Abstract
Linking a knowledge-based system (KBS) to a clinical database is a difficult task, but critical if such systems are to achieve widespread use. The Columbia-Presbyterian Medical Center's clinical event monitor provides alerts, interpretations, research screening, and quality assurance functions for the center. Its knowledge base consists of Arden Syntax Medical Logic Modules (MLMs). The knowledge base was analyzed in order to quantify the use and impact of KBS-database links. The MLM data slot, which contains the definition of these links, had almost as many statements (5.8 vs. 8.8, ns with p = 0.15) and more tokens (122 vs. 76, p = 0.037) than the logic slot, which contains the actual medical knowledge. The data slot underwent about twice as many modifications over time as the logic slot (3.0 vs. 1.6 modifications/version, p = 0.010). Database queries and updates accounted for 97.2% of the MLM's total elapsed execution time. Thus, KBS-database links consume substantial resources in an MLM knowledge base, in terms of coding, maintenance, and performance.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Barnett G. O., Cimino J. J., Hupp J. A., Hoffer E. P. DXplain. An evolving diagnostic decision-support system. JAMA. 1987 Jul 3;258(1):67–74. doi: 10.1001/jama.258.1.67. [DOI] [PubMed] [Google Scholar]
- Barnett G. O., Winickoff R. N., Morgan M. M., Zielstorff R. D. A computer-based monitoring system for follow-up of elevated blood pressure. Med Care. 1983 Apr;21(4):400–409. doi: 10.1097/00005650-198304000-00003. [DOI] [PubMed] [Google Scholar]
- Evans R. S., Larsen R. A., Burke J. P., Gardner R. M., Meier F. A., Jacobson J. A., Conti M. T., Jacobson J. T., Hulse R. K. Computer surveillance of hospital-acquired infections and antibiotic use. JAMA. 1986 Aug 22;256(8):1007–1011. [PubMed] [Google Scholar]
- McDonald C. J., Hui S. L., Smith D. M., Tierney W. M., Cohen S. J., Weinberger M., McCabe G. P. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med. 1984 Jan;100(1):130–138. doi: 10.7326/0003-4819-100-1-130. [DOI] [PubMed] [Google Scholar]
- Miller R. A. INTERNIST-1/CADUCEUS: problems facing expert consultant programs. Methods Inf Med. 1984 Jan;23(1):9–14. [PubMed] [Google Scholar]
- Miller R. A., McNeil M. A., Challinor S. M., Masarie F. E., Jr, Myers J. D. The INTERNIST-1/QUICK MEDICAL REFERENCE project--status report. West J Med. 1986 Dec;145(6):816–822. [PMC free article] [PubMed] [Google Scholar]
- Safran C., Porter D., Lightfoot J., Rury C. D., Underhill L. H., Bleich H. L., Slack W. V. ClinQuery: a system for online searching of data in a teaching hospital. Ann Intern Med. 1989 Nov 1;111(9):751–756. doi: 10.7326/0003-4819-111-9-751. [DOI] [PubMed] [Google Scholar]
- Wyatt J. Computer-based knowledge systems. Lancet. 1991 Dec 7;338(8780):1431–1436. doi: 10.1016/0140-6736(91)92731-g. [DOI] [PubMed] [Google Scholar]