders. A set of utilities allows non-programmer clinicians to develop and maintain the rule set. We will demonstrate these enhancements in the context of the comprehensive patient record.