Title: AN INDEPENDENT FORMULATION OF DISEASE THEORY FOR COMPUTER
ANALYSIS
First Author: R D C Miller, BVM&S, PhD
Affiliation: M-R-Dx, Sydney, Australia
An extension of the normal though process used by the clinician in reaching a diagnosis, is developed within an independent mathematical framework. In this framework we define the concepts of disease space (or K) and sign space (or S). These abstract concepts are realised through three representations: 1) The Clinical representation, which anchors the theory to reality through set theory 2) The Array representation, which make the theory amenable to computer analysis 3) The Expansion representation, a sort of spectral analysis for disease theory which gives a different slant to the theory, thus providing new ideas and analogies. We go on to define the concept of disease correlations and measures in E space and thus that of the differential diagnosis. These concepts are derived within the intuitive clinical representation and extended to the other representations, giving new geometrical insights. Finally the theory is applied to computer aided diagnosis. Two commercial Windows application, the VetDiagnoster 1.0 and the ECG Analyst Vet 1.1 have been constructed by the author using this theory. The first has been developed for detailed blood analysis in the cat and dog in which 155 different blood tests can simultaneously be analysed along with clinical and historical data. The limitations of such diagnostic software are elucidated through the development of the theory itself.
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to the ScheduleTitle: Intelligent Reports for Dairy Herd Management, Built to Order
on the Internet
First Author: Jim Ehrlich, D.V.M.
Affiliation: Dairy Veterinarians Group
The rapid development of the Internet, combined with the increasing power of microcomputers and de-regionalization of Dairy Herd Improvement Associations (DHIA), provides an opportunity to link these systems into a powerful knowledge tool The Client/Server architecture of the Internet, with platform-independent browser software, will make a flexible and efficient means of transmitting data generated on-farm to a centralized server which can then generate reports and transmit them by the same means to farms and farm consultants. Internet technology provides an ubiquitous and inexpensive framework for such a system, but existing tools for data analysis are largely optimized for a system built around character-based paper records and centralized data processing labs Rapidly-developing software tools that allow a World-Wide-Web (WWW) server to make full use of color graphics and animation, will make it possible to express complex multi-dimensional data in novel ways, to enhance comprehension. Increasing processing power will allow the addition of embedded intelligence and measures of confidence to reports, while thoughtful graphic design can make this increased sophistication unobtrusive. Distributed access to a centralized database and report engine will open possibilities in monitoring of industry-wide or localized trends, and provide means of rapid two-way communication among dairy farmers and the businesses and agencies that serve them. Anticipated Results We will develop processes to build and deliver (via the Internet) customized reports designed to aid in the management of dairy herds, making use of color graphics and embedded intelligence where appropriate. The client (a dairyman or dairy consultant) will request a report based on specific needs or questions. Reports will be generated by a server on demand, using herd-specific data resident on the server, or collected via the Internet from another source. Client and server computers will communicate over the Internet using World Wide Web browser software.
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to the ScheduleTitle: Information Technology in the Diagnostic Laboratory: Use of
spreadsheets, databases, and the world wide web to support technicians,
nurses, and doctors in daily practice.
First Author: Chuck Cohen, DVM
Affiliation: New Haven Central Hospital for Veterinary Medicine
This combination poster-electronic poster presentation will show
how software (MS Excel, FolioVIEWS, and Netscape Navigator) used as an
on-screen reference system can support the everyday needs of nurses, lab
technicians, practice managers, and veterinarians. DiagLab (c) is an Excel
spreadsheet document and workbook that provides invoicing reference, a
common sense approach to terminology (with consideration for the LOINC
messaging protocol) and hypertext links to diagnostic test information.
These links are to on-site documentation running as Infobase databases.
Edited by me in cooperation with the staff at ______________ Title: Outbreak Investigation Exercises on the World Wide Web
World Wide Web-based exercises (http://sable.cvm.uiuc.edu) were
developed that teach users about food safety issues and basic epidemiologic
methodology from a problem-solving perspective. Exercises are based on
cases investigated by the Champaign-Urbana Illinois Public Health District
(http://www.cvm.uiuc.edu/cuphd/main.html). Program features include intelligent
sequencing, response judging and scoring, context-sensitive help, an online
calculator, platform and server independence, and transportability. Lesson
completions can be submitted as hardcopy or by e-mail. Target audiences
are the public health/food industry sector, including veterinary students.
A version of the lesson developed by and for high school students is under
development.
Title: VETPLUS-L, A Continuous International Veterinary Meeting
Communication is a great challenge to veterinary practitioners.
The small business nature of veterinary practice can isolate individual
practitioners from daily professional discussions. Expansion of the internet
internationally in the last 5 years has brought the least common denominator
of electronic communications - email - to most corners of the globe. What
was needed was an inexpensive, virtual electronic meeting room reserved
only for veterinary professionals. VETPLUS-L@u.washington.edu is a closed,
free, email list of 1400 veterinarians and veterinary technicians, educators,
researchers and students. Graphics and explanatory captions demonstrate
unique characteristics of the list: 1. Careful definition of the ground
rules for list interaction via a charter. Non-moderated list guided by
committee of two (one academic, one private practitioner). 2. Web-based
application screens for appropriate membership criteria. 3. International
involvement of grass-roots practitioners, academicians and ancillary personnel.
(graphics of demography, job classifications, etc.). 4. A few specific
examples of how the list allows a diverse group of veterinary professionals
to share information are provided (drugs, surgical techniques, ethical
discussions) 5. Examples of use by veterinary medical educators to expose
students to real 'virtual' cases. (Saskatoon, Pullman, College Station)
6. Intense efforts to keep the list free and open to all qualified professionals:
PHASES: PAST- 2 years of total voluntary support PRESENT- corporate sponsorship
of administrators - voluntary sponsorship of list administrators by individuals
FUTURE- continued voluntary sponsorship versus inexpensive private list-based
service: extension of software shareware concept to list-based veterinary
communication
Title: Systematic Approaches to Determining the Values of Patient
Outcomes
An essential element of decision modeling is the determination
of the value, to the owner, of the potential outcomes of patient treatment.
This places importance on the methodology for determining these values.
This presentation will review the most recognized methods in what is referred
to as "medical utility assessment." These methods can be manually applied
to any health state outcomes, often clarifying factors involved while replacing
assumptions or ambiguity. This presentation will cover the fundamentals
of the methods with references to the embellishments afforded with computer
programming. Key resources for the development of advanced skills will
be pointed out. Abbreviated demonstrations of currently available software
will be used to provide examples. The "standard gamble" method is the oldest
and most widely used method prior to the introduction of the "time trade-off"
method in the early 1970's. A third method, the direct "rating scale,"
completes the list of methods introduced. Each method will be briefly explained
providing the audience with an immediate capacity for application. Coupled
with probabilities published in the literature, the results of these methods
can enable Decision Modeling (covered in another presentation) and the
benefits thereof. Research regarding these methods for utility value assessment
is abundant. Although they provide systematic approaches to achieving such
values, their reliability, validity, and comparability leave interesting
questions. No gold standard exists for qualifying the results. This presentation
will review the comparison and the misgivings that remain. An alternative
concept of using life expectancy for utility values in decision models
will be briefly introduced to motivate medical record keeping that will
support such information technology in the future.
Title: Rapid Retrieval of Pertinent Cases in a Free-text Environment
In a teaching hospital environment, not only must all information
related to a specific patient or visit be readily accessible (longitudinal
access), but users must also be able to easily retrieve pertinent cases
across an entire database (longitudinal access), for any set of search
criteria, and such retrieval must be rapid. To accomplish this, we cross-reference
every word entered in our EMR's free text fields to the specific visit
and EMR filed. We also created a search template which enables users to
specify words of interest as they relate to a variety of other criteria
(breed, weight range, procedures performed, data range, etc.). An individual
word may provide the basis of a search, or words in combination may be
searched with "or" operators (e.g., renal or kidney), or "and" operators
(e.g., renal and failure). Words of interest are typically searched with
"wildcards" to pick up different word forms and suffixes. The pertinent
cases can be retrieved by keyword searching of the entire visit summary,
specific reports (e.g., Radiology or Pathology) or by limiting the search
to specific fields (e.g., presenting complaint or clinical diagnosis).
The appropriate cases are usually found and staged for review in a matter
of seconds.
Title: Veterinary Medical PATIENT CARE (c) (Problem-based Access
Tool for Interactive Evaluation Network of Teaching Cases to Assure Relevant
Education)
PATIENT CARE (c) - Veterinary Medical case information stored
in sophisticated database repository and accessed by intelligent retrieval
system - Emphasizes problem analysis driven by query, organization, assessment,
assimilation, evaluation, refinement and postulation - Asking a question
really means typing a question, such as ³What¹s Snuffy¹s
temperature?² or simply ³temperature² ... Retrieval system
is transparent to user as it accesses stored medical information, parses
it and displays response - Stored information for each case includes history,
physical findings, lab values for hundreds of diagnostic tests, treatments,
fees and normals per species - Faculty facilitator is privy to case line
and may serve as enabler to guide discussion group, peer consultation in
professional veterinary medical curricular environment - Automated user
interaction tracking; comparison with experts choices offered at conclusion
of case - Formula to control level of interactivity may be prescribed in
the informational database in order to dynamically control interaction
- Designated branch points may include mastery levels, necessary and sufficient
tasks, guided flowline or progress in time ...Presentation environment
may be individual computer, CD, intranet, internet, CE, individuals, groups,
students, practitioners or other veterinary medical professionals
Title: Evolution of a Comprehensive Electronic Medical Record
Our goal has been to have a complete, functional and useful EMR.
We defined such to minimally include the patient's signalment, the reason(s)
for the patient's visit, pertinent history, physical examination findings,
problems noted, procedures performed, all diagnostic results, pharmaceutical
dispensations, clinical and pathological diagnoses and discharge instructions.
This EMR had to be perceived by clinicians, staff and students as saving
work rather than creating it. To make that happen, we reasoned that information
must be able to be easily entered in timely fashion, by the person closest
to the source of that information. The only way we could see to make that
possible, was to place terminals throughout the hospital, and enable free
text entry by students and clinicians (who were the source of much of the
desired information). We then linked all the free text entries together
with other structured test results to form a Visit Summary. This approach
has enabled the evolution of a very comprehensive EMR; an evolution based
primarily on clinician input and requests. Ultimately, this approach has
had a significant positive impact on individual case management, delivery
of clinical instruction, referral communications and retrospective retrieval
of cases of interest.
Title: A web based approach to seamless linking of textual reports
to medical images in a hospital information system
Our hospital information system (HIS) is capable of generating
an HTML representation of the electronic medical record (EMR). We used
this capability, to incorporate selected images, deemed valuable for teaching,
(radiographs, video, and microscopy) directly into the EMR. A program was
written to facilitate coordinated image input. From the case number, this
program queries a specific URL unique to that patient. In response, the
HIS provides access to this URL, and returns an HMTL file containing, Age,
Breed, Sex, Species, a list of all imaging procedures conducted along with
their dates, and a unique file identifier for image storage. The program
inserts the procedure information into the user interface, permitting the
user to select the specific imaging study being input. It then activates
the image input device and creates the image. All information is automatically
inserted into the image header file, using Photoshop keyword format, a
thumbnail created, and the image stored as a JPEG file on the server. The
HIS then links this file to the EMR and inserts the thumbnail in the textual
report relating to that image. When the report is displayed with a web
browser, this thumbnail becomes a hot link to the full resolution image.
Title: The Development and Implementation of the North Carolina State
College of Veterinary Medicine Teaching Hospital Information System (THIS).
Nicole Scoggins, Sandra Horton, Jom Holland, Wanda Borrelli, Bonnie Tarleton
of MC State College of Veterinary Medicine
The North Carolina State College of Veterinary Medicine (CVM)
has been developing an electronic patient record for five years (see http://renoir.csc.ncsu.edu/THIS/.
In the final stage of revalidating the requirements and testing, the system
begins pilot testing winter 1997-98. CVM wants to present the approach
to development and implementation at the conference. The ultimate goals
are to enhance patient care, improve communication and teaching quality,
and be a rich source for research. Developed using an evolutionary prototyping
model by an analyst/programmer, veterinarians, technicians, and other staff,
the system has thirty-one modules. Added to the small systems staff this
fall have been 100 computer science students to revalidate the requirements
and develop tests. Improved communications allow care providers to review
a patient's chart at the same time from different locations. As a teaching
tool, the system will instill in the student the value of complete medical
records. Furthermore, by reducing time for paperwork, the student will
have more time for learning. For research, any user can gather information
from the system and note keywords for cases. All-in-all, the computerized
patient record holds much promise, but has proved challenging to implement
due to system size, complexity of interfaces, and number and type of users.
Title: Case based problem solving on the computer. To err is not
to maime.
Case based problem solving is regarded as an ideal way to probe
the limitations of an individual's knowledge base. The medical and veterinary
professions have always used clinical exposure as a training tool for students,
interns and residents. Humanitarian and medico-legal considerations have
impacted on student experiential learning by limiting the individual's
involvement in decision making on real patients. Substitutes have, and
continue to be, developed that meet the desire to have the learner make
decisions and then accept responsibility for those decisions by reacting
to the results. Case presentations remain one of the most popular forms
of continuing education for the practicioner. As technology makes recording
and delivery of images and sounds easier, the quality and quantity of case
presentations is growing. A computer software program has been developed
which emulates veterinary practice. The user can choose from an icon based
menu any of more than 600 tests, examinations or procedures in order to
reach a diagnosis of the case under review. The cases are all real and
no guidance is offered on how to proceed. The user is reminded to complete
any critical steps they miss as they work. The program tracks the pathway
taken and will display the time and money expended as tests are ordered.
Realism is simulated by built in delays associated with waiting for test
results. In real time the user can bypass simulated delays by advancing
the clock. At this time the end point is a self evaluation of the accuracy
of the users problem list, plan of action and diagnosis which is compared
to the experts opinion. It is planned to allow comparison of the pathways
and computer grading of efficacy and efficiency. Three cases are currently
available on floppy disk and the updated and revised CD-ROM version will
be released by the end of 1997.
Title: Vertical Integration in a horizontal Veterinary Curriculum
(subtitle: The Urinary System: A Bridge over yellow waters...)
This project is a work in progress and is a means to overcome
a shortcoming of discipline-based veterinary curriculum. In a discipline-based
curriculum, information about each organ system is presented in several
classes across 3 to 4 years of the curriculum, making it difficult for
the student to build a bridge between the various aspects of each organ
system (e.g. anatomy, physiology, clinical medicine, etc.). The urinary
system will be the first organ system to be electronically, vertically
integrated. By presenting organ system information in a web-based, learner-centered,
asynchronous format, clinical relevance can be given to the basic science
classes of anatomy and physiology and conversely the student can apply
the basic principles learned in anatomy and physiology to clinical medical
and surgical entities, thereby "vertically integrating" information. Hyperlinks
can be made between relevant information across the courses (e.g.. physiologic
mechanisms for concentration of urine will be linked to the sections in
clinical medicine about defects in urine concentrating ability). Successful
use of vertical integration in the urinary sytem as described in this proposal
can set the stage for a similar strategy for teaching other organ systems.&&The
Web site is being constructed using a combination of searchable text (class
notes), graphics, case simulations and quizzes. Eleven faculty at OSU and
WSU are participating in this project. The freshman classes are scheduled
to be on-line by fall 1998. The concept is currently being previewed by
the junior students in the small animal medicine class at http://www.vetmed.wsu.edu/Urinary
_Tract
Abstracts
of the Richard B Talbot Symposium for Veterinary Informatics
First Author: Ronald D. Smith
Affiliation: University of Illinois
Abstracts of the Richard B Talbot Symposium for
Veterinary Informatics
First Author: Jeff Parke, DVM, MS
Affiliation: ECP Consulting, Seattle, WA
Abstracts
of the Richard B Talbot Symposium for Veterinary Informatics
First Author: Duane Steward, DVM, MSIE, Fellow AAVI
Affiliation: Clinical Decision Making Group; Laboratory for Computer
Science; Mass. Inst. Tech.
Abstracts
of the Richard B Talbot Symposium for Veterinary Informatics
First Author: James A Self, MA
Affiliation: Veterinary Medical Teaching Hospital, UC Davis
Abstracts of the Richard
B Talbot Symposium for Veterinary Informatics
First Author: Kristine Tischer, BS, MA, DVM
Affiliation: College of Veterinary Medicine; Mississippi State
Abstracts
of the Richard B Talbot Symposium for Veterinary Informatics
First Author: Paul Brentson
Affiliation: Veterinary Medical Teaching Hospital, UC Davis
Abstracts
of the Richard B Talbot Symposium for Veterinary Informatics
First Author: W J Hornof
Affiliation: UC Davis
Abstracts of
the Richard B Talbot Symposium for Veterinary Informatics
First Author: Harriet Mermes
Affiliation: NC State College of Veterinary Medicine
Abstracts of the
Richard B Talbot Symposium for Veterinary Informatics
First Author: Shires, Peter K
Affiliation: Virginia-Maryland Regional College of Veterinary Medicine
Abstracts
of the Richard B Talbot Symposium for Veterinary Informatics
First Author: Cheryl R Dhein DVM, MS
Affiliation: Washington State University