\IEI). I \ F O I < \ J . (1982), \ ( ) I , . 7, \o . 1, 19-28

The role of medical informatics in establishing an integrated and intelligent medical information system

TOSIO KITAGAWA

Director of the International Institute for the Advanced Study of Social Information Science, FUJITSU Limited. Honorary Professor of Kyushu University

(Received September 19x1)

Keywords: Informatics; Integration procedure; Intelligent s3Isterns; Ecosphere; Requirements for realization.

1. Introduction Information science was born, grew and developed out of the needs of and

co-operation between the various scientific fields. In its recent developments, information science had shown two main trends: firstly towards the establishment of an autonomous science called informatics; and secondly the trend toxvards specific applications-work such as environmental informatics, chemical informatics, and geological informatics. Medical informatics can be recognized as one of the most remarkable examples of the second group. The present paper aims to present likely future developments relating to medical informatics.

2. Expectations in the medical sciences and in medical treatment An old Chinese proverb says that upper physicians govern the state, middle

physicians cure human beings, and lower physicians treat diseases. We are not so much concerned here with the issue of whether these criteria for the classification of physicians describe states of physicians or enunciate the ideal goals of physicians; rather, we want to point out that the proverb summarizes the roles and the characteristics of the physician in a very subtle and simple way.

In the first place, the three definitions of the objectives of medical s c i e n c e government, cure and treatment of human beings-illustrate that its aims range over social human and biological sciences.

In the second place, these notions, government, cure and treatment, show that medical science should be concerned not only with cognition, but also with direction and evaluation. Thus medical science implies understanding, planning and action.

In the third place, the classification of physicians’ characteristics into three classes shows that medical science is concerned with many fields and draws upon many methodologies in order to fulfil its functions.

In summarizing these three observations it follows that medical science has a strong connection with information science and similarly requires a systems-science approach. It seems appropriate to put forward a set of basic standpoints for promoting future research activities in informatics.

0307 7640 ~ 2 ~ 0 7 0 1 0019 so200 < 19x2 T ~ ~ I ~ ~ F ~ ~ ~ ~ , ~ i.rd

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20 T . Kitagawa

3. 3.1 . Technologies a i d key notions

These are illustrated in figure 1: where C , =Computation; C , = Communication; C, = Control; C = Cognition; D = Direction; E = Evaluation; I, = Information; I, = Integration; I, = Intelligence and S = System.

Research standpoints for promoting informatics

Figure 1. Technologies and key notions

3.2 . The jive basic research axes in informatics, B-(I) (V) B-(I): the first basic research axis involves a decomposition of the information-

processing process into sexfen subprocesses.

( a ) (PI) -input information-processing subprocess. (6 ) (P2,1)-preliminary information-processing subprocess. ( c ) (P,.,)-structure formation subprocess. (4 (I?,,,)-information storage subprocess. ( e ) (€',.,)-information retrieval subprocess. ( f ) (P4) -information circulation subprocess. (g) (P,) -information utility subprocess.

B-(II): the second basic research axis is the space of informative logics. This space has a construction based upon three co-ordinate systems consisting of three subspaces:

(i) S , -structure subspace. ( i i ) S , -function subspace.

(iii) SFe-feasibility subspace.

The notion of the space of informative logics was introduced by the present author in a paper published in 1973 [l] and extended and elaborated in later papers P, 31.

B-(I I I ) : the third basic research axis: informative expressions. These are broadly classified into groups ( a ) and (b):

( a ) -voices, figures, pictures, symbols, signs and letters. (b) -generalized language systems. (6,) -natural language; (6,) =mathematical language; (b,) =computer pro-

gramming language; ( b 4 ) = technical terminology systems in a specific science division.

B-(IV): the fourth basic research axis has four levels of intelligence:

(B) -biological intelligence. (M) -mechanical intelligence. (H) -human intelligence. (S) -social intelligence.

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Role of nietlictil iilfornratics 21

B-( r.?: tlie tifth basic resarch axis analyses developing systems in terms of genesis, eclu i l i hr;ition, and evolution.

, 7 1 hese five basic research axes were originally proposed by the present author in 1976 [1], and since then have been used to promote informatics approaches in specific tields of application.

3 . 3 . Kealiztrtion of tlie hrrsic vesearch axes ’l’lie four basic research axes B-(I), (11), (111) aiid (IV) are realized by means of

-ID technologies consisting of data-base (DB), data communication (DC), data entry (DE) and data utility ( D U ) as shomm in figure 2. T h e three fundamental notions, objectivization, operatorization and socialization, have been realized through the corresponding subprocesses in the information process. These terminologies have been introduced pre\.iously by the author [5,6].

b.iKure 2. ol>jecti\ ixation. operatorization and socializatioil realized in the information-processlnC process

3 .+. Ii$ov?ncztic niral>3sis of -iwrious ii?f(wrri(itioii systems concerning experimentutiori, siir-i,eq’, control, cowirnuiricntion

( ( 1 ) Information systems can be described in terms of information functions ranging over cognition, direction. and e\.aluation.

( h ) The information-processing processes in information systems can be described in terms of information processors: information flolv materials and information-processing activities.

1Iethodologies in implementation of information systems comprise model- building for theoretical formulations and objecti1.e description; ware formulations ranging over software, hardware, brain\vare, and application ware; adaptation of man-machine interactive procedures; and successi1.e process approach (described in section 4).

( c )

These aspects ha\-e been discussed aiid explained by the author in a previous paper [6] with regard to inf~~rmation-processiiig subprocesses relating to scientific research. Various fundamental notions, such as brainware, research simulators, and computer experiments lvere introduced in that paper. It should be pointed out that these informatic approaches and the several fundamental new notions can be directly applied to various sorts of human social activities including certain experiments, sur\-eys, control and communications.

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22 T. Kitagawa

3 . 5 . Three feasibility features of information systems Analysis, synthesis, and evaluation of any information system should be

described with regard to three feasibility features of information logic consisting of control, adaptation, evolution, and creation [lo].

( a ) Control features: established by standardization, specification, automation, modularization and system formation.

(b ) Adaptat ion and evolution features: these features can be secured by systematic and objective fact-finding attitudes, adaptation to the real world, and admission of various subjective existences.

( c ) Creation features: these features concern abductive processes which con- tribute towards the creation of new systems by attacking the problems involved in the real existence which cannot be solved by either the adaptation or the control features.

The five standpoints also provide a set of general observation standpoints upon which the establishment and evaluation of any specific information, including medical information systems, should be based.

4.

information systems can be realized through the following five steps.

4.1 . Description of information activities of medical scientific organizations and

This can be given in the product space (a) x (b) x (c) x (d), where each of the

Towards the establishment of integrated medical information systems The role of medical informatics in the establishment of integrated medical

health-care institutions

component features of information activity may be defined as follows:

( a ) Institutional features: clinic, hospital, medical research institution, medical science society, medical library, medical department of university, medical school.

(6) Process features: creation of new information (original production of information materials, new structuring of information materials, new publication of information materials), information storage, information structuring and knowledge formation, information retrieval, information circulation and information utilization.

(c) Act ic i ty areas: education, research, development, health care (diagnosis and therapy), control, management, social activity and administration.

( d ) Sc i en t i f i areas: mathematical science, physical science, chemical science, biological science, various specialities in the medical sciences, the humanities and social sciences.

In 1969 the author described the institutional and process features of medical information systems in a paper which considered the implications of information science for scientific research [7].

4.2. Informatical description of various information systems associated wi th health-care

There are various information systems associated with health-care systems, such as the biological system, the diagnostic system, the patient observation system, the

systems

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Role of medical informatics 23

clinical examination system, the reservation system of medical examination, the hospital management system, the hospital catering system, the case-history manage- ment system, the integrated examination, the emergency medical system, and the remote medical treatment system. A description of the characteristic features of each of these medical information systems from theviewpoint of informatics can be illustrated by the product space of the component standpoints illustrated in figures 3 and 4.

Experimentation Cognition

1,iterature stud? Applicationware Evaluation

Figure 3 . Sources x \vares x objectives

X I (m) mathematical formulae and symbols (n) numerical values (s) statistical data (u) linguistic information (d) literature information (f) figures ( g ) pictures (h) sounds and voices

Figure 4. Processes x expressions

These standpoints are closely connected with the knowledge-engineering approach to the data-base management system [S].

4.3. Functional features These can be explained by the following description which refers to several

fundamental notions being introduced by the author in his analysis of information research activities, including the k+ th type of brainware BRW"' (k), (j), ( k = 1, 2 ) in the information-processing system IPS [(i), (j)] associated with each individual information subject ( i ) at time j .

Figure 5 . Information-processiiig system associated with information subject 13"'

where

13"' =the i + th information subject; W(i) =real subject world with which nci) is concerned; Pci) = a set of information processors used by B'"; L"' =a set of generalized artificial grammars adopted by f3(i); D"' ( j ) =information materials in flow in M'" at time j ; nci) (j) =information flow procedure in Bci) at time j .

r . I he description of an information-processing system associated with an information subject can be used for discussing a distributed data base system [9, 101.

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24 T. Kitagawa

4.4. Generalized relational ecosphere feature The generalized relational ecosphere approach has been proposed by the author

in a series of papers [l l-131 and can be applied to the analysis, synthesis and evaluation of the set of individual medical information-processing systems n ( N , T)={IYS(i)Cj), i=1 ,2 . . . , N;j=O,1 ,2 , . . . , T-1rovertimeTbydescribing the following aspects:

( a ) 1,ocal space aspect.

(6) Global space aspect.

(c) Connections and inbedding among local spaces. ( d ) Mutual reflection and equivalent transformations among local spaces.

( e ) Generalized artificial grammars.

The roles of and relationships between various medical information-processing systems can be described systematically by considering the C D E connections of these systems: C = Cognition, D =Direction; and E = Evaluation. These are the three fundamental information functions. Five basic terminologies, (Sb) for the subject, (Ob) object, (Md) medical information system, (St) Standard, and (Bb) behaviour, were put forward by the author to describe C, D and E (see figure 6).

J Md Ob /

Figure 6 . ‘I’he relationships between the three information hnctions: C (cognition), D (direction) and E (e l aluation)

I t should be noted that cognition activities in experimentation and in surveys are concernedwith asetofnodes(Sb, Ob, Md, and C)andwithasetofchords(1,2,5,6). E\duations consist of a set of nodes (Sb, Ob, Md, St, C and E) and with a set of chords (1,2, 3 , 5 , 7 , 9 ) . Control activities consist of all nodes and chords as illustrated in figure 6.

4.5. Integration procedures of information-processing systems. The basic strategy for integration procedures of information-processing systems

in a consolidated information system has two aspects; one is a modular formation and its components, and the second is a systematic combination of these modules in a consolidated organization in order to realize strategic requirements for fulfilling functions, such as gradual developments, innovation and adaptation.

5. Towards an intelligent medical information system. Intensive efforts towards establishing intelligent medical information systems

have been one of the most remarkable tendencies in recent years. Contributions by

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Role .f niedicul inforirrutics 25

medical informatics to this goal have been recognized, as by Feigenbaum, as being extremely important [14]; the MYCIN system is considered to be one of the most remarkable developments [15].

Developments required in medical informatics in order that the science should become a more effective part of the health-care process Lvill now be discussed.

Intelligent information systems can be realized effectively only by establishing integrated information systems as illustrated in part 4 of this paper.

The establishment of intelligent medical information systems should be based upon many considerations and policies in order to cover all the feasibility features (control, adaptation/elevation and creation) in an adequate balance. Such an adequate balanced realization of the three feasibility features is crucial to securing the realization of intelligence features of medical information systems.

T h e intelligence feature of an intelligent medical information system derives basically from the satisfaction of two kno1vledge-engineering requirements. T h e first is concerned Lvith realizing three cognitive functions in information logics: deduction, induction, and abduction. The second is concerned with building up, expanding and utilizing the brainware systems which serve to realize these three cognitive functions in information logic. The notion of brainware was introduced by the present author in his paper [16], and then illustrated and elaborated in subsequent papers [17, 181 as well as in his summary paper [6].

T h e most fundamental and most crucial role in establishing these three cognitive functions in information logic should be made possible by the introduction and use of higher level formal languages being adopted in the framelvork of computer technologies. I t is the opinion of the present author that there is a need for general formulation of the whole problem with regards to coexistence of and mutual connections among various sorts of lower and higher level formal languages on the basis of generalized relational ecosphere considerations in which the notions of generalized local and global grammars are being analyzed and synthesized [ l l , 12, 131.

With regard to the cognitive functions, induction and abduction the establish- ment of a new science area to be called ‘datalogy’ is required so as to provide a systematic methodology for the analysis of all information at all levels of in- processing and to represent all processes (Pl), (PZl), (PZ2), (P31), (P32), (P4), and (P,). If this is to be achieved, the following is imperative:

( i ) ’1’0 clarify the inter-relationships among various storage and utilization procedures of information materials and their evolution processes and to discover an adequate and effective procedure to systematize the set of these various procedures. T h e author introduced various notions in this regard in a Special Research Project, Formation Process of Information System and Organization of Scientifi Information. T h e final English report lvas published in 1980 [19]. Readers lvanting more information should refer to the author’s paper [20], where the notions of Private Researcher File (PRF); Accumulative Researcher File (XRF); User Data 1,ibrary (UDL); and Center Data Library (CDI,) are elaborated.

(ii) Systematic development of successive processes of inference and control has been considered by the author in a series of papers [21-291, published between 1950 and 1963.

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26 T. Kitagawa

Thus, there is a need for the following research tasks to be carried out:

(a) A statistical methodology covering the recent advances in statistics needs to be established. The objective is to amalgamate in a software package various existing statistical methods such as quantification, clustering, multivariate analysis, time series analysis, AIC approaches, and so on. The author gives the reasons for this requirement in a paper published in 1978 [30]. The specific reference was made to the project of preparing a software package for a new interactive statistical analysis system NISAN with the project leader Asano [31,32].

(b ) I t is very important that an intimate connection between successive processes of statistical inferences and those of statistical controls be established for the medical information system.

(c) A theory of successive processes of information processing regarding various ways of expressing information (such as pictures, figures, speech) is also urgently required.

( d ) After the first three research topics are underway, a systematic formulation of the three cognitive functions, deduction, induction and abduction should be developed from the standpoint of successive processes of information processing.

The topics of ‘datalogy’ in the information-processing process will be discussed by the author in a new paper [33].

6.

systems imply the following six requirements.

Conclusion: requirements for realization of expectations Our expectations to realize integrated and intelligent medical information

Requirement 1 To establish the fundamental ideas upon which integrated and intelligent medical information systems should be realized.

Requirement 2 To have a strong, common appreciation of why an integrated and intelligent medical information system should be established.

Requirement 3

Requirement 4

To foster further developments in informatics.

To secure an intimate cooperation between medicine and informatics.

Requirement 5 To have a clear understanding about the reason why the information-oriented society should be developed into a knowledge-oriented society.

Requirement 6 To establish two new fields of industry: a medical industry and a knowledge-oriented industry, in order to have a strong social basis for establishing an integrated and intelligent information system.

In conclusion, the author should like to draw attention to his 1978 papers [34,35], one of which explains the roles and functions of the scientific information systems and their implication for informatics, while the other [35] discusses possible social implications of knowledge-oriented society. It seems to the present author,

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Role of medical informatics 27

considering the methodological achievements and social consensus, that the establishment of integrated and intelligent medical information systems can and should be realized.

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28 Role of medical informatics

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