towards cost-effective clinical computing. nineteenth

University of Calgary

PRISM: University of Calgary's Digital Repository

Research Centres, Institutes, Projects and Units E-Health Resource Repository

1995-10-28

Towards Cost-Effective Clinical Computing.

Nineteenth Annual Symposium on Computer

Applications in Medical Care. Preliminary Program.

American Medical Informatics Association (AMIA)

American Medical Informatics Association (AMIA)

American Medical Informatics Association (AMIA). 1995. Towards Cost-Effective Clinical

Computing. Nineteenth Annual Symposium on Computer Applications in Medical Care.

Preliminary Program. Bethesda, MD: American Medical Informatics Association (AMIA). 2-67.

http://hdl.handle.net/1880/43080

unknown

Downloaded from PRISM: https://prism.ucalgary.ca

WELCQME TO THE 1995 SCAMC!

T o w a r d Cost-Effective Clinical Computing" is the theme of this year's meeting. There is

indeed a growing knowledge base showing that clinical computing can become cost-effective, as illustrated by the over 580 submissions of manuscripts, panels, theater demonstrations, tutorials, and posters. The 1995 SCAMC Program Committee has outlined over 80 sessions on a broad range of topics-from com-puter support of clinical practice to governance of clinical computing and sharing of data. Two diverse plenary sessions should set the tone for the meeting. In addition, there are 52 tutorials this year to help familiarize all of us with the growing and broadening field of informatics.

Ten tracks will provide a broad range of topics from methods for measuring effectiveness to using the computer with Internet connections and providing educational opportunities and services. Seven of the ten tracks are listed under "Program Area Tracks" in the SCAMC Program Committee listing at right. We have also added tracks for Electronic Record System Architectures, Governance of Clinical Computing and Sharing of Data, and Theater-Style Demonstrations of State-of-the-Art Operational Systems.

The symposium takes place at the New Orleans Hilton Riverside, right on the banks of the Mississippi River. In addition to the excellent topics to be presented at the conference, New Orleans is one of the country's most exciting tourist towns. The food and nightlife are world famous, and we will be in New Orleans at a beautiful time of the year. The Program Committee and I invite you to join us for an outstanding meeting.

Reed M. Gardner, Ph.D. 1995 SCAMC Program Chair LDS Hospital and University of Utah Salt Lake City, UT

AMIA BOARD OF DIRECTORS

President Randolph A. Miller, M.D. Vanderbilt University Medical Center Nashville, TN

Treasurer Robert A. Greenes, M.D., Ph.D. Brigham & Women's Hospital Han~ard Medical School Boston, MA

Secretary Naomi C. Broering, M.L.S., M.A. Georgetown Universitv Medical Center Washington, DC

President-Elect Reed M. Gardner, Ph.D. LDS Hospital/University of Utah Salt Lake City, UT

Patricia Flatley Brennan, R.N., Ph.D. Case Western Reserve University Cleveland, OH

James I. Cimino, M.D. Columbia-Presbyterian Medical Center New York, NY

Paul D. Clayton, Ph.D. Columbia-Presbyterian Medical Center New York, NY

Mark E. Frisse, M.D. Washington University St. Louis, MO

Betsy L. Humphreys, M.L.S. National Library of Medicine Bethesda, MD

Michael G. Kahn, M.D., Ph.D. Washington University St. Louis, MO

Donald A.B. Lindberg, M.D. National Library of Medicine Bethesda, MD

Daniel R. Masys, M.D. University of California, San Diego San Diego, CA

Joyce A. Mitchell, Ph.D. University of Missouri Columbia, MO

Judy G. Ozbolt, Ph.D., R.N. Universitv of Virginia Charlottesville, VA

Charles Safran, M.D., MS. Haward Medical School Boston, MA

ACMI President W. Ed Hammond, Ph.D. Duke University Medical Center Durham. NC

1995 SCAMC PROGRAM COMMITTEE Program Chair Reed M. Gardner, Ph.D.

Evening Workshops~Theater-Style Demonstrations James J. Cimino, M.D.

PosterIElectronic Poster Session R. Scott Evans, Ph.D.

Student Paper Competition E. Andrew Balas, M.D., Ph.D.

Tutorials and Panels Mark S. Tuttle

Computer Support of Clinical Practice Susan I. Grobe, Ph.D., RN

Decision Support Systems in Clinical Practice M. Michael Shabot, M.D.

Designing Computerized Patient Records David W. Bates, M.D., MSc.

Computer and Intemet-Based Educational Systems Pawati Dev. rh.D.

Evaluation of Clinical Information Systems Erica Drazen, Sc.D.

Evaluation of Computerized Health Care Strategies John P. Glaser, Ph.D.

Computerized Image Processing and Transmission Melvyn Greberman, M.D., MPH

Library Information Science Mary Ellen Sievert, Ph.D.

Networks, Standards, and JCAHO Assessment George S. Conklin

Primary Care Practice Systems H.C. "Moon" Mullins, M.D.

CPM Credits Avai!aQle

1995 SCAMC attendees may a:..valuable Continuing Medical Education (CME) credits by attending presentations and tutorials. The College of Physicians and Surgeons of Columbia University is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians. The College of Physicians

and Surgeons designates this continuing medical education activity as meeting the criteria for 41.5 credit hours in Category 1 of the Physician's Recognition Award of the American Medical Association. This program has also been reviewed and is acceptable for 12 prescribed hours by the American Academy of Family Physicians. Up to 48 hours of continuing education credit for nurses are available through the University of Maryland; there is an admin-istrative charge of $5.00 for processing nursing accreditation.

Objectives The objectives of the symposium are

to promote awareness of the benefits of clinical computing, to provide a forum for p-esenting meth-ods for evaluation of clinical computing, to illustrate effective clinical systems and help attendees understand why they have been successful, to present research in the broad field of medical informatics,

to promote collaboration among atten-dees, and to educate attendees about the complex

organizational structures of medicine and how computer systems can be used effectively in such complex systems.

The conference is intended for people who have an interest in clinical data acquisition, decision support, and evaluation for

improving the value of the electronic med-ical record and the quality of health care. The format is designed to accommodate participants with a wide range of experi-

ence, from novice to expert. Tutorials, pan-els, formal presentations, poster sessions, and informal gatherings will provide an excellent opportunity for participants to network with colleagues.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Welcome to the 1995 SCAMC . 2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .AMIA Board of Directors . 2

1995 SCAMC Program Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .AMIA Staff. . 3

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .General Information . 4

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Special Events Schedule . 7

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SCAMC Awards . 8

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Student Paper Competition . 9

Tutorial and Workshop Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tutorials.. 12

Workshops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Plenary Sessions I and 11. .28

ProgramOverview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Closing Session and ACMI Debate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

Primary Care Informatics Standards Conference. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Hotel Reservation Form .63

AMIA Membership Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64

AMIA Membership Application/Renewal Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .65

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .RegistrationInstructions 66

Advance Registration Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67

Disclosure Before the program, all faculty will dis-close the existence of any financial inter-est and/or other relationships they might have with the manufacturer or manufacturers of any commercial prod-uct or products to be discussed during their presentation (honorarialexpenses; grants; consultant role; speaker's bureau membership, stock ownership, or any other special relationships).

AM!A Staff Acting Executive Director

Jeanne Nevin, M.B.A.

Assistant Executive Director

Janice D. Kennedp

Meetings Manager Vernell Henry

Database Administrator Renee Fleuette

Accountant Debbie Preusse

Membership Assistant Y. Michelle Daniels

Following, in alphabetical order, is

general information about the 1995 SCAMC.

Advance Registration Send your Advance Registration Form (so that it arrives by October 14, 1995) to

American Medical lnformatics Association 4915 St. Elmo Avenue, Suite 401 Bethesda, MD 20814

Advisory Council AMIA is honored to enlist the assistance of volunteer leaders from similar organizations that comprise the Advisory Council. The Advisory Council works with AMIA toward the common goal of using medical informatics to improve patient care. Members of these groups have always been strong supporters of

AMIA and SCAMC.

Agency for Health Care Policy and Research

American Academy of Child and Adolescent Psychiatry

American Academy of Dermatology

American Academy of Family Physicians

American Association of Dental Schools

American Association for Medical Instrumentation

American College of Cardiology

American College of Obstetrics and

Gynecology

American College of Physicians

American College of Radiology

American Health Information Management Association

American Institute for Medical and Biological Engineering

American Medical Association

American Nurses Association

American Society for Testing and Materials

Association of American Medical Colleges

College of American Pathologists

IEEE Engineering in Medicine and Biology Sciences

Healthcare Information and Management Systems Society

Medical Library Association

National Association of Managed Care Physicians

National Electrical Manufacturers Association

National Library of Medicine

Society for Computer Assisted Radiology

Society for Medical Decision Making

Air Travel Discount

is the official carrier for the 1995

SCAMC. Delta offers discounts to all attendees who are residents of the U.S., Canada, Bermuda, Nassau, San Juan, St. Croix, and St. Thomas. A 5 percent discount will be applied to most published round-trip promotion airfares in first class (restrictions may apply). A 10 percent discount will be applied to Delta coach (Y06/YR06) fares (restrictions may apply). Make reservations by calling Delta directly at 1-800-241-6760 daily from 8:00 A.M. to 11:OO P.M. (Eastern time); refer to file number H1010.

Bookstore Is your library well stocked with publications and abstract books from AMIA conferences? If not, drop by the AMIA bookstore, located in the Exhibit Hall, to pick up a SCAMC proceedings or Spring Congress abstract book. Or take advan- tage of the opportunity to purchase our newest publication (and first book), A

History ofMedical lnforrnatics in the United

States: 1950 to 1990, by Morris F. Collen, M.D. The bookstore is open during regular exhibit hours. Save postage charges by purchasing these publications at the bookstore!

Ruyerk Guide Once again, AMIA is proud to offer to SCAMC attendees the opportunity to uti-

lize a comprehensive Buyer's Guide of AMIA Corporate Member companies' and SCAMC exhibitors' products and services. This guide will be conveniently incorporated into the final program, which is distributed when attendees register at the meeting. Last year, nearly 100 categories of products and services were listed in the guide, from ad hoc reporting to CD-ROM networks to nursing software. The Buyer's Guide is a service that lasts long after the symposium has ended.

Cassette Tapes Most sessions, panels, and evening workshops will be audiotaped. Cassette tapes are available for sale thirty minutes after the session has ended. To purchase cassette tapes, stop by the Cassette Tapes counter near AMIA registration or complete the cassette tape order form in your registration packet to order tapes by mail.

E-maib Access at the Message Center The message center will be significantly updated this year! Attendees may now enter and retrieve messages at stations located near the tutorial/session rooms, in the registration area, and in the exhibit

hall. Want to access your e-mail while you're at the meeting? Stop by the message center booth located near AMIA reg-

istration and find out how.

Exltihib: A !/asfArray of Proha=& at SGAMC 95 See the latest in clinical computing software, the most up-to-date hardware and software, and the best in patient education and student teaching aids at the 1995 SCAMC exhibit area at the New Orleans Hilton Riverside. It's an excellent opportunity to "shop" the exhibit hall and purchase, peruse, or demonstrate products

on site.

There's still time for your business to exhibit! Call Vemell Henry, AMIA Meetings Manager, at 301-657-1291 for information. Note: Children under 18 are not allowed in the Exhibit Hall.

Exhibit Hours October 30, 11:00 A.M. to 6:00 P.M. October 31,10:00 A.M. to 6:00 P.M. November 1, 10:OO A.M. to 3:00 P.M.

1995 SCAMC Exhibitors (as of mid- August) ALLTEZ, Information Services, Inc. American Society of Health-System

Pharmacists The Anatomy Project

Apple Computer Appleton & Lange New Media Applied Medical Informatics Aries Systems Corporation

CapMed Systems Corporation Cerner Corporation Ciba-Geigy Corporation CliniComp, International Computer Scheduling Services D.B.L. Enterprises EMTEK Health Care Systems, Inc.* Facts and Comparisons, Inc.+ First DataBank Franklin Electronic Publishers HBO & Company Health Data Sciences Corporation Healthcare Communications, Inc. Healthvision Corporation IBM Healthcare Solutions IDX Systems Corporation Keyboard Publishing, Inc. Key Info Manager Lexi-Comp, Inc.

Medical Connections/Zydoc Medical Data Exchange MedicaLogic, Inc. Medical Records Institute Micro-Design Software Corporation Micromedex, Inc. NASA Technology Transfer Alliance National Library of Medicine Paperchase Patient Medical Records, Inc. Photonics Corporation Planar America, Inc.

Proxim, Inc.

QMI Sih7er Platter Information, Inc. Soft~vareTechnologies Corporation SpaceLabs Medical, Inc.+ Springer-Verlag New York, Inc. Sunquest Information Systems, Inc. Systems Plus, Inc. 3M Health Information Systems TreeAge Software, Inc. The US. Pharmacopeia Ventecli Systems, Inc.+* Williams & Wilkins

* Corporate Member of AMIA **Gold Corporate Member of AMIA

AMIA's Gold Corporate members are extraordinary supporters of AMIA's activities, mission, and goals.

food Donations AMIA will donate excess food from the Symposium to a local organization feed- ing homeless citizens of New Orleans.

HIMSS Members A reminder: AMIA's strategic partners for 1995, the members of the Healthcare Information and Management Systems Society (HIMSS), will receive a special discount when registering for the 1995 Symposium on Computer Applications in Medical Care (SCAMC).

Motels All hotel rates are listed on the Hotel Reservation Form on page 63. Please make your hotel reservations no later than October 5,1995. When making a reservation, you must mention that you are attending the American Medical Informatics Association's 1995 SCAMC. Hotel reservations must be accompanied by the first night's deposit to the hotel.

The official SCAMC hotel is New Orleans Hilton Riverside Poydras at the Mississippi River New Orleans, LA 70140 Phone: 504-561-0500 Fax: 501-584-3979

Government rates and suites are available from the New Orleans Hilton Riverside on a limited basis. Please call Vernell Henry, AMIA Meetings Manager, at 301-657-1291 for information about suites. For government-rated rooms, complete the Hotel Reservation Form, including payment information (checks should be made payable to the New Orleans Hilton), and fax or mail it to the AMIA office.

Two blocks from the Hilton, a small block of rooms is also available at the DoubleTree Hotel 300 Canal Street New Orleans, LA 70130 Phone: 504-581-1300 Fax: 504-522-4100

At both hotels, check-in time is

390 P.M.; check-out time is noon.

The Hilton's Rivercenter Racquet and Health Club is a complete facility with four racquetball courts, three squash courts, a golf studio, and a basketball court. The exercise center features Nautilus equipment, step machines, treadmills, aerobics studio, massage

therapy, saunas, and whirlpools.

The DoubleTree features a fitness center that is complimentary to all guests, an outdoor pool, and gift shop. The hotel is in a location that provides easy access to all major New Orleans attractions including restaurants and shopping.

Job Exchange Database Stop by the Job Exchange, located in the Exhibit Hall. For a nominal fee, as a potential employer or employee, you may exchange employment information. Resumes and job descriptions collected during SCAMC will be kept in AMIA's Job Exchange Database for six months. On request, job exchange information will be kept confidential. Potential employers and employees may contact AMIA at 301-657-1291 to retrieve specific

information after the symposium.

5

Medical Emergencies The nearest hospital is Tulane University Medical Center. The phone number is 504-588-5263. For emergencies within the Hilton, dial the Assistant Hotel Manager

at extension 66 or dial 0. At the Doubletree, dial 0.

MedSig We encourage you to experiment with MedSig, AMIA's on-line medical special interest group on the CompuServe Information Service. MedSig is carried on CompuServe 24 hours a day You may ask questions, exchange ideas, post information, and acquire public domain and shareware software. MedSig contains over 700 files and has thousands of active members.

The MedSig computer is available

Sunday, October 29, through Wednesday, November 1. The hours of operation are 8:00 A.M. to 5:00 P.M.

Ivo-Smoking Policy AMIA requests that a no-smoking policy be observed during all SCAMC events. We appreciate your cooperation.

Proceedings The Proceedings of the 19th annual Symposium on Computer Applications in Medical Care is published by Hanley &

Belfus, Inc. as a supplement to JAMIA, the Journal of the American Medical Informatics Association. Each fully registered SCAMC attendee is entitled to one copy of the Proceedings. Copies will be distributed at the Hilton's third floor registration counters during AMIA registration hours and during scheduled exhibit hours at the AMlA bookstore in the exhibit hall. Additional copies of the Proceedings may be purchased at the Hilton's third floor registration counters, during scheduled registration hours, for $65.00 U.S. plus 4 percent sales tax.

Recycling AMIA will provide recycling bins for badge holders in the registration area and meeting areas.

Responsible Drinking Policy AMIA will have cash bars at the First Timer's Reception on Sunday night and at the Halloween Dessert Reception on Tuesday night. Please use the bar responsibly.

Restaurants There will be a restaurant reservation service near the AMIA registration area.

The New Orleans Hilton has four restaurants. Enjoy continental cuisine with Cajun/Creole specialties, along with a spectacular view of the Mississippi River, at Kabby's On the River. For breakfast, lunch, and dinner buffets, try Le Cafe Bromeliad, or a la carte service at Le Croissant. Also, room service is offered 24 hours a day. Looking for nightlife nearby? Try the.Flamingo Casino, accessible from the hotel's Riverside lobby.

The DoubleTree hosts the Chicory Rotisserie and Grille Restaurant for breakfast, lunch, or dinner and the Chicory Lounge for cocktails.

Safety First! AMIA wants you to have a safe and enjoyable time in New Orleans. We will include a brochure in your registration packet, with safety tips on hotel check-in, stepping out, fire precautions, and so forth.

Speaker-Ready Room The Durham room on the third floor of the Hilton is available for speakers who wish to review slides or overheads before their session.

Sfuden! ?/dunbeers AMIA needs fifteen student volunteers to staff SCAMC tutorials and sessions in

exchange for a complimentary registration to the meeting (excluding hotel accommodations or travel). Responsibilities will include collecting tickets (where appropriate), distributing hand-out materials, changing slides and overheads for speakers, and working the lighting in each room. Individuals will be required to work at least three full days between Saturday, October 28 and Wednesday, November 1, from 7:30 A.M. to 6:00 P.M. each day.

To apply, contact Vernell Henry, AMIA Meetings Manager, by September 30. Send e-mail to [email protected] or a fax to 301-657-1296. Include your name, telephone number, fax number, preferred schedule (days and dates), and a copy of your student I.D. AMIA will notify (by e-mail or fax) those assigned as volunteers.

Transportstion The airport is approximately thirty minutes from the Hilton. Airport shuttles are recommended for transportation from the New Orleans International Airport. They run daily every fifteen minutes from 4:30 A.M. to 11:OO PM. The cost is $10 each way Tickets may be purchased at the airport's baggage claim area. Taxis are also available at $21 per one-way

fare.

The Riverfront Streetcar stops just outside the Hilton en route to the French Quarter and other city attractions at a $1.25 fare.

The DoubleTree Hotel is within easy walking distance of the Hilton, or taxis are available.

What to Wear New Orleans weather in October is typically mild, with temperatures in the 70s. Lightweight clothing and walking shoes are most comfortable. Business attire is appropriate for the tutorials and sessions. The AMIA Halloween Dessert Reception on Tuesday evening is casual; we encourage you to wear a costume!

First Timer's Reception If you're a new AMIA member or this is your first SCAMC, join us at the First Timer's Reception on Sunday evening, October 29. It's a great way to become acquainted with the AMIA officers, Board of Directors, staff, and other newcomers.

AMIA General Membership Meeting Once a year AMIA members and guests attend the General Membership Meeting to review progress in meeting goals, hear AMIA's leaders report on successes in 1995 and preview things to come, and learn AMIA election results. Plan to attend on Monday, October 30.

AMIA Halloween Dessert Reception This year's dessert reception on Tuesday, October 31 promises to be a "spooktacular" event! A chilling air of excitement will color the evening with intrigue and mystery. New Orleans, renowned for witchcraft, voodooism, and romance, will be the setting for AMIA attendees to celebrate Halloween at this ghoulishly grand evening. Wear your costume and enjoy sweet Halloween treats! Cash bars will be available. Spouses, exhibitors, media representatives, and attendees who do not have full registration may attend for an additional $25 by signing up for the reception on the Registration Form.

Working Group Tables On Monday, October 30 from 1200 noon to 2:00 P.M. and Tuesday, October 31 from 11:30 A.M. to 1:00 P.M., AMIA's thirteen Working Groups will display information on table-top exhibits located throughout the hotel. The Working Groups encourage SCAMC atten- d e e ~to stop by to talk with a Working Group representative and view their latest work in progress, from newsletters to e-mail conferences to seminars. (The exhibits will be open during the rest of the day, but a representative may not be present.)

President3 Club Reception President's Club members (AMIA members who have recruited at least three new members to AMIA since last year's SCAMC) will be invited to an exclusive, early evening reception in their honor. Ed Hamrnond, Ph.D., chair of AMIA's Membership Committee, and Randolph A. Miller, M.D., AMIA President, will host this reception, which will take place in the AMIA President's Suite. This reception is AMIA's way to say thank you to members who have worked hard to increase AML4's membership base.

Saturday, October 28

1:00 - 6:00 P.M. AMIA Board of Directors Meeting

Sunday, October 29 1:00 - 5:00 P.M. Student Paper Competition 2:00 - 5:30 P.M. ACMI Executive Committee Meeting 5:30 - 6:30 P.M. First Timer's Reception 7:00 - 10:00 P.M. ACMI Reception and Dinner Meeting (by invitation only)

Monday, October 30 5:30 - 6:15 P.M. AMIA General Membership Meeting

Tuesday, October 31 8:30 - 10:30 P.M. AMIA Halloween Dessert Reception

Wednesday, November I 1:00 - 3:00 P.M. Closing Session and ACMI Debate 3:00 - 5:00 P.M. AMIA Board of Directors Meeting

Committee/Mlorhing Group (WG)Meetings Schedule Most AMIA Standing Committees will meet during the Symposium. Before the Symposium, committee members will receive an agenda with meeting time and place.

Sunday, October 29 8:00 A.M. - noon JAMIA Editorial Board Breakfast Meeting 12:45 - 1:45 P.M. Awards Committee Luncheon Meeting

Professional Relations Committee Luncheon Meeting 700 - 10:OO P.M. Advisory Council Dinner Meeting

Monday, October 30 7:00 - 8:15 A.M. Education Committee Breakfast Meeting

Finance and Audit Committee Breakfast Meeting Publications Committee Breakfast Meeting

12:15 - 1:45 P.M. Computerized Medical Records WG Luncheon Meeting Hospital/Medical Information Systems WG Luncheon Meeting Medical Imaging WG Luncheon Meeting Meetings Committee Luncheon Meeting Membership Committee Meeting

7:00 - 10:OO P.M. Anesthesiology/Critical Care and Emergency Medicine WG Meeting and Reception Automated Encoding/Electronic Patient Records WG Meeting and Reception Family Practice/Primary Care WG Meeting and Reception Nursing Informatics WG Meeting and Reception Prevention and Health Evaluation Informatics WG Meeting and Reception

700 - 11:OO P.M. Intemet WG Meeting

8:00 - 10:OO P.M. Student WG Meeting and Reception

Tuesday, October 31 7:00 - 8:30 A.M. Dental lnformatics WG Breakfast Meeting

11:45 A.M - 1245 PM. Bylaws Committee Luncheon Meeting Clinical Computing WG Luncheon Meeting Education WG Luncheon Meeting International Affairs Committee Luncheon Meeting WG Chair Committee Luncheon Meeting

Wednesday, November 1

7:00 - 8:15 A.M. Telecommunications and Networking Committee Breakfast Meeting Noon - 1:00 P.M. 1996 SCAMC Program Committee Luncheon

veryone whose work has been

-accepted for presentation at SCAMC 1s eliglble for awards.

AMIA manages the Student Paper Competition, where finalists compete in

both oral and written competitions for cash awards ranging from $300 to $1,000. In addition, all Student Paper

Competition finalists are awarded complimentary registrations to the symposium. These awards will be presented at

the SCAMC Plenary Session.

The AMLA Awards Committee, with help from the SCAMC Program Committee, will also give $500 awards for the Best Theoretical Paper and the Best Paper on an Application from those presented at SCAMC. In addition, the Best Traditional Poster and the Best Electronic Poster win awards of $250 each. These awards will be given at the SCAMC Closing Session.

The University of Utah will present the Priscilla Mayden Award, named for the first director of the University of Utah's medical library. This is an annual presentation with an accompanying monetary award. It will be announced at the SCAMC Closing Session.

Papers nominated for awards at the 1995 SCAMC follow.

~Vorninated for Best Paper Awards

Cross-Site Study of the lmplementation of lnformation Technology Innovations in Health Sciences Centers

Joan Ash, M.L.S., M.S., M.B.A.

An Architecture for a Distributed Guideline Server

Mike Barnes, M.D., and G. Octo Barnett, M.D.

A Data Model that Captures Clinical Reasoning About Patient Problems

Randolph C. Barrows, Jr., M.D., and Stephen B. Johnson, P11.D.

Web-Based Access to an Online Atlas of Anatomy: The Digital Anatomist Common Gateway Interface

S.W. Bradley, C. Rosse, and J.F. Brinklev

HealthDesk for HemophiliaB: An Interactive Computer and Communications System for Chronic Illness Self-Management

Fran Carl, M.P.H., and T. John Gribble, M.D.

Verification and Validation Algorithms for Data Used in Critical Care Decision Support Systems

Debra Carlson, C. Jane Wallace, R.N., M.S., Thomas D. East, Pli.D., and Alan H. Morris, Ph.D.

Health System Re-engineering: A CPRS Economic Decision Model

Mark Diehl

Implementing a Low-Cost Computer- Based Patient Record: A Controlled Vocabulary Reduces Database Design Complexity Daniel J . Essin, M.D., and Thomas L. Lincoln, M.D.

Computer-Aided Learning Validation: A CA/-Critical Mission

Thomas J. Handler, M.D., Patrick Lynch, M.S., and C. Carl Jaffe, M.D.

Creating Temporal Abstractions in Three Clinical lnformation Systems

Michael G. Kahn, M.D., Ph.D., and Keith A. Marrs. MS.

The Constellation Project: Experience and Evaluation of Personal Digital Assistants in the Clinical Environment

Stephen E. Labkoff, M.D., Sandeep Shah, M.S., Joseph Bormel, M.D., M.P.H., YoonJoon Lee, and Robert A. Greenes, M.D., Ph.D.

A Model for Adapting Clinical Guidelines for Electronic lmplementation in Primary Care David F. Lobach, M.D., Pli.D., MS.

Strategic Planning for lnformation Management: What Are the Delivera bles ?

Ann J. Olsen, M.B.A., M.A., and William W. Stead, M.D.

Validity and Reliability of Standard Terms and Codes for Patient Care Data

Judy G. Ozbolt, PhD., R.N., Marguerite Russo, R.N., and Melissa P. Stultz, R.N.

Converting a Legacy System Database into Relational Format to Enhance Query Efficiency Jonathan C. Prather, David F. Lobach, M.D., Ph.D., M.S., Joseph W. Hales, Ph.D., Marvin L. Hage, M.D., Set11 J. Fehrs, and William E. Hammond, Ph.D.

Enhancements of Anatomical lnformation in UMLS Knowledge Sources

Cornelius Rosse, M.D., DSc., Mohamed Ben Said, M.D., M.S., Kraig R. Eno, and James F. Brinkley, M.D., Ph.D.

Methods for Assessing lnformation Needs of Clinicians in Ambulatory Care

Paul C. Tanp, M.D., Mary A. Jaworski, R.N., Cindy A. Fellencer, R.N., Michael P. LaRosa, Jerry M. Lassa, Pamela Lipsey, and Wendy C. Marquardt, R.N.

Nurses, Pagers, and Patient-Specific Criteria: Three Keys to Improved Critical Value Reporting

Karen E. Tate, Ph.D., Reed M. Gardner, Ph.D., and Kurt Scherting

Cross-Platform Hypermedia Examinations on the Web

Thomas W. Williams, Jr., Nunzia B. Giuse, M.D., M.L.S., Jeffrey T. Huber, Ph.D., and Robert L. Janco, M.D.

AMIA is proud to feature the annual Student Paper Competition again as part of the SCAMC program.

This popular competition was open to all persons enrolled in a degree-granting program or in a medical residency or a post- doctoral fellowship as of April 25, 1995.

Students were invited to submit papers expressing original ideas and reasonably complete research or development efforts in medical informatics. Topics or issues derived from (but were not limited to) such areas as computer science and artifi- cial intelligence, biomedical engineering, health care technology, health care administration, nursing, medical education, imaging and graphics, communications and networking, and biomedical research.

The judging process occurs in two phases. In the first phase, submitted manuscripts were evaluated for technical and scientific merit by a panel of independent reviewers. The reviewers scored for originality and innovativeness, analysis of relevant prior work, importance of the contribu- tion to medical informatics, and organization and clarity of the exposition. Up to four finalists in each category were chosen for the second phase: oral presentations.

The finalists have been invited to SCAMC, and will give their oral presentations on Sunday, October 29, from 1:00 to 5:00 P.M. The finalists' SCAMC registration fees are waived, and they receive transportation, hotel, and per diem expenses. The winning authors will be announced at the Plenary Session on Monday morning, October 30.

The panel of judges will select first and second prize-winning papers. The author of the First Prize Paper judged best paper overall will receive the Martin Epstein Award ($1,000). The author of the other First Prize Paper will receive an award of

$500. The authors of the two Second Prize papers will receive awards of $300 each. All finalists will receive certificates of recognition. Finalists' papers are published in the supplemental SCAMC

Proceedings.

Student Paper Competition Finalists

A Comparison of the Temporal Expressiveness of Three Database Query Methods Amar K. Das, Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA

Using Knowledge Maintenance for Preference Assessment Nilesh L. Jain, DSc., Section on Medical Informatics, Washington University, St.

Louis. MO

Using a Pen-Based Computer to Collect Health-Related Quality of Life and Utilities Information Phillip P. Le, MIT Clinical Decision- Making Group, Cambridge, MA

A Computer-Generated Reminder System Improves Physician Compliance with Diabetes Preventive Care Guidelines David S. Nilasena, M.D., M.S.P.H., Department of Medicine, Salt Lake Veterans Affairs Medical Center, Department of Medical Informatics,

University of Utah,

Contextual Models of Clinical Publications for Enhancing Retrieval from Full-Text Databases

Gretchen P. Purcell, Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA

Evaluation of a Belief-Network-Based Reminder System that Learns from Utility Feedback Michael M. Wagner, Section on Medical Informatics, University of Pittsburgh, Pittsburgh, PA

LabTalk/Z: A Middleware Approach to HIS Integration Aamir M. Zakaria, M.D., Biomedical

Informatics, Vanderbilt University, Nashville, TN

Categorization of Free-Text Problem Lists: An Effective Method of Capturing Clinical Data Julian Zelingher, M.D., M.Sc., Betli Israel Hospital, Harvard Medical School, Boston, MA

9:00 A.M. - 1230 P.M. T3 l3 T7 How to Identify Mar l(et Text lnformation Knon~ l e d g ~ Opportunities for Retrieval Fund;men1

the Arden syntax tor Consumer Health Hersh of R0bust [ Medical Loaic Modules lnformatics Deck;ion S Hripcsak Applications SystE!ms

Locke, Veale East, Wall;

200 - 530 P.M. T2 T4 T6 T8 Creating and Patient Records and Software Design and H a messinc Disseminating Medical Computer-Based Testing, Clinical . . .. .. - . .

Developing Virtual Reality Record Svstems: Installation, Iralnlng, bearch Strareg~esror lnrormarlon lecnnoloov. Jagannamirr, >nrr~vas

andProcedural Training An lntroductlon and Support C l ~ n ~ c ~ a n s and the CPR Applicat~ons Wyatr Wallace, East, Sadors, Researchers D~ehl Roy, Merrii Morr~s McK~bbon,Walker-

Dllks, W~lczynsk~, Haynes

v.---- m

T33 1r359:00 A.M. - 1230 P.M. T25 T27 T29 T3 Managing 30 Graphics in Information Securityfor Ca Medical Concept tivaluation of Medical

mformation Systems:Technological Change Medicine for Beginners Computer-Based A : r I

Lorenzi, Riley Cook Patient Records Classification to How to Measure What's Miller Understanding Important

Chute Friedrnan

T34 T36200 - 530 P.M. T26 T28 T30 T32 HL7 Vers~on2 2 and Declsion Analysis for The Role of lnformatlon Implementing Practice Mosaic and Digital Distributed Health Care Progress Toward HL7 Health Care Technology In GL~idelinesand Video on the lnternet lnformation Systems Vers~ons2 3 and 3 Profess~onals Outcomes Cc~mputer-Stored Grirnson Shafarrnan Cork, Downs Measurement RE!cords

Chaloner, Ault M cDonald, Dverhage, f im e y p

200 - 5:30 P.M. T49 Techniques and Tools for Converting Analog Resources into Multimedia Content for CD-ROMs VanBiewiiet, Gest

945A.M. - 1245 P.M. T50 (no break) Lexical Tools for UMLS Developers

McCray, Brown, Divita

7:00 - 10:OO A.M. T51T51 T52 (no break) lnformation Systems SecuritySystems SecurityInformation Version 3 of the Read Codes: Its Role in

(INFOSEC) International Primary Care Dawson Mullins, Bird, Stuart-Buttle, Hayes, Booth

T21 l23 stic Conjoint Emerging Trends and Future Project Management Aeasurement: Directions in Health Care for Health ;~d Application lnformation Systems: Care/lnformatics 31 lnformatics Increasing Benefits from Professionals

. .Clinlcal Systems AutomaOon Knight Dorenfest

T22 l 2 4 ata Modeling lnformation Design in Advanced Methods for

Health Care Practical Natural- Cole Language-Based

lnformation Management Evans

9:00 A.M. - 12:30P.M. T37 T39 T41 T43 T45 T47 Introduction to Mosaic Emerging Domain Models and Defining and Using Encounter-Based Biomedical Imaging: and the World Wide Communic,ation Reference Nursing Data ir 1 Systems: Part l Practical Tools and Web Technologies for Health Archltectures in Clinical Systems Campbell Techniques Stoddard, Piper lnformatioriSystems Systems Tielstorff, Henry, Ozt i lolt, Bergeron

Orthner Musen, Tuttle Jouglas, Grobe, 1

200 P.M. - 5:3tI P.M. T38 T40 T42 1 T46 T48 .- .. .Tel~merlicin~.A Primer . ... ction to A n l n t r n h ~ ~ Case Management: IIistributed Computin g Encounter-Based Information Design in (The On-Ramp to the Case-Based Reasoning Utilizing lnformation i~n Health Care Systems: Health Care lnformation Macura Technology to Assist in :iideli, Forman Part 2 Cole Superhighway) Managing Care Campbell Moidu, Divakarunb Remrnlinger, Hanrahan Falsone

W3 Uv4 W5 W6 rategic Workshop: Stimulating \iVorkshop: The Role of Workshop: Toward a Workshop: A i n of the Clinical Encounter Iitart-ups and Working Group on Amazing Clini ystems Hagen, Zilen, Weeks Financing in Advancing Ethics in Medical Workstation I

,rise-Wide hAedical lnformatics lnformatics Runaway Gle Crescenzo Goodman Development

Project? Perry

W9 Vv10 W11 lidating Workshop: This is the VVorkshop: Plight or Workshop: Information natics PITS: Planning, F'anacea: On-line Systems for the

Installation, and Clocumentation in the Outcomes Movement: lindon Training Strategically Emergency Department Strategic and Practical

Wagner, Bjornstad, IIJelson, Merkley Considerations Orysdale, Neiswanger Aller

'F' am Committee has designed the SCAMC tutorial program to help you

! learn more about the theme before the p r o p m begins. We urge individuals who are interested in new concepts or who want to brush up on their knowledge of current theories to participate. A separate fee is charged for each tutorial. Fees are listed on the Advance Registration Form (page 67). Tutorial fees include any hand-outs or textbooks. Tutorial participation is limited, so register early to ensure that you are able to attend the tutorial(s) of your choice. You may register for one of each of the two time slots, morning and afternoon. A maximum of hvo tutorials is allowed each day. Please remember, tutorials are filled on a first- come, first-served basis. They are often filled to capacity before SCAMC begins. We recommend pre-repstration for tutorials; we cannot guarantee on-site registration. AMIA reserves the right to cancel a tutorial in the unlikely event of insufficient preregistration.

Tutorial T1 Saturday, October 28 9:00 A.M. - 12:30 f? M.

Writing Medical Rules for Computers Using the Arden Syntax for Medical Logic Modules The Arden Syntax for Medical Logic Modules (MLMs) is a language for writing and sharing computer-based rules for clinical care. From the very start, the Arden Syntax project has been aimed at producing a language that can be read and written by clinicians without extensive computer experience. So far, MLMs have been used to provide medical alerts, interpretations, d~agnosis scoring, protocols, clinical research screens, and quality assurance functions.

The tutorial will address the initial motivation for the syntax-sharing-and cover the history and scope of the syntax; use extensive examples to teach participants how to write MLMs; cover the details of the syntax (slots, data types, expressions, statements, lists, time, queries, triggering, actions, nesting, and so forth); and cover the actual writing of MLMs, screening MLMs, trend analysis algorithms, algorithms to avoid duplicate alerts, and sample queries. Participants will write their own MLMs. The instructor will discuss implementation of the syntax and will explain methods of contribut- ing and receiving MLMs from the central MLM collection.

At the completion of this presentation, attendees will be able to M determine whether they should use MLMs, rn know how to use MLMs, M write effective MLMs,

M share MLMs, and 8 know ~vhcre to get more help.

Instructor: George Hripcsak, M.D., Assistant Professor, Department of Medical Informatics, Columl~ia-PresbyterianMedical Center, New York, NY.

Who should attend: Anyone who wants to learn about automated decision-support systems; sharing knowledge bases; using the Arden Syntax in his or her own practice or institution; writing MLMs for clinical care, research, or quality assurance; or implementing an Arden Syntax-based system.

Tutorial T2 '

Saturday, October 28 2:OO - 5:30 P M.

Creating and Disseminating Medical Virtual Reality Procedural Training Appdications

Medical education often involves teaching about complex three-dimensional anatomic relationships in the body. These relationships can be modeled in three dimensions with a computer and can be programmed to act and behave like actual tissues. Medically based scenarios, such as surgical operations, can be practiced with the use of these models through a powerful visualization tool called "Virtual Reality" (VR). VR involves the use of systems that simulate situations through the use of event driven, real-time, three-dimensional graphics and realistic interfaces like proxy surgical instruments.

This tutorial will include an introduction to VR technology, an overview of the applicabili ty to medical imaging, and demonstration of two systems that are complete and that have use in medical education and training. The instructors will explain and demonstrate the process for building models, applying texture mapping, and real-time rendering. They will also focus on how anatomical structures can be modeled using MR and CT data, and how texture maps of the tissues can be mapped to the model.

The participant will gain M a working knowledge of how VR can be

applied in medical education; a knowledge of the efforts currently taking place to make VR a viable learning tool; a perspective on the issues involved in designing a VR system in terms of educational issues, cost, hardware, and software needed; and

W an understanding of cross-platform development of software, which allows for the development of VR systems on low-cost personal computers.

Instructors: Rita T.Roy, M.D., Medical/Surgical Educational Technology Liaison, George Washington University Medical Center, Washington, DC, and Jonathan Merril, M.D., Co-founder, High Techsplanations, and Adjunct Professor of Anatomy, George Washington University Medical Center, Washington, DC.

Who should attend: Anvone with an interest in learning more about this field.

Tutorial T3 Saturday, October 28 9:00 A.M. - 12:30 f? M.

HoW to Identify Market Opportunities for Consumer Health lnformatics Applications A recent Gallup poll asked consumers what kind of interactive services they want when the information superhighway finally arrives at their door. The clear answer: health information. In response to the growing need for more and better information, health care providers and institutions are developing computer-based systems to educate patients and families. As interactive products become more common in the home, patient education will shift from institution-based to home-based. Computer-based patient education is a key element in health care cost reduction and quality improvement.

The instructors will describe a method to identify potential market opportunities for interactive consumer health education products developed by a team from Harvard Medical School, Boston's Beth Israel Hospital and the Harvard Business School. The presenters will review how disease-specific and demographic factors influence the cho~ce of technology-based educational solutions. The market analysis approach described can easily be adapted to a variety of populations.

The instructors will M present a market research approach to

assess the feasibility of marketing new con- sumcr health education products, and

rn provide insights into developing a business plan and a market research process using a generic process and examples from the audience.

Instructors: Steven E. Locke, M.D., Director of Psychiatric Informatics, Department of Psychiatry, Beth Israel Hospital, Harvard Medical School, Boston, MA, and Todd Veale, M.B.A.,Executive Vice President, MBNA America, Newark, DE.

Who should attend: Physicians, nurses, health educators, entrepreneurs, medical informatics specialists, or anyone interested in developing applications for computer-based consumer or patient health education.

WTOR!ALS - SATURDAY

Tutorial T4 Saturday, October 28 200 - 5:30 PM.

Patient Records and Computer- Based Record Systems: An Infroduction This in t roducto~ tutorial is designed for clinicians and others interested in informatics principles underlying the patient record, and is based on a recent series of review articles in the Lancet. The tutorial will cover key aspects of the acquisition, processing, and dissemination of patient data in conventional and computer-based record systems for the purpose of patient care. There will be little discussion of the use of patient data for other purposes, or of the computerization of medical knowledge. An outline of implementation tools and methods is included.

Participation in the tutorial will help atten- d e e ~to commission or participate in projects to successfully implement computerized clinical record systems, and to understand and critically appraise reports describing the evaluation of these systems.

The scope of the tutorial is restricted to the acquisition, processing, and dissemination of patient data in conventional and computer- based record systems for patient care, with little discussion of its use for other purposes, or of the computerization of medical knowledge. Basic details of implementation tools and methods are included.

This tutorial will a equip clinicians and others with an under-

standing of the fundamental informatics principles underlying the patient record,

a enable attendees to commission or participate in projects to successfully implement computerized clinical record systems, and

a help clinicians understand and critically appraise reports describing clinical data systems.

Instructor: Jeremy C. Wyatt, DM, MRCP, Biomedical Mormatics Unit, Imperial Cancer Research Fund, London, United Kingdom.

Who should attend: Physicians interested in understanding more about clinical data and conventional and computerized record systems; developers of computerized record systems looking for a clinical perspective; and others looking for a grounding in th s core area of medical informatics.

Tutorial T5 Saturday, October 28 9:00 A.M. - 12:30 PM.

Text Information Retrieval Computers enable us to store vast quantities

of text, from bibliographic and full-text databases to patient records. But it is much easier to store all this text than it is to organize and retrieve it. This tutorial is designed to introduce the basic concepts of text information retrieval in the context of medical reference and patient dormation systems. After covering the basic concepts of information retrieval, the instructor will discuss the principles of text indexing and retrieval and will give an overview of evaluation techniques and results. The remainder of the tutorial will be devoted to new research methods, new technologies (including the Internet and World Wide Web), and text processing of patient records.

The instructor will provide participants with a comprehensive overview of information retrieval, covering the rn fundamental concepts of text information

retrieval; rn different approaches to indexing text; W different approaches used in retrieval; W methods, results, and controversies in

evaluation of retrieval systems; directions of information retrieval research systems;

rn technologies shaping the direction of information retrieval, including the multimedia, the Internet, and the World Wide Web; and

rn promise and problems of processing text in medical charts.

Instructor: William Hersh, M.D., Assistant Professor of Medicine and Medical Mormatics, Oregon Health Sciences University, BICC, Portland, OR.

Tutorial T6 Saturday, October 28 LOO - 5:30 PM.

The Heart of Robust Clinical Decision Support Systems: Software Design and Testing, Clinical Installation, Training, and Support Standardization is an essential component of outcomes research and continuous quality improvement. Specific executable standards of care are often too complex to implement manually. Computerized decision support systems offer an ideal vehicle for disseminating and implementing standards of care. Unfortunately, creating and implementing a computerized clinical decision support system is not a simple matter. There are few publications on the practical matter of how to accomplish this task effectively in the real world clinical setting.

The purpose of this tutorial is to provide training in techniques for software design and testing, as well as clinical installation, training, and support, that have been shown to produce robust clinical decision support systems.

Instructors will teach participants how to take a standardization project from a set ot specific clinical rules to software effectively providing decision support at the point of care.

Instructors: C. Jane Wallace, R.N., M.S., Thomas D. East, Ph.D., R. Matthew Sailors, MS., and Alan H. Morris, M.D., Pulmonary Division, LDS Hospital, Salt Lake City, UT.

Who should attend: Health care providers, hospital administrators, nurse informaticists, nurse trainers, information system trainers, and medical informaticists interested in techniques for software design and testing as well as clinical installation, training, and support.

Tutorial T7 Saturday, October 28 9:OO A.M. - 12:30 PM.

Knowledge Engineering Fundamentals: The Soul of Robust Clinical Decision Support Systems An essential element of health care reform is the standardization of many of the processes inherent in modern health care. Standardization is an essential component of outcomes research and continuous quality improvement. A wide variety of clinical practice guidelines and standards have been published by local, regional, and national organizations; however, few have been widely embraced and only a handful are in routine practice. The missing link in the current guidelines and standards is that they are not executable by the care provider at the point of care. One of the key elements in creating executable standards for use at the point of care is the knowledge engineering necessary to produce specific rule sets that are clinically robust and result in instructions that require no additional judgment by the clirucian at the bedside.

Instructors will enable participants to a use an iterative knowledge engineering

process that includes as an essential component the clinical environment, and

a take a standardization project from concept to a set of specific rules that are in a form to be easily implemented in a computer system and used at the point of care.

Instructors: Thomas D. East, Ph.D., C. Jane Wallace, R.N., M S , Alan H. Morris, M.D., Pulmonary Division, LDS Hospital, Salt Lake City, UT.

Who should attend: Health care providers, hospital administrators, and medical informaticists interested in obtaining knowledge engineering skills necessary for the development of "executable" computerized decision support systems that are effective tools for standardizing care and continuous quality improvement.

Tutorial T8 Saturday, October 28 2:OO - 5:30 F?M.

Harnessing MEDLINE: Developing Effective Search Strategies for Clinicians and Researchers MEDLINE searching is a skill that health care professionals and researchers are using increasingly. Retrievals, however, are often problematic. This course is desibved for persons with MEDLINE searching experience who are interested in improving or refining their searching skills, either for their own use or for teachiilg. The instructors will address searching for both clinical topics and research. The course content will be based on both the instructors' multidisciplinary experience and the results of their completed research studies

The instructors encourage participants to bring problem searches for group problem- solving exercises.

At the completion of this tutorial, participants will 8 recognize when it is appropriate to use

each of the two different search approaches; learn how to alter their strategies to address problems of too much, too little, or irrelevant retrieval;

8 understand the theory and practice of retrieving clinically relevant and method- ologically sound studies for health care decision making.

Instructors: K. Ann McKibbon, M.L.S., Cynthia J. Walker-Dilks, M.L.S., Nancy L. Wilczynski, M.Sc., and R. Brian Haynes, M.D., Ph.D., Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Who should attend: Clinicians doing their own MEDLINE searching for clinically relevant and valid studies to construct their own searches, and researchers, graduate students, and guideline developers searching for all relevant citations on a particular topic.

Tutorial T9 Saturday, October 28 9:00 A.M. - 12:30 F! M.

!mplementing Nectronic Medical Records in the Primary Care Office A growing number of primary care practices are now considering adoption of electronic medical record (EMR) systems as a tool to enhance quality and efficiency. Successful implementation of an EMR requires attention to much more than just product select~on: gaining user commitment, managing expectations, re-engineering workflow, training personnel, planning installation, converting data, and developing operational pollcies must all be managed correctly, or disaster may ensue. This h~torial will address the entire process of implementing an EMR in the primary care setting, with emphasis on practical, rather than theoretical, answers to problems.

At the completion of this tutorial, participants will 8 understand the nature of electronic med-

ical record systems applicable to primary care offices,

8 learn techniques for comparative evaluation of products and vendors,

8 clearly visualize workflow and how it is re-engineered when EMR is implemented,

8 be able to plan an installation, including solving common ergonomic problems

8 recognize the practical challenges in bring- ing existing data into a new EMR system, and

8 know the operational policies that must be developed to keep the system running smoothly.

Instructor: Mark Leavitt, M.D., Ph.D., MedicaLogic, Inc., Beaverton, OR.

Who should attend: Physicians, nurses, administrators, consultants, and anyone who is planning or currently involved with implementation of electronic medical records in the primary care office. No technical computer background is required.

Tutorial TIO Saturday, October 28 2:OO - 5:30 F! M.

Health Enterprise Re-engineering, lnformation Bechnology, and the CPR Re-engineering is essential to maintain or improve the competitive position of an organization in the future health service market- place. The instructor will discuss factors involved in developing a level of re-engineer-

ing expertise so that the staff can understand, direct, and oversee consultant actiwties and thus achieve the best result for the re-engineering investment. The instructor will present the rationale, process, techniques, and objectives of re-engineering a health care delivery system.

Participants will learn 8 what re-engineering is, and why; 8 phases and steps involved in the re-engi-

neering process; 8 information engineering tools and tech-

niques: modeling processes and data; 8 why information systems are key and

essential to business process involvement; 8 how to develop a computer-based patient

record from the enterprise data model; 8 how to work with re-engineering consul-

tants; how to perform the essential economic analysis, including selecting appropriate financial measures and decision models; and

8 how to set up, perform, and determine implementation priorities for an enterprise-wide re-engineering effort.

The instructor will show why the information system is the heart of the health service re- engineering process. He will guide the user to determine the key and essential features of health service business process improvement, and how and why the computer-based patient record enables business process improvement. The tutorial will conclude with thoughts on how to solve sticky organizational problems in change management.

Instructor: Mark Diehl, D.D.S., M.A., OSD Health Affairs, Medical Functional Integration Management Project Officer, DoD Computer- based Patient Record, Frederick, MD.

Who should attend: Senior executives, CIOs and informatics staff, and providers whose organizations are about to embark on the re- engineering adventure.

Tutorial T11 Saturday, October 28 9:00 A.M. - 12:30 F! M.

Integrating Health Care Delivery Systems: Ale W

Requirements for Managing Information Technology Assets The information technology needs of emerging integrated health care delivery systems (IDS) are growing rapidly as the direct result of managed care's evolution. The instructors will discuss the information technology requirements and methods required to

TUTOP!ALS - SATURDAY

redeploy IT assets in support of the develop-ment of an IDS and will share lessons learned.

After completion of this presentation, atten-d e e ~will be able to

define the IDS, discuss infrastructure required to support an IDS, identify changes necessary for streamlin-ing operations, and discuss the conversion of current ITsolu-tions appropriate for IDSs.

Instructor: Helen S. Levine, Principal, Practice Leader, Healthcare Management Counselors, New York, NY.

Who should attend: Individuals involved in health care information teclmology and emerging integrated delivery systems.

Tutorial T12 Saturday, October 28 200 - 5:30 f? M.

Collaboration Technology Information sharing, communication, and coordination are basic elements of any collab-orative endeavor. In the health care domain, collaboration is characterized by cooperative activities by health care providers to deliver total and real-time care for their patients. Communication between providers and man-aged access to distributed patient records should enable health care providers to make informed decisions about their patients in a timely manner. With an effective medical information infrastructure in place, a patient will be able to visit any health care provider with access to the network, and the provider will be able to use relevant information from even the last episode of care in the patient record. Such patient-centered perspective is in keeping with the real mission of health care providers.

This tutorial will provide an overview of what collaboration technology is and of its applicability to the health care arena. The instructors will present an overview of cur-rent state of the art and state of practice of these technology areas.

Instructors: V. "Juggy" Jagannathan, Ph.D., Associate Director of Research, and K. Srinivas, Ph.D., Assistant Professor of Computer Science,Concurrent Engineering Research Center, West Virginia University, Morgantown, WV.

Who should attend: Anyone interested in the concepts and underpinnings of technology that support collaboration.

Tutorial T13 Saturday, October 28 9:00 A.M. - 1230 f? M.

h o v a t i v e Methods for Evaluating Computerized Patient Record Systems: A Cognitive-Engineering Approach This tutorial will provide attendees with a set of knowledge and skills pertaining to the use of cognitive-engineering methods in the eval-uation of medical information technologies such as computerized patient record (CPR) systems. The methods also provide a basis for characterizing the effectiveness of students', physicians', and other health care workers' use of these systems. The instructors will out-line the theoretical rationale and motivation for such an analysis, followed by an illustra-tion of techniques. These include the Cognitive Walkthrough, a design evaluation methodology for assessing the usability of a computer system and assigning causes to usability problems; Analysis of Representations, a method for examining the ways in which structured representational models that constitute CPR systems are trans-lated into physicians' mental models of patient problems; and video-based methods of analysis for evaluating computer-based technologies. These methodologies yield pre-cise and reliable qualitative and quantitative process and outcome measures of evaluation.

In this tutorial, the instructors will introduce cognitive methods of analysis to physicians, system designers, and medical informatics professionals; demonstrate the efficacy of such a methodology using pen-based CPR sys-tem to illustrate the use of these tecli-niques; and provide attendees with the prerequisite skills to carry out cognitive analysis of medical technologies such as CPR sys-tems.

Instructors: Vimla L. Patel, Ph.D., David R. Kaufman, Ph.D., and Andre W. Kushnimk, M.Sc., Centre for Medical Education, McGill University, Montreal, Quebec, Canada.

Who should attend: Researchers in medical informatics, health care workers, system designers and developers, medical educators, and anyone interested in innovative methods for evaluating medical technologies such as CPR systems. Some background in issues per-taining to CPR systems would be helpful but is not required.

Tutorial T14 Saturday, October 28 2:OO - 5:30 P.M.

A Data Structure for Medical Language: The Extended SAWIEQ Model SNOMED International is a linked data struc-ture that attempts to faithfully represent in computer-processable form the activities, observations, and diagnoses found in the medical record. The computer-based patient record (CPR) requires a standardized vocabu-lary/data dictionary. SNOMED is an ideal candidate for this role.

This tutorial will provide insight into issues and problems related to transposing clinical information, often in the form of natural lan-guage, into a data structure suitable for com-putation. The instructors will present and dis-cuss conceptual graph and object-oriented representation of clinical terms using SNOMED notation and issues surrounding the parsing and transformations of natural language medical text to a linked SNOMED data structure.

Tutorial participants will become familiar with the deep structure, content, and scope of SNOMED; and gain insight into and some understanding of the problems related to transforming concepts found in natural language and in structured text into a non-redundant rep-resentational framework with their mean-ing intact.

Instructors: David J. Rothwell, M.D., Chicago Medical School, Chicago, K, Roger A. C M , M.D., Yves Lussier, M.D., and Louise Brochu, CRDMI, Universite de Sherbrooke, Quebec, Canada.

Who should attend: Individuals interested in medical vocabularies, indexing, and data structure used for the representation of clini-cal information needed for the computer-based patient record.

Tutorial T15 Saturday, October 28 9:00 A.M. - 1230 f?M.

IMriting for the Reader This tutorial is a review of the elements of English grammar and style, with emphasis on and examples of the utility of clear, graceful writing in computer applications. The aim of the course is to enable those who set up com-puting systems or computer-based records, those who design patient education programs or programs for the education of health care professionals, and those who are working in

other areas of informatics to construct sentences, paragraphs, and longer units of prose that are clear, coherent, and concise. The underlying assumption is that all of us can use a review of the elements of good writing from time to time. The emphasis will be on computer applications.

This tutorial will enable participants to rn examine their own work from the perspec-

tive of the reader, and rn use the principles of good writing to edit

and shape their sentences and paragraphs.

Instructor: Elizabeth M. Tomquist, M.A., School of Public Health and School of Nursing, University of North Carolina-Chapel Hill, Chapel Hill, NC.

Who should attend: Anyone who writes any- thing at all.

Tutorial T16 Saturday, October 28 2:OO - 5:30 k? M.

A Case Study in Development and Implementation: Clearing the Legal, Regulatory, and Contractual Barriers In t h s case study-based tutorial, legal experts will explain the fundamental issues affecting medical computing, including government regulation (FDA, CLIA, other); patents, copy- rights and trade secrets; licensing and vendor contracting; and confidentiality and malprac- tice. These areas are important to the design, development, acquisition, and utilization of medical computing applications and systems. The instructors, who have practical experience in the field and are educators, will adopt a highly interactive format to facilitate educat- ing a lay audience. They will provide instructional materials for attendees' future reference and for sharing with colleagues.

Participants will learn rn key issues for each topic, rn when they should seek expert advice on a

specific issue, what questions they should ask the expert and how to assess the advice given, and

rn how to integrate pivotal legal factors into planning.

Instructors: Gary E. Gamerman, M.S., J.D., and Phillip D. Porter, J.D., Fenwick & West, Washington, DC.

Who should attend: Persons responsible for system or application design, purchase, planning, or use.

Tutorial T17 Saturday, October 28 9:00 A.M. - 12:30 F?M.

Continuous Quality Improvement Using Clinical Computing Computerized, real-time quality assurance can be used to improve the quality and decrease the cost of health care. Most hospitals perform quality assurance by defining criteria for quality and then, via a random review of manually collected charts, determine their compliance with standards for appropriate care. Then through educational and procedural mechanisms they attempt to improve quality. Using integrated clinical computer databases, this process can be greatly simplified and applied to 100 percent of the care processes.

The instructors will describe and illustrate the theory of continuous quality improvement (CQI) and how, with simple computing and data collection methods, it can be applied to hospitals and health care facilities today. Participants will rn come to understand how applications of

CQI methodologies can result in dramatic improvements in patient care, and

rn discuss the use of integrated patient record systems, computerized expert systems, and CQI team approaches, which will illustrate the power of CQI techniques in improving quality of patient care and eliminating "quality waste."

Instructors: Reed M. Gardner, Ph.D., Professor of Medical Informatics, University of Utah, and CO-Director of Medical Computing, LDS Hospital, and David C. Classen, M.D., M.S., Infectious Disease Physician, LDS Hospital, Salt Lake City, UT.

Who should attend: Those interested in how computers can be used to improve the quality of health care; those interested in the theory and clinical application of CQI; and physicians, nurses, computer scientists, and medical informatics scientists who want to see concrete examples of clinical computing being used to improve the quality of patient care.

Tutorial T18 Saturday, October 28 2:OO - 5:30 k? M.

Pen- and Speech-Based Systems for Clinical Use This introductory-level tutorial will provide guidance in the design of pen-based and spo- ken interfaces to clinical systems. The emphasis will be on pen computing. The instructors will describe the advantages and disadvan-

tages of these two modalities and provide an assessment of the current state of the art of the hardware and software supporting these interface techniques. The major focus of the tutorial will be to describe how to adjust the interface design for clinical systems in response to limitations in the current state of these input technologies.

Both speech and pen-based interfaces have been presented as a method to provide a new degree of naturalness for clinical data access. This argu- ment is based on the fact that care-givers have used speaking and writing for most of their lives. Unfortunately, limitations in the current state of the hardware and software systems for these interface modalities require significant design modifications to the applications.

In this tutorial, the instructors will W present demonstrations of typical pen and

speech applications, rn describe fundamental issues in using these

technologies, and m review lessons learned from building appli-

cations with both modalities.

Tnstructors: Lawrence M. Fagan, M.D., Ph.D., Richard Acuff, and Alex Poon, Medical Information Sciences, Stanford Universiv Stanford, CA, and Steven Labkoff, M.D., Decision Systems Group, Brigham and Women's Hospital, Boston, MA.

Who should attend: Individuals interested in developing or using pen- and speech-based interfaces.

Tutorial T19 Saturday, October 28 9:00A.M. - 12:30 k? M.

Brobabilistic Conjoint (Rasch) Measurement: Theory and Application in Medical lnformatics This tutorial will introduce Danish mathemati- cian Georg Rasch's measurement theory, show how to implement it via computer, and show how the results can be used to improve the measurement of health status, functional inde- pendence, patient satisfaction, and other vari- ables for outcomes research, quality assessment and improvement, and program evaluation. Examples will include data from medically relevant topics.

The tutorial should enable participants to rn discuss and recognize the elements of prob-

abilistic conjoint measurement theory and recognize the data quality it requires;

rn create, execute, and interpret a BIGSTEPS Rasch analysis; and

rn articulate the advantages of Rasch measurement for applications in medical informatics.

Instructor: William P. Fisher, Jr., Ph.D., Health Systems Research and Public Health, Louisiana State University Medical Center, New Orleans, LA.

Who should attend: Anyone who has to create, analyze, or interpret rating scale, performance assessment, or test data.

Tutorial T20 Saturday, October 28 2:OO - 5:30 PM.

Clinical Data Modeling This tutorial will present techniques for data modeling and demonstrate how to apply them to clinical data. The instructor will address the following questions: M What is a data model? M Why do l need one? 8 How do 1 build one? 8 What standards are there for data models in

health care?

The instructor will focus on the diagrams used in Object-Oriented Analysis. He will present the methods of mapping an Entity Relationship diagram to a relational database design. Each attendee will gain hands-on experience with these techniques by developing a small data model during the tutorial.

Lnstructor: Stephen B. Johnson, Ph.D., Assistant Professor, Department of Medical Informatics, Columbia-Presbyterian Medical Center, New York, NY.

Who should attend: Programmers, analysts, and consultants involved in developing soft-ware for health care; administrators interested in having a deeper understanding of data for meeting institutional needs; and physicians, nurses, and other health care providers interest-ed in conveying their knowledge of medical data to technical personnel.

Tutorial T21 Saturday, October 28 9:00 A. M. - 12:30 PM.

Emerging Trends and Future Directions in Health Care Information Systems: Increasing Benefits from Clinical Systems Automation The move toward integrated health care delio-ery systems and community care networks; the increase in mergers, acquisitions, and other forms of collaboration between health care providers; and the emphasis on greater cost-effectiveness will put additional burdens on

existing information spstems as well as height-en the expectations of what information sys-tems can achieve in the future.

This tutorial will enable participants to formu-late orderly approaches with reasonable goals to meet the automation challenges of today by 8 identifying emerging trends in health care

computer use; M d e f i i g the current state of the art in clin-

cal application areas, and based on this defi-nition, discussing which system ideas are implementable and which are not;

M discussing how health care organizations should determine their automation goals, defining an acceptable level of investment, and building information strategies; providing a basis for making an analysis of current manual and automated processes to determine where there is redundancy and inefficiency; and

M discussing how to create plans for systems improvement that focus on process improve-ment and increased benefits and how to monitor the results of these processes.

Instructor: Sheldon I. Dorenfest, M.B.A., C.P.A., President, Sheldon I. Dorenfest & Associates, Ltd., Chicago, IL.

Who should attend: Health care executives, physicians, nurses, and other health care pro-fessionals who are interested in the direction of health care information systems.

Tutorial T22 Saturday, October 28 2:OO - 5-30 PM.

hformation Design in Health Care As computer information systems become com-mon within health care, system designers, pro-grammers, users, and information officers are facing a major problem in presentation of data and information. Users increasingly expect graphical user interfaces (GUIs),but how to design such an interface is not obvious, and few in medical informatics have any idea why GUIs work better than line-oriented interfaces. These and other issues in health care informa-tion systems are addressed by an emerging interdisciplinary field called information design. Drawing from research and practice in cognitive psychology, statistical graphics theo-ry, linguistics, technical communication, and graphic design, workers in this field aim at both practical solutions to specific problems and accumulation of a more general body of rules, laws, and theories to guide them.

In this tutorial the instructor will use the best projection equipment available to ensure that participants will be able to see and understand visual nuances that are vital to effective com-munication.

The goals of the tutorial are M to provide a detailed historical overview of

information design and information design in medicine;

M to provide a human factors and cop t ive psychology tutorial, outlining the funda-mental human information processing char-acteristics that suggest u.hch information designs will be usehd and which will not;

M to provide a useful collection of design principles, techniques, and rules, from the dual perspectives of theoretical reasons why one way works and another doesn't, and pragmatic guidelines for how to know what to do.

Instructor: William G. Cole, Ph.D., Department of Medical Education, University of Washington, Seattle, WA.

Who should attend: Those who evaluate the qual~tyof information design in health care, including designers and potential purchasers of computer and paper systems that present data, information, and knowledge to users. No back-ground in design will be assumed.

Tutorial T23 Saturday, October 28 9:00 A. M. - 12:30 PM.

Project Management for Health Care/lndormatics Professionals This tutorial will focus on how to organize and define a project. First-time project leaders as well as seasoned professionals will improve their ability to complete projects on time and within budget, and to guarantee results. Participants will learn 8 what project leadership is and what skills

are needed; M how to choose and build the right team

structure for a project; M how to gain the immediate support of the

project sponsor, owner, and stakeholders; 8 how to establish no-nonsense team rules

and define clear accountabilities; M how to employ key techniques to conduct

effective project team meetings; how to understand the three criteria that all project goals must have;

8 how to write a clear and concise objective statement;

8 how to utilize project analysis to create detailed project specifications;

M how to manage the expectations of the pro-ject team and stakeholders; and

M how to improve total quality management (TQM) programs using project management.

Instructor: Glen R. Knight, Director, Information Services, St. Luke's Regional Medical Center, Boise, ID.

Who should attend: Anyone responsible for organizing, planning, implementing, or managing projects.

Tutorial T24 Saturday, October 28 2 0 0 - 5:30 E M.

Advanced Methods for Practical Natural- Language Based hformation Management Modern medical information systems must manage very large numbers of documents and coordinate documents of many different types. Traditional information management (IM) methods have extremely limited effectiveness and utility. In addition, as documents in electronic form become increasingly available, the limitations of traditional approaches to document management-whether the string-based indexing of full texts or "authoritative" classification of documents into databases-will become obstacles to system performance. It is important to understand the strengths and limitations of content-based processing to realize practical improvements in information management.

This tutorial will cover information management for electronic documents, including reference materials, sl~ch as MEDLINE titles and abstracts, databases of unstructured text, online information, and electronic medical records. The instructor will emphasize advanced-function techniques for information retrieval and text analysis utilizing natural- language processing. Participants will be able to see real-time processing of large amounts of medical documents, in demonstration of the techniques and technology that will be in focus.

The instructor will m familiarize participants with advanced

topics in information retrieval, and give participants a basis for making judg- ments about the practicality of applying alternative techniques to their information-management problems.

Instructor: David A. Evans, Ph.D., Departments of Philosophy and Computer Science, Camegie Mellon University, Pittsburgh, PA

Who should attend: Anyone who wishes to leam about or be oriented to advanced information retrieval topics, especially in context- based and NLP-based information processing. It is appropriate both for information professionals and for individuals beginning a deeper study of problems and potentials in full- text, large-scale, homogeneous, or heterogeneous document management.

Tutorial T25 Sunday, October 29 9:00 A.M. - 12:30 E M.

Managing Technological Change

Successfully introducing new information systems into any health care organization, whether a primary care physician's office or a complex health care organization, requires an effective blend of good technical and good organizational skills. The technically best system may be woefully inadequate if its implementation is resisted by people who have low psychological ownership in that system. On the other hand, people with high ownership can make a technically mediocre system function fairly well. Therefore, the person who knows how to manage the organizational impact of new information systems can over- come behavioral resistance to change, and resistance to new technology in particular, to achieve a more rapid and productive introduction of information technology and systems.

Using examples that cross all departments and disciplines within the health environment, the instructors will W present an overview of current technical

system implementation problems and the role of change management in today's health care environment;

m review some critical organizational issues, strategies, and tools involved in implementing health informatics systems in today's health care environment; and

rn review some of the critical people issues involved in implementing health informatics systems in today's health care environment.

Instructors: Nancy M. Lorenzi, Ph.D., Associate Senior Vice President, University of Cincinnati Medical Center, and Robert T. Riley, Ph.D., President, Riley Associates, Cincinnati, OH.

Who should attend: Leaders of health information efforts who are meeting or expect to meet resistance to change within the organization.

Tutorial T26 Sunday, October 29 2:OO - 5:30 E M.

HL7 Version 2.2 and Progress Toward H67 Versions 2.3and 3

This tutorial will introduce version 2.2 of the Health Level Seven (HL7) standard, cover changes and new features in HL7 version 2.2, and introduce proposed changes for version

2.3 (in ballot now) and the changes in basic approach that will be used in HL7 version 3. The instructors will review progress in creating an object data model for HL7, and the related efforts to study changes needed for HL7 to support object technologies such as CORBA and OLE. They will also discuss the relationship between HL7 and other US. and European health informatics efforts, including the ANSI/HISPP, ASTM, X12N, MEDIX, NCPDP, and CEN TC-251.

The goals of this tutorial are to provide participants with W a basic introduction to HL7 2.2 and (draft

version) 2.3, and W an overview of future directions being

considered for HL7 version 3, and an ovenriew of the role of HL7 in the U.S. and European medical informatics standards community.

Instructor: Mark J. Shafarman, M.S., OACIS Healthcare Systems, Greenbrae, CA.

Who should attend: Physicians and other health care providers, hospital/health care administrators and information systems personnel, health care information consultants, and health care application vendors planning implementation or needing an overview to HL7 versions 2.2 and beyond.

Tutorial T27 Sunday, October 29 9:00 A.M. - 1230 EM,

311 Graphics in Medicine for Beginners This tutorial presents an introduction to the theory and techniques of 3D graphics applied to medical applications. The instructor will develop the basic concepts used in 3D graph-ics, progress to the application of more advanced techniques, and finish with the analysis of a graphics system suitable for a physician's office or consulting room.

The tutorial will provide participants with a theoretical groundwork for 3D graphics in medicine,

m an understanding of advanced topics and their application to medicine, and

m an overview of the office-based system as an introduction to hardware requirements.

Instructor: David E. Cook, MSc., School of Mathematics and Computing, University of Derby, Derby, United Kingdom.

Who should attend: Health care professionals who want to know more about the theoretical basis underpinning current applications so that they may be better informed when assessing the applicability of developments to their needs.

Tutorial T28 Sunday, October 29 2:OO - 5:30 t?M.

Decision Analysis for Health Care Professionals This tutorial will provide an introduction to decision analysis applied to health care. The instructors rvill explain the concepts and techniques of decision analysis and expected value decision making and will illustrate them in simple and intuitive terms. Topics to be covered inc l~~de probability, decision mod- elling, Bave's theorem, expected utility theory, utility assessment (including quality-adjusted- life-years), and cost-effectiveness analysis. The instructors will provide simple problems, including examples submitted by tutorial participants, and will solve them using commercially available decision-support software to allow participants both hands-on experience and an overview of software tools available. The instructors will also provide copies of overheads, example problems, a glossary, and a list of resources.

Participants will gain an understanding of the basics of decision analysis,

W gain hands-on experience with decision analytic techniques,

m be able to use decision analytic techniques to analyze problems they confront in their professional lives,

W he able to understand decision analytic techniques as employed in the professional literature, and

m be aware of the resources available to assist them in decision-making.

Instructors: Randy D. Cork, M.D, Office of Educational Development, and Stephen M. Downs, M.D., M S , Department of Pediatrics, University of North Carolina, Chapel Hill, NC.

Who should attend: Physicians, nurses, allied health personnel, and administrators. The instructors invite preregistrants for this tutorial to submit in advance descriptions of decision problems they face in their professional lives; these problems may serve as examples in the session. Preregistrants may send problems by e-mail to [email protected]; please cite "1995 SCAMC Tutorial 28 sample problem" as the subject of your correspondence.

Tutorial T29 Sunday, October 29 9:00 A.M. - 12:30 t? M.

Information Security for Computer-Eased Patient Wecords

This tutorial presents practical approaches to developing a cost-effective, organization- wide, formal health care information security program. The instructors will cover the policies, procedures, training, system controls, and organization structure needed to protect the confidentiality and integrity of patient records as well as the organization's financial and administrative information.

The tutorial will provide participants with the knowledge to strengthen information securit!~ measures at their organizations. After taking it, participants should be able to

understand the need for information security in the health care environment;

W know the essential components of an organization-wide information security program;

m know how to implement an information security program that will meet JCAHO and legal requirements;

m be aware of security measures for CHINS; m be familiar with the basic concepts for

organizing, staffing, and managing the information security function;

W plan and begin the process of developing information security policies and standards;

m understand the process for selecting cost- effective controls; and

m he familiar with basic protection of Intemet access.

Instructor: Dale W. Miller, Director of Consulting Services, Irongate, Inc., San Rafael, CA.

Wlio sl io~~ld attend: Chief information officers, health information network designers and managers, nursing informatics managers, MIS directors, health information managers, clinical information systems managers, LAN managers, and internal auditors.

Tutorial T31, Sunday, October 29 2:OO - 5:30 t? M.

The Role of hf~rmat ion Technology in Outcomes Measurement As organizations assume increased financial risk, they will require methods to maximize performance and increase efficiency and quality while decreasing costs. This presentation explores information technology requirements for outcon~es measurement and potential information technology strategies for improving a health care organization's outcomes management efforts.

This presentation will enable participants to

I discuss the role of outcomes in measuring clinical and financial performance under capitated managed care contracts;

8 identify critical information requirements for outconles measurement; describe the current state of the market- place, including current product development efforts;

8 discuss the status of currently available outcome measures; and identify short- and long-term practical solutions.

Instructor: Robert Chaloner, Principal, and Star Ault, Ivlanager, Healthcare Management Counselors, Ne~v York, N1:

Who should attend: Individuals involved in health care information technology and quality and performance improvement activities, including physicians, health care administrators, arid nurses.

Tutorial T31 Canceled.

Tutorial T32 Sunday, October 29 2:OO - 5:30 f?M,

Implementing Practice Guidelines and Computer- Stored Records Incorporating practice guidelines into clinical care has proven to be a difficult task-ne that can be accomplished by linking guidelines to an electronic patient record system. In this tutorial the instructors will address the practical issues relevant to creating, implementing, running, and evaluating automated practice guidelines using an electronic patient record system.

Automated practice guidelines represent a critical component in realizing the full benefit of capturing clinical data and integrating data capture into routine practice. The instructors will use examples to illustrate problems that arise from guideline content, complexitv, data availability, and development of specific rec- ommendations.

The instructors will 8 review existing methods for representing

guidelines in electronic patient records, including procedural languages and frame-based systems; present factors that influence physician behavior, learned from many years of experience; and outline methods for testing and validating the completed implementation.

Participants will apply principles presented to operationalize a simple practice guideline.

TUTORIALS - SUNDAY

Instructors: Clement J. McDonald, M.D., J. Marc Overhage, M.D., Ph.D., and William Tierney, M.D., Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN.

Who should attend: Individuals (practitioners, administrators, systems integrators, and programmers) involved in developing clinical guidelines, interested in standardizing clinical care, or charged with monitoring patient outcomes.

Tutorial T33 Sunday, October 29 9:00 A.M. - 12:30 F! M.

Medical Concept ~e~resentat ioniFrom Classification to Understanding The effective application of medical informatics tools to the conduct of health services research, quality improvement, clinical decision support, or administrative practice management requires a conceptual framework for representing and invoking clinical event data. Traditionally, such a framework has been real- ized by classification systems, such as the International Classification of Disease (ICDs).

The instructor will briefly trace the evolution of clinical classification from the 17th century efforts attributed to John of Graunt, through Bertillon, to the present-day repertoire of clinical, reimbursement, and comorbidity systems; consider the concept of multiaxial representation (B la SNOMED) and its logical extension to semantic frames; and highlight the strengths and weaknesses of several systems, including ICD-9-CM, ICD-10, CPT, SNOMED, DRGs, DSM-IV, Read codes, ICD- 0 , CMIT, UMLS, UCDS, and nursing classfi- cations. Standards efforts, such as IEEE Medix, ASTM, and ANSI, will be considered as they relate to clinical concept representation. A hand-out will include all overhead slides used and pertinent summaries of topics covered.

Instructor: Christopher G. Chute, M.D., Dr.P.H., Consultant, Department of Health Science Research, Associate Professor of Epidemiology, and Section Head of Medical Information Resources, Mayo Foundation, Rochester, MN.

Who should attend: Clinicians, researchers, or administrators with an interest in understanding the maze of classifications and their relative merits from a principled consideration of their functions. No special skills or background are required.

Tutorial T34 Sunday, October 29 2:OO - 5:30 /?M.

Mosaic and Digital Video on the lnternet NCSA Mosaic is an internationally used, freely available, public domain, multi-media, multi-platform, multi-protocol, client-server application for network-based information retrieval. It has been widely hailed as the first "killer application" on the international high- speed computer network known as the Internet.

Using a "Tl" (1.5 Mbs) connection to the Internet, live browsing and retrieval of text, graphics, audio, and video from sites around the world will help attendees appreciate the current and potential uses of World Wide Web (WWW) and NCSA Mosaic.

Tutorial hand-outs will help attendees understand current and emerging technical and conceptual issues, e.g.,

how to set up a Mosaic as a WWW client, m how to set up a simple WWW server, m how to make your workstation twc-way

video-capable, and m what to expect from attempts to build dig-

i tal video archives.

The instructor will emphasize experiential learning and audience interaction. The tutorial will conclude with an attempt to "frame" the general emergence of distributed, multimedia technology as it will come to be used worldwide.

Instructor: To be determined

Who should attend: lndividuals interested in the appreciation, use, development, and deployment of WWW clients and servers and in the integrated or independent use of distributed digital video.

Tutorial T35 Sunday, October 29 9:00 A.M. - 12:30 /? M.

Evaluation of Medical Information Systems: Ho W

to Measure What5 Important Within medical informatics, there is increasing interest in evaluation and empirical studies where phenomena of interest are systematically measured and/or observed. Complete research projects in informatics, including doctoral dissertations and masters theses,

now often include an evaluation or empirical study component. Most funded research in informatics is required to have such a component. It is generally acknowledged that these studies are difficult both to design and to conduct. These difficulties have been the subject of journal articles as well as tutorials and presentations at SCAMC and elsewhere.

The overall goal of this tutorial is to enable participants to develop measurement methods for evaluation studies in medical informatics. Participants will be able to

frame many of the recurring difficulties of evaluation in medical informatics as problems of measurement;

m apply a methodology to approach measurement systematically, to identify the sources of error in any measurement process, and to estimate the magnitude of these errors; and

8 develop measurement methods and instruments that reflect principles of good practice likely to reduce measurement errors.

Instructor: Charles P. Friedman, Ph.D., Laboratory for Computing and Cognition, University of North Carolina School of Medicine, Chapel Hill, NC.

Who should attend: Anyone interested in con- ducting empirical (data-driven) research in informatics, including those preparing research grants and trainees designing thesis and dissertation projects. Although no specific background is required, the instructor will assume familiarity with basic statistical notions such as standard deviation and corre- lation.

Tutorial T36 Sunday, October 29 2:OO - 5:30 /?M.

Distributed Health Care Information Systems The delivery of health care is undergoing a change from that of having a single carer relationship to one where the patient, in order to be treated, will be managed by several health professionals at the same time (shared care). Vast amounts of information are collected not only verbally and by physical examination of the patient, but also increasingly by data- intensive diagnostic services, such as clinical laboratories, imaging, and other investigative departments. This information must be collat- ed and securely transported within the health care environment so that each health professional involved in treatment has access to the required information at the optimal level of detail and at the appropriate time.

TUTORIALS - SUMAY

Tliis tutorial will give an ovenview of the enabling teclmologies--open distributed pro-cessing, distributed/federated databases, object-orientation, knowledge-based systems, multimedia and telecommunications-required for the development of secure distrib-uted health care information systems. The instructor will emphasize the development of open solutions based on standards as the key to interoperability in health care.

The objectives of this tutorial are m to identify the need for distributed infor-

mation systems in healthcare, m to present an overview of the key enabling

teclmologies, m to emphasize the importance and role of

standards in supporting interoperability, and

m to address security issues.

Instructor: Jane B. Grimsen, MSc., Ph.D., Department of Computer Science, Trinity College, Dublin, Ireland.

Who should attend: Health informaticians, information systems managers, chief informa-tion officers, researchers, and academicians.

Tutorial T37 Sunday, October 29 9:00A.M. - 12:30 PM.

Introduction to Mosaic and the World Wide Web This tutorial will examine biomedical resources and various tools for searching the Web. The instructors will look at evaluating, acquiring, installing, and using Internet connections (commercial and institutional) and Web browsers. The tutorial will conclude with a look at technical issues, including writing for the Web (HTML)and managing Web services.

Instructors: Mari J. Stoddard, M.L.I.S., and Dave Piper, M.L.S., University of Arizona Health Sciences Library Tucson, AZ.

Who should attend: Anyone interested in learning more about the Intemet or the World Wide Web, including health care providers, administrators, information personnel, and planners.

Tutorial T38 Sunday, October 29 2:OO - 5:30 F!M.

Telemedicine: A Primer (The On-Ramp to the Information Superhighw ay) Telemedicine is the emerging frontier in the field of medical informatics that will have great impact on the way health care is deliv-

ered, opening the potential to access global expertise. Telemedicineprovides the on-ramp for health care to derive the full potentials of the information superhighway The re-emer-gence of telemedicine at a more advanced state of art has been possible due to rapid a d ~ m c e sin computer hardware teclmology, software system integration, and optical links and telecommunication switching.

This primer is designed to meet the interests of participants will different levels of familiar-ity with telemedicine. The instructors will dis-cuss the basics and end with the current state of the art, giving an orientation to the poten-tial of telemedicine in health care delivery, management, and research.

At the end of the tutorial, participants will be familiar with the

different schools of telemedicine, m commonly used technical terms, m standards uqed to deqcribe the transmis-

sion and recipient signals, m probes that could be configured in a

telemedicine workstation, and m current concepts of potential, especially an

awareness of pitfalls and perils.

Instructor: Khalid Moidu, M.D., Ph.D., Beulah Hinds Center, Norwalk Hospital, Norwalk, CT, Shastri Divakaruni, M S , M.B.A., Southern New England Telephone Company, New Haven, CT, and Jack J. Falsone, M.D., Beulah Hinds Center, Norwalk Hospital, Norwalk, CT.

Who should attend: Individuals interested in telemedicine and its applications.

Tutorial T39 Sunday, October 29 9:OO A.M . - 12:30 P M.

Emerging Communication Technologies for Health lnformafion Systems To optimize health care services in vertically integrated health care organizations, the boundaries of the local area network need to be extended beyond the campus environment. The new boundaries may include physician office practices, other hospitals, and perhaps even the homes of physicians and patients. Wide-area networking technologies such as the narrow-band Integrated Services Digital Network (N-ISDN),Frame Relay, Switched Multimegabit Data Service (SMDS),and broad-band ISDN (B-ISDN) offer new solu-tions. The capabilities of these emerging tech-nologies not only provide higher data rates, but also have the potential for increased secu-rity and manageability. Example scenarios will provide templates for potential solutions in other situations.

This tutorial will provide a broad technical overview, survey, and adoption strategies of selected con~municationteclmologies, such as frame and cell switching technologies (ATM, SMDS, Frame Relay, and ISDN) that are important for the next generation of health information systems. The instructor will pro-vide selected papers on ISDN, Frame Relay, and ATM, as well as a list of references and a survey of industry products.

Instructor: Helmuth F. Orthner, Ph.D., Professor of Medical Informatics, University of Utah Health Sciences Center, Salt Lake City, UT.

Who should attend: System architects of health information systems, chief information officers, telecommunication and network managers, and anyone who wants to get a quick overview of emerging telecommunica-tions technologies for the local area and wide area networks. Cursory knowledge of local area network technology and data communi-cations through the telephone system is desir-able but not required.

Tutorial T40 Sunday, October 29 2:OO - 5:30 P M.

An Introduction to Case-Based Reasoning This tutorial will be a comprehensive, hands-on course on developing medical case-based reasoning (CBR) systems. The instructor will provide a theoretical introduction to CBR and will discuss development of a CBR system, concentrating on case representation, case indexing, case storage and retrieval, case adaptation, learning and generalization, and evaluation and validation. The instructor will also describe and demonstrate some existing medical CBR systems and, with participants, will plan, design, and implement CBR sys-tems with the use of tools and shells. The instructor will cover essential developments in the field of CBR and will provide attendees with written materials. On audience request, he may discuss more advanced issues.

Participants will acquire knowledge and understanding of the CBR systems architecture, work, and development; become familiar with three medical and one educational CBR systems; and

W be prepared to develop prototype CBR systems using software provided by the instructor.

Instructor: Robert T. Macura, M.D., Ph.D., Assistant Professor of Medical Informatics and Radiology, Department of Radiology, Medical College of Georgia, Augusta, GA.

TUTORIALS - SUNDAY

Who should attend: Computer-l~terate health care professionals M-ho are interested in developing a CBR system.

Tutorial T41 Sunday, October 29 9:00 A. M. - 12:30 P M.

Domain Models and Reference Architectures in Clinical Systems Developers of component-based architectures claim that the availability c,f explicit domain models is essential to the design, extensibility, and reuse of complex systems. For example, if a software component can match patient descriptions to potentially applicable clinical practice guidelines or protocols in some specific clinical domain (e.g., ontology), then making the underlying domain model explicit permits reuse of the generic matching capabil- ity in some other clinical domain (e.g., management of AIDS).

Tlie instructors will review the domain model hypothesis in the context of two software systems: one that supports the care of patients who have AIDS and one that supports the care of patients who have breast cancer. They will focus primarily on the clemcnts of the domain model that are required by two reusable software components that make use of patient descriptions found in a computer- based patient record (CPR). One component determines whether any of a repertoire of therapentic protocols might be applicable to patients known to the CPR system, and the other helps to apply a given protocol based on patient descriptions from the CPR. Reusable patient descriptions are becoming easier to create because the maturing Unified Medical Language System (UMLS) now cata- logs a large range of clinical concepts, and development environments, such as PROTEGE-11, facilitate both access to libraries of domain models and modification of those models to fit new task requirements.

Domain models capture the semantic aspects of component interoperability, and reference architectures document how software components exchange information to realize the desired computational beliavior. This tutorial will include a review of the current theory in model-based software development, and the current competing standards for component interoperability, such as CORBA, OLE, OpenDoc, ODBC, and languages for agents.

This tutorial will I provide an introduction to the role of

domain models and reference architec-

tures in component-based clinical software del&pmen t; corer component-based sofhvare, domain models, and reference architectures;

rn provide examples of the reuse of components in two different clinical settings; and review competing standards for software interoperability

lnstructors: Mark A. Musen, M.D., Ph.D., Associate Professor of Medicine and Computer Science, Stanford University School of Medicine, Stanford, CA, and Mark Tuttle, Vice President, Lexical Technology Inc., Pllameda, CA.

Who should attend: Modelers, architects, developers, and maintainers of clinical systems; and researchers interested in software architectures and knox\.ledge-based systems.

Tutorial T42 Sunday, October 29 2:OO - 230 P M.

Case Management: Utilizing Information Technology to Assist in Managing Care Managed care initiatives have underscored tlie importance of quality outcomes at decreased costs. With the growth of fully capitated health plans, health care providers now have financial incentil~es to decrease or elimi- nate the use of acute care resources. As a response to these initiatives, case management has emerged as a strategy designed to move the patient proactively through the care process through monitoring of expected outcomes, removing barriers to progress, and assuring appropriate utilization of resources.

This presentation will enable participants to rn discuss tlie evolution of case management

and associated information technology requirements; understand the current state of the mar- ketplace; and identify short- and long-term strategies for deployment of information technology to support the managed care process.

Instructor: Elaine Remmlinger, Principal, Healthcare Management Counselors, New York, NY, and Lisa Hanrahan, R.N., M.S., Director of Clinical Improvement Services, VHA Metro New York, New Rochelle, NY.

Who should attend: Individuals involved in health care information tcchnology and health care operational redesign, including case managers.

Tutorial T43 Sunday, October 29 9:OO A. M. - 12:30 P M.

Defining and Using Nursing Data in Systems Tlus tutorial will give attendees a comprehen- si1.e overview of the current status of professional and scientific activities focused on defining and describing nursing's clinical data for use in systems. The instructors-nurse informaticians from clinical, vendor, and aca- deniic sites-will provide practical and pragmatic approaches to tlie topic. They will include a review of the ANA Database Steering Committee activities.

The tutorial will cover identification of nursing data, data standards, coding of data, and related language issues. l i e instructors will summarize implications for future system developments and will reserve time for questions and discussion.

lnstructors: Rita Zielstorff, R.N., MS., Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA, Suzanne Henry, D.N.Sc., R.N., University of California-San Francisco, San Francisco, CA, Judy G. Ozbolt, Ph.D., R.N., U~urersity of Virginia School of Nursing, Charlottesville, VA, Kathy Douglas, R.N., M.H.A., Director of Clinical Services, Oceania, Inc., and Susan J. Grobe, Ph.D., R.N., Unixwsity of Texas School of Nursing, Austin, TX.

Who should attend: Clinicians, rt~searchers, liealtli educators, and developers interested in nursing data and its use in systems for documentation, quality improvement and assurance, and outcomes studies.

Tutorial T44 Sunday, October 29 2:OO - 230 P M.

Distributed Computing in Health Care Tlds tutorial will cover an open systems approach to distributed computing in the health care setting. The instructors will rn present the use of modular components

within a layered architecture and interfac- ing methodologies that enable rapid implementation; stress tlie importance of standards for interapplication and network communication, as exemplified by the HL7 protocol and the TCP/IP software suite;

rn include a complete description of the

Columbia-Presbyterian Medical Center (CPMC) distributed computing environment; and

rn explore "real world" examples of CPMC applications, with a focus on managing and controlling an expanding distributed environment.

Instructors: Robert Sideli, M.D., Director of Administrative Information Services, Presbyterian Hospital, and Assistant Professor, Department of Medical Informatics, Columbia University, and Bmce Forman, M.D., Presbyterian Hospital, and Assistant Professor, Department of Medical Informatics, Columbia University, New York, NY.

Who shodd attend: All those interested in inter-system communications and information exchange.

Tutorial T45 Sunday, October 29 9:00 A.M. - 12:30 F! M.

Encounter-Based Systems: Par? 1 Tutorials T45 and T46 are parts 1 and 2 of a day-long session. Participants should register for both parts.

Tutorials T45 and T46 will acquaint the attendee with requisite features of design and function for automated clinical information systems. The instructor will give a brief history of systems development and the relationship of computerized records to other types of clinical systems, with emphasis on integrated and ambulatory products. Based on his experiences with a successful ambulatory clinical system and a literature review,.he will present features important to system success. He will discuss the Institute of Medicine paper on computerized record systems relative to system selection and will use graphical examples taken from his home system to aid understanding. A focused review of the market will emphasize broad principles of system selection in ambulatory and hospital systems. The instructor will review the impact of such systems on the organization as part of an integrated planning process for systems acquisition and implementation. Finally, he will present a structured approach to evaluate and select software packages in an effort to allow the attendee to become a more informed and effective buyer.

At the completion of the day-long presentation in Tutorials T45 and T46, the attendee will be able to rn recount the history of ambulatory systems

development and be cognizant of major offerings in the current software market;

rn list features of system function that are critical to administrative success;

rn understand and describe sample terms (e.g., data dictionary, report generator,

quen language, decision support teclmology, expert system, and computerized reminder);

rn list the major impacts of computerized clinical information systems on care delivery and management in an ambulatory environment; and

rn describe a structured approach for the evaluation and selection of automated systems for clinical care.

Instructor: James R. Campbell, M.D., Associate Professor of Internal Medicine, Department of Internal Medicine and Associate Director of Clinical Information Science, Information Technology Services, University of Nebraska Medical Center, Omaha, NE.

Who should attend: Physicians, nurses, hospital administrators, clinic managers, and others interested in the computerized patient record who may be facing the difficult choice of choosing and purchasing a clinical information system.

Tutorial T46 Sunday, October 29 2:OO - 230 F! M.

Encounter-Based Systems: Part 2 Tutorials T45 and T46 are parts 1and 2 of a day-long session. (See Tutorial T45 for a description.) Participants should register for both parts.

Tutorial T47 Sunday, October 29 9:00A.M. - 12:30 P M.

Biomedical lmaging: Practical Tools and Techniques Recent advantages in imaging and imaging technologies, including the availability of affordable and powerful microcomputer- based applications and peripherals, have made it possible for medical educators, researchers, and practitioners to work with images in ways that were impractical only a few years ago.

This tutorial is designed to provide participants with a practical ovenriew of biomedical imaging technology, with a focus on real- world applications and techniques. Topics to be covered include rn the basics of images and imaging, includ-

ing image standards; rn image acquisition tools and techniques,

including digital cameras, flat-bed and slide scanners, and commercial services;

rn image archiving systems and techniques, from both a hardware and a software perspective; and

rn image processing tools and tecluriques, from general-purpose software solutions to specialized hardware/software systems.

After attending this tutorial, participants will be knowledgeable enough to select the hardware and software solutions specific to their imaging needs.

Instructor: Bryan E Bergeron, M.D., Research Affiliate, HST Division of Harvard Medical School and Massachusetts Institute of Teclmology, Brookline, MA.

Who should attend: Anyone interested in acquiring, storing, or analyzing images in digital form, e.g., pathologists who want to create automated microscope-based analysis systems, or multimedia courseware developers and clinicians who want to create an easily accessed digital teaching collection.

Tutorial T48 Sunday, October 29 2:OO - 5:30 F! M.

Information Design in Health Care See description under Saturday's Tutorial 22.

Instructor: William G. Cole, Ph.D., Department of Medical Education, University of Washington, Seattle, WA.

Who should attend: Those who evaluate the quality of an information design in health care, including designers and potential purchasers of computer and paper systems that present data, information, and knowledge to users. No background in design will be assumed.

Tutorial T49 Monday, October 30 2:OO - 5:30 PM.

Techniques and Tools for Converfing Analog Resources into Multimedia Content for CD-ROMs This tutorial is designed to provide medical educators with the knowledge, skills, and resources for converting analog-based instructional resources, such as videodiscs, video- tapes, photographs, and slides, into digital formats for use in multimedia programs distributed via CD-ROM.

TUTORIALS - MONDAY/ TUESDAY / WEDNESDAY

This tutorial will cover the process of producing an instructional CD-ROM from the initial justification stage to duplication of discs. Two ongoing CD-ROM development projects, the digital conversion of Tire Arlntory Proj~ct video discs and the creation of a patient education program on spinal cord injury, will be used as examples of the processes. The instructors will discuss and demonstrate information and digital techniques that medical educators can use to produce high-quality instructional programs. They will provide attendees with a detailed course syllabus, including a bibliography and supporting documentation, and a disk containing multimedia freeware and shareware.

Upon completion of this tutorial participants will be able to a discuss current trends in multimedia

development, a present a justification for creating digital

instructional programs and distributing the programs via CD-ROM,

a convert videodisc content to high-quality digital,

a incorporate commercially available sources,

a discuss factors to facilitate optimum play- back via CD-ROM,

a digitally capture and optimize video and graphic images,

a record and compress digital audio, a plan a cross-platform development pro-

ject, and a describe the process used to publish a CD-

ROM.

Instructors: Alan VanBiervliet, Ph.D., Professor and Director of Research and Development, Department of Physical Medicine and Rehabilitation, and Thomas R. Gest, Ph.D., Associate Professor, Office of Educational Development and Department of Anatomy, University of Arkansas for Medical Sciences, Little Rock, AR.

Who should attend: Individuals who are considering or are in the early stages of developing educational programs for distribution via CD-ROM, particularly health educators who have an interactive video disc, computer- assisted, or video tape-based program and want to convert the program for CD-ROM.

Tutorial T50 Tuesday, October 31 9:45 A.M. - 1245 F M. (no break)

Lexical Tools for UMLS Developers The 1994 release of the UMLS knowledge sources include tools that may be of use to developers who work with the UMLS knowl-

edge sources. Included on tlie CD-ROM will be a fourth knowledge source, the SPECIAL- IST lexicon, together with a set of lexical problems, indexes, and databases. The lexicon is a large English language lexicon containing many biomedical terms. The lexical variant generation programs are written in C and use data from the SPECIALIST lexicon as they compute different forms of lexical items. The lexical programs generate a range of variations for English lexical terms and should be useful for recognizing lexical variation in bio- med~cal terminologies andtexts.

In this tutorial the instructors will demonstrate the lexical tools in some detail and will use terms from one or more controlled vocabularies to illustrate the capabilities of the tools. They will solicit additional examples from participants. The instructors will also demonstrate the UMLS clientlsen~er knowledge source server, particularly with regard to its use of the lexical programs. After the tutorial, participants should have a full understanding of how to use the UMLS lexical tools as they build their own applications.

Instructors: Alexa T. McCray, Ph.D., Allen C. Browne, and Guy Divita, National Library of Medicine, Bethesda, MD.

Who should attend: Individuals interested in the UMLS knowledge sources and in medical language processing.

Tutorial T51 Wednesday, November 1 7:00 - 1O:OOA.M. (no break)

Information Systems Security Information Systems Security (INFOSEC) encompasses all aspects of communications and computer systems security. In today's environment of highly integrated and net- worked information systems, an integrated approach to INFOSEC is essential.

INFOSEC is becoming more and more important to health care managers as CHINS, physician-to-hospital networks, distributed provider systems, and other provider organizations make extensive use of networking and data exchange in order to remain cost-competitive in the world of capitation and increased competition. The objective of this tutorial is to provide a basic understanding of INFOSEC through a detailed discussion of the various applications, threats, and issues faced by today's health care managers. Using case studies, the instructor will discuss both communications and computer systems security in an integrated context.

The goals of this tutorial are a to provide a basic foundation for under-

standing the many aspects of INFOSEC, a to create an awareness of the proliferating

threats faced by health care providers as their infrastructure becomes more and more dependent on nebvorking,

a to familiarize participants with security products and technologies, and

a to illustrate the need for an integrated approach to information systems security.

Instructor: William F. Dawson, BDM Federal, Inc., McLean, VA.

Who should attend: Health care managers, executives, and anyone else interested in a better appreciation of all aspects of INFOSEC. No technical or educational prerequisites are assumed.

Tutorial T52 Wednesday, November 1 7:00 - 10:OOA.M. (no break)

Version 3 of the Read Codes: Its Role in International Primary Care The Read Code is a comprehensive coded clinical vocabulary that is a candidate for inclusion/adoption as a standard for future coniputerized patlent record systems. Although Read Code version 2 has been used successfully in primary care records in the United Kingdom for 12 years, it has not been widely used internationally due to issues of licensure and distribution. As a result, there has been little reporting or presentation of studies. In addition, little is known internationally about version 3, which was released in 1994.

The purpose of this tutorial is to provide full, authoritative, and up-to-date information about tlie nature of Read Codes, evidence of their usefulness in automated medical records, and availability and licensing.

Instructors: Henry C. "Moon" Mullins, M.D., Department of Family Practice, University of South Alabama, Mobile, AL, David Bird, LL.B., CAMS, Loughborough, United Kingdom, Charlie Stuart-Buttle, M.B., NHS Center for Coding and Classification, Loughborough, United Kingdom, Glyn Hayes, M.B., Ch.B., AAH Meditel Limited, Worcestershire, United Kingdom, and Nick Booth, M.A., M.B., University of Newcastle, Northumberland, United Kingdom.

Who should attend: Clinicians, informaticians, developers, governmental agencies, academicians, and other individuals interested in learning about Read Codes and its usefulness in computerized medical record systems.

WORKSHOPS - SATURDAY

W1 Saturday, October 28 7:30- 1O:OO F M.

Workshop: Institution- Wide lmplementation of an EMR The implementation of an electronic medical record system in any large organization is as large a task as the design of the system. The Mayo Clinic in Rochester, Minnesota has completed a substantial part of the implementation of such a system. One of the major clial- lenges facing the implementation teams was the need to keep communications between health care workers who were in the electronic world and those who were using the standard paper systems to avoid any perturbation of patient care. This workshop will explore the solutions to these dual environment problems. Modules will senTe as the organizational framework for the workshop presentations and discussion. The physician head of each of five core modules will present a brief summary of the functions of a module; present the communication/dual environment issues; and solicit experiences from the audience.

Speakers: David N. Mohr, M.D., Department of Internal Medicine, Paul Carpenter, M.D., Department of Endocrinology, Paul Claus, M.D., Division of Community Internal Medicine, Thomas Fisk, Department of System Support Services, Phil Hagen, M.D., Division of Preventive Medicine, Phil Karsel, M.D., Department of Diagnostic Radiology, Jane Stewart, Department of System Support Services, and Robert VanScoy, M.D., Division of Infectious Diseases, Mayo Clinic, Rochester, MN.

W2 Saturday, October 28 7:30 - 1O:OO P M.

Workshop: Strategic lmplementation of Information Systems into an Enterprise- Wide Environment This workshop will explore the implementation of an enterprise-wide system, with emphasis on the integration of all information systems. The moderators will share a working definition of an enterprise and what it means to the homogeneity of existing legacy and clinical systems; will discuss project scope, success strategies, and realistic end user expectations,

with a look toward future system growth; and will lead attendees through the various activities encountered at Cedars-Sinai Health System in an enterprise endeavor.

The workshop will m encourage attendees to share experiences

and exchange ideas about the implementation of enterprise-wide systems using single or multiple vendor solutions, and

m provide a forum for attendees to discuss common issues and share strategies for implementing an enterprise-wide information system.

Speakers: Beverley J. Leyerle, R.N., M.P.H., Clinical Information Systems, and Jeanette X. Polaschek, R.N., M.S., End User Support Services, Cedars-Sinai Health System, Los Angeles, CA.

W3 Saturday, October 28 7:30- 1O:OO FM.

Workshop: Simulating the Clinical Encounter: Practical Issues in Producing High-Quality, Case-Based Multimedia Continuing Medical Education The rapid growth of CD-ROM technology and multimedia development has opened the way for novel delivery of Continuing Medical Education (CME) using a personal computer. However, production of high-quality multimedia CME is expensive and technologically challenging. In this workshop the organizers will demonstrate a commercially available product, PrimePractice, developed jointly by Mayo Clinic and IVI Publishing. Members of the joint development team will briefly summarize their roles; discuss the challenges faced by the production team; and lead a discussion on topics ranging from technical and medical to process and marketing.

The workshop will m convey the variety of challenges and

opportunities faced in the production of multimedia-based continuing medical education (CME), and stimulate discussion of these issues.

Speakers: Philip T. Hagen, M.D., Department of Internal Medicine, Mayo Clinic, Rochester, MN, Liz Zilen, and Martha Weeks, IVI Publishing, Minneapolis, MN.

W4 Saturday, October 28 7:30 - 1O:OO F M. Workshop: The Role of Start-ups and Financing in Advancing Medical In formatics This workshop will provide a forum for tech- nologists, financial experts, and system imple- menters to discuss the issues around the role of start-up companies in advancing medical informatics. The workshop organizer will present a brief overview of key issues, followed by two case studies of the interplay between entrepreneurship and medical informatics. For each case study, the entrepreneur who developed the technology and founded his or her own company will describe the case briefly; two venture capitalists who typically review such companies will then comment. Participants will then be able to ask questions and provide their own insights into the challenges and opportunities faced in getting the technology implemented in the health care setting. The case studies will review technologies and systems oriented toward patient care and clinical practice. Following the case studies, another technology will be described and workshop participants will be asked to con- tribute ideas on how it could best be implemented in the health care system, e.g., through an entrepreneurial, academic, or large-scale commercial approach.

The goals of the workshop are to increase participants' understanding of the interplay between entrepreneurship and advancing medical informatics, to learn the key issues in evaluating an entrepreneurial approach to medical informatics technologies, to develop an understanding of the key issues seen by financing sources in evaluating medical informatics technologies, and to provide an opportunity to use effective evaluation methodologies.

The workshop is intended for those interested in medical informatics technologies' development and implementation, electronic patient education, clinical informatics, grant funding, licensing, and entrepreneurship.

Speaker: Neil E. de Crescenzo, M.B.A., New Health Ventures, Blue Cross Blue Shield of Massachusetts, Boston, MA.

W5 Saturday, October 28 7:30 - 1O:OO I? M.

Workshop: To ward a Working Group on Ethics in Medical lnformatics At the 1994 SCAMC a panel discussion on "Ethics and Informatics" drew some 100 attendees and sparked considerahle interest in development of an AMIA Working Group on ethical and social issues. A number of volunteers have since come forward to offer help in organizing such a group.

Th~ssession will provide an opportunity for discussion about the role of ethics in medical informatics, and the question of a new AMIA Working Group;

m a venue for determining the extent to which AMIA members would like ethical and social issues to be addressed on a regular and ongoing basis, and whether a Working Group is the appropriate mecha- nism to achieve this; and

m an opportunity to collect signatures to establish a group, in case it is decided that such a group would be worthwhile to the organization and its members.

The workshop is intended for those interested in a potential Working Group and other activities in ethics and medical informatics.

Speaker: Kenneth W. Goodman, Ph.D., Forum for Bioethics and Philosophy, University of Miami, Miami, FL.

W6 Saturday, October 28 7:30 - 10:OOI? M.

Workshop: An Amazing Clinical Workstation or a Runaway Development Project? This workshop will focus on the management issues associated with launching, monitoring, and implementing a clinical workstation (CWS) in two different outpatient clinics. The workshop organizer will discuss the team process for defining requirements with single authority final approval for screens, highlight- ing the initial divergence and later conver- gence of requirements between the two clinics. The enormous, unanticipated input of clinician time and the information services resources allocated to the project affected both the timeline and the quality of the product.

The CWS has been an immense success in two clinics where it is implemented, and staff at both clinics want more functions. Neither clinic considers the CWS a "pilot," but rather considers it an essential part of daily operations.

The goals of the workshop are to identify issues that helped and hin- dered development of a CWS, to discuss how the project changed from inception to implementation, and to discuss transformation from a pilot development project to an essential clinical information system.

Speaker: Patricia L. Perry, M.H.A., Texas Children's Hospital, Houston, TX.

W7 Sunday, October 29 7:30 - 10:OO I? M.

Workshop: Serving hformation on the World Wide Web The World Wide Web (WWW) is growing at an exponential rate, providing an easy-to-use graphic interface for accessing information on the Internet. Businesses, educational institutions, and medical institutions are now on the Web in large numbers, and many more are interested in how to join this group of information providers. This workshop is directed at explaining and encouraging discussion of how individuals and organizations can put documents on the Web. A talk covering document creation, connection to the Internet, and document serving will be followed by a demonstration of how to set up a server that connects to the Internet using WebStar (MacHTTP). We will review some issues of server maintenance and end with an open discussion.

The objectives of the workshop are m to instruct participants on the steps

involved in Web publishing and serving, including connecting to the Intemet and putting documents on a server; and

m to encourage discussion among developers of Web information to explore greater possibilities.

The workshop is open to anyone wishing to learn how information is put up on the WWW. No knowledge of HTML is necessary

Speakers: Milton Huang, M.D., and Norman E. Alessi, M.D., Department of Psychiatry, University of Michigan, Am Arbor, MI.


Workshop: Validating Nursing lnformatics Skills This workshop will provide an overview of theory and practice pertinent to the specialty of nursing informatics. The workshop organizers will

discuss the systems development life cycle (SDLC), systems analysis techniques, and processes of system selection, system implementation, and system evaluation;

m present theories of change, innovation and adoption, data processing and management, and models of nursing informatics; review nursing language frameworks; and discuss trends and issues that are currently affecting nursing informatics practice.

The workshop attendee will be able m to distinguish theoretical frameworks of

importance for the field of nursing informatics, to identify processes pertinent for nursing informatics practice, to recognize trends that are shaping nursing informatics practice, and

m to discuss issues that are important to

nursing informatics practice.

This workshop is intended for the practicing informatics nurse who is interested in validating skills needed for demonstrating compe- tency in the field and for nurses who may be interested in pursuing nursing informatics as a career.

Speakers: Carole Gassert, Ph.D., R.N., School of Nursing, University of Maryland, Baltimore, MD, and Mary McAlindon, Ed.D., R.N., Nursing, McLaren Healthcare Corp., Flint. MI.


Workshop: This is the PITS: Planning Installation and Training Strategically Considering the resource restrictions in the current health care environment, a step-by- step guide can provide increased efficiency and improve the installation of new applications in an inpatient or an outpatient setting. Using quality improvement techniques, a CQI team developed a model for a standard training and installation guide to assist installers and trainers in delivering software to clinicians in the most efficient, painless manner possible.

The workshop will include discussion of techniques, resources, and software used to develop tools for installing new software. The tools include timelines, checklists, training materials, evaluations, and systems analysis hints.

The goals of the workshop are to demonstrate a variety of tools that may be useful when installing new software, and to provide a forum for issues related to training and installation.

The workshop is intended for those interested in techniques for optimizing training and implementation and for those interested in support, coordination, and evaluation of installation.

Speakers: Kristen L. Wagner, M.A., Information Systems, Intermountain Health Care, Ginger Bjornstad, M.S.N., R.N., Primary Children's Medical Center, Laurel Drysdale, M.P.A., Intermountain Health Care, Salt Lake City, UT, and Mig Neiswanger, McKay-Dee Hospital, Ogden, UT.

W10 Sunday, October 29 7:30 - 1O:OOPM.

Workshop: Plight or Panacea: On-Line Documentation in the Emergency Department The Emergency Deparhnent (ED) is a unique health care environment where care provided can range from simple follow-up to severe trauma. Prior to 1993 most of the computerized programs available for ED use consisted of patient tracking, billing, and discharge instructions. A pilot project installed in the ED at LDS Hospital in April 1995 replaces the current manual documentation used by the nursing department with a comprehensive, integrated, on-line documentation program. The program captures triage category, chief complaint, current medications, past medical history, history of present illness, vital signs, physical assessment, interventions, evaluation, and discharge teaching. While this program is part of the HELP documentation system used throughout LDS Hospital for the past eight years, many new design features, including charting by exception, have been added to meet the unique needs identified by the ED staff. Use of this program requires changes in practice by both nurses and physicians.

Can the computer compete with the ease, portability, speed, and generic nature of a paper form and pen in an environment as dynamic as the ED? The goal of this work-

shop is to promote discussion and information sharing as it relates both to this project and to the computerization needs of Emergency Departments in general.

The workshop is intended for nurses, physicians, information systems personnel, and hospital administrators with an interest in the Emergency Department.

Speakers: Nancy C. Nelson, R.N., and Kathleen Merkey, R.N., M.S.N., LDS Hospital, Salt Lake City, UT.

W11 Sunday, October 29 7:30 - 1O:OO PM.

Workshop: Information Systems for the Outcomes Movement: Strategic and Practical Considerations This session will begin with a presentation, including a review of the "outcomes movement" and the current state of outcomes information systems. The workshop organizer will then consider forces in the health care and information systems industries that will significantly affect outcomes information systems. The final portion of the presentation will be a model for health care organizations to use in incorporating outcomes into their strategic information systems plan. Following the presentation, participants will share their own experiences with outcomes data defini- tions and collection, outcomes information systems, and with demands from outside agencies for outcomes data. Throughout the session, the emphasis will be on the value of outcomes information; practical, cost-effective strategies; and the integration of outcomes into the overall information systems plan.

This workshop will enable participants W to understand terminology and implica-

tions of outcomes research, measurement, management, and assessment;

W to have a practical working model for evaluating their own outcomes information set; to apply concepts and ideas introduced to the information systems strategy within their organizations; and

W to begin deriving almost immediate value from their existing information systems for the outcomes requirements.

The workshop is intended for clinicians and information systems professionals who are seeking to address the demands of the outcomes movement within their organizations.

Speaker: Kathleen C. Aller, M.B.A., HBO and Company, Amherst, MA.

W12 Monday, October 30 12:OO noon - 200 EM.

Workshop: Forum on lnformatics Training The National Library of Medicine (NLM) currently supports medical informatics training via ten institutional training grants, as well as training through individual fellowships. An NLM representative will explain these grant mechanisms, their differences, and methods of application. In addition, descriptions of the ten institutional training grants will be available. Representatives from other institutions providing informatics training will also be present on a space-available basis. After a brief opening monologue, the forum will be devoted to dialogue between audience and trainers.

This forum is intended for individuals interested in initial or additional training in the field of medical (broadly defined) informatics.

Speaker: Roger W. Dahlen, Ph.D., National Library of Medicine, Bethesda, MD.

PLENARY SESSIOIW /

Monday, October 30 8:30 - 10:OOA.M.

Brent C. James, M.D., M.Stat.

R rent C. James, M.D., M.Stat., is Executive Director of the Institute for Health Care Delivery Research and Vice President for Medical Research and Continuing Medical

W Education at Intermountain Health Care (IHC). IHC is an integrated system of 24

hospitals, more than 30 clinics, and a 500,000+-member HMO/PPO insurance plan serving communities in Utah, southeastern Idaho, and southwestern Wyoming.

Since 1986 IHC has been a national leader in applying quality management principles to reduce costs by improving health care delivery. Dr. James has been at the forefront of IHC's quality effort, adding a strong emphasis on patient care, clinical medicine, and the application of the scientific method to daily care delivery. He has been instrumental in showing that quality improvement extends far beyond "industrial quality control"-that it represents a natural extension of clinical research and medicine's long-standing commitment to better patient outcomes. He also advocates a defensible clinical methodology for quality improvement, arguing that clinical quality improvement links guideline development and outcomes research to give health care professionals the tools they need to more fully manage their own clinical care processes, at a level not possible through other managed care strategies.

Dr. James is an Adjunct Assistant Professor in the University of Utah School of Medicine's Division of Biostatistics, Department of Family and Preventive Medicine. He also holds a Visiting Lectureship in the Department of Health Policy and Management at the Harvard School of Public Health. He received his M.D. degree from the University of Utah School of Medicine, followed by residency training in general surgery. His undergraduate degrees in computer science and medical biology supplement a Master of Statistics degree, all from the University of Utah, with subsequent fellowship training in biostatistics at the Harvard School of Public Health.

Dr. James came to IHC in 1986 from the Harvard School of Public Health, where he was Assistant Professor of Biomedical Computing in the Department of Biostatistics and a biostatistician with the Eastern Cooperative Oncology Group, where he was responsible for randomized controlled trials in gastrointestinal cancers. Before that he served as the Cancer Department Assistant

ADirector and Consultant on Computers for the '-l1--- -l C.------- &

PLENARY SESSION /!

Tuesday, October 31 8:00 - 9:30A. M.

The Visible Human Project"

Michael J. Ackerman, Ph. D,

ichael J. Ackerman, Ph.D., Assistant Director for High Performance Computing and Communications of the National Library of Medicine (NLM), will demonstrate the NLM's "Visual Human ProjectT"," a digital image data set of complete

human male and female cadavers.

The NLM has long been a world leader in the archiving and distribution of the print-based images of biology and medicine. NLM has also been a pioneer in the use of computer systems to encode and distribute textual knowledge of the life sciences. The NLM Planning Panel on Electronic Imaging recommended that NLM undertake the building of a digital image library consisting of computer assisted tomography (CAT), magnetic resonance interferometry (MRI), and cryosection images of a representative, carefully selected and prepared male and female cadaver-the "Visible IIuman ProjectTM." The male Visible Human data set is now being made available through a license agreement with the NLM. A wide range of educational, diagnostic, treatment planning, and commercial uses is predicted. The female Visible Human data set will be available in late fall. The Visible Human data set will serve as a common public domain data set against which all medical imaging algorithms can be tested and as a test bed and model for the construction of network-accessible image libraries.

Key issues remain in the development of methods to link such image data to symbolic text-based data comprised of names, hierarchies, principles, and theories. Standards for such linkages do not exist currently. Generalizable methods, such as the use of hypermedia, where words can be used to find pictures, and pictures can be used as an index into relevant text, are the subject of experiments. Basic research in the description and representation of structures and the connection of structural-anatomical to functional-physiological knowledge is needed. This is the larger, long-term goal of the Visible Human Project: to link the print library of functional-physiological knowledge with the image library of structural-anatomical knowledge transparently into one unified resource of health information.

i Dr. Ackerman joined the NLM in 1987. He served as the Chief of the Educational Technology Branch of the Lister Hill National L Center for Biomedical Communications, applying interactive technology to medical education, and as the Associate Director for

Specialized Information Services, responsible for the Library's non-bibliographic data bases. He is Associate Professor in the Deparlment of Computer Medicine at the George Washington University.

1995 SCAMC PROGRAM OVERVIEWY TRACK l TRACK 2 TRACK 3 Computer Support of Declsion Support Systems Designing Computerized Clinical Practice in Clinical Practice Patient Records

8:30 - 10:OO A.M. S1 Plenary Session I: Computers, Data, and Continuous lluality Improvement Welcome and Introduction: Randolph A. Miller, M.D. Reed M. Gardner, Ph.0. Keynote Address: Brent C. James, M.D.,M. Stat. Student Paper Competition Awards Presentation: E. Andrew Balas, M.D., Ph.0.

I t 3 0 A.M. - 1200 noon S2 S3 S4 Clinical Decision Support Advances in Decision Patient Record Manage- Haug Support: Alerts ment: Design Implications

Pryor Kuperman

30 P.M. S13

EXHIBITS OPEN 11:OO A.M. - 6:00 P.M.

Henry Language and Terminology Tools for Effective Decision

Support Kahn

and Patient Records Cooper

Knowledge Representation

30 P.M. S22 S23 S24 Database Technology Belief Networks for Design of Clinical Systems Clayton Decision Support in Hospitals

Higgins Safran

TRACK 4 Computer and Internet- Based Educational Systems

-!55 Ih r i c u l a and Issues in .reaching lnformatics I?iedman

-E15 Authoring Educational Software for the WWW C. Cimino

-S25 Efficacy of Computer and Web-Based Education

8:30 - 10:OO A.M. S63 S64 S65 ! Changing Database Knowledge Representation Building Clinical Systems in Systems in Decisi on Systems Hospitals: Case Examples (h idel ines O'Steen Lincoln I :Iagle

10:30 A.M. - 12:OO noon S74 ! Human Factors in Building Fletworking Images and

and Quality Management Clinical Systems lata - .

EXHIBITS OPEN Classen Forsythe I n s s e -

I t 0 0 A.M. - 390 P.M. 1:00 - 3 0 0 P.M. S81 IClosing Session and ACMI Debate

Closing Remarks: Randolph A. Miller, M.D., Reed M. Gardner, Ph.D. Best Theoretical Paper, Best Paper on an Application, Best Poster, and Best Electronic Poster Awards: Joyce A. Mitchell, Ph.0. Prlscilla Mayden Award: Homer Warner, M.D., Ph.D. ACMI Debate

l

30 "See pages l0 and lI for the SCAMC Tutorial and Workshop Overview I

TRACK 5 TRACK 6 TRACK 7 TRACK 8 TRACK 9 TRACK l0 Evaluation of Clinical Evalution of Computerized Computerized Image Electronic Record System Governance of Clinical Theater-Style Demonstrations Information Systems Health Care Strategies Processing and Architectures Computing and Sharing of State-of-the-Art Operational

Transmission of Data Systems

-

- -

Panel Patlent Privacy and Panel N Data Secur~ty ~n Med~c Kohane Bail

S29 S30 11 Panel CPR Standards to Panel E

Improve Quality and Reduce Physwa l Cost - Schtpma Rockfell

S37 S39 S40 S41 Advances in D e s i ~ Organizing and Retrieving Panel: Case Studies in Panel: Sha~ use of Clinical Der from the WWW Implementing Clinical Among Ins1

Support Pa trick Information Systems Chueh Balas Page

S47 S49 S50 S51 Evaluating New Clinical Diagnostic and Mgt. Tools on Practice

System Evaluation:lmpact Panel: Facilitating Change through Info. Technology rrooem LISR ano Lommon

Panel: Discipline-Specific - , , . . , " Panel: Hea Informatics

Dewey Drazen Lorenzi d Progre

S57 S58 S59 Assessing the Value of the System Evaluation: The Panel: Info. Infrastructure CPR Patient's Perspective for TeleHealth Services Glaser Humphreys Jagannathan

S70 S71 I: International Panel: Alternative The Virtual Hospital: IAlMS borations in Medical Architectures for Scalable on the lnternet matics lnfomation Systems Gaivin

Stead

S79 I: CPRl Phase I I Study: Panel: Finding, Cataloging Regenstrief Medical Record ~rehensive Coding Results of Randomized System 7beil Trials - Hayward McDonald

PROGRAM - MONDAY MORNING

Clinical Decision Support Monday, October 30 10:30A.M . - 12:OO noon

Session Chair: P.J. Haug, M.D., Department of Medical Informatics, LDS Hospital, Salt Lake City, UT.

Support for Information Management in Critical Care: A New Approach to Identify Needs

Speaker: T.W. Rosenal, M.D., University of Calgary, Alberta, Canada.

Authors: T.W. Rosenal, M.D., University of Calgary, Alberta, Canada, D.E. Forsythe, Ph.D., M.A. Musen, M.D., Ph.D., and A. Seiver, M.D., Ph.D., Stanford University, Stanford. CA.

Hand-Held Computing in the Patient Care Setting: A Pilot Project

Speaker: J.F. Karshmer, R.N., Ph.D., Department of Nursing, New Mexico State University, Las Cruces, NM.

Authors: J.F. Karshmer, R.N., Ph.D., Department of Nursing, and A.I. Karshmer, Ph.D., Department of Computer Science, New Mexico State University, Las Cruces, NM.

An Overview of the CERC ARTEMIS Project

Speaker: V. Jagannathan, Ph.D., Concurrent Engineering Research Center, West Virginia University, Morgantown, WV.

Authors: V. Jagannathan, Ph.D., Y.V. Reddy, Ph.D., K. Srinivas, Ph.D., R. Karinthi, Ph.D., R. Shank, S. Reddy, Ph.D., G. Almasi, T. Davis, R. Raman, S. Qiu, and S. Friedman, M.D., Concurrent Engineering Research Center, West Virginia University, B. Merkin, M.D., M. Kilkenny, M.D., Valley Health Systems, Morgantown, WV.

Automated Patient Care Documentation: What's In It for Us? An Expert System Emergency Drug Card Printout

Speaker: G.C. Bjornstad, R.N., M.S.N., Primary Children's Medical Center, Salt Lake City, UT.

Authors: G.C. Bjornstad, R.N., M.S.N., F, Farr, PhD., P. Vernon, R.N., K. Welkie, R.N., and M. Witte, M.D., Primary Children's Medical Center, Salt Lake City, UT.

Advances in Decision Support Alerts Monday, October 30 10:30 A.M. - 12:OO noon

Session Chair: T.A. Pryor, Ph.D., Department of Medical Informatics, LDS Hospital, Salt Lake City, UT.

Nurses, Pagers, and Patient-Specific Criteria: Three Keys to Improved Critical Value Reporting

Speaker: K.E. Tate, Ph.D., LDS Hospital, Salt Lake City, UT.

Authors: K.E. Tate, Ph.D., R.M. Gardner, Ph.D., and K. Scherting, LDS Hospital, Salt Lake City, m.

Medical Decision Support: Experience with Implementing the Arden Syntax at the Columbia-Presbyterian Medical Center

Speaker: R.A. Jenders, M.D., M.S., Departments of Medical Informatics and Medicine, Columbia University, New York, NY.

Authors: R.A. Jenders, M.D., MS., Departments of Medical Informatics and Medicine, G. Hripcsnk, M.D., Department of Medical Informatics, R.V. Sideli, M.D., Department of Medical Informatics, W. DuMouchel, Ph.D., Departments of Medical Informatics and Biostatistics, H. Zhang, MS., Department of Biostatistics, J.J. Cimino, M.D., Departments of Medical Informatics and Medicine, S.B. Johnson, Ph.D., Department of Medical Informatics, E.H. Sherman, M.D., M.S., Departments of Medical Informatics and Medicine, and P.D. Clayton, Ph.D., Departments of Medical Informatics, Medicine, and Radiology, Columbia University, New York, NY.

Real-Time Wireless Decision Support Alerts on a Palm-top PDA

Speaker: M.M. Shabot, M.D., Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.

Authors: M.M. Shabot, M.D., and M. LoBue, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.

A Tool for Provider Interaction During Patient Care: G-CARE

Speaker: J.M. Overhage, M.D., Ph.D., Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN.

Authors: J.M. Overhage, M.D., Ph.D., B. Mamlin, J. Warvel, J. Warvel, W. Tierney, M.D., and C.J. McDonald, M.D., Regenstrief Institute, Indiana University School of Medicine, Indianapolis, IN.

Patient Record Management: Design

Monday, October 30 10:30A.M. - 12:OO noon

Session Chair: G. Kuperman, M.D., Ph.D., Department of Information Systems, Brigham & Women's Hospital, Boston, MA.

Querying Temporal Clinical Databases with Different Time Granularities: The GCH-OSQL Language

Speaker: C. Combi, Ph.D., Dipartimento di Bioingegneria del Politecnico di Milano, Milan, Italy.

Authors: C. Combi, Pli.D., F. Pinciroli, Dipartimento di Bioingegneria del Politecnico di Milano, M. Cavallaro, and G. Cucchi, Centro di Teoria dei Sistemi del CNR, Milan, Italy.

A Comparison of the Temporal Expressiveness of Three Database Query Methods

Speaker: A.K. Das, Section on Medical Informatics, Stanford University, Stanford, CA.

Authors: A.K. Das and M.A. Musen, M.D., Ph.D., Section on Medical Informatics, Stanford University, Stanford, CA.

Acts and Knowledge Management in the NUCLEUS Hospital Information System

Speaker: H. Kanoui, Ph.D., IIRIAM, Technopble de Chhteau-Gombert, Marseille Cedex, France.

Authors: H. Kanoui, Ph.D., IIRLAM, Technopble de Chbteau-Gombert, M. Joubert, Ph.D., CERTIM, FacultC de MCdecine, R. Favard, Ph.D., G. Maury, M.S., and M. Pelletier, Ph.D., IIRIAM, Technopale de Chbteau-Gombert, Marseille Cedex, France.

Transforms of the Computerized Patient Record Data Model: From Transactions to Analytical Processing

Speaker: K. Canfield, Ph.D., Department of Information Systems, University of Maryland, Baltimore, MD.

Authors: K. Canfield, Ph.D., M. Silva, MS., S. Zhaohui, R. Manchanda, MS., and P. Abbott, R.N., MS., Department of Information Systems, University of Maryland, Baltimore, MD.

PROGRAM - MONDAY MORNIIWG

Curricula and Issues in Teaching lnformatics Monday, October 30 10:30 A. M. - 12:OO noon

Session Chair: C.P. Friedman, Ph.D., Laboratory for Computing Cognition, University of North Carolina, Chapel Hill, NC.

A Model Curriculum of Health Care Informatics for Dutch Higher Professional Education

Speaker: J.E.C.M. Aarts, M.Sc., Causa, Hogeschool Eindhoven, Eindhoven, The Netherlands.

Author: J.E.C.M. Aarts, M.Sc., Causa, Hogeschool Eindhoven, Eindhoven, The Netherlands.

Summative Evaluation of a Baccalaureate Nursing Informatics Curriculum

Speaker: L.L. Travis, Ph.D., R.N., Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

Authors: L.L. Travis, Ph.D., R.N., C.A. Hudak, M.Ed.,R.N.,andP.F.Brennan,Ph.D.,R.N., Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

Modeling Respiratory Anatomy and Physiology in VR

Speaker: J.M. Kaye, M.S.E., Center for Human Modeling and Simulation, University of Pennsylvania, Philadelphia, PA.

Authors: J.M. Kaye, M.S.E., D.N. Metaxas, Ph.D., Center for Human Modeling and Simulation, University of Pennsylvania, Philadelphia, PA, and F.P. Primiano, Jr., Ph.D., ECRI, Plymouth Meeting, PA.

Cost-Efficient Management of Educational Material

Speaker: C. Cimino, M.D., Office of Computer Based Education, Albert Einstein College of Medicine, Bronx, NY.

Authors: C. Cimino, M.D., Office of Computer Based Education, J. Reichel, M.D., Department of Medicine, and M. Serrano, Office of Instructional Support Services, Albert Einstein College of Medicine, Bronx, W.

Tools for Analysis of Resource Use and Costs Monday, October 30 10:30 A.M. - 12:OO noon

Session Chair: R.D. Zielstorff, R.N., MS., Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA

Use of Severity-Adjusted Comparative Systems in the Development of Critical Pathways

Speaker: P.J. Landry, M.D., Department of Surgery, Clinical Informatics, and Medical QI, South Shore Hospital, South Weymouth, MA.

Author: P.J. Landry, M.D., Department of Surgery, Clinical Informatics, and Medical QI, South Shore Hospital, South Weymouth, MA.

Promoting Measure of Nursing Care Workload Through Computerization

Speaker: E. Lepage, M.D., Ph.D., Departments of Biostatistics and Medical Informatics, Saint- Louis University Hospital, Paris, France.

Authors: E. Lepage, M.D., Ph.D., Departments of Biostatistics and Medical Informatics, B. Guillemet, R.N., Department of Nursing, P. Durepaire, M. Dupont, Department of Computer Systems, and K. Veyer, R.N., Department of Nursing, Saint Louis University Hospital, Paris, France.

A Clinical Economics Workstation for Risk-Adjusted Health Care Cost Management

Speaker: E.L. Eisenstein, D.B.A., Outcomes Research and Assessment Group, Duke University Medical Center, Durham, NC.

Authors: E.L. Eisenstein, D.B.A., Outcomes Research and Assessment Group, and J.W. Hales, Ph.D., Division of Medical Informatics, Duke University Medical Center, Durham, NC .

Developing an Outcomes Infrastructure for Nursing

Speaker: M.T. Lush, M.S., R.N., Kaiser Permanente Medical Care Program, Northern California, Oakland, CA.

Authors: M.T. Lush, M.S., R.N., and D.L. Jones, MS., R.N., Kaiser Permanente Medical Care Program, Northern California, Oakland, CA.

Evaluation of Knowledge- Based Systems Monday, October 30 10:30 A.M. - 12:OO noon

Session Chair: D.W. Bates, M.D., M.S., Brigham & Women's Hospital, Boston, MA.

Factors Impacting the Success of Computerized Preadmission Screening

Speaker: J.W. Hales, Ph.D., Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Authors: J.W. Hales, Ph.D., Division of Medical Informatics, Duke University Medical Center, Durham, NC, R.M. Gardner, Ph.D., Department of Medical Informatics, LDS Hospital and University of Utah, and J.T. Jacobson, Quality Management Department, LDS Hospital, Salt Lake City, UT.

Structured Knowledge Representation: An Improved Methodology for Communication of Hospital Policy

Speaker: J.J. Guterman, M.D., MS., Departments of Medicine, Emergency Medicine, and Medical Informatics, Olive View-UCLA Medical Center, Sylmar, CA.

Authors: J.J. Guterman, M.D., MS., Departments of Medicine, Emergency Medicine, and Medical Informatics, N.J. Mankovich, Ph.D., Radiological Sciences, S. Weinstein, J.D., and B. Picken, M.D. (posthu- mous), Psychiatry, Olive View Medical Center, Sylmar, CA.

A Comparison of Two Computer-Based Prognostic Systems for AIDS

Speaker: L. Ohno-Machado, M.D., M.H.A., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Authors: L. Ohno-Machado, M.D., M.H.A., and M.A. Musen, M.D., Ph.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Iliad and Medical House-Call: Evaluating the Impact of Common Sense Knowledge on the Diagnostic Accuracy of a Medical Expert System

Speaker: 0 . Bouhaddou, Ph.D., Applied Medical Informatics, Salt Lake City, UT.

Authors: 0 . Bouhaddou, Ph.D., J.G. Lambert, M.D., and G.E. Morgan, Applied Medical Informatics, Salt Lake City, UT.

PROGRAM - MONDAY MORNllvG

Information Retrieval Monday, October 30 10:30A. M . - 12:OO noon

Session Chair: To be determined.

Retrieving Research Studies: A Comparison of Bibliographic and Full- Text Versions of the New England Journal of Medicine

Speaker: E.D. Johnson, M.A., J. Otto Lottes Health Sciences Library, University of Missouri-Columbia, Columbia, MO.

Authors: E.D. Johnson, M.A., J. Otto Lottes Health Sciences Library, M.C. Sievert, Ph.D., and E.J. McKinin, M.A., School of Library and Informational Science, University of Missouri- Columbia, Columbia, MO.

Conceptual Models of Clinical Publications for Enhancing Retrieval from Full-Text Databases

Speaker: G.P. Purcell, Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Authors: G.P. Purcell and E.H. Shortliffe, M.D., Ph.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

The SAPHIRE Sewer: A New Algorithm and Implementation

Speaker: W. Hersh, M.D., Biomedical Information Communication Center, Oregon Health Sciences University, Portland, OR.

Authors: W. Hersh, M.D., and T.J. Leone, MS., Biomedical Information Communication Center, Oregon Health Sciences University, Portland, OR.

A Trial Bank Model for the Publication of Clinical Trials

Speaker: I. Sim, M.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Authors: I. Sim, M.D., Section on Medical Informatics, and G. Rennels, M.D., Ph.D., Section on Medical Informatics, Stanford University, Stanford, CA.

Panel: To ward Electronic Medical Record Systems: An Infrastructure for Comparability Monday, October 30 10:30 A. M . - 12:OO noon

Members of this panel will discuss progress from a recent program initiative of the National Library of Medicine (NLM) and the Agency for Health Care Policy and Research (AHCPR) that seeks to advance electronic medical records. Funding by cooperative agreement assures full agency involvement with a group of eight highly qualified investigators. Six working group chairs will discuss intersite collaboration focused on six important issues that have emerged: confidentiality and security, outcomes, problem lists, remote data sharing, standards, and large-scale vocabulary experiments.

The objectives of the panel are W to understand the importance of develop-

ing an integrated computerized record, W to gain insight into the problems of data

sharing, and W to develop an understanding of collabora-

tion across institutions and sites.

Organizer: M. Corn, M.D., National Library of Medicine, Bethesda, MD.

Participants: G.O. Bamett, M.D., Massachusetts General Hospital, Boston, MA, M.G. Kahn, M.D., Ph.D., Washington University, St. Louis, MO, C.J. McDonald, M.D., Regenstrief Institute for Health Care, Indianapolis, IN, J.J. Cimino, M.D., Columbia Presbyterian Medical Center, New York, NY, B.L. Humphreys, M.L.S., National Library of Medicine, Bethesda, MD, and LS. Kohane, M.D., Ph.D., Children's Hospital, Boston, MA.

Moderator: M. Tuttle, Vice President, Lexical Technologies, Alameda, CA.

Panel: lnformation Systems Governance and Management Issues in an Integrated Delivery System Monday, October 30 10:30A.M. - 12:OO noon

Integrated delivery systems present complex health information system governance and management challenges: establishing strategic directions, setting priorities, allocating resources, and establishing a balance between

local authority and central control. Tlus panel will discuss the strategies and tactics that can be used to address these issues. Panel members are involved in consultation and implementation of complex health information systems.

Objectives of the panel include D to learn how medical informatics special-

ists and health information system managers can optimize management of complex health information systems,

D to understand how to develop a dialogue among representatives of disparate fac- tions in integrated health care enterprises, and

W to see a vision of cooperation in complex health care enterprises.

Organizer: E. Drazen, Sc.D., Arthur D. Little, Inc., Cambridge, MA.

Participants: J.P. Glaser, Ph.D., Partners Healthcare System, Boston, MA, S. Hupfeld, Oklahoma Health Systems, Oklahoma City, OK, and D.A. Weiss, BJC Health Systems, St. Louis, MO.

Moderator: H.C. Mullins, M.D., Department of Family Practice, University of South Alabama, Mobile, AL.

S11

Theater-Style Demonstration: lnternet- Based Support for a Collaborative Genome Center to Map Human Chromosome 12 Monday, October 30 10:30 A.M. - 12:OO noon

Speaker: P. Miller, M.D., Ph.D., Center for Medical Informatics, Yale University School of Medicine, New Haven, CT.

Authors: P. Miller, M.D., Ph.D., Center for Medical Informatics, P. Nadkarni, M.D., A. Banks, P. Brayward, Ph.D., K. Cheung, Yale University School of Medicine, New Haven, CT, L. Cupelli, Ph.D., V. Herdman, Albert Einstein College of Medicine, Bronx, NY, K. Kidd, Ph.D., Yale University School of Medicine, New Haven, CT, K. Krauter, Ph.D., I. Marondel, Ph.D., K. Montgomery, Ph.D., B. Renault, Ph.D., Albert Einstein College of Medicine, Bronx, NY, D.C. Ward, Ph.D., Yale University School of Medicine, New Haven, CT, S. Yoon, Ph.D., and R. Kucherlapati, Ph.D., Albert Einstein College of Medicine, Bronx, NY.

1

PROGRAM - MONDAY AFiTdWIV00N

Language and Terminology Monday October 30 2:OO - 3:30 P.M.

Session Chair: S.B. Henry, R.N., D.N.Sc., School of Nursing, University of California, San Francisco, CA.

Care-Base: A Reference Base for Nursing

Speaker: U. Schrader, Dr.rer.nat, Department of Medical Informatics, Albert-Ludwigs- University, Freiburg, Germany.

Authors: U. Schrader, Dr.rer.nat, Department of Medical Informatics, Albert-Ludwigs- University, Freiburg, R. Marx, and R. Balint, Department of General Informatics, Fachhochschule Furtwangen, Germany.

Analysis of Medical Texts Based on a Sound Medical Model

Speaker: A.-M. Rassinoux, Ph.D., Medical Informatics Division, University Hospital of Geneva, Geneva, Switzerland.

Authors: A.-M. Rassinoux, Ph.D., J.C. Wagner, M.S., C. Lovis, M.D., R.H. Baud, Ph.D., Medical Informatics Division, University Hospital of Geneva, Geneva, Switzerland, A. Rector, M.D., Ph.D., Medical Informatics Group, Department of Computer Sciences, University of Manchester, Manchester, United Kingdom, and J.R. Scherrer, M.D., Medical Informatics Division, University Hospital of Geneva, Geneva, Switzerland.

Sampling Strategies in a Statistical Approach to Clinical Classification

Speaker: Y. Yang, Ph.D., Section of Medical Information Resources, Mayo Clinic/Foundation, Rochester, MN.

Authors: Y. Yang, Ph.D., and C.G. Chute, M.D., Dr.P.H., Section of Medical Information Resources, Mayo Clinic/Foundation, Rochester, MN.

Validity and Reliability of Standard Terms and Codes for Patient Care Data

Speaker: J.G. Ozbolt, Ph.D., R.N., School of Nursing and Division of Patient Care Services, University of Virginia, Charlottesville, VA.

Authors: J.G. Ozbolt, Ph.D., R.N., School of Nursing and Division of Patient Care Services, M. Russo, R.N., Division of Patient Care Services, University of Virginia Medical Center, and M.P. Stultz, R.N., Department of Nursing, Martha Jefferson Hospital, Charlottesville, VA.

S13

Tools for Effective Decision Support Monday October 30 2:OO - 3:30 F! M.

Session Chair: M.G. Kahn, M.D., Ph.D., Division of Medical Informatics, Washington University, St. Louis, MO.

The Single Log-on Application: An Enabler for Access to Disparate Systems in a Patient-Focused Care Environment

Speaker: S.L. SooHoo, Ph.D., Information Systems Services, Cedars-Sinai Health Systems, Los Angeles, CA.

Authors: S.L. SooHoo, Ph.D., F. Aabedi, M.S., R.C. Wagenet, MS., Information Systems Services, Cedars-Sinai Health Systems, Los Angeles, CA, M. Dorst, Information Services, Walker, Richer and Quinn, Seattle, WA, and M. Stempson, R.N., M.S.N., Information Systems Services, Cedars-Sinai Health Systems, Los Angeles, CA.

Verification and Validation Algorithms for Data Used in Critical Care Decision Support Systems

Speaker: D. Carlson, Pulmonary Division, LDS Hospital, Salt Lake City, UT.

Authors: D. Carlson, C.J. Wallace, R.N., M.S., T.D. East, Ph.D., and A.H. Morris, M.D., Pulmonary Division, LDS Hospital, Salt Lake City, UT.

Analysis of Medical Decision Making: A Cognitive Perspective on Medical Informatics

Speaker: A.W. Kushniruk, M.Sc., Centre for Medical Education, McGill University, Montreal, Canada.

Authors: A.W. Kushniruk, M.Sc., V.L. Patel, Ph.D., and D. Fleiszer, M.D., Centre for Medical Education, McGill University, Montreal, Canada.

Concept Formation vs. Logistic Regression: Predicting Death in Trauma Patients

Speaker: M. Hadzikadic, Ph.D., Orthopaedic Medical Center/University of North Carolina, Charlotte, NC.

Authors: M. Hadzikadic, Ph.D., Orthopaedic Medical Center/University of North Carolina, A. Hakenewerth, General Surgery, B.F. Bohren, Orthopaedic Informatics Research, J.M. Norton, Ph.D., Biostatistics, B. Mehta, Biostatistics, and C. Andrews, General Surgery Research, Carolinas Medical Center, Charlotte, NC.

Knowledge Representation and Patient Records Monday, October 30 2:OO - 3:30 F! M.

Session Chair: G.F. Cooper, M.D., Ph.D., Department of Medicine, University of Pittsburgh, Pittsburgh, PA.

Architectural Requirements for a Multipurpose Natural Language Processor in the Clinical Environment

Speaker: C. Friedman, Ph.D., Department of Medical Informatics, Columbia University, New York, NY.

Authors: C. Friedman, Ph.D., S.B. Johnson, Ph.D., B. Forman, M.D., and J. Starren, M.D., M S , Department of Medical Informatics, Columbia University, New York, NY.

A Distributed, Scalable, Community Care Network Architecture for Wide- Area Electronic Patient Records: Modeling and Simulation

Speaker: S. Ghosh, Ph.D., Department of Computer Science and Engineering, Arizona State University, Tempe, AZ.

Authors: S. Ghosh, Ph.D., K. Han, Department of Computer Science and Engineering, Arizona State University, Tempe, AZ, R. Reddy, Ph.D., S. Reddy, Ph.D., S. Kankanahalli, Ph.D., V. Jagganathan, Ph.D., and R. Shank, CERC, West Virginia University, Morgantown, WV.

A Multi-Lingual Architecture for Building a Normalised Conceptual Representation from Medical Language

Speaker: P. Zweigenbaum, Ph.D., DIAMSIM, Assistance Publique-Hopitaux de Paris, Paris, France.

Authors: P. Zweigenbaum, Ph.D., B. Bachimont, Ph.D., J. Bouaud, Ph.D., J. Charlet, Ph.D., and J.F. Boisvieux, M.D., Ph.D., DIAM- SIM, Assistance Publique-Hopitaux de Paris, Paris, France.

Treatment Planning: Implications for Structure of the CPR

Speaker: K.W. Hammond, M.D., American Lake V.A. Medical Center, University of Washington, Seattle, WA.

Author: K.W. Hammond, M.D., American Lake V.A. Medical Center, University of Washington, Seattle, WA.

I

PROGRAM - MONDAY AFTERNOON

Authoring Educational Software for the World Wide Web Monday, October 30 200 - 3:30 F! M .

Session Chair: C. Cimino, M.D., Office of Computer-based Education, Albert Einstein College of Medicine, Bronx, NY.

Cross-Platform Hypermedia Examinations on the Web

Speaker: T.W. Williams, Jr., Eskind Biomedical Library, Informatics Center, Vanderbilt University Medical Center, Nashville, TN.

Authors: T.W. Williams, Jr., Eskind Biomedical Library, Informatics Center, N.B. Giuse, M.D., M.L.S., Division of Biomedical Informatics, J.T. Huber, Ph.D., Eskind Biomedical Library, Informatics Center, and R.L. Janco, M.D., Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.

A Method for Interactive Medical Instruction Utilizing the World Wide Web

Speaker: K.W. McEnery, M.D., Washington University School of Medicine, St. Louis, MO.

Authors: K.W. McEnery, M.D., S.M. Roth, M.D., L.K. Kelley, K.R. Hirsch, M.D., D.N. Menton, M.D., and E.A. Kelly, M.L.S., Washington University School of Medicine, St. Louis, MO.

The Interactive Image Tool: Adding Structure to Images

Speaker: P. Constantinou, Stanford University, Stanford, CA.

Authors: P. Constantinou, R. Mather, and P. Dev, Ph.D., Stanford University, Stanford, CA.

Web-Based Access to an Online Atlas of Anatomy: The Digital Anatomist Common Gateway Interface

Speaker: S.W. Bradley, Department of Biological Structure, University of Washington, Seattle, WA.

Authors: S.W. Bradley, C. Rosse, M.D., D.Sc., and J.F. Brinkley, M.D., Ph.D., Department of Biological Structure, University of Washington, Seattle, WA.

S16

Assessing and Meeting the lnformation Needs of Ambulatory Care Monday, October 30 200 - 3:30 F? M.


Methods for Assessing Information Needs of Clinicians in Ambulatory Care

Speaker: P.C. Tang, M.D., Northwestern Memorial Hospital, Chicago, IL.

Authors: P.C. Tang, M.D., M.A. Jaworski, R.N., C.A. Fellencer, R.N., M.P. LaRosa, J.M. Lassa, P. Lipsey, and W.C. Marquardt, R.N., Northwestern Memorial Hospital, Chicago, IL.

Prompting for Cost-Effective Test Ordering: A Randomized Controlled Trial

Speaker: G.R. Hollingworth, M.D., Elisabeth Bruyere Health Centre, Ottawa, Ontario, Canada.

Authors: G.R. Hollingworth, M.D., R.M. Bemstein, M.D., Ph.D., G.S. Viner, M.D., Elisabeth Bruyere Health Centre, J.S. Remington, M.D., and W.E. Wood, M.D., Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.

A Computer-Generated Reminder System Improves Physician Compliance with Diabetes Preventive Care Guidelines

Speaker: D.S. Nilasena, M.D., M.S.P.H., Department of Medical Informatics, University of Utah, Salt Lake City, UT.

Authors: D.S. Nilasena, M.D., M.S.P.H., and M.J. Lincoln, M.D., Department of Medical Informatics, University of Utah, Salt Lake City, UT.

S17

Design of Clinical lnformation Systems Monday, October 30 2:OO - 3:30 F! M.


Problems with Integrating Legacy Systems

Speaker: E.M. van Mulligen, Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.

Authors: E.M. van Mulligen, R. Comet, MSc., and T. Timmers, Ph.D., Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.

The Evolution of a Scalable Departmental Real-Time Clinical Information System

Speaker: A. Galewsky, Clinical Resource Systems, Inc., Austin, TX.

Authors: A. Galewsky, D. Galewsky, MS., P. Statham, and C.B. Owen, M.D., Clinical Resource Systems, Inc., Austin, TX.

The Role of the Information Architect at King Faisal Specialist Hospital and Research Centre

Speaker: D.F. Sittig, Ph.D., King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Authors: D.F. Sittig, Ph.D., King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, S. Sengupta, Ph.D., King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, and George Washington University Medical Center, Washington, DC, H. Al-Daig, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia, T. Payne, M.D., King Faisal Specialist Hospital and Research Centre and George Washington University Medical Center, Washington, DC, and P. Pincetl, M.D., George Washington University Medical Center, Washington, DC.

Real Time Monitoring in the Control Theory Paradigm

Speaker: B. Seroussi, M.D., Ph.D., DIAM-SIM, Assistance Publique-Hopitaux de Paris, Paris, France.

Authors: B. Seroussi, M.D., Ph.D., V. Morice, Ph.D., F. Dreyfus, M.D., and J.F. Boisvieux, M.D., Ph.D., DIAM-SIM, Assistance Publique- Hopitaux de Paris, Paris, France.

Panel: Progress in HL7/ASTM Clinical Messaging Monday October 30 200 - 3:30 f!M .

Members of this panel will discuss standardization developments related to Health Level 7/American Society for Testing and Materials (HL7/ASTM) messages. These developments will make it easier to gather and pool clinical data from many independent sources for the purpose of creating electronic medical records, assuring quality, reviewing utilization, and asking research questions. Committees in HL7 are balloting or developing messages for maintaining the problem list, reporting patient consents, requesting

PROGRAM - MONDAY AFTERNOON

appointments, and transmitting patient data from automated instruments (the last is being developed in cooperation with ASTM and EEE). Other committees have developed object models for clinical data exchange and are proposing technical infrastructure based on Common Object Request Broker Architecture (CORBA) and/or Microsoft's OLE. Full dex~elopment of these proposals would greatly simplify communication of clinical data among heterogeneous systems.

The panel's objectives are to inform the attendee about the latest in HL7 data transfer technology, to gain insight into how HL7 and ASTM messaging technologies complement each other, and to understand how these technologies will interface with the latest workstation infrastructure.

Organizer: C.]. McDonald, M.D., Indiana University, Regenstrief Institute for Health Care, Indianapolis, IN.

Participants: B. Griffin, MetPath Labs, Westwood, MA, R. Seliger, Hewlett-Packard, Andover, MA, S.M. Huff, M.D., IHC/Primary Children's Medical Center, Salt Lake City, UT, and M. Kimura, M.D., MS., Hamamatsu University School of Medicine, Hamamatsu, Japan.

Panel: Patient Privacy and Data Security Monday October 30 2:OO - 3:30 t?M.

The rapid growth and deployment of electronic medical record systems (EMRS), the economic pressures to share data among collaborating health care systems, and the benefits of common data standards to multi-institutional studies are leading to an increase in the volume and detail of patient data being encoded in electronic form, stored, and trans- mitted. The increase of traffic in electronic patient data has not been paralleled by formulation of pidelines or even consensual standards on how patient privacy and data security should be protected in this context. The questions that require urgent answers relate to both policy and technology. They fall into broad categories, such as the following: Who can control or store patient information? Does the list include Medical Information Bureaus? To what extent are providers, insur- ers, or even patients already allowing colla- tion of large data banks of identifiable and sensitive information?

This panel's objectives are to explore how the emergence of data standards for electronic medical records increases the threat to patient privacy, to understand the security issues related to the creation of a universal patient identifier, and to share practical experience with clinically operational systems.

Organizer: IS. Kohane, M.D., Ph.D., Children's Hospital, Harvard Medical School, Boston, MA.

Participants: P. Szolovits, Ph.D., Massachusetts Institute of Technology, Boston, MA, S. Cohn, BBN Network Security Group, Cambridge, MA, B. Woodward, Ph.D., American Civil Liberties Union, and P.D. Clayton, Ph.D., Columbia University, New York, NY.

Moderator: D.A.B. Lindberg, M.D., National Library of Medicine, Bethesda, MD.

Panel: Medlnfo 95: Trends in Medical lnformatics Monday October 30 2:OO - 3:30 t?M.

This panel will report on MedInfo 95, an international congress on medical informatics held in July 1995 in Vancouver, British Columbia, Canada. The theme of the congress was "From Theory to Practice." The International Medical Informatics Association (IMIA), of which AMIA is a member, sponsored the meeting. An informal survey of the topics covered at MedInfo suggests evolving trends within the discipline. The top category for papers, decision support systems, included papers on supporting and assessing clinical care through expert systems and logic. The next four top-ranking categories were education and training, medical language and coding, health information systems, and nursing informatics. The panelists will summarize Medlnfo 95 from their perspective as obse~er s .

The objectives of this panel are to help AMIA members become familiar with IMIA and MedInfo, to understand better the international progress of medical informatics, and

I to gain insight into cooperation in the international medical informatics community.

Organizer: M.J. Ball, Ed.D, University of Maryland at Baltimore, Baltimore, MD.

Participants: M.F. Collen, M.D., The Permanente Medical Group, Oakland, CA, K. Hannah, Calgary, Canada, J. Van Bemmel, Erasmus University, The Netherlands, B. de. F, Lelo, M.D., Ph.D., Institute de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil, and J.S. Silva, M.D., Advanced Research Projects Agency, Arlington, VA.

Theater-Style Demonstration: lntermed: An Internet-based Medical Collaboratory Monday, October 30 2:OO - 3:30 P M.

Speaker: D.E. Oliver, M.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Authors: D.E. Oliver, M.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA, M.R. Bames, G.O. Barnett, M.D., H.C. Chueh, M.D., MS., Massachusetts General Hospital, Boston, MA, J.J. Cimino, M.D., P.D. Clayton, Ph.D., Columbia-Presbyterian Medical Center, New York, NY, W.M. Detmer, M.D., J.H. Gennari, Stanford University School of Medicine, Stanford, CA, R.A. Greenes, M.D., Ph.D., Brigham and Women's Hospital, Boston, MA, S.M. Huff, M.D., LDS Hospital, Salt Lake City, UT, M.A. Musen, M.D., Ph.D., Stanford University School of Medicine, Stanford, CA, E. Pattison-Gordon, MS., Brigham and Women's Hospital, Boston, MA, E.H. Shortliffe, M.D., Ph.D., Stanford University School of Medicine, Stanford, CA, S.A. Socratous, and S.W. Tu, Columbia- Presbyterian Medical Center, New York, NY.

Database Technology Monday, October 30 4:OO - 5:30 P M.

Session Chair: P.D. Clayton, Ph.D., Department of Medical Informatics, Columbia-Presbyterian Medical Center, New York, NY.

Generating Penetration Path Hypotheses for Decision Support in Multiple Trauma

Speaker: 0.Ogunyemi, M.S.E., Center for Human Modeling and Simulation, University of Pennsylvania, Philadelphia, PA.

Authors: 0 . Ogunyemi, M.S.E., J. Kaye, M.S.E., B. Webber, Ph.D., Center for Human Modeling and Simulation, University of Pennsylvania, and J. Clarke, M.D., Department of Surgery, Medical College of Pennsylvania, Philadelphia, PA.

Estimation of Pharmacokinetic Model Parameters

Speaker: A. Tirncenko, Pli.D., Department of Anesthesiology, Mt. Sinai Medical Center, New York, NY.

Authors: A. Ticenko, Ph.D., D.L. Reich, M.D., Department of Anesthesiology, Mt. Sinai Medical Center, New York, NY, and G. Tmnfio, M.D., Veterans Administration Medical Center, New York, NY.

A Computer Program for the Multivariate and Graphical Monitoring of Acid-Base Data in an Intensive Care Unit

Speaker: M. Hekkiig, M.Sc., Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.

Authors: M. Hekking, MSc., Department of Medical Informatics, Erasmus University, J. Lindemans, Ph.D., Laboratory for Clinical Chemistry, Dijkzigt Ziekenhuis, and E.S. Gelsema, Ph.D., Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.

SmaCS: Smart Classification System for the Design, Maintenance, and Use of Complex Terminologies: Application in Pediatric Cardiology

Speaker: E van den Heuvel, M.D., Division of Pediatric Cardiology, Sophia Children's Hospital, and Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.

Authors: F. van den Heuvel, M.D., Division of Pediatric Cardiology, Sophia Children's Hospital, and Department of Medical Informatics, Erasmus University, T. Timmers, Ph.D., Department of Medical Informatics, Erasmus University, and J. Hess, M.D., Ph.D., Division of Pediatric Cardiology, Sophia Children's Hospital, Rotterdam, The Netherlands.

S23

Belief Networks for Decision Support Monday, October 30 4:OO - 5:30 F! M .

Session Chair: M. Higgins, Medical Department, Hewlett-Packard Labs, Palo Alto, CA.

Clinical Simulation Using Context- Sensitive Temporal Probability Models

Speaker: P. Haddawy, Ph.D., Department of Electrical Engineering and Computer Science, University of Wisconsin, Milwaukee, WI.

Authors: P. Haddawy, Ph.D., J.W. Helwig, L. Ngo, MS., and R.A. Krieger, M.S., Department of Electrical Engineering and Computer Science, University of Wisconsin, Milwaukee, WI.

Preliminary Investigation of a Bayesian Network for Mammographic Diagnosis of Breast Cancer

Speaker: C.E. Kahn, Jr., M.D., Medical Informatics and Decision Science Consortium, Milwaukee, WI.

Authors: C.E. Kahn, Jr., M.D., L.M. Roberts, M.S., K. Wang, D. Jenks, M.S.N., and P. Haddawy, Ph.D., Medical Informatics and Decision Science Consortium, Milwaukee, WI.

A New Formalism for Temporal Modeling in Medical Decision-Support Systems

Speaker: C.F. Aliferis, M.D., M.Sc., Section of Medical Informatics and Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA.

Authors: C.F. Aliferis, M.D., MSc., and G.F. Cooper, M.D., Ph.D., Section of Medical Informatics and Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA.

Using Belief Networks to Enhance Sharing of Medical Knowledge Between Sites with Variations in Data Accuracy

Speaker: W.R. Hogan, M.D., Department of Medicine, University of Pittsburgh, Pittsburgh, PA.

Authors: W.R. Hogan, M.D., Department of Medicine, and M.M. Wagner, M.D., Section of Medical Informatics, University of Pittsburgh, Pittsburgh, PA.

Design of Clinical Systems in Hospitals Monday, October 30 4:OO - 5:30 f?M.

Session Chair: C. Safran, M.D., M.S., Center for Clinical Computing, Hamard Medical School, Boston, MA.

Evaluation of an Object-Based Data Model Implemented Over a Proprietary, Legacy Data Model

Speaker: D.L. Pollard, Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Authors: D.L. Pollard and J.W. Hales, Ph.D., Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Converting a Legacy System Database into Relational Format to Enhance Query Efficiency

Speaker: J.C. Prather, Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Authors: J.C. Prather, D.F. Lobach, M.D., Ph.D., J.W. Hales, Ph.D., Division of Medical Informatics, M.L. Hage, M.D., Department of Obstetrics and Gynecology, S.J. Fehrs, and W.E. Hammond, PhD., Division of Medical Informatics, Duke University Medical Center, Durham, NC.

An Object-Oriented Computer-Based Patient Record Reference Model

Speaker: L. Dore, Ph.D., Medical Informatics Department, Broussais University Hospital, Paris, France.

Authors: L. Dore, Ph.D., M. Lavril, M.D., F.-C. Jean, and P. Degoulet, Medical Informatics Department, Broussais University Hospital, Paris, France.

A Comparison of Problem Lists Generated by Physicians, Nurses, and Patients: Implications for CPR Systems

Speaker: S.B. Hemy, R.N., D.N.Sc., School of Nursing, University of California, San Francisco, CA.

Authors: S.B. Henry, R.N., D.N.Sc., and W.L. Holzemer, R.N., Ph.D., School of Nursing, University of California, San Francisco, CA.

Efficacy of Computer and Web-Based Edi~cation Monday, October 30 4:OO - 5:30 P.M.

Session Chair: To be determined

A Model for Connecting Doctors to University-Based Medical Resources through the Internet

Speaker: A.J. Vanzyl, M.B.B.S., Medical Informatics, Monash University, Victoria, Australia.

Authors: A.J. Vanzyl, M.B.B.S., and B. Cesnik, M.B.B.S., M.D., Medical Informatics, Monash University, Victoria, Australia.

Computer-Aided Learning Validation: A CAI-Critical Mission

Speaker: T.J. Handler, M.D., Center for Advanced Instructional Media and Center for Medical Informatics, Yale University School of Medicine, New Haven, CT.

I

PROGRAM - MO/WDAY AFTERNOON

Authors: T.J. Handler, M.D., P. Lynch, MS., and C.C. Jaffe, M.D., Center for Advanced Instructional Media and Center for Medical

I Informatics, Yale University School of Medicine, New Haven, CT.

Expert System for Management of Urinary Incontinence in Women

Speaker: R.H. Gorman, Ph.D., R.N., Gainesville Veterans Affairs Medical Center, Gainesville, FL.

Author: R.H. Gorman, Ph.D., R.N., Gainesville Veterans Affairs Medical Center, Gainesville, FL.

Internet for Teaching and Learning Introductory Health Informatics

Speaker: D.J. Bigsby, School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.

Authors: D.J. Bigsby and J.R. Moehr, Drmed., School of Health Information Science, University of Victoria, Victoria, British

I Columbia, Canada.

Panel: CPRI Davies Presenters: Critical Success Factors and Unique Lessons Learned Monday, October 30 4:OO - 230 FM.

CPlU's Nicholas E. Davies CPR Symposium promotes excellence in development and implementation of computer-based patient records (CPRs) by recognizing health care provider organizations with computer-based patient record systems that demonstrate impact on health care quality, cost reduction, and improved access to care. Three health care provider organizations were recognized at the First Annual Davies Symposium. Selections were based on a peer review of their responses to the CPR Project Evaluation Criteria. This panel will bring together representatives of each of the three health care provider organizations to summarize the critical success factors in their implementation of CPR systems and to discuss in an open forum lessons learned through their development and implementa tion.

This panel's objectives are as follows: to hear about three early models of computerized patient record systems,

to gain an understanding of the Davies Award and its importance to the development of high quality computerized patient records, and to understand the factors involved in developing a computerized medical record.

Organizer: P.C. Tang, M.D., Northwestern Memorial Hospital, Chicago, IL.

Participants: R.M. Gardner, Ph.D., Intermountain Health Care, Salt Lake City, UT, S.B. Johnson, Ph.D., Columbia- Presbyterian Medical Center, New York, NY, and A.C. Curtis, M.D., Veterans Administration Medical Center, Jamaica Plains. MA.

Access to Medical Knowledge and Data Monday, October 30 4:OO - 5:30 F M.

Session Chair: R.A. Greenes, M.D., Ph.D., Decision Systems Group, Brigham and Women's Hospital, Boston, MA.

Strategic Exploration and Analysis Using Interactive Visualization of Health Care Databases

Speaker: J.I. Bormel, M.D., M.P.H., Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA.

Authors: J.I. Bormel, M.D., M.P.H., and G.O. Barnett, M.D., Laboratory of Computer Science, Massachusetts General Hospital, Boston. MA.

The Deployment of a World Wide Web (W3) Based Medical Information System

Speaker: K.E. Willard, M.D., M.S.E.E., Medical Decision Support Group, University of Minnesota Hospital and Clinic, Minneapolis, MN.

Authors: K.E. Willard, M.D., M.S.E.E., J.H. Hallgren, B. Sielaff, Ph.D., and D.P. ConneUy, M.D., Ph.D., Medical Decision Support Group, University of Minnesota Hospital and Clinic, Minneapolis, MN.

A ClienffServer Approach to Telemedicine

Speaker: B.J. Vaughan, MS., Medical College of Ohio, Toledo, OH.

Authors: B.J. Vaughan, MS., K.E. Torok, L.M. Kelly, D.J. Ewing, Ph.D., and L.T. Andrews, Ph.D., Information Systems, Medical College of Ohio, Toledo, OH.

Cost-Effective Internet Access and Video Conferencing for a Community Cancer Network

Speaker: J.W. London, Ph.D., Jefferson Cancer Center/Thomas Jefferson University, Philadelphia, PA.

Authors: J.W. London, Ph.D., D.E. Morton, MS., D. Marinucci, R. Catalano, Pharm.D., and R.L. Comis, M.D., Jefferson Cancer Center/Thomas Jefferson University, Philadelphia, PA.

Vocabularies for Biomedical Entities Monday, October 30 4:OO - 5:30 F M.

Session Chair: S. Fuller, Ph.D., Health Sciences Information System Integration, Health Sciences Center, University of WA, Seattle, WA.

ASN.1: Defining a Grammar for the UMLS Knowledge Sources

Speaker: A.T. McCray, Ph.D., National Library of Medicine, Bethesda, MD.

Authors: A.T. McCray, Ph.D., National Library of Medicine, Bethesda, MD, and G. Divita, Management Systems Designers, Vienna, VA.

Enhancements of Anatomical Information in UMLS Knowledge Sources

Speaker: C. Rosse, M.D., DSc., Department of Biological Structure, University of Washington, Seattle, WA.

Authors: C. Rosse, M.D., DSc., Department of Biological Structure, University of Washington, Seattle, WA, M. Ben Said, M.D., MS., Service de 1'Information Medicale, Hopital Tenon, Paris, France, K.R. Eno, and J.F. Brinkley, M.D., Ph.D., Department of Biological Structure, University of Washington, Seattle, WA.

Categorization by Reference: A Novel Approach to MeSH Term Assignment

Speaker: V. Kouramajian, Ph.D., Department of Computer Science, Wichita State University, Wichita, KS.

Authors: V. Kouramajian, Ph.D., V. Devadhar, Department of Computer Science, Wichita State University, Wichita, KS, J. Fowler, Ph.D., and S. Maram, Department of Community Medicine, Baylor College of Medicine, Houston, TX.

PROGRAM - MOWAY AFTERNOOM / TUESDAY IMORMIMG

Comparing Clinical Vocabularies Using Coding System Fidelity

Speaker: J.C. Klimczak, D.V.M., MS., Health Services Management, Medical Informatics Group, University of Missouri-Columbia, Columbia, MO.

Authors: J.C. Klimczak, D.V.M., M.S., Health Services Management, Medical Informatics Group, A.W. Hahn, D.V.M., Ph.D., College of Veterinary Medicine, M.E. Sievert, Ph.D., School of Library and Informational Science, G. Petroski, M.S., Medical Informatics Group, and J. Hewett, Ph.D., Medical Informatics Group, U~vers i ty of Missouri-Columbia, Columbia, MO.

Panel: Computer- Based Patient Record Standards to Improve Quality and Reduce Cost in Health Care Monday, October 30 4:OO - 5:30 k?M.

Widespread adoption of informatics standards, especially standards related to the computer-based patient record (CPR), is essential to improving the cost-effectiveness of clinical care supported by the use of computers. Imagine the difficulties in delivery of health care that would occur in the absence of standards for such things as oxygen tanks and fittings, as just one example among thousands. Similarly, while there is consensus that adoption of CPR systems can significantly enhance the quality of health care, reduce costs, and augment the general medical knowledge base, CPR systems can never be widely deployed or operate in a cost-effective manner until standards for their use are added to those that already exist in other health care areas. A wide range of standards is required: everything from standard ways to identify patients and provider organizations to standards that define comprehensive clinical terminology. The magnitude of the problem is large, but the potential rewards are also great. Several groups are deeply into the development process for the full range of CPR-related standards, under the coordination of the American National Standards Institute (ANSI) Healthcare Informatics Standards Planning Panel (HISPP). This panel discussion will bring attendees up to date on progress and players in this rapidly evolving arena.

The objectives of the panel are to gain an understanding of the importance of developing standards for the computer- based patient record,

rn to understand the importance of a good patient identification system, and to discuss important standards organizations in the US. and elsewhere.

Organizer: P.B. Schipma, M.S., IS. Grupe, Inc., Westmont, IL.

Participants: J.M. Fitzmaurice, Ph.D., Agency for Health Care Policy and Research, Rockville, MD, S.P. Colm, M.D., M.P.H., Kaiser Permanente, Oakland, CA, C.P. Waegemann, Medical Records Institute, Newton, MA, C.J. McDonald, M.D. Regenstrief Institute for Health Care, Indianapolis, IN, and W.E. Hammond, Ph.D., Duke University Medical Center, Durham, NC.

Panel: Empowering Patient- Physician Partnerships Monday, October 30 4:OO - 5:30 k? M.

The panelists will present and discuss current and imminent changes in the health care system and the corresponding transformation of the traditional patient-doctor relationship. They will demonstrate several computerized shared decision making technologies; examine their applications, with audience participation; introduce the notion of a "democratized" health care system as the product of new computer-based information technologies and more patient-centered approaches to care; and discuss positive and negative influences of managed care and other capitated systems on these changes.

This panel's objectives are rn to understand how patient and physician

partnerships are changing, rn to develop methodologies to optimize

patient care, and to understand how managed care might influence patient-physician relationships.

Organizer: R.G. Rockefeller, M.D., M.Ed., Health Commons Institute, Portland, ME

Participants: D.A. Deatrick, M.P.H., Health Commons Institute, Portland, ME, W.V. Slack, M.D., Haward Medical School, Boston, MA, P. Mongerson, B.S.M.E., Computer-Assisted Medical Diagnosis and Therapy Foundation, Marathon, FL.

Moderator: M. Greberman, M.D., M.P.H., Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD.

Theater-Style Demonstration: Advanced Clinical Systems in a Hospital Environment: The Brigham Integrated Computing System (BICS) Monday, October 30 4:OO - 5:30 k? M.

Speaker: J.M. Teich, MD., Ph.D., Brigham and Women's Hospital, Boston, MA.

Author: J.M. Teich, M.D., Ph.D., Brigham and Women's Hospital, Boston, MA.

Clinical Knowledge Databases Tuesday, October 31 10:OO - 1 l:3O A. M .

Session Chair: J. Mitchell, Ph.D., Medical Informatics Group, University of Missouri, Columbia, MO.

Supporting Ad-Hoc Queries in an Integrated Clinical Database

Speaker: S.A. Steib, Section of Medical Informatics, Washington University School of Medicine, St. Louis, MO.

Authors: S.A. Steib, Section of Medical Informatics, Washington University School of Medicine, R.M. Reichley, S.T. McMullin, The Jewish Hospital of St. Louis, K.A. Marrs, T.C. Bailey, W.C. Dunagan, and M.G. Kahn, M.D., Ph.D., Washington University School of Medicine, St. Louis, MO.

Semantic Visualization of Oncology Knowledge Sources

l

Speaker: W.G. Cole, Ph.D., Lexical Technology, Inc./Information Design Seattle, Seattle, WA.

Authors: W.G. Cole, Ph.D., Lexical Technology, Inc./Information Design Seattle, Seattle, WA, D.D. Sherertz, M.S. Tuttle, G.T. I

Hsu, Lexical Technology, Inc., Alameda, CA, L.M. Fagan, M.D., Ph.D., and R.W. Carlson, i M.D., Stanford University School of Medicine, Stanford, CA.

A Probability Database for Design- Analytic Models of Coronary lRevascularization Procedures

Speaker: J.F. Murphy, M.D., Cardiovascular l Division, Washington University School of Medicine, St. Louis, MO. 1

PROGRAM - TUESDAY MORNING

Authors: J.F. Murphy, M.D., Cardiovascular Division, K.A. Marrs, MS., and M.G. Kahn, M.D., Ph.D., Section of Medical Informatics, Washington University School of Medicine, St. Louis, MO.

Patient Precautions: A Forgotten Piece of the Electronic Patient Record

Speaker: D.Z. Sands, M.D., M.P.H., Divisions of Clinical Computing and General Medicine, Beth Israel Hospital and Harvard Medical School, Boston, MA.

Authors: D.Z. Sands, M.D., M.P.H., and C. Safran, M.D., MS., Divisions of Clinical Computing and General Medicine, Beth Israel Hospital and Harvard Medical School, Boston, MA.

Decision Support for Clinical Practice Guidelines Tuesday, October 31 10:OO - 1 l:3O A.M.

Session Chair: M. Shabot, M.D., Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.

Representation of Clinical Practice Guidelines Through an Interactive World Wide Web Interface

Speaker: E.B. Liem, M.D., Decision Systems Group, Haward Medical School, Brigham and Women's Hospital, Boston, MA.

Authors: E.B. Liem, M.D., J.S. Obeid, M.D., E.P.Shareck,M.D.,L.Sato,M.D.,andR.A. Greenes, M.D., Ph.D., Decision Systems Group, Harvard Medical School, Brigham and Women's Hospital, Boston, MA.

Computerized Practice Guidelines for Heart Failure Management: The

I HeartMan System

Speaker: A. Margolis, M.D., Department of Medical Informatics, University of Utah, Salt Lake City, UT, and Hospital de Clinicas, Montevideo, Uruguay.

I Authors: A. Margolis, M.D., Department of Medical Informatics, University of Utah, Salt

I Lake City, UT, and Hospital de Clinicas, Montevideo, Uruguay, B.E. Bray, M.D., Departments of Medical Informatics and Cardiology, E.M. Gilbert, M.D., Department of Cardiology, and H.R. Warner, M.D., Ph.D., Department of Medical Informatics, l University of Utah, Salt Lake City, UT.

An Architecture for a Distributed Guideline Server

Speaker: M.R. Bames, M.D., Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA.

Authors: M.R. Bames, M.D., and G.O. Bamett, M.D., Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA.

Using Intermediate States to Improve the Ability of the Arden Syntax to Implement Care Plans and Reuse Knowledge

Speaker: E.H. Sherman, M.D., MS., Department of Medical Informatics, Columbia University, New York, NY.

Authors: E.H. Sherman, M.D., MS., G. Hripcsak, M.D., J. Starren, M.D., R.A. Jenders, M.D., MS., and P.D. Clayton, Ph.D., Department of Medical Informatics, Columbia University, New York, NY.

Data Design for the Computerized Medical Record Tuesday, October 31 10:OO - 1 l:3O A. M.

Session Chair: P.F. Brennan, R.N., Ph.D., Francis Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

Extending a Clinical Repository to Include Multiple Sites

Speaker: K.A. Marrs, MS., Section of Medical Informatics, Washington University, St. Louis, MO.

Authors: K.A. Marrs, MS., and M.G. Kahn, M.D., Ph.D., Section of Medical Informatics, Washington University, St. Louis, MO.

Creating Temporal Abstractions in Three Clinical Information Systems

Speaker: M.G. Kalm, M.D., Ph.D., Section of Medical Informatics, Washington University, St. Louis, MO.

Authors: M.G. Kahn, M.D., Ph.D., and K.A. Marrs, MS., Section of Medical Informatics, Washington University, St. Louis, MO.

Comparison of Probabilistic and Deterministic Record Linkage in the Development of a Statewide Trauma Registry

Speaker: D.E. Clark, M.D., Department of Surgery, Maine Medical Center, Portland, ME.

Authors: D.E. Clark, M.D., and D.R. Hahn, Department of Surgery, Maine Medical Center, Portland, ME.

Panel: New Technologies in Medical and Health Science Education Tuesday, October 31 10:OO - 1 l:3O A. M.

Just as the flight simulator has changed the way pilots are trained, the application of new teclmologies to medical and health science education will change the way health care professionals are trained and how medicine is practiced. This panel will explore these new technologies: image data sets, distributed libraries, high speed networks, distributed processing, client-server applications, advanced imaging and force feedback techniques, virtual reality. What is available today? What is the promise for health science education in the future?

Among the panel's objectives are W to gain an understanding of how libraries

of the future will change our library use paradigm,

W to understand how we might become better research investigators and teachers by using this new technology, and

W to glimpse the "flight simulator" approach to the practice of medicine.

Organizer: M.J. Ackerman, Ph.D., High Performance Computing and Communications, National Library of Medicine, Bethesda, MD.

Participants: J.R. Merrill, M.D., High Techsplanations, Inc., Rockville, MD, P. Dev, Ph.D., Stanford University, Stanford, CA, and R. Roy, M.D., George Washington University Medical Center, Washington, DC.

Moderator: M.E. Sievert, Ph.D., Library and Informational Sciences, Columbia, MO.

Advances in the Design and Use of Clinical Decision Support Tuesday, October 31 10:OO - 1 l:3O A. M.

Session Chair: E.A. Balas, M.D., Ph.D., Health Services Management, University of Missouri School of Medicine, Columbia, MO.

Computerized Support of Pressure Ulcer Prevention and Treatment Protocols

Speaker: D.F. Willson, M.S.N., R.N., Department of Medical Informatics,

PROGRAM - TUESDAY NORnllNG

Intermountain Health Care, Salt Lake City, m. Authors: D.F. Willson, M.S.N., R.N., Department of Medical Informatics, C. Ashton, Ph.D., R.N., N. Wingate, M.S.N., R.N., C. Goff, R.N., S. Horn, Ph.D., M. Davies, and R. Buxton, M.S.N., R.N., Intermountain Health Care, Salt Lake City, UT.

A Decision Support Tool for Antibiotic Therapy

Speaker: R.S. Evans, Ph.D., Clinical Epidemiology, LDS Hospital, Salt Lake City, m. Authors: R.S. Evans, Ph.D., Clinical Epidemiology, D.C. Classen, M.D., MS., Clinical Epidemiology, S.L. Pestotnik, MS., R.Ph., Pharmacy, T.P. Clemmer, M.D., Critical Care, L.K. Weaver, M.D., Critical Care, and J.P. Burke, M.D., Clinical Epidemiology, LDS Hospital, Salt Lake City, UT.

The Effects of a Computer-Assisted Reminder System on Patient Compliance with Recommended Health Maintenance Procedures

Speaker: E.C. Vincent, M.D., Swedish Family Medicine, Swedish Hospital, Seattle, WA.

Authors: E.C. Vincent, M.D., Swedish Family Medicine, Swedish Hospital, Seattle, WA, P.A. Hardin, Ph.D., CYBIS Medical Systems, Bellevue, WA, L.A. Norman, M.D., M.B.A., M.H.S., Swedish Family Medicine, Swedish Hospital, Seattle, WA, E.A. Lester, CYBIS Medical Systems, Bellevue, WA, and S.H. Stinton, Swedish Family Medicine, Swedish Hospital, Seattle, WA.

Lowering Physician Hospital Resource Consumption Using Low-Cost, Low- Technology Computing

Speaker: CC. Johnson, M.S.P.H., M.P.H., Anderson Area Medical Center, Anderson, SC.

Authors: C.C. Johnson, M.S.P.H., M.P.H., Anderson Area Medical Center, Anderson, SC, and M.M. Martin, Ph.D., Medical University of South Carolina, Charleston, SC.

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Success Factors in System Planning and lmplementation Tuesday, October 31 1O:OO - 1 l:3O A. M.

Session Chair: R.B. Haynes, McMaster University Medical Center, Hamilton, Ontario, Canada.

Strategic Planning for Information Management: What Are the Deliverables?

Speaker: A.J. Olsen, M.B.A., M.A., Vanderbilt University Medical Center, Nashville, TN.

Authors: A.J. Olsen, M.B.A., M.A., and W.W. Stead, M.D., Vanderbilt University Medical Center, Nashville, TN.

Successful Implementation of an Integrated Physician Order Entry Application: A Systems Perspective

Speaker: C. Weir, Ph.D., Salt Lake City Veterans Affairs Information Systems Center, Salt Lake City, UT.

Authors: C. Weir, Ph.D., M. Lincoln, M.D., D. Roscoe, R.N., M.Ed., and G. Moreshead, Salt Lake City Veterans Affairs Information Systems Center, Salt Lake City, UT.

Cross-Site Study of the Implementation of Information Technology Innovations in Health Sciences Centers

Speaker: J. Ash, M.L.S., M.S., M.B.A., Biomedical Information Communication Center, Oregon Health Sciences University, Portland, OR.

Author: J. Ash, M.L.S., M.S., M.B.A., Biomedical Information Communication Center, Oregon Health Sciences University, Portland, OR.

Participatory Design of Computer- Supported Organizational Learning in Health Care: Methods and Experiences

Speaker: T. Timpka, M.D., Ph.D., Linkoping University, Linkoping, Sweden.

Authors: T. Timpka, M.D., Ph.D., C. Sjoberg, Ph.Lic., N. Hallherg, MSc., H. Eriksson, Ph.D., M.D.A., Linkoping University, P. Lindblom, M.Sc., P. Hedblom, M.Sc., B. Svensson, R.N., and H. Marmolin, Ph.D., U1 Design AB, Linkoping, Sweden.

Organizing and Retrieving from the World Wide Web Tuesday, October 31 10:OO - 11:30 A.M.

Session Chair: T. Patrick, Ph.D., Medical Informatics Group, University of Missouri, Columbia, MO.

Teaching Literature Searching in the Context of the World Wide Web

Speaker: K.A. Brandt, Ph.D., M.L.S., William H. Welch Medical Library, Johns Hopkins University, Baltimore, MD.

Authors: K.A. Brandt, Ph.D., M.L.S., William H. Welch Medical Library, and H.P. Lehmann,

M.D., Ph.D., Office of Medical Informatics Education, Johns Hopkins University, Baltimore, MD.

Automated MeSH Indexing of the World Wide Web

Speaker: J. Fowler, Ph.D., Department of Community Medicine, Baylor College of Medicine, Houston, TX.

Authors: J. Fowler, Ph.D., Department of Community Medicine, Baylor College of Medicine, Houston, TX, V. Kouramajian, Ph.D., S. Maram, and V. Devadhar, Department of Computer Science, Wichita State University, Wichita, KS.

A Model of Clinical Query Management that Supports Integration of Biomedical Information over the World Wide Web

Speaker: W.M. Detmer, M.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Authors: W.M. Detmer, M.D., and E.H. Shortliffe, M.D., Ph.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Medical Information Retrieval and WWW Browsers at Mayo

Speaker: C.G. Chute, M.D., Dr.P.H., Section of Medical Lnformation Resources, Mayo Clinic/Foundation, Rochester, MN.

Authors: C.G. Chute, M.D., Dr.P.H., D.L. Crowson, J.D. Buntrock, Section of Medical Information Resources, Mayo Clinic/Foundation, Rochester, MN.

Panel: Case Studies in the lmplementation of Cost- Effective Clinical Information Systems Tuesday, October 31 10:OO - 1 l:3O A. M.

A panel of CIOs from leading health care provider organizations will discuss their strategies for increasing the cost-effectiveness and improving the utilization of clinical information systems in health care delivery, research, education, and patient management.

Organizer: J. A. Page, Healthcare Information and Management Systems Society (HIMSS), Chicago, IL.

Participants: To be determined.

Moderator: J. Ozbolt, Ph.D., R.N., Division of Patient Care Services, University of Virginia School of Nursing, Charlottesville, VA.

S41

Panel: Sharing Clinical Data Among Different Institutions: Technology Tuesday, October 31 10:OO - 1 l:3O A.M.

The panelists will discuss a collaborative experiment now under way to demonstrate the technical feasibility of making available over the Internet key components of the electronic medical record at several different institutional sites. They will discuss a number of the issues involved in the technology of sharing clinical data across institutional hound- aries and will describe the current state of the experiment in the collaborating institutions. The panelists will also review how the data- sharing technologies they are evaluating for following individual patients across multiple institutions can also be used to aggregate data across the same institutions for clinical or outcomes research. The collaboration is orga- nized under the Electronic Medical Record Collabcirative Agreement supported by the National Library of Medicine.

Following are the objectives of this panel: H to understand the technological issues and

problems of sharing electronic patient records,

H to learn how methodologies for sharing patient records are developing, and

H to gain insight into the legal and technical complexities of sharing patient records.

Organizer: G.O. Barnett, M.D., Laboratory for Computer Science, Massachusetts General Hospital, Boston, MA.

Participants: H. Chueh, M.D., MS., Laboratory for Computer Science, Massachusetts General Hospital, Boston, MA, and IS. Kohane, M.D., Ph.D., Children's Hospital, Boston Medical School, Boston, MA.

S42

Theater-Style Demonstration: Developing AJN Network: Transforming Information -A Cost- Effective lnformation Resource Tuesday, October 31 10:OO - 1 l:3O A. M.

Speaker: M.A. Rizzolo, Ed.D., R.N., American Journal of Nursing Co., New York, NY.

Authors: M.A. Rizzolo, Ed.D., R.N., and K. DuBois, M.S.N., American J o ~ ~ r n a l of Nursing Co., New York, NY.

Data Entry for Clinical Systems Tuesday, October 31 1:OO - 2:30 l? M.


Cat 6 moT symptoms: Online Physician Charting and More

Speaker: M. Lee, Information Services, Texas Children's Hospital, Houston, TX.

Authors: M. Lee, Information Services, Texas Children's Hospital, D. Niemeyer, Insource Management Group, D. Seilheimer, M.D., S. Abramson, M.D., Children's Asthma Center, Texas Children's Hospital, Z. Lin, and M. GLI, Information Services, Texas Children's Hospital, Houston, TX.

TeleformTMScannable Data Entry: An Efficient Method to Update a Community-Based Medical Record?

Speaker: P. Guerette, Ph.D., General Internal Medicine and Gerontology, Bowman Gray School of Medicine, Winston-Salem, NC.

Authors: P. Guerette, Ph.D., General Internal Medicine and Gerontology, Bowman Gray School of Medicine, B. Robinson, Adult Medicine, Reynolds Health Center, W.P. Moran, M.D., C. Messick, M.D., General Internal Medicine and Gerontology, Bowman Gray School of Medicine, M. Wright, Wright Systems Solutions, Inc., J.L. Wofford, M.D., and R. Velez, M.D., General Internal Medicine and Gerontology, Bowman Gray School of Medicine, Winston-Salem, NC.

Design Considerations for Intelligent Data Entry: Development of MedIO

Speaker: R.J. DeFriece, M.D., M.E.E., Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Author: R.J. DeFriece, M.D., M.E.E., Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Intelligent Monitor for an Anesthesia Breathing Circuit

Speaker: S.P. Narus, M.S., Anesthesiology Bioengineering Laboratory, University of Utah, Salt Lake City, UT.

Authors: S.P. Narus, MS., K. Kiick, and D.R. Westenskow, Ph.D., Anesthesiology Bioengineering Laboratory, University of Utah, Salt Lake City, UT.

Computerized Support for Patient Care Protocols Tuesday, October 31 1:00 - 230 l? M.


Medical Informatics Academia and Industry: A Symbiotic Relationship that May Assure Survival of Both Through Health Care Reform

Speaker: T.D. East, Pli.D., Pulmonary Division, LDS Hospital, Salt Lake City, UT.

Authors: T.D. East, Ph.D., C.J. Wallace, R.N., M.S., M.A. Franklin, A.T. Kinder, R.M. Sailors, M.E.B.E., D. Carlson, R. Bradshaw, and A.H. Morris, M.D., Pulmonary Division, LDS Hospital, Salt Lake City, UT.

A Successful Protocol for the Use of Pulse Oximetry to Classify Arterial Oxygenation into Four Fuzzy Categories

Speaker: R.M. Sailors, M.E., Pulmonary Division, LDS Hospital, Salt Lake City, UT.

Authors: R.M. Sailors, M.E., T.D. East, Ph.D., C.J. Wallace, R.N., M.S., and A.H. Morris, M.D., Pulmonary Division, LDS Hospital, Salt Lake City, UT.

Formalisation of Safety Reasoning in Protocols and Hazard Regulations

Speaker: P. Hammond, PhD., Brunel University, Uxbridge, United Kingdom

Authors: P. Hammond, Ph.D., Brunel University, Uxbridge, M.J. Sergot, M.A., Imperial College of Science, Teclmology, and Medicine, London, and J.C. Wyatt, D.M., Imperial Cancer Research Fund, London, United Kingdom.

Prevention of Sudden Cardiac Death: A Probabilistic Model for Decision Support

Speaker: G.D. Sanders, Section on Medical Informatics and Division of General Internal Medicine, Stanford University School of Medicine, Stanford, CA.

Authors: G.D. Sanders, Section on Medical Informatics and Division of General Internal Medicine, Stanford University School of Medicine, R.A. Harris, M.Sc., M.A. Hlatky, M.D., Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, and D.K. Owens, M.D., MSc., Department of Veterans Affairs Medical Center, Palo Alto, CA, and Stanford Universitv School of Medicine, Stanford, CA.

PROGRAM - TUESDAY AFTERNOON

S45

Computerized Ambulatory Medical Records Tuesday, October 31 1:OO - 230 F! M.


A Data Model That Captures Clinical Reasoning About Patient Problems

Speaker: R.C. Barrows, Jr., M.D., Department of Medical Informatics, Columbia University, New York, NY.

Authors: R.C. Barrows, Jr., M.D., and S.B. Johnson, Ph.D., Department of Medical Informatics, Columbia University, New York, W.

Can One Patient Record Accommodate the Diversity of Specialized Care?

Speaker: A.M. van Ginneken, M.D., Ph.D., Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.

Authors: A.M. van Ginneken, M.D., Ph.D., and H. Stam, Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.

A Findings Model for an Ambulatory Pediatric Record: Essential Data, Relational Modeling, and Vocabulary Considerations

Speaker: R.N. Shiffman, M.D., M.C.I.S., Center for Medical Informatics and Department of Pediatrics, Yale School of Medicine, New Haven, CT.

Author: R.N. Shiffman, M.D., M.C.I.S., Center for Medical Informatics and Department of Pediatrics, Yale School of Medicine, New Haven, CT.

Categorization of Free-text Problem Lists: An Effective Method of Capturing Clinical Data

Speaker: J. Zelingher, M.D., M.Sc., Beth Israel Hospital, Harvard Medical School, Boston, MA.

Authors: J. Zelingher, M.D., M&., D.M. Rind, M.D., M.S., E. Caraballo, Beth Israel Hospital and Harvard Medical School, Boston, MA, M.S. Tuttle, D.D., N.E. Olson, Lexical Technology, Inc., Alameda, CA, and C. Safran, M.D., MS., Beth Israel Hospital, Harvard Medical School, Boston, MA.

Pictures on the World Wide Web Tuesday, October 31 1:00 - 230 F! M.

Session Chair: R. Shannon, M.D., Veterans Affairs Medical Center, Durham, NC.

Automatic Assessment of Scintmammographic Images Using a Novelty Filter

Speaker: M. Costa, MSc., University of Amazonas/FUCAPI, Amazonas, and Unicamp, SBo Paulo, Brazil.

Authors: M. Costa, MSc., University of Amazonas/FUCAPI, Amazonas, and Unicamp, SBo Paulo, and L. Moura, Ph.D., InCor, SZo Paulo Heart Institute, SBo Paulo University Medical School Hospital, SBo Paulo, Brazil.

Description Generation of Abnormal Densities Found in Radiographs

Speaker: A. Abella, Ph.D., AT&T Bell Laboratories, Murray Hill, NJ.

Authors: A. Abella, Ph.D., AT&T Bell Laboratories, Murray Hill, NJ, J.R. Kender, Ph.D., Computer Science Department, and J. Starren, M.D., Department of Medical Informatics, Columbia University, New York, W.

Automated Reconstruction of Endoscopic Images of the Esophagus

Speaker: A.O. Shar, Ph.D., University of Pennsylvania School of Medicine, Philadelphia, PA.

Authors: A.O. Shar, Ph.D., University of Pennsylvania School of Medicine, M. Weiner, M.D., Hospital of the University of Pennsylvania, Philadelphia, PA, R. Kim, M.D., and J. Reynolds, M.D., University of Pittsburgh School of Medicine, Pittsburgh, PA.

Hypermedia Patient Data Retrieval and Presentation Through WWW

Speaker: U. Tachinardi, M.D., InCor - Instituto do Cora~Bo - HCFMUSP, SBo Paulo, Brazil.

Authors: U. Tachinardi, M.D., S.S. Furuie, Ph.D., N. Bertozzo, E.E., L. Moura, Ph.D., M.A. Gutierrez, E.E., and C.P. Melo, M.Sc., InCor - lnstituto do Cora~Bo - HCFMUSP, SBo Paulo, Brazil.

Evaluating New Clinical Diagnostic and Information Management Tools Tuesday, October 31 1:OO - 230 F! M.

Session Chair: J. Dewey, M.D., Kaiser Permanente, Rockville, MD.

Evaluation of a Belief-Network-Based Reminder System that Learns from Utility Feedback

Speaker: M.M. Wagner, M.D., M.S., Section of Medical Informatics, University of Pittsburgh, Pittsburgh, PA.

Authors: M.M. Wagner, M.D., M.S., and G.F. Cooper, M.D., Ph.D., Section of Medical Informatics, University of Pittsburgh, Pittsburgh, PA.

MCAT-A Multimedia Cardiac Angiogram Tool

Speaker: D.Y. Cheng, Ph.D., Philips Research Palo Alto, Palo Alto, CA.

Authors: D.Y. Cheng, Ph.D., A. Banerjea, Ph.D., E.J. Pol, Ph.D., Philips Research Palo Alto, Palo Alto, CA, and R.J. Lundstrom, M.D., Kaiser Foundation Hospital, San Francisco, CA.

The Constellation Project: Experience and Evaluation of Personal Digital Assistants in the Clinical Environment

Speaker: S.E. Labkoff, M.D., Decision Systems Group, Rrigham and Women's Hospital, Harvard Medical School, Boston, MA.

Authors: S.E. Labkoff, M.D., Decision Systems Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, S. Shah, M.S., K2 Consultants, Nashua, NH, J. Bormel, M.D., M.P.H., Laboratory of Computer Science, Massachusetts General Hospital, Harvard Medical School, Y. Lee, and R.A. Greenes, M.D., Ph.D., Decision Systems Group, Brigham and Women's Hospital, Boston, MA.

Evaluation of an Expert System Producing Geometric Solids as Output

Speaker: C.H. Ketting, M.D., Radiation Oncology Department, University of Washington, Seattle, WA.

Authors: C.H. Ketting, M.D., M.M. Austin- Seymour, M.D., LJ. Kalet, Ph.D., J.P. Jacky, Ph.D., S.E. Krornhout-Schiro, Ph.D., S.M. Hummel, J.M. Unger, MS., Radiation Oncology Department, University of


Washington, Seattle, WA, and L.M. Fagan, M.D., Ph.D., Section on Medical Informatics, Department of Medicine, Stanford University, Stanford, CA.

S48

System Evaluation: Impact on Practice Tuesday, October 31 1:00 - 2:30 t?M.

Session Chair: E. Drazen, Sc.D., Arthur D. Little, Inc., Cambridge, MA.

Assessing the Behavioral Impact of a Diagnostic Decision Support System

Speaker: Y. Li, M.D., Ph.D., Taipei Medical College, Taipei, Taiwan.

Authors: Y.Li, M.D., Ph.D., Taipei Medical College, Taipei, Taiwan, P.J. Haug, M.D., LDS Hospital/University of Utah, M.J. Lincoln, M.D., C.W. Turner, Ph.D., TA. Pryor, Ph.D., and H.H. Warner, M.D., Ph.D., University of Utah, Salt Lake City, UT.

Cost-Effective Computerized Decision Support: Tracking Caregiver Acceptance at the Point of Care

Speaker: C.J. Wallace, R.N., M.S., Division of Pulmonary and Respiratory Care Services, LDS Hospital, Salt Lake City, UT.

Authors: C.J. Wallace, R.N., M.S., S. Metcalf, X. Zhang, M.D., A.T. Kinder, L. Greenway, and A.H. Morris, M.D., Division of Pulmonary and Respiratory Care Services, LDS Hospital, Salt Lake City, UT.

Cost-Effective Clinical Uses of Wide- Area Networks: Electronic Mail as Telemedicine

Speaker: E.R. Worth, M.D., Medical Informatics Group, University of Missouri, Columbia, MO.

Authors: E.R. Worth, M.D., Medical Informatics Group, T.B. Patrick, Ph.D., J.C. Klimczak, D.V.M., M.S., Medical Informatics Group and Department of Information Science, and J.C. Reid, Ph.D., Medical Informatics Group, University of Missouri, Columbia, MO.

Outcomes Research Using the Electronic Patient Record: Beth-Israel Hospital's Experience with Anticoagulation

Speaker: J.S. Einbinder, M.D., Beth Israel Hospital, Haward Medical School, Boston, MA.

Authors: J.S. Einbinder, M.D., C. Rury, and C. Safran, M.D., M.S., Beth Israel Hospital, Harvard Medical School, Boston, MA.

Panel: Facilitating Change through Information Technology: Case Studies Tuesday, October 31 1:OO - 230 t?M.

Organizations are coping with rapid change. In many organizations, information technology issues are supporting and leading the change. However, the strategies and processes to identify and lead the change are sometimes both uncertain and difficult to grasp. Most of us would like an easy, uncomplicated, step- by-step plan for effectively managing the change process within our institutions. Many people within our institutions were trained to be "action-oriented" problem solvers; they feel that spending time on the process issues con- nected with information technology and organizational change is both ineffective and a waste of their time. Change leaders ask what they can do to involve action-orientecl people in the rapidly moving change process. They also need to involve the "quieter" people within the organization in the informatics process, wlule at the same time moving planning, design, and implementation along as rapidly as possible. Use of a case that describes the circumstances, processes, and issues within an organization may be an effective strategy, as the case presentation allows members of one organization to read about what has occurred elsewhere. This in turn helps people see what is both occurring and needed within their own institutions.

The panel's objectives are I to gain an understanding of health infor-

mation systems through case studies, W to see how case studies provide examples

for improvement, and W to learn how to manage institutional

change through knowledge gained from several case study presentations.

Organizer: N.M. Lorenzi, Ph.D., University of Cinci~u~ati,Cincinnati, OH.

Participants: J.P. Glaser, Ph.D., Brigham and Women's Hospital, Boston, MA, B.J. Dixon, Ph.D., University of Western Ontario, London, Ontario, Canada, R.T. Riley, Ph.D., Riley Associates, Cincinnati, OH, M.J. Ball, Ed.D., University of Maryland, Baltimore, MD., and J.V. Douglas, University of Maryland, Baltimore, MD.

Moderator: W. Hammond, M.D., Department of Medical Education, Providence Medical Center, Seattle, WA.

Panel: Discipline-Specific Problem Lists: How Can We Build a Common Record to Care for Our Patients? Tuesday, October 31 1:OO - 230 l?M.

This is a follow-up of a well-received panel presented at the 1994 SCAMC. In 1995 the focus will be more on specific strategies for implementing a system of common problem lists. These might include nesting problem lists, enforcing adherence to specific vocabularies, and creating computer programs that permit users to view patient problems using the vocabulary with which they were entered or to view the problems after translating all problem list terms to a chosen vocabulary (NANDA, SNOMED, Read, etc.) with which the user may be more comfortable. This latter solution would probably use the UMLS Metathesaurus as a translation medium.

Among the panel's objectives are to understand the importance of computerized patient problem lists, to learn which vocabularies are best suited for the formulation of problem lists, to understand how to translate problem lists.

Organizer: D.Z. Sands, M.D., M.P.H., Beth Israel Hospital, Harvard Medical School, Boston, MA.

Participants: W.T. Hole, M.D., National Library of Medicine, Bethesda, MD, J.G. Ozbolt, Ph.D., R.N., University of V i rp i a School of Nursing, Charlottesville, VA, D.M. Rind, M.D., Beth Israel Hospital, Harvard Medical School, Boston, MA, and R.D. Zielstorff, R.N., M.S., Massachusetts General Hospital, Boston, MA.

Moderator: D. Lobach, M.D., Ph.D., Duke University Medical Center, Durham, NC.

S51

Panel: Health Care In formatics: Cooperation and Progress Tuesday, October 31 1:OO - 230 t?M.

The members of this panel will present an update on current standards development activities in health care informatics. Representatives of several standards organizations will discuss how existing standards

help health care systems function more effectively and efficiently. They will focus on the nuts and bolts of practical, "real life" applications of these standards. The panelists will also address the issue of coordination among the various organizations. A question-and- answer session will give audience members an opportunity to discuss their needs and concerns with developers of standards.

This panel's objectives are to share knowledge of existing and developing health care record standards, to understand how different organizations develop standards and how they are coop- erating, and to learn how standards development will enhance the movement to a computerized patient record.

Organizer: T.L. Luthy, M.B.A., American Society for Testing and Materials, Philadelphia, PA.

Participants: M. Diehl, American Dental Association, Chicago, IL, D. Nelson, American Society for Testing and Materials, Philadelphia, PA, B. Owens, Data Interchange Standards Association, Alexandria, VA, B. Kemelly, Institute of Electronic and Electrical Engineers, Piscataway, NJ, D. Staniec, National Council for Prescription Drug Programs, Phoenix, AZ, W.E. Hammond, Ph.D., Duke University, Chapel Hill, NC, P. Waegemam, Medical Records Institute, and W.R. Bishop, North Little Rock, AR.

Thea ter-Style Demonstration: Stanford Teledermatology Technical Demonstration Tuesday October 31 1:OO - 230 I? M.

Speaker: C.M. Bamard, M.D., Stanford University Medical Center, Stanford, CA.

Authors: C.M. Barnard, M.D., and B. Middleton, M.D., M.P.H., Stanford University Medical Center, Stanford, CA.

lnternet Applications Tuesday, October 31 3:OO - 4:30 I? M.

Session Chair: S. Grobe, Ph.D., R.N., University of Texas at Austin, Austin, TX.

The Bioethics Discussion Forum - An Implementation of an Internet-Based Bioethics Information Analysis Resource

Speaker: A.R. Derse, M.D., J.D., Center for the Study of Bioethics, Medical College of Wisconsin, Milwaukee, WI.

Authors: A.R. Derse, M.D., J.D., Center for the Study of Bioethics, and S.R. Krogull, MS., Office of Research, Technology, and Information, Medical College of Wisconsin, Milwaukee, WI.

Developing AJN Network: Phase Two, An Information Resource for Nurses

Speaker: M.A. Rizzolo, Ed.D., R.N., American Journal of Nursing Co., New York, NY.

Authors: M.A. Rizzolo, Ed.D., R.N., and K. DuBois, M.S.N., American Journal of Nursing Co., New York, NY.

The Informatics Superhighway: Prototyping on the World Wide Web

Speaker: J.J. Cimino, M.D., Department of Medical Informatics, Columbia University College of Physicians and Surgeons, New York, NY.

Authors: J.J. Cimino, M.D., S.A. Socratous, and R. Grewal, M.B.A., Departments of Medical Informatics and Surgery, Columbia University College of Physicians and Surgeons, New York, NY.

WHAM!: A Forms Constructor for Medical Record Access via the World Wide Web

Speaker: A. Hinds, Children's Hospital Informatics Program, Children's Hospital, Boston, MA.

Authors: A. Hinds, Children's Hospital Informatics Program, Children's Hospital, Boston, MA, P. Greenspun, Laboratory for Computer Science, Massachusetts Institute of Technology, Cambridge, MA, and IS. Kohane, M.D., Ph.D., Children's Hospital Informatics Program, Children's Hospital, Boston, MA.

New Systems for Decision Support Tuesday, October 31 3:OO - 4:30 I? M.

Session Chair: H. Orthner, PhD., Department of Medical Informatics, Primary Children's Medical Center, Salt Lake City, UT.

Using Knowledge Maintenance for Preference Assessment

Speaker: N.L. Jnin, DSc., Section of Medical Informatics, Washington University St. Louis, MO.

Authors: N.L. Jain, DSc., and M.G. Kahn, M.D., Ph.D., Section of Medical Informatics, Department of Internal Medicine, and Department of Computer Science, Washington University, St. Louis, MO.

Knowledge Discovery in Clinical Databases Based on Variable Precision Rough Set Model

Speaker: S. Tsumoto, M.D., Department of Information Medicine, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.

Authors: S. Tsumoto, M.D., Department of Information Medicine, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan, W. Ziarko, Ph.D., N. Shan, Department of Computer Science, University of Regina, Regina, Saskatchewan, Canada, and H. Tanaka, Ph.D., D.M.Sci., Department of Information Medicine, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.

A Web-Based Architecture for a Medical Vocabulary Server

Speaker: J.H. Gennari, Ph.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Authors: ].H. Gemari, Ph.D., D.E. Oliver, M.D., W. Pratt, J. Rice, and M.A. Musen, M.D., Ph.D., Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

An Object-Oriented, Knowledge-Based System for Cardiovascular Rehabilitation - Phase I1

Speaker: R.M. Ryder, Ph.D., Intelligent Medical Systems, Inc., Fairhope, AL.

Authors: R.M. Ryder, Ph.D., and B. Inamdar, M.S., Intelligent Medical Systems, Inc., Fairhope, AL.


Role of Controlled Vocabulary in Building the Computerized Medical Record Tuesday, October 31 3:OO - 4:30 f? M.

Session Chair: S.M. Huff, M.D., Department of Medical Informatics, Primary Children's Medical Center, Salt Lake City, UT.

Applying a Controlled Medical Terminology to a Distributed, Production Clinical Information System

Speaker: B.H. Forrnan, M.D., Department of Medical Informatics, Columbia University, Columbia-Presbyterian Medical Center, New York, NY.

Authors: B.H. Forman, M.D., J.J. Cimino, M.D., S.B. Johnson, Ph.D., S. Sengupta, Ph.D., R.V. Sideli, M.D., and P.D. Clayton, Ph.!l., Department of Medical Informatics, Columbia University, Columbia-Presbyterian Medical Center, New York, NY.

Representation of Clinical Problem Assessment Phrases in U.S. Family Practice Using Read Version 3.1 Terms: A Preliminary Study

Speaker: R.R. Hausam, M.D., Medical Informatics Group, University of Missouri, Columbia, MO.

Authors: R.R. Hausam, M.D., and A.W. Halui, D.V.M., Ph.D., Medical Informatics Group, University of Missouri, Columbia, MO.

Implementing a Low-Cost Computer- Based Patient Record: A Controlled Vocabulary Reduces Database Design Complexity

Speaker: D.J. Essin, M.D., Cluiical lnformation Systems, LAC+USC Medical Center, Monrovia, CA.

Authors: D.J. Essin, M.D., Clinical Information Systems, LAC+USC Medical Center, Monrovia, CA, and T.L. Lincoln, M.D., LAC+USC Medical Center, Monrovia, CA, and RAND Corporation, Los Angeles, CA.

Reasons for the Loss of Sensitivity and Specificity of Methodologic MeSH Terms and Textwords in MEDLINE

Speaker: N.L. Wilczynski, MSc., Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Authors: N.L. Wilczynski, MSc., C.J. Walker, M.L.S., K.A. McKibbon, M.L.S., and R.B. Haynes, M.D., Ph.D., Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

Health lnformation Networks: Worth !t or PIPE Dreams? Tuesday, October 31 3:OO - 4:30 f? M.


Health Care Network Communications Infrastructure: An Engineering Design for the Military Health Service System

Speaker: P.F. Hoffn~an, M.D., Ph.D., Office of the Command Surgeon/Air Mobility Command, Scott Air Force Base, IL.

Authors: P.F. Hoffman, M.D., Ph.D., E.H. Kline, M.A., L. George, K. Price, R.N., M.P.A., M. Clark, and R. Walasin, MS., Office of the Command Surgeon/Air Mobility Command, Scott Air Force Base, IL.

CHIME-Net, The Connecticut Health Information Network: A Pilot Study

Speaker: L.L. Reed-Fourquet, Research Department, Connecticut Hospital Research and Education Foundation, Inc., Wallingford, CT.

Authors: L.L. Reed-Fourquet, D. Durand, Research Department, Connecticut Hospital Research and Education Foundation, Inc., Wallingford, CT, L. Johnson, The Stamford Hospital, Staniford, CT, S. Beaudin, Research Department, Coruiecticut Hospital Research and Education Foundation, Inc., Wallingford, CT, J. Trask, Rockville General Hospital, Rockville, CT, E. DiSilvestro, Greenwich Hospital, Greenwich, CT, L. Smith, Blue Cross and Blue Shield of Connecticut, No. Haven, CT, P. Courtway, Danbury Hospital, Danbury, CT, J. Pappanikou, St. Mary's Hospital, Waterbury, CT, R. Bretaigne, Bridgeport Hospital, Bridgeport, CT, R. Pendleton, L&M Hospital, New London, CT, E. Vogler, Greenwich Hospital, Greenwich, CT, J.R. Lobb, S. Dalal, and J.T. Lynch, M.P.H., Research Department, Connecticut Hospital Research and Education Foundation, Inc., Wallingford, CT.

Cost Justification of a Community Health Information Network: The Computer Link for AD Caregivers

Speaker: F.C. Payton, Management lnformation and Decision Systems, Case Western Reserve Unirersity, Cleveland, OH.

Authors: F.C. Payton, Management Information and Decision Systems, P.F. Brennan, Ph.D., R.N., Schools of Nursing and Systems Engineering, and J.B. Silvers, Ph.D., Department of Finance, Case Western Reserve University, Cleveland, OH.

Networking a Need: A Co~t-Effective Approach to Statewide Health Information Delivery

Speaker: J.J. McGotvan, Ph.D., Vermont Initiative for Rural Health Informatics and Telemedicine, Unirersity of Vermont College of Medicine, Burlington, VT.

Authors: J.J. McGowan, Ph.D., 1. Evans, Ph.l>., and K. Michl, M.D., Vermont Initiative for Rural Health Informatics and Telemedicine, University of Vermont College of Medicine, Burlington, VT.

Assessing the Value of the Computerized Patient R e c ~ r d Tuesday, October 31 3:OO - 4:30 f? M.

Session Chair: J. Glaser, Ph.D., Brigham & Women's Hospital, Boston, MA.

Health System Re-engineering: A CPRS Economic Decision Model

Speaker: M.C. Diehl, D.D.S., M.A., OSD Health Affairs, Frederick, MD.

Author: M.C. Diehl, D.D.S., M.A., OSD Health Affairs, Frederick, MD.

A Randomized Evaluation of a Computer-Based Physician's Workstation: Design Considerations and Baseline Results

Speaker: B.L. Rohnan, M.D., Department of Veterans Affairs Medical Center, Palo Alto, CA, Division of General Internal Medicine, Stanford University, Stanford, CA.

Authors: B.L. Rotman, M.D., Department of Veterans Affairs Medical Center, Palo Alto, CA, Division of General Internal Medicine, Stanford University, Stanford, CA, A.N. Sullivan, Department of Veterans Affairs Medical Center, Palo Alto, CA, T. McDonald, M.D., Department of Veterans Affairs Medical Center, Palo Alto, CA, Division of General Internal Medicine, Stanford University Stanford, CA, P. DeSmedt, MS., D. Goodnature, MS., M. Higgins, Ph.D., H.J. Suermondt, Ph.D., C.Y. Young, Ph.D., Hewlett-Packard Laboratories, Palo Alto, CA, and D.K. Owens, M.D., MSc., Department of Veterans Affairs Medical Center, Palo Alto, CA,


Division of General Internal Medicine, Department of Health Research and Policy, Stanford University, Stanford, CA.

:valuation of Community Care Network (CCN) System in a Rural Health Care Setting

Speaker: H.C. Galfalvy, MS., Concurrent Engineering Research Center, West Virginia University, Morgantown, W.

Authors: H.C. Galfalvy, MS., S.M. Reddy, Ph.D., Concurrent Engineering Research Center, M. Niewiadomska-Bugaj, Ph.D., Department of Statistics and Computer Science, S. Friedman, M.D., Concurrent Engineering Research Center, West Virginia University, Morgantown, W,and B. Merkin, M.D., Valley Health Systems, Inc., Huntington, WV.

Cost-Effective Health Information Systems: User-Driven Internal Development at the University of Iowa

Speaker: J.R. Flanagan, M.D., Ph.D., Department of Internal Medicine and Health Information Systems, University of Iowa Hospitals and Clinics, Iowa City, IA.

Authors: J.R. Flanagan, M.D., Ph.D., Department of Internal Medicine and Health Information Systems, J.D. Olson, M.D., Ph.D., Department of Pathology, J.R. Wagner, MS., N.E. Nuehring, and S.D. Krumbholz, Health Information Systems, University of Iowa Hospitals and Clinics, Iowa City, IA.

System Evaluation: The Patient's Perspective Tuesday, October 31 3:OO - 4:30 P.M.

Session Chair: B.L. Humphreys, M.L.S., Health Services Research Information, National Library of Medicine, Bethesda, MD.

Computers in the Examining Room: The Patient's Perspective

Speaker: C.E. Aydin, Ph.D., Nursing Research and Development, Cedars-Sinai Medical Center, Los Angeles, CA.

Authors: C.E. Aydin, Ph.D., Nursing Research and Development, Cedars-Sinai Medical Center, Los Angeles, CA, P.N. Rosen, M.D., Kaiser-Permanente Medical Care Program and Department of Family Practice and Preventive Medicine, University of California, S.M. Jewell, R.N., and V.J. Felitti, M.D., Kaiser- Permanente Medical Care Program, San Diego, CA.

HealthDesk for Hemophilia@: An Interactive Computer and Communications System for Chronic Illness Self-Management

Speaker: F. Carl, M.P.H., HealthDesk Corporation, Berkeley CA.

Authors: F. Carl, M.P.H., HealthDesk Corporation, Berkeley CA, and T.J. Gribble, M.D., Ted R. Monotoya Hemophilia Program, University of New Mexico, Albuquerque, NM

Clinical Results Using Informatics to Evaluate Hereditary Cancer Risk

Speaker: S. Eoans, MS., Hereditary Cancer Institute, Omaha, NE.

Authors: S. Evans, MS., H.T. Lynch, M.D., R.M. Fusaro, M.D., Ph.D., Hereditary Cancer Institute, Omaha, NE.

Using a Pen-based Computer to Collect Health-Related Quality of Life and Utilities Information

Speaker: P.P. Le, Clinical Decision-Making Group, Massachusetts Institute of Technology, Cambridge, MA.

Authors: P.P. Le, Clinical Decision-Making Group, Massachusetts Institute of Technology, Cambridge, MA, IS. Kohane, M.D., Ph.D., Boston Children's Hospital and Harvard Medical School, and J.C. Weeks, M.D., M.Sc., Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.

Panel: lnformation Infrastructure for Tele Health Services Tuesday, October 31 3:OO - 4:30 P.M.

The objective of this panel is to bring together participants from the National Library of Medicine's High Performance Computing and Communications (HPCC) initiative to discuss the ramifications of the evolving National Information Infrastructure on improving health care. The panel participants are exploring innovative applications of the Internet, ranging from community care networks to the virtual hospital and national collaboratories. The focus of this panel is to stimulate discussion about the impact of these innovative technologies on health care in the 21st century.

Among the objectives of this panel are rn to understand what the HPCC initiative is

and how it relates to your future in medical informatics,

m to learn about community care networks and how they will operate in the future, and

rn to understand the power of the Internet as an information highway.

Organizer: V. Jagannathan Ph.D., Concurrent Engineering Research Center, West Virginia University, Morgantown, WV.

Participants: J.R. Galvin, M.D., University of Iowa College of Medicine, Iowa City, IA, E.H. Shortliffe, M.D., Ph.D., Stanford University School of Medicine, Stanford, CA, J.M. Overhage, M.D., Ph.D., Regenstrief Institute for Health Care, Indianapolis, IN, R.Y.V. Reddy, Ph.D., Concurrent Engineering Research Center, West Virginia University, Morgantown, W,and D.R. Masys, M.D., University of California-San Diego School of Medicine, San Diego, CA.

Moderator: G.S. Conklin, Oklahoma Health Systems, Oklahoma City, OK.

S60

Panel: Maximizing the Benefits Received from a Clinical lnformation System Tuesday, October 31 3:OO - 4:30 /?M.

A panel of clinical systems experts representing the consultant, vendor, clinician, and information tecluiology management communities will provide a multi-faceted "how-to" perspective for the selection, implementation, development, and utilization of clinical information systems.

Organizer: R. Howe, Ph.D., University of Cincinnati Hospital, Cincinnati, OH.

Participants: To be determined.

Moderator: C.G. Chute, M.D., Dr.P.H., Mayo Foundation, Rochester, MN.

S61

Theater-Style Demonstration: ARTEMIS: Collaboration in a Rural Community Care Network Tuesday October 31 3:OO - 4:30 k?M.

Speaker: R.R. Shank, Concurrent Engineering Research Center, West Virginia University, Morgantown, WV.

Author: R.R. Shank, Concurrent Engineering Research Center, West Virginia University, Morgantown, W.

PROGRAM - TUESDAY A FTERNOOM

Poster/Electronic Poster Session Tuesday, October 31 4:30 - 6:30 R M.

Electronic Posters

Hyperbaric Medicine - Creating an Integrated Computer-based System

Speaker: M.W. Soback, Clinical Information Systems, Geisinger Medical Center, Danville, PA.

Authors: M.W. Soback and J.A. Scopelliti, Clinical Information Systems, Geisinger Medical Center, Danville, PA.

An Electronic Quality Management Bookshelf

Speaker: R. Adelson, D.D.S., Department of Veterans Affairs, Minneapolis Regional Medical Education Center, Minneapolis, MN.

Authors: R. Adelson, D.D.S., Department of Veterans Affairs, Minneapolis Regional Medical Education Center, Minneapolis, MN, J. MacDonald, VA Quality Management Institute, Durham, NC, B. Coyle-Friedman, ConQuest Software, Columbia, MD, and G. DuPont, VA Library Service, Washington, DC.

Cost-Effective Computerized Patient Records for Small HIV Clinics

Speaker: A.S. Atav, Ph.D., Decker School of Nursing, Binghamton University, Binghamton, NY.

Author: AS. Atav, Ph.D., Decker School of Nursing, Binghamton University, Binghamton, NY.

A Prescription-Writing Tool for a Primary Care Pediatric Office

Speaker: P. Winkelstein, M.D., Department of Pediatrics, State University of New York at Buffalo, Children's Hospital of Buffalo, Buffalo, NY.

Author: P. Wikelstein, M.D., Department of Pediatrics, State University of New York at Buffalo, Children's Hospital of Buffalo, Buffalo, NY.

Combining a Patient Registry with a Disease Knowledge Base: The University of Illinois Intelligent Stroke Registry

Speaker: C.S. Jao, Ph.D., Department of Neurology, University of Illinois, Chicago, IL.

Authors: C.S. Jao, Ph.D., D.B. Hier, M.D., and S.U. Brint, M.D., Department of Neurology, University of Illinois, Chicago, IL.

Curricular Integration of Problem- Knowledge Couplers: Improved Educational Outcomes with Reduced Educational Costs

Speaker: J.J. McGowan, Ph.D., Vermont Initiative for Rural Health Informatics and Telemedicine, University of Vermont, Burlington, VT.

Authors: J.J. McGowan, Ph.D., P. Winstead-Fry, Ph.D., D. O'Malley, M.L.S., T. Bertsch, M.D., P. Dietrich, M.D., and W.T. McGowan, Ph.D., Vermont Initiative for Rural Health Informatics and Telemedicine, University of Vermont, Burlington, VT.

Digital Clinicopathologic Conferences: Reducing Cost in Resident Education

Speaker: S.E. Sandroni, M.D., Department of Medicine, University of Florida Health Science Center, Jacksonville, FL.

Authors: S.E. Sandroni, M.D., J.B. McGee, M.D., Department of Medicine, G.S. Tennyson, M.D., and S.A. Hollington, M.D., Department of Pathology, University of Florida Health Science Center, Jacksonville, FL.

Design of a Clinical Information Management System to Support DNA Analysis Laboratory Operation

Speaker: C.J. Dubay, Ph.D., Biomedical Information and Communication Center, Oregon Health Sciences University, Portland, OR.

Authors: C.J. Dubay, Ph.D., Biomedical Information and Communication Center, Oregon Health Sciences University, D. Zimmerman, Cube Consulting, and B. Popovich, Ph.D., Medical and Molecular Genetics Department, Oregon Health Sciences University, Portland, OR.

PEP: An Information Decision Support System for Osteoarthritis Patients

Speaker: T.B. Patrick, Ph.D., Medical Informatics Group, University of Missouri, Columbia, MO.

Authors: T.B. Patrick, Ph.D., J.H. Cutts HI, MS., J.Z. Griffin, Ph.D., J.C. Reid, Ph.D., Medical Informatics Group, M.A. Minor, Ph.D., Department of Physical Therapy, and J.A. Mitchell, Ph.D., Medical Informatics Group, University of Missouri, Columbia, MO.

The Columbia Integrated Speech Interpretation System (CISIS)

Speaker: J. Starren, M.D., Department of Medical Informatics, Columbia University, New York, NY.

Authors: J. Starren, M.D., Department of Medical Informatics, Columbia University, C. Friedman, Ph.D., Department of Computer Science, Queens College CUNY, New York, NY, and S.B. Johnson, Ph.D., Department of Medical Informatics, Columbia University, New York, NY.

An Expert System Shell as a Cost- Effective Tool for Predicting Preterm Birth Risk

Speaker: L.K. Woolery, Ph.D., Medical Informatics Group, University of Missouri, Columbia, MO.

Authors: L.K. Woolery, Ph.D., Medical Informatics Group, D.S. Harr, MS., and D.L. Harr, P.E., College of Engineering, University of Missouri, Columbia, MO.

An Expert System for Generating Medical Screening Examination Reports

Speaker: A.J. Kaplowitz, M.D., Strang Cancer Prevention Center, New York, NY.

Author: A.J. Kaplowitz, M.D., Strang Cancer Prevention Center, New York, NY.

Gratifying the Biomedical Researcher: Introducing the Negative Search Interface

Speaker: S.L. MacCall, M.S.I.S., Interdisciplinary Ph.D. Program in Information Science, University of North Texas, Denton, TX.

Author: S.L. MacCall, M.S.I.S., Interdisciplinary Ph.D. Program in Information Science, University of North Texas, Denton, TX.

Delivering Structured Educational Images over a Network

Speaker: H.P. Lehmann, M.D., Ph.D., Office of Academic Affairs, Johns Hopkins University School of Medicine, Baltimore, MD.

Authors: H.P. Lehmann, M.D., Ph.D., and M.R. Wachter, M.E.S., Office of Academic Affairs, Johns Hopkins University School of Medicine, Baltimore, MD.

The WebRes Project: Web-Based Client- Server Technologies for Multicenter Clinical Research

Speaker: S.E. Kaufrnan, M.D., Division of Cardiology, University of Washington, Seattle, WA.

Authors: S.E. Kaufman, M.D., and J. Spertus, M.D., M.P.H., Division of Cardiology, University of Washington, Seattle, WA.


The Clinical Informatics Network (CLINT)

Speaker: R.S.A. Hayward, M.D., Health Information Research Unit, McMaster University, Hamilton, Ontario, Canada.

Authors: R S A . Hayward, M.D., M. Nahirny K. Langton, MSc., and J. Hogeterp, Health Information Research Unit, McMaster University, Hamilton, Ontario, Canada.

Multi-Media Cancer Education Core Curriculum for Residents and Primary Care Practitioners at the Arkansas Cancer Research Center

Speaker: T.R. Gest, Ph.D., Department of Anatomy, University of Arkansas for Medical Sciences, Little Rock, AR.

Authors: T.R. Gest, Ph.D., Department of Anatomy, D.H. Berry, M.D., L.A. Deloney, M.A., and M. Fulper-Smith, Arkansas Cancer Research Center, University of Arkansas for Medical Sciences, Little Rock, AR.

Use of IDEF Modeling to Develop an Electronic Patient Record for Drug and Alcohol Outpatient Treatment Clinics

Speaker: K. Hoffman, M.D., M.P.H., Department of Preventive Medicine/ Biometrics, Center for Training and Education in Addiction Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.

Author: K. Hoffman, M.D., M.P.H., Department of Preventive Medicine/Biometrics, Center for Training and Education in Addiction Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.

MEDSDIMMo - A QuickTime0-based Hypermedia Software System for Generating Realistic Pediatric Emergency Clinical Simulations

Speaker: C. Hisley, MS., Academic Computing/Information Services, University of Maryland, Baltimore, MD.

Authors: C. Hisley, M.S., Academic Computing/Information Services, R. Lichendein, M.D., and J. Louie, M.D., Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, MD.

Preference Assessment for Outcomes of Deep Vein Thrombosis Using a Multimedia Approach

Speaker: R.M. Soetikno, M.D., Section of Medical Informatics and Division of Gastroenterology, Stanford University School of Medicine, Stanford, CA.

Authors: R.M. Soetikno, M.D., Section of Medical Informatics and Diwsion of Gastroenterology, and L.A. Lenert, M.D., Division of Clinical Pharmacology, Stanford University School of Medicine, Stanford, CA.

Patient-Centered Telemedicine

Speaker: A.R. Wenner, M.D., Department of Family and Preventi\,e Medicine, West Columbia, SC.

Author: A.R. Wenner, M.D., Departnient of Family and Preventive Medicine, West Columbia, SC.

Pharmaco-Informatics: Accelerated NPEM Population Pharmacokinetic Modeling, "Maximum Entropy" (ME) Parameter Distributions, and New "Multiple Model" (MM) Stochastic Dosage Regimens now by Oral, IM, and both Intermittent and Continuous IV

Speaker: R.W. Jelliffe, M.D., Laboratory of Applied Pharmacokinetics, University of Southern California School of Medicine, Los Angeles, CA.

Authors: R.W. Jelliffe, M.D., D. Bayard, I'h.D., A. Schumitzkv, Ph.D., M. Milman, Ph.D., M. Van Guilder, Ph.D., X. Wang, Ph.D., and F. Jiang, MS., Laboratory ot Applied Pharmacokinetics, University of Southern California School of Medicine, Los Angeles, CA.

Demonstration of a ClientlServer System for Remote Diagnosis of Cardiac Arrhythmias

Speaker: D.A. Tong, Ph.D., Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Authors: D.A. Tong, Ph.D., V. Gajjala, and L.E. Widman, M.D., Ph.D., Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Audio-Enhanced Computer-Assisted Self-Interview in an HIV Vaccine Clinical Safety Trial

Speaker: S.J. Schneider, Ph.D., The Hennr M. Jackson Foundation, Rockville, MD.

Authors: S.J. Schneider, Ph.D., and R.A. Jenkms, Ph.D., The Henry M. Jackson Foundation, Rockville, MD.

A Searchable Video Database of Dysmorphology

Speaker: L. Reiter, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX.

Authors: L. Reiter, Department of Molecular and Human Genetics, D. Steffen, Ph.D., Department of Cell Biology, S. Shapira, M.D., Ph.D., J.R. Lupski, M.D. Ph.D., M. Frazier, Department of Molecular and Human Genetics, and D.A. Wheeler, Ph.D., Department of Cell Biology, Baylor College of Medicine, Houston, TX.

cMORE, A Tool Using Smart Objects and Intelligent Navigation to Validate the Minimum Common Terminology for Gastrointestinal Endoscopy While Producing Reports

Speaker: 0.W. Cass, M.D., Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.

Authors: O.W. Cnss, M.D., and D. Steinberger, M.D., Department of Medicine, Hennepin County Medical Center, Minneapolis, MN.

Wizorder, a User-Friendly Interface for Order Entry and Clinical Decision Support Tools

Speaker: A. Geissbuhler, M.D., Division o' Biomedical Inforamtics, Vanderbilt University Medical Center, Nashville, TN.

Authors: A. Geissbuhler, M.D., and R.A. Miller, M.D., Division of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.

PDQ-3D: A Prototype Three Dimensional Semantic Visualizer for Oncology Knowledge Sources

Speaker: D.D. Sherertz, M.S., Lexical Teclmology, Inc., Alameda, CA.

Authors: D.D. Sherertz, M.S., M.S. T~~tt le , G. Hsu, MS., Lexical Technology, Inc., Alameda, CA, W.G. Cole, I'h.D., Lexical Teclmology, Inc./University of Washington, Seattle, WA, L.A. Fagan, M.D., Ph.D., and R.W. Carlson, M.D., Stanford University, Stanford, CA.

Application of the Visual Chart in an Ambulatory OB-GYN Clinic

Speaker: H.I. Litt, Ph.D., Children's Hospital of Buffalo/State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY.

Authors: H.I. Litt, Ph.D., and D.F. Schmidt, M.D., Children's Hospital of Buffalo/State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, W.

MedIO: A Program for Intelligent Clinical Data Entry

Speaker: R.J. DeFriece, M.D., M.E.E., Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Author: R.J. DeFriece, M.D., M.E.E., Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Teaching Principles of Childhood Cancer with Computerized Cases

Speaker: MM. Wofford, M.D., Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC.

Authors: M.M. Wofford, M.D., and D.L. Spitler, Ph.D., Bowman Gray School of Medicine, Wake Forest University, Wiston- Salem, NC.

Integrating Commercial Applications with the Decentralized Hospital Computer Program at the Philadelphia Veterans Affairs Medical Center

Speaker: M. Coyle, Veterans Affairs Medical Center, Philadelphia, PA.

Authors: M. Coyle and G. Moyer, M.S.N., R.N., Veterans Affairs Medical Center, Philadelphia, PA.

A Computerized Comprehensive Geriatric Assessment Tool

Speaker: L.F. Homey, M.D., M.S.H., Veterans Affairs Geriatric Research, Education, and Clinical Center, University of Utah, Salt Lake City, UT.

Authors: L.F. Horney, M.D., M.S.P.H., S.L. Elmer, and C.S. Fehlauer, M.D., Veterans Affairs Geriatric Research, Education, and Clinical Center, University of Utah, Salt Lake City, UT.

An Intelligent Pen-based Ophthalmologic Patient Record

Speaker: N.M. Bressler, M.D., Wilmer Eye Institute of the Johns Hopkins Medical Institutions, Laurel, MD.

Authors: N.M. Bressler, M.D., Wilrner Eye Institute of the Johns Hopkins Medical Institutions, Laurel, MD, R.V. Cain, MS., and D.G. Steigerwald, M.S., Applied Physics Laboratory of the Johns Hopkins University, Laurel, MD.

Observations from a Clinical Workstation Implementation

Speaker: J. Coppa, Texas Children's Cancer Center/Texas Children's Hospital/Baylor College of Medicine, Houston, TX.

Authors: I. Coppa, P. Perry, S. Jarriel, M.D., B. Duggan, R.N., D. Niemeyer, and M. Horowitz, M.D., Texas Children's Cancer Center/Texas Children's Hospital/Baylor College of Medicine, Houston, TX.

Technology Transfer: The BERMED Project Comes to the U.S.A.

Speaker: ].R. Brown, Ph.D., Berkom USA, Austin, TX.

Authors: J.R. Brown, Ph.D., J.D. Sims, and M.O. Carpenter, Berkom USA, Austin, TX.

An Electronic PDR'"' Using Fielded Searches in HTML

Speaker: J. Zucker, M.A., Office of Scholarlv Resources, Health Sciences Division, Columbia University, New York, NY.

Authors: J. Zucker, M.A., R.M. Kahn, Ph.D., and P. Molholt, M.L.S., Office of Scholarly Resources, Health Sciences Division, Columbia University, New York, NY.

Cross-sectional Anatomy Tutor

Speaker: A.L. Bushyhead, M.Ed., Duke University School of Medicine, Durham, NC.

Authors: A.L. Bushyhead, M.Ed., M. Bouvier, PhD., and A.N. Benson, M.A., Duke University School of Medicine, Durham, NC.

Simulating the Clinical Care of Patients: A Comprehensive Mathematical Model of Human Pathophysiology

Speaker: T.D. Valdivia, M.D., Department of Internal Medicine, St. Paul Ramsey Medical Center, University of Minnesota, St. Paul, MN.

Authors: T.D. Valdivia, M.D., J.R. Hotchkiss, M.D., P. Crooke ID,Ph.D., and J.J. Marini, M.D., Department of Internal Medicine, St. Paul Ramsey Medical Center, University of Minnesota, St. Paul, MN.

Case-Oriented Design of the Radiology Educational Resource

Speaker: K.J. Macura, M.D., Ph.D., Department of Radiology, Medical College of Georgia, Augusta, GA.

Authors: K.J. Macura, M.D., Ph.D., R.T. Macura, M.D., Ph.D., E.F. Binet, M.D., J.H. Trueblood, Ph.D., and B.D. Morstad, M.S., Department of Radiology, Medical College of Georgia, Augusta, GA.

The Digital Anatomist Series: 3-D, Segmented, Dynamic Atlases of Body Regions

Speaker: D.M. Conley, M.S., Department of Biological Structure, University of Wasiungton, Seattle, WA.

Authors: D.M. Conley, M.S., J.W. Sundsten, Ph.D., P. Ratiu, M.D., W. Rauschning, M.D., Ph.D., and C. Rosse, M.D., DSc., Department of Biological Structure, University of Washington, Seattle, WA.

A Pen-Based System for the Psychiatric Emergency Room

Speaker: R.S. Kennedy, M.A., Department of Psychiatrv, Albert Einstein College of Medicine, Bronx, NY.

Author: R.S. Kennedy, M.A., Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY.

MedLogic: A Windows Application for Creating Medical Logic Modules

Speaker: J.L. Mackey, MS., Department of Computer Science, Duke University, Durham, NC.

Authors: J.L. Mackey, M.S., Department of Computer Science, and J.C. Prather, Division of Medical Informatics, Duke University, Durham, NC.

Harnessing SNOMED: A Relational Database Design for the Computerized Patient Record (CPR)

Speaker: Y.A. Lussier, M.D., CRDMI, Faculty of Medicine, Universitt. de Sherbrooke, Sherbrooke, P.Q., Canada.

Authors: Y.A. Lussier, M.D., and R.A. Gate, M.D., M.Sc., CDRMI, Faculty of Medicine, Universite de Sherbrooke, Sherbrooke, P.Q., Canada.

Posters

Computer System of Control of the Treatment Process for the Patients with Closed Fractures of Long Bones

Speaker: S.V. Gyulnazarova, M.D., Urals Institute of Traumatology and Orthopaedy, Ekaterinburg, Russia.

Authors: S.V. Gyulnazarova, M.D., V.I. Mamaev, M.D., L.A. Kazak, M.D., Urals Institute of Traumatology and Orthopaedy, S.I. Goldberg, Ph.D., Institute of Physiology, and E. Fedorova, Urals State University, Ekaterinburg, Russia.

A Paperless Fetal Monitoring System

Speaker: C.E. Cianflone, M.D., M.Sc., Discipline of Medical Informatics, University of Slo Paulo School of Medicine, Slo Paulo, Brazil.

Authors: C.E. Cianflone, M.D., M.Sc., Discipline of Medical Informatics, University of Slo Paulo School of Medicine, and H. Komagata, M.D., Department of Obstetrics, Hospital das Clinicas, University of SIo Paulo School of Medicine, Slo Paulo, Brazil.

PROGRAM - TUESDAY Af;TER/VOO/V

Telemedicine-Health Care Business Process Reengineering

Speaker: J.A. KaiKai, M.S., National Data Corporation, FSI, Rockville, MD.

Author: J.A. KaiKai, MS., National Data Corporation, FSI, Rockville, MD.

Point of Care System (POC) in the Pediatric Intensive Care Unit (PICU)

Speaker: J.A. Menke, M.D., Department of Pediatrics, Children's Hospital Education Center, Columbus, OH.

Authors: J.A. Menke, M.D., C.W. Broner, hf.D., Department of Pediatrics, D.Y. Campbell, R.N., E.A. Loch, MS., Information Systems, M.Y. McKissick, R.N., and J.A. Edwards-Beckett, Ph.D., Department of Nursing, Children's Hospital, Columbus, OH.

The Many Faces of Natural Language Searching

Speaker: N.A. Schoch, M.L.S., Ph.D., College of Library and Information Services, University of Maryland, College Park, MD.

Authors: N.A. Schoch, M.L.S., Ph.D., and W. Sewell, M.L.S., DSc., College of Library and Intbrmation Services, University of Maryland, College Park, MD.

Iconic Reporting: A New Way of Communicating Radiological Findings

Speaker: S. Abad-Mota, M.Sc., Ph.D., Universidad Simhn Bolivar, Caracas, Venezuela.

Authors: S. Abad-Mota, MSc., Ph.D., Universidad Simon Bolivar, Caracas, Venezuela, C. Kulikowski, Ph.D., L. Gong, Ph.D., S. Stevenson, Ph.D., Rutgers University, New Brunswick, NJ, R. Mezrich, M.D., Ph.D., Laurie Imaging Center, New Brunswick, NJ, A. Tria, M.D., and K. Klein, M.D., Robert Wood Johnson Medical School, New Bnmswick, NJ.

A World Wide Web Server for Dental Informatics and Dental Public Health

Speaker: W.P. Lang, D.D.S., M.P.H., School of Dentistry, University of Michigan, AM Arbor, Mr.

Authors: W.P. Lang, D.D.S., M.P.H., School of Dentistry, and K.M. Roberts, College of Engineering, University of Michigan, Ann Arbor, MI.

Dynamic Data Icons: Graphical Display of Uterine Cervical Cytologic Exams, Diagnostic Studies, and Treatments

Speaker: D.W. Miller, Jr., M.D., Center for Medical Informatics, Yale University School of Medicine, New Haven, CT.

Author: D.W. Miller, Jr., M.D., Center for Medical Informatics, Yale University School of Medicine, New Haven, CT.

Automated Linkage of an Electronic Medical Record with QMR (Quick Medical Reference)

Speaker: R.J. Kiel, M.D., Medical Education, Oakwood Hospital, Dearbom, MI.

Author: R.J. Kiel, M.D., Medical Education, Oakwood Hospital, Dearborn, MI.

Quality Care Program (QCP): Integrated Software for Preventive Health Care, Quality Improvement, and Risk Management

Speaker: E.C. Vincent, M.D., Swedish Family Medicine, Swedi41 Hospital, Seattle, WA.

Authors: E.C. Vincent, M.D., Swedish Family Medicine, Swedish Hospital, Seattle, WA, P.A. Hardin, Ph.D., CYBIS Medical Systems, Bellevue, WA, L.A. Norman, M.D., M.B.A., M.H.S., Swedish Family Medicine, Swedish Hospital, Seattle, WA, E. Lester, CYBIS Medical Systems, Bellevue, WA, and S. Stinton, Swedish Family Medicine, Swedish Hospital, Seattle, WA.

Orthostatic Blood Pressure: Using a CPR to More Effectively Manage Patient Care

Speaker: R.A. Stoupa, M.S.N., Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.

Authors: R.A. Stoupa, M.S.N., and J.R. Campbell, M.D., Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.

A Clinical Evaluation of Medical Information Transfer System Using MOD

Speaker: T. Kawamura, Ph.D., Department of Medical Information Sciences, Suzuka University of Medical Science and Technology, Suzuka City, Japan.

Authors: T. Kawamura, Ph.D., Department of Medical Information Sciences, T. Okabe, Suzuka University of Medical Science and Technology, M. Hamada, M.D., K. Nakamura, M.D., Suzuka General Hospital, T. Kodera, M.D., Kodera Clinic, and H. Saijoh, M.D., Saojoh Clinic, Suzuka City, Japan.

A Survey of Telemedicine Applications in Italy

Speaker: D.M. Pisanelli, Consiglio Nazionale delle Ricerche, Rome, Italy.

Authors: D.M. Pisanelli, EL. Ricci, Consiglio Nazionale delle Ricerche, and R. Maceratini, Universiti di Roma "La Sapienza," Rome, Italy.

The Visible Human Dataset for the Simulation of the Cardiac Electrical Activity Propagation

Speaker: P. Valenza, Dottorato di Ricerca in Lngegneria Elettrotecnica of the Politecnico di Milano, Milan, Italy.

Authors: P. Valenza, Dottorato di Ricerca in lngegneria Elettrotecnica of the Politecnico di Milano, and F. Pinciroli, Dipartimento di Bioingegneria of the Politecnico di Milano, Centro di Teoria dei Sistemi of the CNR, Milan, Italy.

Use of Computerised Clinical Database for Support of a Home Dialysis Programme

Speaker: K.L. LVM, Christchurch Hospital, Christchurch, New Zealand.

Authors: K.L. Lynn, A.L. Buttimore, and J.A. Inkster, Christchurch Hospital, Christchurch, New Zealand.

Integrating and Presenting Clinical and Treatment Outcome Data for Cost- Effective Case Management

Speaker: E.E. Westberg, Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.

Authors: E.E. Westberg, N.H. Mann 111, Ph.D., and D.M. Spengler, M.D., Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN.

Archive Node for Health Care Information System

Speaker: T.T. Chiang, Ph.D., Loral AeroSys, Seahrook, MD.

Authors: T.T. Chiang, Ph.D., and Y.K. Tang, Ph.D., Loral AeroSys, Seabrook, MD.

A Concept Model for a Standard Computer-based Oral Health Record

Speaker: M. Diehl, D.D.S., M.A., Frederick, MD.

Authors: M. Diehl, D.D.S., M.A., S. Stanford, J. Narcisi, J. Bramson, D.D.S., and D. Collins, D.D.S., M.P.H., Frederick, MD.

MEDLINE Retrieval: Grateful Med, Paperchase, and Physicians' Online

Speaker: F.A. Brahmi, M.A., M.L.S., Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, N.

Author: EA. Brahmi, M.A., M.L.S., Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN.

MY ASSISTANT: Computer-Assisted Record-Keeping for the Case Manager

Speaker: W.J. Gingerich, Ph.D., Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH.

Author: W.J. Gingerich, Ph.D., Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH.

Patient-Administered, Computerized Questionnaire to Support Hormone Replacement Therapy Decision Making

Speaker: J.R. Horsman, Health Information Research Unit, McMaster University, Hamilton, Ontario, Canada.

Authors: J.R. Horsman, RSA. Hayward, M.D., A. Gafni, Ph.D., and J.W. Feightner, M.D., Health Information Research Unit, McMaster University, Hamilton, Ontario, Canada.

Implementation of a HELP-Based Labor and Delivery Log

Speaker: P.A. Michael, Ph.D., M.D., HIS Clinical Systems Research, Rex Hospital, Raleigh, NC.

Author: P.A. Michael, Ph.D., M.D., HIS Clinical Systems Research, Rex Hospital, Raleigh, NC.

Using Oracle to Track a Course Given on the World Wide Web

Speaker: R.B. Murray, Ph.D., Thomas Jefferson University, Philadelphia, PA.

Authors: R.B. Murray, Ph.D., I. Kang, M.S.E., A. Frisby, Ph.D., E.R. Warner, M.S.L.S., and M. Handin, Ph.D., Thomas Jefferson University, Philadelphia, PA.

Clinician-Oriented Access to Data -C.O.A.D.: A Natural Language Interface to a VA DHCP Database

Speaker: C. Levy, MS., VA Quality Management Institute, Duke-UNC Training Program in Medical Informatics, University of North Carolina in Chapel Hill, Durham, NC.

Authors: C. Levy, MS., VA Quality Management Institute, Duke-UNC Training Program in Medical Informatics, University of North Carolina in Chapel Hill, Durham, NC, and E. Rogers, M.D., Department of Veterans Affairs GRECC, Durham, NC.

Identification of Database Elements for Assessing the Quality of Referrals in Primary Care

Speaker: C. Weir, Ph.D., Universitv of Utah, Salt Lake City, UT.

Authors: C. Weir, Ph.D., V. Johnson, L. Lange, Ed.D., S. Haak, Ph.D., D. Nilasena, M.D., C. Turner, Ph.D., C. Thompson, Ph.D., and M. Lincoln, M.D., University of Utah, Salt Lake City, UT.

Reminders for Redundant Tests: Results of a Randomized Controlled Trial

Speaker: D.W. Bates, M.D., MSc., Brigham and Women's Hospital, Boston, MA.

Authors: D.W. Bates, M.D., MSc., G.J. Kupennan, M.D., Ph.D., E. Rittenberg, M.A., J.M. Teich, M.D., Ph.D., A. Onderdonk, Ph.D., J. Winkelman, M.D., A.L. Komaroff, M.D., and M. Tanasijevic, M.D., Brigham and Women's Hospital, Boston, MA.

The Adoption of Clinical Information Systems by Physicians and Nurses: A Case Study Report

Speaker: L. Lapointe, Technologies de l'information, Ecole des Hautes Etudes Commerciales, Montreal, Canada.

Authors: L. Lapointe, Technologies de l'information, Ecole des Hautes Etudes Commerciales, Montreal, Canada.

Implementation of a Semantic Network Product Using a Standard Database Platform

Speaker: B.D. Nelson, Ph.D., Ameritech Health Connections, Richardson, TX,

Authors: B.D. Nelson, Ph.D.. D.N. Will, R.A. Munoz, Ph.D., S. McBride, M.A., and J.K. Singh, M.S., Ameritech Health Connections, Richardson, TX.

Data Aggregation in Laboratory Medicine

Speaker: S.A. Moser, PhD., University of Alabama, Birmingham, AL.

Authors: S.A. Moser, Ph.D., University of Alabama, Birmingham, AL, C. Dehner, MS., Cerner Corporation, Kansas City, MO, and S.J. Steindel, Ph.D., Centers for Disease Control and Prevention, Atlanta, GA.

Structured Abstracts of Clinical Trial Reports in MEDLINE, 1993: Descriptive Survey and Assessment

Speaker: C.A. Bean, Ph.D., M.L.S., Department of Medical Informatics, Columbia University, New York, NY.

Author: C.A. Bean, Ph.D., M.L.S., Department of Medical Informatics, Columbia University, New York, NY.

Rapid Medical Model Development Using Neural Networks

Speaker: D.W. Piraino, M.D., Cleveland Clinic Foundation, Cleveland, OH.

Authors: D.W. Piraino, M.D., P. Grooff, M.D., R. Zepp, M.D., B. Herts, M.D., and M. Recht, M.D., Cleveland Clinic Foundation, Cleveland, OH.

Automated Guidelines Implemented via the World Wide Web

Speaker: J.J. Cimino, M.D., Department of Medical Informatics, Columbia University, New York, NY.

Authors: J.J. Cimino, M.D., S. Socratous, and P.D. Clayton, Ph.D., Department of Medical Informatics, Columbia Universitv, New York, NY.

A Survey of World Wide Web Lists of Medical Schools

Speaker: A.T. Wright, Active Digital Library, Informatics Center, Vanderbilt University Medical Center, Nashville, TN.

Authors: A.T. Wright, J.T. Huber, Ph.D., and N.B. Giuse, M.D., M.L.S., Active Digital Library, Vanderbilt University, Nashville, TN.

Users' Evaluation of Learning with a Hypermedia System: Interaction Experience and Satisfaction in Learning

Speaker: H. Hsu, M.A., Department of Communications, Stanford University.

Authors: H. Hsu, M.A., Department of Communications, P. Del: PhD., SUMMIT, Stanford University, Stanford, CA, and E. Tancred, Ph.D., University of New South Wales, Australia.

Formal Properties of the Metathesaurus: An Update

Speaker: SS. Lipow, M.L.I.S., Lexical Technology, Inc., Alameda, CA.

Authors: SS. Lipow, M.L.I.S., Lexical Technology, Inc., Alameda, CA, K.E. Campbell, M.D., Stanford University, Stanford, CA, N.E. Olson, MS., MS. Tuttle, MS. Erlbaum, M.D., L.F. Fuller, Ph.D., D.S. Sherertz, MS., Lexical Technology, Inc., Alameda, CA, S.J. Nelson, M.D., Medical College of Georgia, Augusta, GA, and W.G. Cole, Ph.D., Lexical Technology, Inc./University of Washington, Seattle, WA.

Providing Travel Health Information on the World Wide Web

Speaker: G.P. Barnas, M.D., Divisions of General Internal Medicine and Medical Informatics, Medical College of Wisconsin, Milwaukee, WI.

PROGRAM - TUESDAYAFTEREu6bBN

Author: G.P. Bamas, M.D., Divisions of General Internal Medicine and Medical Informatics, Medical College of Wisconsin, Milwaukee, WI.

An Individualized Pediatric Primary Care Report Card to Assess and Improve the Quality of Preventive Services

Speaker: W.G. Adams, M.D., Boston University School of Medicine and Public Health, Boston, MA.

Authors: W.G. Adams, M.D., H. Bauchner, M.D., C. Sonn, and P. Gertman, M.D., Boston University School of Medicine and Public Health, Boston, MA.

Using Multiple Techniques and Measurements to Manage an IAIMS Environment

Speaker: S. Grajek, Ph.D., Yale University School of Medicine, New Haven, CT.

Authors: S. Grajek, Ph.D., I. McKay, J.A. Paton, Ph.D., and N.K. Roderer, M.L.S., Yale University School of Medicine, New Haven, CT.

A Patient Scheduling System: Toward Cooperative Enterprise-wide Scheduling

Speaker: D.P. Strum, M.D., Department of Anesthesiology and CCM, University of Pittsburgh, Pittsburgh, PA.

Authors: D.P. Strum, M.D., Department of Anesthesiology and CCM, L.G. Vargas, Ph.D., and J.H. May, Ph.D., Joseph M. Katz Graduate School of Business, University of Pittsburgh, Pittsburgh, PA.

Writing the Discharge Summary: A Cost Performance Analysis Using a Computerized Patient Record System

Speaker: J. Hohnloser, M.D., Med. Klinik, Klinikum Innenstadt, Ludwig-Maximilians- Universit'at Munchen, Munich, Germany.

Authors: J. Hohnloser, M.D., and T. Engelmeier, Med. Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universit'at Munchen Munich, Germany.

The Design and Implementation of Computerized Questionnaires for Mammography and G1 Patients in a Large Multi-Specialty Practice

Speaker: V.M. Heckel, M.P.H., Kelsey-Seybold Foundation, Houston, TX.

Autlwrs: V.M. I-Ieckel, M.P.H., Kelsey-Seybold Foundation, G.L. Jackson, M.D., and J.I. Hughes, M.D., Kelsey-Seybold Clinic, Houston, TX.

Configuration of a Clinical Pathway Charting System for an On-Line Clinical Information System

Speaker: M.F. Mangila, R.N., M.S.N., Cedars- Sinai Medical Center, Glendale, CA.

Authors: M.F. Mangila, R.N., M.S.N., B.J. Leyerle, R.N., M.P.H., S. Kelman, R.N., and M.M. Shabot, M.D., Cedars-Sinai Medical Center, Los Angeles, CA.

The Impact of Data Sharing on Data Quality

Speaker: E.D. Whitman, M.D., Waslungton University, St. Louis, MO.

Authors: E.D. Whitman, M.D., M.E. Frisse, M.D., and M.G. Kahn, M.D.,Ph.D., Washington University, St. Louis, MO.

Use of Computer-Generated ECG Reports by Residents and Faculty

Speaker: E.S. Berner, Ed.D., University of Alabama, Birmingham, AL.

Authors: E.S. Berner, Ed.D., 1.1. Kennedy, M.D., G. Blackwell, M.D., and J.B. Box, M.D., University of Alabama, Birmingham, AL.

Evaluation of User Interactions with Clinical Information Systems Using Cognitive and Ethnographic Methods

Speaker: L. Farand, M.D., Centre for Medical Education, McGill University, and Health Administration Department, University of Montreal, Montreal, P.Q., Canada.

Authors: L. Farand, M.D., Centre for Medical Education, McGill University, and Health Administration Department, University of Montreal, and V.L. Patel, Ph.D., Centre for Medical Education, McGill University, Montreal, P.Q., Canada.

Handsfree Decison Support: Toward a Non-invasive Human-Computer Interface

Speaker: E.J. Horvitz, M.D., Ph.D., Decision Theory Group, Microsoft Research, Redmond, WA.

Authors: E.J. Horvitz, M.D., Ph.D., Decision Theory Group, Microsoft Research, Redmond, WA, and M.A. Shwe, MS., Knowledge Industries, Palo Alto, CA.

Concept, Code, Term, and Word: Preserving the Distinctions

Speaker: M.S. Tuttle, Lexical Technology, Inc., Alameda, CA.

Authors: MS. Tuttle, Lexical Technology, Inc., Alameda, CA, K.E. Campbell, M.D., Stanford University, Stanford, CA, N.E. Olson, M.S., Lexical Technology, Inc., Alameda, CA, S.J. Nelson, M.D., Medical College of Georgia,

Augusta, GA, 0 . Suarez-Munist, MS. Erlbaum, M.D., S.S. Lipow, L.F. Fuller, D.D. Sherertz, Lexical Technology, Inc., Alameda, CA, and W.G. Cole, Lexical Technology, Inc., Seattle, WA.

Explaining Your Terminology to a Computer

Speaker: N.E. Olson, MS., Lexical Technology, Inc., Alameda, CA.

Authors: N.E. Olson, MS., D.D. Sherertz, M.S. Erlbaum, M.D., S.S. Lipow, M.L.I.S., 0. Suarez-Munist, L.F. Fuller, Ph.D., Lexical Technology, Inc., Alameda, CA, K.E. Campbell, M.D., Stanford University, Stanford, CA, MS. Tuttle, Lexical Technology, Inc., Alameda, CA, S.J. Nelson, M.D., Medical College of Georgia, Augusta, GA, and W.G. Cole, Ph.D., Lexical Technology, Inc., Seattle, WA.

MEME-11: An Environment for Managing Meaning

Speaker: 0 . Suarez-Munist, Lexical Technology, Inc., Alameda, CA.

Authors: 0.Suarez-Munist, Lexical Technology, Inc., Alameda, CA, W.T. Hole, M.D., R.J. Irons, National Library of Medicine, Bethesda, MD, M.S. Erlbaum, M.D., N.E. Olson, MS., S.S. Lipow, L.F. Fuller, PhD., MS. Tuttle, D.D. Sherertz, Lexical Technology, Inc., Alameda, CA, A.K. Ganju, National Library of Medicine, Bethesda, MD, S.J. Nelson, M.D., Medical College of Georgia, Augusta, GA, and W.G. Cole, Ph.D., Lexical Technology, Inc., Seattle, WA.

An Easier Route for Choosing Appropriate Health Care Technology?

Speaker: S. Kay, Ph.D., Department of Computer Science, The University, Manchester, England.

Author: S. Kay, Ph.D., Department of Computer Science, The University, Manchester, England.

An Expert System for Dosing Renally Excreted Drugs

Speaker: C.A. Abrams, MS., Section of Medical Informatics, Washington University School of Medicine, St. Louis, MO.

Authors: C.A. Abrams, M.S., M.G. Kahn, M.D., Ph.D., S.A. Steib, MS., K.A. Marrs, M.S., Section of Medical Informatics, Washington University School of Medicine, R.M. Reichley, S.T. McMullin, Pharm.D., Department of Pharmacy, BJC Health System, and T.C. Bailey, M.D., Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO.

Using an Electronic Medical Record to Perform Clinical Research on Mitral Valve Prolapse and PanicIAnxiety Disorder

Speaker: D.M. Rind, M.D., Beth Israel Hospital, H a r ~ a r d Medical School, Boston, MA.

Authors: D.M. Rind, M.D., J. Yeh, and C. Safran, M.D., MS., Beth Israel Hospital, Harvard Medical School, Boston, MA.

Computer-Supported Preventive Services for Children: The C.H.I.P. Project

Speaker: S.M. Downs, M.D., MS., Departments of Pediatrics and Biomedical Engineering, University of North Carolina, Chapel Hill, NC.

Authors: S.M. Downs, M.D., MS., Departments of Pediatrics and Biomedical Engineering, J.M. Arbanas, MS., Department of Pediatrics, and L.R. Cohen, M.S.P.H., Department of Health Behavior/Health Education, University of North Carolina, Chapel Hill, NC.

An Overview of CADIAG-4: A Medical Diagnostic and Therapeutic Consultation System

Speaker: G. Kolousek, MSc., Department of Medical Con~puter Sciences, Medical School, University of Vienna, Vienna, Austria.

Authors: G. Kolousek, MSc., K.-P. Adlassnig, Ph.D., K. Bogl, M.Sc., H. Leitich, M.D., Department of Medical Computer Sciences, Medical School, University of Vienna, Vienna, Austria, and T. Rothenfluh, Ph.D., Department of Psychology, University of Zurich, Zurich, Switzerland.

A General Framework for Dynamic Decision Analysis in Medicine

Speaker: T-Y. Leong, Ph.D., Department of Information Systems and Computer Science, National University of Singapore, Singapore.

Author: T-Y. Leong, Ph.D., Department of Information Systems and Computer Science, National University of Singapore, Singapore.

Suggesting Terms for Query Expansion in a Medical Information Retrieval System

Speaker: M. Hirsch, MS., Center for Intelligent Information Retrieval, University of Massachusetts, Amherst, MA.

Authors: M. Hirsch, MS., and D.B. Aronow, M.D., M.P.H., Center for Intelligent Information Retrieval, University of Massachusetts, Amherst, MA.

Plan Recognition and Revision in Protocol-Based Care

Speaker: Y. Shahar, M.D., Ph.D., Section on Medical Informatics, Stanford University Medical School, Stanford, CA.

Authors: Y. Shahar, M.D., Ph.D., and M.A. Musen, M.D., Ph.D., Section on Medical Informatics, Stanford University, Stanford, CA.

Data-to-Symbol Conversion in Cadiag- 4: An Improved Model of Medical Data ~nter~retationBased on Fuzzy Set Theory

Speaker: H. Leitich, M.D., Department of Medical Computer Sciences, Uni\rersity of Vienna Medical School, Vienna, Austria.

Authors: H. Leitich, M.D., K. Biigl, M.Sc., G. Kolousek, MSc., Department of Medical Computer Sciences, University of Vienna Medical School, Vienna, Austria, T.E. Rothenfluh, Ph.D., Department of Psychology, University of Zurich, Zurich, Switzerland, and K.-P. Adlassnig, Ph.D., Department of Medical Computer Sciences, University of Vienna Medical School, Vienna, Austria.

EINTHOVEN on the World Wide Web: A Tool for Analysis of Cardiac Arrhythmias

Speaker: L.E. Widman, M.D., Ph.D., Cardiovascular Section, University of Oklahoma Health Sciences Center and Medical Service, Oklahoma City Veterans Affairs Medical Center, Oklahoma City, OK

Authors: L.E. Widman, M.D., 13h.D., Cardiovascular Section, University of Oklahoma Health Sciences Center and Medical Service, Oklahoma City Veterans Affairs Medical Center, and D.A. Tong, Ph.D., Cardiovascular Section, University of Oklahoma Health Sciences Center and Medical Service, Oklahoma City, OK.

Knowledge Module Authoring with Terminology Support

Speaker: M. Carlsson, M.Sc., Medical Informatics, Linkoping University, Linkoping, Sweden.

Authors: M. Carlsson, MSc., H. Ahlfeldt, Ph.D., A. Thurin, M.D., and 0 . Wigertz, DSc., D.Med, Medical Informatics, Linkoping University, Linkoping, Sweden.

Data Transformations for Patient Simulations

Speaker: W. Surnner 11, M.D., Department of Family Practice, University of Kentucky, Lexington, KY.

Authors: W. Sumner II, M.D., Department of Family Practice, M. Truszczynski, Ph.D., Department of Computer Science, and V.W. Marek, Ph.D., DSc., Department of Computer Science, University of Kentucky, Lexington, KY.

Methods for Model-Based Knowledge Representation in Anatomy

Speaker: R. Schubert, M.D., Institute of Mathematics and Computer Science in Medicine, University Hospital Eppendorf, Hamburg, Germany

Authors: R. Schubert, M.D., A. Pommert, MS., and K.H. Hohne, Institute of Mathematics and Computer Science in Medicine, University Hospital Eppendorf, Hamburg, Germany.

A Distributed Framework for Distance Learning in Anatomy: The Digital Anatomist Interactive Atlas

Speaker: J.F. Brinkley, M.D., Ph.D., Department of Biological Structure, University of Washington, Seattle, WA.

Authors: ].F. Brinkley, M.D., Ph.D., K.R. Eno, J.W. Sundsten, Ph.D., D.M. Conley, MS., and C. Rosse, M.D., DSc., Department of Biological Structure, University of Washington, Seattle, WA.

Beyond the Web: HTML as an Abstract Document Specification

Speaker: R. Rathe, M.D., Medical Informatics, University of Florida, Gainesville, FL.

Authors: R. Rathe, M.D., and G. Cornwall, M.Ed., Medical Informatics, University of Florida, Gainesville, FL.

Learning to Recognize Categories: A Fuzzy Hybrid Approach

Speaker: E.A. Mendonqa, M.D., Institute of Cardiology RS, Porto Alegre, RS, Brazil.

Authors: E.A. Mendonqa, M.D., Institute of Cardiology RS, A. Pavan, M.Sc., Institute of Informatics, Federal University of Rio Grande do Sul, and B. d e F. LeSo, M.D., Ph.D., Institute of Cardiology RS, Institute of Mormatics, Federal University of Rio Grande d o Sul, Porto Alegre, RS, Brazil.

Changing Database Systems Wednesday November 1 8:30 - 10:OO A.M.

Session Chair: R. O'Steen, R.N., Systems and Development, Oklahoma Health Systems, Oklahoma City, OK.

LabTalW2: A Middleware Approach to HIS Integration

Speaker: A.M. Zakaria, M.D., Division of Biomedical Informatics, Vanderbilt Unwersity, Nashville, TN.

Authors: A.M. Zakaria, M.D., and D.A. Giuse, Dr.Ing., Division of Biomedical Informatics, Vanderbilt University, Nashville, TN.

An Efficient Delivery of Historical Information for the Mendelian Inheritance in Man Database

Speaker: P.W. Li, Ph.D., Genome Database, Johns Hopkins University, Baltimore, MD.

Authors: P.W. Li, Ph.D., D. Waldo, MS., S. Pineo, MS., and P. Foster, MS., Genome Database, Johns Hopkins University, Baltimore. MD.

Legacy Systems: Managing Evolution Through Integration in a Distributed and Object-Oriented Computing Environment

Speaker: D. Lemaitre, Medical Informatics Department, Broussais University Hospital, Paris, France.

Authors: D. Lemaitre, D. Sauquet, I. Fofol, L. Tanguy, E-C. Jean, and P. Degoulet, Medical Informatics Department, Broussais University Hospital, Paris, France.

Representing Hospital Events as Complex Conditionals

Speaker: G.J. Kuperman, M.D., Ph.D., Center for Applied Medical Information Systems Research, Brigham and Women's Hospital, Boston, MA.

Authors: G.J. Kuperman, M.D., Ph.D., J.M. Teich, M.D., Ph.D., D.W. Bates, M.D, M. Sc., J. McLatchey, T.G. Hoff, Center for Applied Medical Information Systems Research, Brigham and Women's Hospital, Boston, MA.

Knowledge Representation in Decision Systems Wednesday, November 1 8:30 - 10:OOA.M.

Session Chair: T. Lincoln, M.D., University of Southern California, Los Angeles, CA.

Experience with a Mixed SemanticlSyntactic Parser

Speaker: P.J. Haug, M.D., Department of Medical Informatics, LDS Hospital, University of Utah, Salt Lake City, UT.

Authors: P.J. Haug, M.D., S. Koehler, Ph.D., L.M. Lau, M.D., Ph.D., P. Wang, Ph.D., R. Rocha, M.D., Ph.D., and S.M. Huff, M.D., Department of Medical Informatics, LDS Hospital, Primary Children's Medical Center, and University of Utah, Salt Lake City, UT.

A Rational Reconstruction of INTERNIST-Iusing PROTEGE-11

Speaker: M.A. Musen, M.D., PI1.D.. Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Authors: M.A. Musen, M.D., Ph.D., J.H. Gennari, and W.W. Wong, Section on Medical Informatics, Stanford University School of Medicine, Stanford, CA.

Enhancing Medical Database Semantics

Speaker: B. de F. LeZo, M.D., Ph.D., Institute of Cardiology RS and Institute of Informatics of Rio Grande do Sul, Porto Alegre, RS, Brazil.

Authors: B. de F. LeZo, M.D., Ph.D., Institute of Cardiology RS and Institute of Informatics of Rio Grande do Sul, and A. Pavan, MSc., Institute of Informatics of RIO Grande do Sul, Porto Alegre, RS, Brazil.

Decision-Theoretic Refinement Planning: A New Method for Clinical Decision Analysis

Speaker: A. Doan, Department of Electrical Engineering and Computer Science, University of Wisconsin, Milwaukee, WI.

Authors: A. Doan, P. Haddawy, Ph.D., and C.E. Kahn, Jr., M.D., Department of Electrical Engineering and Computer Science, University of Wisconsin, Milwaukee, WI.

Building Clinical Systems in Hospitals: Case Examples Wednesday, November 1 8:30 - 10:OOA.M.


Using Agent-Based Technology to Create a Cost-Effective, Integrated, Multimedia View of the Electronic Medical Record

Speaker: H.J. Lowe, M.D., Section of Medical Informatics, University of Pittsburgh, Pittsburgh, PA.

Authors: H.J. Lowe, M.D., W.K. Walker, and J.K. Vries, M.D., Section of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA.

ARIS: Integrating Multi-Source Data for Research in Andrology

Speaker: T. Timmers, Ph.D., Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.

Authors: T.Timmers, Ph.D., Department of Medical Informatics, F. Pierik, MSc., Departments of Medical Informatics and Andrology, M. Steenbergen, M.Sc., H. Stam, A.M. van Ginneken, M.D., Ph.D., Department of Medical Informatics, E.M. van Mulligen, Ph.D., Department of Medical Informatics, University Hospital Dijkzigt, Erasmus University, and R.F.A. Weber, M.D., Ph.D., Department of Andrology, Erasmus University, Rotterdam, The Netherlands.

Coding Drug Effects on Laboratory Tests for Health Care Information Systems

Speaker: P.E. Gronroos, M.D, Department of Clinical Chemistry, Turku University Central Hospital, Turku, Finland.

Authors: P.E. Grijnroos, M.D, K. Irjala, M.D., Department of Clinical Chemistry, and J.J. Forsstrom, M.D., Department of Medicine, Turku University Central Hospital, Turku, Finland.

PLACO: A Cooperative Architecture for Managing Workflow in CCU

Speaker: F, Yousfi, CERIM/University of Lille 11, Lille, France.

Authors: F. Yousfi, R. Beuscart, CERIM/University of Lille 11, and J.-M. Geib, LIFL/University of Lille I, Lille, France.

PROGRAM - WEDNESDAY MORNING

Standards/Quality/ Guidelines Wednesday, November 1 8:30 - l0:OO A.M.

Session Chair: C.D. Flagle, D.Eng., Health Policy and Management, Johns Hopkins Uni\.ersity, Baltimore, MD.

The Impact of a Guideline-Driven Computer Charting System on the Emergency Care of Patients with Acute Low Back Pain

Speaker: F. Day, M.D., UCLA Emergency Medicine Center, UCLA School of Medicine, Los Angeles, CA.

Authors: F. Day, M.D., L.P. Hoang, S. Ouk, S. Nagda, and D.L. Schriger, MD., M.P.H., UCLA Emergency Medicine Center, UCLA School of Medicine, Los Angeles, CA.

A Model for Adapting Clinical Guidelines for Electronic Implementation in Primary Care

Speaker: D.F. Lobach, M.D., Ph.D., MS., Department of Community and Family Medicine and Department of Medicine, Duke University Medical Center, Durham, NC.

Author: D.F. Lobach, M.D., Pli.D., MS., Department of Community and Family Medicine and Department of Medicine, Duke University Medical Center, Durlmn, NC.

Using Statistical Quality Control Techniques to Monitor Blood Glucose Levels

Speaker: T.A. Oniki, M.S., Department nf Critical Care, LDS Hospital, Salt Lake City, m. Authors: T.A. Oniki, MS., T.P. Clemmer, M.D., Department of Critical Care, L.K. Arthur, R.N., and L.H. Linford, R.N., Nutritional Support Service, LDS Hospital, Salt Lake City, m.

Implementing Systems: Critical Success Factors and Lessons Learned Wednesday, November 1 8:30 - 10:OO A.M.

Session Chair: J. Metzger, Arthur D. Little, Inc., Cambridge, MA.

Acceptance and Performance by Clinicians Using an Ambulatory Electronic Medical Record in an HMO

Speaker: M.A. Krall, M.D., Kaiser Permanente, Northwest Region, Hillsboro, OR.

Author: M.A. Krall, M.D., Kaiser Permanente, Northwest Region, Hillsboro, OR.

Evaluating the Impact of Structured Text and Templates in Ambulatory Nursing

Speaker: D. Crist-Gnmdman, R.N., Nursing Administration, Kaiser Permanente, Southern California Region, Riverside, CA.

Authors: D. Crist-Grundman, R.N., Nursing Administration, Kaiser Permanente, Southern California Region, Riverside, CA, K. Douglas, R.N., M.H.A., V. Kern, R.N., M.S.N., Oceania, Inc, Palo Alto, CA, J.C. Gregory, Department of Communications, UCSD and EMR Prototype Research, Riverside, CA, and V! Switzer, R.N., Kaiser Permanente, Southern California Region, Riverside, CA.

Evaluating a Comprehensive Outpatient Clinical Information System: A Case Study and Model for System Evaluation

Speaker: H.L. Chin, M.D., I<aiser Permanente, Northwest Region, Portland, OR.

Authors: H.L. Chin, M.D., and P. McClure, M.B.A., Kaiser Permanente, Northwest Region, Portland, OR.

Overcoming the Limitations of Proprietary Computerized Billing Systems to Enhance Patient Care

Speaker: J.G. Arbogast, M.D., Department of Family Medicine, West Virginia University, Morgantown, WV.

Authors: 1.G. Arbogast, M.D., Department of Family Medicine, West Virginia University, M.C. Carr, Colin-Dale System Group, and W.H. Dodrill, MS., Department of Statistics and Computer Science, West Virginia University, Morgantown, WV.

Panel: Developing a State wide Community Health Information Network from the Grassroots Up: Experiences in Oklahoma Wednesday, November 1 8:30 - 10:OO A. M.

The state of Oklahoma has been a leader in the development of telemedicine applications to support the delivery of health care systems.

Given the overlap of networks, mounting telecomm~~nicationsinfrastructure costs for each of the organizations developing telemedicine systems, and a commitment to meet the health care needs of the state's citizens, representatives of various telemedicine efforts have been meeting to develop senice delive~?. architectures that will permit each group to leverage the work done by other organizations and to create a lobbying and buying consortium, thus reducing costs overall. This effort may result ultimately in implementation of a statetv~de communitp health information network (CHIN) with a range of features and capabilities far beyond the efforts undertaken by the separate parties today. The group set as its goal to show a measurable benefit to their respective organizations and the citizens of Oklahoma, leading to cost reductions related to telecommunications networking, increased external funding and research benefit, and adoption of technology standards leading to improved quality of health services.

This panel's objectives are W to understand the opportunities and chal-

lenges of shared information networks, 8 to gain insight into the policies and poli-

tics of integrated health networks, and to learn how to get involved in community networks to provide maximum benefit to citizens.

Organizer: R. Blackwell, Comanche County Memorial Hospital, Larvton, OK.

Participants: G. Soderstrom-Hopper, Oklahoma University Health and Science Center, Oklahoma City, OK, G.S. Conklin, Oklahoma Health System, Oklahoma City, OK, and G. R~tdd,St. Francis Hospital, Laureate Psychiatric Clinic and Hospital, Tulsa, OK.

Panel: International Collaborations in Medical lnformatics Wednesday, November 1 8:30 - 10:OO A.M.

The US. medical informatics community for the most part sees itself as self-sufficient and has therefore tended to remain isolated from the rest of the world. During the formative years of the field this presented little problem since no one was quite sure what to do and strong pioneering individuals with true "vision" were the only answer. Prior to the widespread availability of the Internet and/or satellite-based telecommunications links, the

difficulties of arranging (not to mention paying for) time to communicate and/or travel probably outweighed the benefits to be gained through collaboration. In more recent years, researchers have discovered that to be truly successful in the field of medical informatics requires such a wide range of talents and skills that one individual or small research group cannot possibly hope to con- tinue to compete efficiently or effectively with larger multidisciplinary groups. This has necessitated the need for more collaborative efforts, both nation- and world-wide. The panelists will discuss several current medical informatics projects that involve international collaboration.

The objectives of the panel are 8 to provide informaticists from the U.S.

insight into international collaborations, 8 to understand how telecommunications

are making sharing easier and better, and W to encourage the sharing of informatics

technologies worldwide.

Organizer: D.F. Sittig, PkD., King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.

Participants: J.H. van Bemmel, Ph.D., Erasmus University, Rotterdam, The Netherlands, R. Freedman, Johns Hopkins University, Baltimore, MD, I. Kalet, I'h.D., University of Washington, Seattle, WA, and R.M.E. Sabbatini, Ph.D., State University of Campinas, Campinas, Brazil.

Panel: A ldernatiwe Architectures for Scalable Information Systems Wednesday, November 1 8:30 - 10:OO A.M.

The patient care information systems developed over the past quarter century are not adequate to support the information needs of the emerging patient-focused integrated health care system. The elapsed time and effort required for application development or implementation are too long. The data integration facilities are inadequate. The information technology industry has developed tools that enable new strategies for application development. Relational databases, client- server architectures, object-oriented development, and so forth will each play a role. Although de-novo development of a new generation of scalable systems should begin, the health care industry cannot wait for those systems. What should be done in the mean- time? How do we manage the evolution while responding to enormous and immediate husi- ness pressures?

This panel will bring together individuals from four medical centers. Each panelist is implementing an architecture designed to support a foundation of integrated data while reducing the bottleneck in application development or implementation. Each panelist will present a seven-minute overview of his strategy for meeting the challenge, leaving an hour for interactive discussion.

The panel's objectives include the following: to understand the issues of technology migration for computerized health record systems,

8 to learn how one can move from a "legacy" system to a more flexible system architecture, and

W to get feedback from systems experts on how they are developing "fast track" developmental systems.

Organizer: W.W. Stead, M.D., Vanderbilt University, Nashville, TN.

Participants: J.K. Vries, M.D., University of Pittsburgh, Pittsburgh, PA, S.B. Johnson, Ph.D., Columbia-Presbyterian Medical Center, New York, NY, T.A. Pryor, Ph.D., Intermountain Health Care, Salt Lake City, UT.

Moderator: S. Cohn, M.D., M.P.H., PMG Interregional Services, Kaiser-Permanente, Oakland. CA.

Thea ter-Style Demonstration: The Virtual Hospital: An /AIMS on the lnternet focused on Education Via Integration of Continuing Education into the Workflow Wednesday, November 1 8:30 - 10:OOA.M.

Speaker: J.R. Galvin, M.D., Department of Radiology, University of Iowa, Iowa City, IA.

Authors: J.R. Galvin, M.D., M.P. D'Alessandro, M.D., W.E. Erkonen, M.D., Department of Radiology, D.S. Curry, M.S.L.S., E.A. Holturn, MS., Hardin Library for the Health Sciences, D.L. Lacey, M.D., Department of Radiology, D.M. D'Alessandro, M.D., Department of Pediatrics, M.G. Kienzle, M.D., National Laboratory for the Study of Rural Telemedicine, and J.R. Wagner, Hospital Information Systems, University of Iowa, Iowa City, IA.

Electronic Medical Record Wednesday, November 1 10:30 A.M. - 12:OO noon


ASOP: A New Method and Tools for Capturing a Clinical Encounter

Speaker: R.A. Gensinger, Jr., M.D., Department of Internal Medicine, Southern Illinois School of Medicine, Springfield, IL.

Authors: R.A. Gensinger, Jr., M.D., Department of Internal Medicine, Southern Illinois School of Medicine, Springfield, IL, and J. Fowler, Ph.D., Medical Informatics and Computing Research Program, Baylor College of Medicine, Houston, TX.

Patient Entries in the Electronic Medical Record: An Interactive Interview Used in Primary Care

Speaker: J.S. Wald, M.D., M.P.H., Center for Clinical Computing and Department of Psychiatry, Beth Israel Hospital, Harvard Medical School, Boston, MA.

Authors: J.S. Wald, M.D., M.P.H., Center for Clinical Computing and Department of Psychiatry, D. Rind, M.D., MS., C. Safran, M.D., MS., H. Kowaloff, Center for Clinical Computing and Department of Medicine, R. Barker, and W.V. Slack, M.D., Center for Clinical Computing and Departments of Psychiatry and Medicine, Beth Israel Hospital, Harvard Medical School, Boston, MA.

Enroute Toward a Computer-Based Patient Record: The ACIS Project

Speaker: H.R. Warner, M.D., Ph.D., University of Utah, Salt Lake City, UT.

Authors: H.R. Warner, M.D., Ph.D., D. Guo, Ph.D., C. Mason, J. Livingston, and B.E. Bray, M.D., University of Utah, Salt Lake City, U ' .

Implementing an EMR: Paper's Last Hurrah

Speaker: D.N. Mohr, M.D., Area General Internal Medicine, Mayo Clinic, Rochester, MN.

Authors: D.N. Mohr, M.D., Area General Internal Medicine, P.C. Carpenter, M.D., Endocrinology, P.L. Claus, M.D., Community Internal Medicine, P.T. Hagen, M.D., Preventive Medicine, P.R. Karsell, M.D., Diagnostic Radiology, and R.E. Van Scoy, M.D., Infectious Diseases, Mayo Clinic, Rochester, MN.

I

Decision Supporf for Cost and Quality Management Wednesday, November 1 10:30A.M. - 12:OO noon

Session Chair: D. Classen, M.D., Department of Infectious Diseases, LDS Hospital, Salt Lake City, UT.

The Use of Misclassification Costs to Learn Rule-Based Decision Support Models for Cost-Effective Hospital Admission Strategies

Speaker: R.A. Ambrosino, M.D., Section of Medical Informatics, University of Pittsburgh, Pittsburgh, PA.

Authors: R.A. Ambrosino, M.D., Section of Medical Informatics, B.G. Buchanan, Ph.D., Intelligent Systems Laboratory, G.F. Cooper, M.D., Ph.D., Section of Medical Informatics, and M.J. Fine, M.D., Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA.

Automated Identification of Episodes of Asthma Exacerbation for Quality Measurement in a Computer-Based Medical Record

Speaker: D.B. Aronow, M.D., M.P.H., Clinical Quality Management, Harvard Community Health Plan, Brookline, MA, and Center for Intelligent Information Retrieval, University of Massachusetts, Amherst, MA.

Authors: D.B. Aronow, M.D., M.P.H., Clinical Quality Management, Harvard Community Health Plan, Brookline, MA, and Center for lntelligent Information Retrieval, University of Massachusetts, Amherst, MA, ].R. Cooley, M.D., Clinical Quality Management, Hanwd Community Health Plan, Brookline, MA, and S. Soderland, MS., Center for Intelligent Information Retrieval, University of Massachusetts, Amherst, MA.

A Rule-Based Decision Support Application for Laboratory Investigations Management

Speaker: L. Boon-Falleur, M.D., Cliniques Universitaires St Luc, Universiti. Catholique de Louvain, Brussels, Belgium.

Authors: L. Boon-Falleur, M.D., E. Sokal, M.D., Cliniques Universitaires St. Luc, Universite Catholique de Louvain, Brussels, Belgium, M.W. Peters, Wolfson Research Laboratories, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK, and J.M. Ketelslegers, Ph.D., Cliniques Universitaires St. Luc, UniversitC Catholique de Louvain, Brussels, Belgium.

IMPACT: An Object-Oriented Graphical Environment for Construction of Multimedia Patient Interviewing Software

Speaker: LA. Lenert, M.D., M.S., Department of Medicine, Stanford University Medical Center, Stanford, CA.

Authors: L.A. Lenert, M.D., M.S., D. Michelson, C.R. Flowers, and M.R. Bergen, Department of Medicine, Stanford University School of Medicine, Stanford, CA.

Human Factors in Building Clinical Systems Wednesday, November 1 10:30 A.M. - 12:OO noon

Session Chair: D. Forsythe, Ph.D., Department of Computer Science, University of Pittsburgh, Pittsburgh, PA.

Enhancement of Clinician Workflow with Computer Order Entry

Speaker: J.M. Teich, M.D., Ph.D., Department of Information Systems, Brigham and Women's Hospital, Boston, MA.

Authors: J.M. Teich, M.D., Ph.D., C.D. Spurr, R.N.,M.B.A., J.L. Schmiz,M.S., E.M. O'Connell, R.N., and D. Thomas, R.N., Department of Information Systems, Brigham and Women's Hospital, Boston, MA.

On-Line Documentation of Patient Care Orders

Speaker: C.M. Prophet, MA., R.N., Department of Nursing, University of Iowa Hospitals and Clinics, Iowa City, IA.

Author: C.M. Prophet, M.A., R.N., Department of Nursing, University of Iowa Hospitals and Clinics, Iowa City, IA.

Contextual Inquiry: Discovering Physicians' True Needs

Speaker: J.M. Coble, M.S., Medical Informatics, Washington University School of Medicine, St. Louis, MO.

Authors: J.M. Coble, M.S., Medical Informatics, Washington University School of Medicine, J.S. Maffitt, Information Systems, BJC Health System, M.J. Orland, M.D., Washington University School of Medicine, and M.G. Kahn, M.D., Ph.D., Washington University School of Medicine, St. Louis, MO.

Interaction and Dialogue Between the Users and the Patient Record Core of Hospital Information System: Looking for a Solution

Speaker: M.C. Mazzoleni, Medical Informatics Service, Clinica del Lavoro Foundation, Medical Center of Pavia, Pavia, Italy.

Authors: M.C. Mazzoleni, G. Franchi, R. Marconi, M. Cortesi, and P. Baiardi, Medical Informatics Service, Clinica del Lavoro Foundation, Medical Center of Pavia, Pavia, Italy.

Networking Images and Data Wednesday, November 1 10:30 A.M. - 12:OO noon

Session Chair: M. Frisse, M.D., Medical School Library, Washington University, St. Louis, MO.

DICOM Media Interchange Standards for Cardiology: Initial Interoperability Demonstration

Speaker: J.L. Elion, M.D., Brown University Institute for Medical Computing, Providence, RI.

Author: J.L. Elion, M.D., Brown University Institute for Medical Computing, Providence, RI.

Evaluation of a Telepathology System Between Boston (USA) and Dijon (France): Glass Slides versus Telediagnostic TV-Monitor

Speaker: F.A. Allaert, M.D., Ph.D., Department of Medical Informatics, University of Dijon, Dijon, France.

Authors: EA. Allaert, M.D., Ph.D., Department of Medical Informatics, University of Dijon, Dijon, France, D. Weinberg, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, P. Dussere, Centre de Pathologie Dijon, P.J. Yvon, Resintel France, L. Dusserre, Department of Medical Informatics, University of Dijon, Dijon, France, and P. Cotran, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

A ClientlServer System for Remote Diagnosis of Cardiac Arrhythmias

Speaker: D.A. Tong, Ph.D., Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Okl+homa City, OK.

Authors: D.A. Tong, Ph.D., V. Gajjala, and L.E. Widman, M.D., Ph.D., Cardiovascular Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Cost-Benefit Ramifications of PACS: Do the Dollars Make Sense?

Speaker: J.P. Weil, Healthcare Management Counselors, New York, NY.

Authors: J.P. Weil, Healthcare Management Counselors, New York, NY.

Panel: Clinical Use of Information Technology by lnternists Wednesday, November I 10130A. M,- 1200noon

The American College of Physicians (ACP) will conduct a panel discussion on internists' experiences in using information technology (IT) to support patient care. Three internists will describe their daily use of IT tools to sup-port clinical lnformation management in their medical practices. The panel organizer will summarize common themes from these pre-sentations and will discuss ACP activities aimed at supporting the clinical use of IT. The internists on the panel reflect a variety of practice arrangements, including solo, group, and academic institution-based practices. Each of the presentations will last 10 to 15 minutes, leaving 30 to 50 minutes for interac-tive discussion between audience members and panelists.

The panel's objectives are B to understand the issues practicing physi-

cians must consider when using comput-erized records,

rn to understand how electronic medical records are used in each physician's prac-tice, and

rn to develop ideas for future implementa-tion of computerized medical records.

Organizer: J.A. Osheroff, M.D., American College of Physicians, Philadelphia, PA.

Participants: L. Blonde, M.D., Ochsner Clinic, New Orleans, LA, R. Kapicka, M.D., Northwest Community Hospital, Arlington Heights, K, and C.L. Starke, M.D., Briarcliff Manor, NY.

Moderator: D. Masys, M.D., University of California, San Diego, CA.

Panel: Syntactic and Semantic Mapping of Structured Clinical Content Wednesday, November l 10:30 A.M. - 12:OO noon

Members of this panel will analyze the prob-lems confronted in conveying correct mean-ing from structured terms and phrases and will provide some potential solutions. The panelists represent a cross-section of medical informatics and will cover theoretical approaches, practical problems, tools, and commercial implementations. Their presenta-tions will focus on the use of discrete and defined terms, phrases and concepts, and their syntactic and semantic mapping to con-vey context, meaning, and comparability to established coding schemes and emerging standards. They will discuss the validity, accuracy, and practical advantages of using syntactically and semantically mapped data for clinical and administrative analysis rela-tive to clinical outcomes, knowledge represen-tation, and knowledge systems.

The objectives of this panel are B to understand the large number of med-

ical coding systems that currently exist, B to learn about the advantages and limita-

tions of each coding system, and to gain insight into the use of coding sys-tems for knowledge representation.

Organizer: R.M. Peters Jr., M.D., Oceania, Inc., Palo Alto, CA.

Participants: K.E. Campbell, M.D., Stanford University, Sunnyvale, CA, and D.J. Rothwell, M.D., College of American Pathologists, Brookfield, WI.

Moderator: I? Del; Ph.D., Stanford University School of Medicine, Stanford, CA.

Panel: CPRI Phase Il Study: An Evaluation of Comprehensive Coding Systems for CPR Implementation Wednesday, November 1 10:30 A.M.- 12:OO noon

The major codes working group of the Computer-based Patient Record Institute (CPRI) completed a preliminary evaluation of

coding systems in 1993. This project docu-mented the deficiencies of major billing schemes in representing the content of the CPR and identified only three comprehensive classification systems that offered the CPR developer promise for systems development. That trial examined only the issue of domain completeness and was hampered by limited source material in nursing. Furthermore, each of the classifications studied has since released updated versions.

The CPRI phase I1 trial was undertaken to examine SNOMED International, the READ coding system, and the Unified Medical Language System in greater detail with a broader sampling of source material. In addi-tlon to completeness, the project seeks to study features of the classification hierarchy, extent of duplication, and translation into common billing schemes.

Using source material from the study project as "cases" for review, the panelists will dis-cuss summary results from the phase I1 pro-ject. They will highlight specific examples of difficulties in conceptual coding with refer-ence to the classification systems under evalu-ation. Members of the panel will also discuss the strengths and weaknesses of these sys-tems, their potential utility to systems devel-opers, and implications for the clinical practi-tioner.

The panel will enable participants B to gain an understanding of CPRI strate-

ges for recommending coding systems, rn to gain knowledge from testing of medical

language coding systems, and B to understand the strengths and weak-

nesses of several coding systems.

Organizer: J.R. Campbell, M.D., University of Nebraska Medical Center, Omaha, NE.

Participants: S.P. Cohn, M.D., M.P.H., Kaiser Permanente, Oakland, CA, J.J.Warren, Ph.D., R.N., University of Nebraska Medical Center, Omaha, NE, C.A. Sneiderman, M.D., Ph.D., National Library of Medicine, Bethesda, MD, and C.G. Chute, M.D., Dr.P.H., Mayo Foundation, Rochester, MN.

Moderator: P. Szolovits, Ph.D., Laboratory for Computer Science, Massachusetts Institute of Technology, Cambridge, MA.

S79

Panel: Finding, Cataloging, Reviewing, and Disseminating the Results of Randomized Clinical Trials: The Cochrane Collaboration Wednesday, November 1 10:30A.M. - 12:OO noon

Over twenty years ago, noted British physi-cian Dr. Archie Cochrane called the medical profession to task for not systematically reviewing every clinical intenention with a thorough literature review and appropriate statistical analysis. Since that time, accessing the literature via MEDLINE has become con-siderably easier, and statistical methodology such as meta-analysis has improved suhstan-tially. Yet physicians still have difficulty iden-tifying and using the best quality evidence in their practice. The Cochrane Collaboration (CC) was formed in 1992 as an international effort to identify and systematically review all

randomized controlled trials of medical inter-ventions. Several participants in the collabora-tion will discuss their efforts, from organizing and indexing reviews to disseminating their results.

Among the objectives of this panel are to understand the strengths of randomized control trials, to understand the complexity of sharing these trials with practicing clinicians, and to p i n an insight into how collaborations are helping to resolve problems of informa-tion dissemination.

Organizer: R.S.A. Hajward, M.D., M.P.H., McMaster Universitv, Hamilton, Ontario, Canada.

Participants: R.B. Haynes, M.D., Ph.D., McMaster University, Hamilton, Ontario, Canada, J.C. Wyatt, M.B., Ph.D., Imperial Cancer Research Fund Laboratories, London, United Kingdom, and W.R. Hersh, M.D., Oregon Health Sciences University, Portland, OR.

Moderator: J. Hales, Ph.D., Division of Medical Informatics, Duke University Medical Center, Durham, NC.

Theater-Style Demonstration: The Regenstrief Medical Record System: Cross-institutional Usage, Note Writing, and MQSAIC/HTM6 Wednesday, November 1 10:30 A.M. - 12:OO noon

Speaker: C.J. McDonald, M.D., Regenstrief Institute for Health Care, Indianapolis, IN.

Authors: C.]. McDonald, M.D., Regenstrief Institute for Health Care, J.M. Overhage, M.D., Ph.D., W.M. Tierney, M.D., G. Abemathy, M.D., Indiana University School of Medicine, P. Dexter, M.D., B. Smith, R.N., C. Wodniak, R.N., Wishard Memorial Hospital, L. Rlevins, J. Warvel, J. Warvel, J. Meeks-Johnson, L. Lemmon, and T. Glazener, Regenstrief Institute for Health Care, Indianapolis, IN.

Map provided by the Greater New Orleans Tourist & Convention Commission. Inc.

rap up your SCAMC experience by attending the Closing Session from L00 to 3:00 P.M. on

Wednesday, November 1. During this session, Joyce A. Mitchell, Ph.D., chair of the AMIA Awards Committee, will

present SCAMC awards for Best Theoretical Paper, Best Paper on an Application, Best Traditional Poster, and Best Electronic Poster. The Priscilla Mayden Award will also be presented. Reed M. Gardner, Ph.D., 1995 SCAMC Program Chair, will make closing remarks and pass the gavel to James J. Cimino, M.D., 1996 SCAMC Program Chair. After brief remarks, Dr. Cimino will turn the session over to W. Ed Hammond, Ph.D., President of the American College of Medical Informatics

(ACMI).

ACMI was formed in 1984 as an honorary organization to recognize the contributions of leaders in the science and applica-

tion of medical informatics. As part of the consolidation of the American Association for Medical Systems and Informatics (AAMSI), ACMI, and SCAMC, ACMI became the fellowship component of AMIA. Individuals are nominated for membership by members of ACMI, and five to ten new members are elected to ACMI each year. New members are inducted into

ACMI at the SCAMC meeting. ACMI currently has approximately 175 members.

"RESOLVED: Free market forces, unfettered by federal government intervention or regulation, are adequate for providing appropriate deployment of the National Information Infrastructure in support of health and health care. "

Debating in favor of the resolution: Christopher Caine, Director of Public Affairs, IBM Corporation

Howard Bleich, M.D., Hanwd Medical School and Beth Israel Hospital, Boston, MA

Debating in opposition to the resolution: Donald W. Simborg, M.D.

Daniel R. Masys, M.D., University of California-San Diego, San Diego, CA

Organizer and Moderatoc Edward H. Shortliffe, M.D., Ph.D., Stanford University School of Medicine, Stanford, CA

n November 1 and 2, there will be a conference for those

interested in establishing standards for clinical vocabularies for primary care. It will take place in New Orleans following

SCAMC.

This meeting grew out of informal discussions among the leaders of AMIA's Family Practice/Primary Care Working Group, the Primary Health Care Specialist Group of the British Computer Society, and IMIA's Working Group 5. Members of the AMIA Working Group and faculty members of the Department of Family Medicine at the University of Arkansas and University of South Alabama have done the initial planning. The steering committee

has representatives from primary care organizations from the US., Canada, Australia, and the Netherlands.

The purpose of the meeting is to begin a process to develop con-

sensus about standards and coding for primary care ambulatory clinical information systems. The conference will provide an

opportunity for people with expertise, experience, and interest in primary care informatics to come together

to define current opportunities, issues, and problems in developing and adopting standards in coding for primary care medical informatics;

C to become familiar with models of success from around the world and to identify the salient features that might be tran- portable and useful in other settings;

L to participate in a process designed to develop consensus regarding stadards and coding in primary care informatics; and

to speculate on the future, the impact on primary care future

directions, and strategies.

Additional information is available on the Internet (fam-med and

gp-uk) and WWW. For more information, contact Robert D. Price, Ph.D., at [email protected].

To register for the conference, fill in the appropriate part of the SCAMC advance registration form on page 67.

HQ ;SEh RESEFWATlON FORM

American Mediical lnformatics Association

Ninefeenth Annual Symposium on Computer New Orleans Hilton Riverside 'Riverside

Applications in Medical Care (SCAMC) New Orleans, LA

October 28-November 1, 1995

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All sleeping room reservations must be accompanied by the first night's deposit,

As a deposit for first night's lodging, I have enclosed my check for $ (made payable to the New Orleans Hilton Riverside or DoubleTree Hotel) or give my credit card information:

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Send this hotel reservation form (so that it arrives no later than October 5, 1995) to one of the following:

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Poydras at the Mississippi River 300 Canal Street A M l A

N e w Orleans, LA 70140 N e w Orleans, LA 70130 4915 St. Elmo Ave., Suite 401

Phone: 504-584-3999*** or l - 800-HlLTONS*** Phone: 504-581-1300*** Bethesda, M D 20814

Fax: 504-584-3979 Fax: 504-522-4100 Fax: 301-657-1296

* A limited number of sleeping rooms is available at the DoubleTree. "For government-rated rooms only, complete this form and mail it to the AMlA address above.

*** When calling in your reservation, refer to the American Medical lnformatics Association's 1995 SCAMC.

To cancel your reservation without penalty, you must contact the hotel directly at least 72 hours before your scheduled arrival date.

Join AMIA now and save up to $100 on your SCAMC registration!

Membership in the American Medical Informatics Association is an excellent in~~estment.The educational benefits, networking opportunities, and constant exposure obtained from AMIA's resources are virtually unlimited.

MEETINGS AND CONFERENCES AMIA's meetings and conferences offer

the best in panels, tutorials, research paper presentations, workshops, and exhibits. In addition to the annual Symposium on Computer Applications in Medical Care, AMIA sponsors an annual Spring Congress, which will be held June 5-9,1996 in Kansas City, Missouri. The theme of that meeting is "Telemedicine." AMIA members save up to $250 on Spring Congress and SCAMC registration fees.

PUBLICATIONS AMIA News: We produce our own quarter- ly newsletter, letting you know about

what's going on at your association's headquarters, new services on the hori-

zon, messages from AMIA's leaders, and upcoming events.

AMlA Yearbook & Directory: This valu-

able networking tool provides complete address and e-mail information for each AMIA member. It also provides an overview of the current year, and lets you know what's in store for the following year.

Annual Buyer's Guide: This handy guide is incorporated into the SCAMC Final Program. It showcases the many fine products and services of SCAMC exhibitors and our Corporate members.

JAMIA: All Regular, Institutional, and Corporate members receive AMIA's exciting new journal, JAMIA, the Journal of the American Medical Informatics Association. Students may order JAMIA at a special member rate. Contact the AMIA office to receive the Author's Guidelines.

Computers and Biomedical Research: A refereed journal that provides researchers and clinicians with up-to-date information about the application of computers to health care. Regular, Corporate, Institutional, and Student members may purchase a subscription at a special member rate.

M.D. Computing: A magazine-format journal that covers the entire spectrum of computers in medicine, providing information about new products and services and in-depth hardware and software reviews. Regular, Corporate, Institutional, and Student members may purchase a subscription at a special member rate.

IMIA Yearbook of Medical Informatics: Published by the International Medical Jnformatics Association, this annual publication includes the best papers from the international arena of medical informatics.

Proceedings: Members may obtain proceedings from SCAMC and abstract books from our Spring Congress.

Working Group Newsletters: You will receive newsletters from the Working Group(s) with which you are affiliated. These newsletters provide even more in-depth information about your particular field of interest.

MORE BENEFITS AMIA Membership Card: Your exclusive AMIA membership card displays your commitment to continuing informatics education and training.

Continuing Education Credits: By attending SCAMC and the Spring Congress, members may earn valuable Continuing Medical Education credits and (for SCAMC) Nursing Contact Hours.

AMIA Job Exchange: Members can learn "who's looking" and "who's available" for various positions within the medical informatics field, both dur-

ing SCAMC and after it's over.

MedSig: 1992 marked the tenth anniver-

sary for the Medical Special Interest Group bulletin board system on CompuServe. MedSig is accessible from almost every city in the United States and contains many message sessions for discussing areas of interest, from computing to clinical, ethical, and social topics. Contact AMIA for a MedSig brochure.

President's Club: Get the recognition you deserve by participating in AMIA's popular "member-get-a-member" recruitment campaign. Jn addition to recognition awards, members are invited to exclusive receptions and receive prestigious plaques and valuable prizes.

Site Visit Program: Members can visit the finest institutions and see medical informaticians at work.

WORKING GROUP AFFILIATIONS Thirteen Working Group (WG) affiliatmns are available and encouraged for all AMIA

members. The WGs are rn Anesthesiology/Critical Care and

Emergency Medicme rn Automated Encoding/Electronic

Patient Records m Clinical Computing rn Co~nputerized Medical Records rn Dental Informatics rn Education rn Family Prachce/Prirnary Care rn Hospital/Medical Information Systems rn Internet rn Medical Imagmg Systems rn Nursing Informatics rn Prevention and Health Evaluation

Informatics rn Student

This is just a partial list of services available to AMIA members. Many more are on the horizon. Join AMIA today!

l

1995% AMM MEMBERSMjP APPLICATIOA!/RENEWA6 FORM

4915 St. E l m o Avenue, S u i t e 401, Bethesda, M a r y l a n d 20814 Phone: 301-657-1291 Fax: 301-657-1296 E-mail: ( In te rne t ) [email protected]

PERSONAL INFORMATION, PLEASE ...D O N O T USE THIS APPLICATION AFTER 11/l/95.

U Regular Member - $175 includes physicians, nurses, dentists, biomedical engineers, educators, medical librarians, researchers, and other health care professionals who have a strong interest in medical informatics. Regular Members receive JAMIA and newsletters at no additional fee. Discounts for AMlA Spring Congress and SCAMC apply.

U Institutional Member - $300 includes nonprofit organizations, nonprofit associations, nonprofit universi- ties, nonprofit hospitals and libraries. All Regular Member benefits apply, institutional Members are listed separately in the AMlA Yearbook and Directory. One individual is designated as AMlA contact person for mailing purposes and conference registration discounts. JAMIA and newsletters are included. Discounts for AMlA Spring Congress and SCAMC apply.

U Corporate Member - $1,500 - $10,000 includes for- profit corporations that are vendors to the medical informatics community, such as hardware and software vendors, and consulting firms. Please contact AMlA for the special Corporate Membership Packet.

Student Member - $30 includes persons currently enrolled full-time in a degree-granting program or in an academic program such as a medical residency or post- doctoral fellowship. A copy of the Student 1.0. is required wi th membership application. Students may purchase journals. Students are automatic members of the Student Working Group at no additional charge. Discounts apply.

U Associate Member - $30 for one year only. Individuals may join one Working Group. No Regular Member benefits apply. No journals or newsletters, no AMlA Spring Congress or SCAMC discounts. At the end of the year, Associate Members are expected to renew at Regular Member rates and wil l then receive services.

Please rndrcate your occupatron(s). Check al l that apply.

U Physlclan 9 Programmer

UD~etrcran 3 Systems Analyst

Q Pharmacrst rI] Computer Screntrst

1Phys~calTherapist 17Busmess Admln~strator

U Educator U Technologist

U Engmeer 3 Hospltal Admrnrstrator

U Nurse 3 Medrcal Lrbrarran

UDentrst UHealth lnfo Professronal

D Undergrad Student UVendorIConsultant

3 Fellow '_I Veterrnary Medrcme

Ll Graduate Student 2 Screntrst/Researcher

Other (please specrfy)

Name

lnstitutionlOrganization

Address

City/State/Zip/Country

Business Phone

E-mail Address(s)

Sponsor's Name (who encouraged you t o join AMIA?)

Regular, Institutional, and Corporate Members recerve JAMIA, the Journal of the American Medical lnformatics Association, automatically. These members may wish to purchase subscriptions t o M.D. Computing and Computers and Biomedical Research a t the specially discounted subscription rates below. Student members may purchase JAMIA or these journals at special AMlA member prices:

U JAMIA ($30) - Student discount only

D M.D. Computing ($32)

5 Computers and Biomedical Research ($42)

All members may purchase the following publications:

1995 SCAMC Proceedings* ($65 t $4 postage & handling = $69)

1994 SCAMC Proceedings ($65 + $4 postage & handling = $69)

1993 SCAMC Proceedings ($65 t $4 postage & handling = $69)

1991 SCAMC Proceedings ($65 t $4 postage & handling = $69)

1995 Spring Congress Abstracts ($50 t $2 postage & handling = $52)



1993 IM lA Yearbook of Medical lnformatics ($35 + $4 postage & handling = $39)

1992 IM lA Yearbook of Medical lnformatics ($35 t $4 postage & handling = $39)

Amounts for postage and handling above are for U.S. only. For Canada and Mexico, postage and handling is $8; for other countries, $34.

NOTE: 1992 SCAMC Proceedings may be purchased by contacting the publisher, McGraw-Hill, directly at 1-800- 262-4729.

"Available late October 1995

U Please do not include my name on mailing lists given to other organizations.

Oegreent le

Fax

and

Regular, Institutronal, and Corporate Members may join one Working Group (WG) at no added charge. Each additional WG affiliation is $30. Students are automatic members of the Student Working Group, however, students may join other WGs for $15 per WG.

Anesthesiology/Critical Care & Emergency Medicine

Automated EncodingIElectronic Patient Records

Clinical Computing

Computerized Medical Records

Dental lnformatics

Education

Family PracticeIPrimary Care

HospitalIMedical Information Systems

lnternet

Medical lmaging Systems

Nursing lnformatics

Prevention & Health Evaluation lnformatics

Student

m AMlA Membershrp $

JAMlA $

M D Computrng $

Computers and Blomedlcal Research $

Addltronal Workrng Groups $

ProceedrngsIPublrcatrons $

Forergn Postage ADD $15 $

TOTAL (U.S Dollars only) $

I enclose my D U S Check U U S Money Order U VISA 0 Mastercard a Am Express Card Number

Exp Date l

Srgnature

Q New Member URenewed Member

Please use a separate form for each registration.

Advance Registration Advance registration discounts apply to all registrations received by AMIA, and paid in full, by October 14,1995.

Registrations not paid in full by October 14, 1995 will be charged the on-site registration rate, and attendees will be expected to register on site.

Any attendee with an outstanding balance must pay it before registration materials can be obtained.

Full Registration The h11 registration fee includes all symposium activities, including attendance at all educational sessions (except tutorials), the Tuesday evening AMIA Halloween Dessert Reception, and a copy of the 1995 SCAMC Proceedings.

Single-Day Registration For attendees who are not able to attend the entire conference, a single-day registration is available. The single-day registration fee includes attendance at all educational sessions (except tutorials) for the day or days for which the individual has registered.

Single-day registration fees DO NOT include the Tuesday evening AMIA Halloween Dessert Reception or the Proceedings. Attendees and their guests may attend the reception for an additional $25 per person.

Friday, October 27 5:OO F! M . - 8:OO EM.

Saturday, October 28 7:00 A.M. - 6:00 EM.

Sunday, October 29 7:OO A.M. - E00 f? M.

Monday, October 30 7:00 A.M. - 6:00 F! M.

Tuesday, October 31 7:OO A.M. - 6:00 PM.

Wednesday, November 1 7:00 A.M. - 3:00 f?M.

Pm-Brofessioraa! Student, Student, Resident, and Fello W

Registration Pre-professional students, students, residents, and fellows are eligible for reduced SCAMC registration rates. A pre- professional student is any student who has not yet earned a professional degree at the doctoral level.

Student registrations must be accompanied by proof of student status (e.g., a copy of the Student I.D. or a letter from a school or departmental official verifying status). For registrations received without proof of student status, AMIA will charge full registration rates.

The pre-professional student and student registration fees include all SCAMC activities, including attendance at all educational sessions (except for tutorials), the Tuesday evening AMIA Halloween Dessert Reception, and a copy of the 1995 SCAMC Proceedings.

Payment Payment must be in US. currency and payable through a US. bank. Accepted forms of payment include personal or company check, money order, VISA, MasterCard, or American Express. Other credit cards are not accepted. Your account will be charged on the date on which AMIA processes your registration.

You may fax your registration to 301-657- 1296 ONLY if you are paying by VISA, MasterCard, or American Express. Please DO NOT call the AMIA office to confirm receipt of your fax. You will receive confirmation of your registration by mail.

Discounted AMBA Member Rates SCAMC registrants who are paid AMIA members for 1995 or 1995-96 qualify for the reduced member rate. (Associate Members do not qualify for the reduced member rate.)

Deferred Payment In lieu of payment, you may submit proof of payment (authorization or purchase order) with your registration. Attendees are responsible for payment of fees, including those billed to third parties. Deferred payment must be made within 30 days of billing, or a service fee of $50 will be charged. You must provide a copy of your purchase order or authorization along with a correct billing address. AMIA will not process registrations without a copy of the purchase order or authorization. Purchase order numbers alone are not acceptable.

Registration Cancekla tion Registration fees, less a $50 cancellation fee, are refundable if AMlA receives written notice by October 20,1995. Refunds will be processed four to six weeks after SCAMC.

No refunds will be given after October 20, 1995. Registrants who are unable to attend the symposium may transfer their registration; if the alternate is not an AMIA member, he or she will be charged the non-member rate. Transfer of registration must be in writing.

Tutorial Cancellation Tutorial fees, less a $25 cancellation fee, are refundable if AMIA receives written notice no later than October 20,1995. Refunds will be processed four to six weeks after the symposium.

No refunds will be given after October 20, 1995. Registrants may transfer their tutorials in writing only.

On-Site Registration Registration is available on site during the conference; however, AMIA cannot guarantee your choice of tutorials. Reduced registration rates do not apply on site.

Confirmation of Registration Registrations will be confirmed in writing within approximately two weeks of receipt of payment.

f9TH SCAMC ADVANCE REGISTRAiTIOIM FORM

r

AMlA Membership Number

Name (last, flrst) Degree

TitleIPosit~on Department

Organization

Address

CityIStatelZip Country

Phone Fax E-Mail

Social Security Number

Signature (required for CME Credit)

Adrlarice On S ~ t e b y i!J I I) W o r k i n g Group M e e t i n g s

F u l l R e g i s t r a t i o n You must preregister for Working Group (WG) meetings,

AMlA Member $375 $475 $ which are free to members of the WG. If you are not a member of the WG, add $10 per meetinq:

HlMSS Member $425 $525 $ 2 AnesthesiologylCritical Care $

Non-Member $475 $575 $ U Automated Encoding/Electronic

S t u d e n t R e g i s t r a t i o n Patient Records $ AMlA Student Member $175 $220 $ J Clinical Computing $

HlMSS Student Member $200 $235 $ J Computerized Medical Records $

Student Non-Member $225 $250 $ -I Dental l n fo rmatm $

AMlA Pre-Professional $ 8 8 $1 10 $ :J Education $ Student Member 3 Familv PracticelPrimarv Care $ HlMSS Pre-Professional $100 $118 $ J HospitalIMedical lnformatlon Systems $ Student Member

3 lnternet $ Pre-Professional $113 $125 $ Student Non-Member a Medical lmaqinq Systems $

$S i n g l e - D a y R e g i s t r a t i o n (please check dayldays) J Nursing lnformatics

13 Prevention and Health Evaluation $J Monday, October 30 i_l Tuesday, October 31 J Wednesday, November 1 J Student

All Registrants $180/day $180/day $ Advance On-Site

E x h i b i t s O n l y (by 10114)

R e c e p t i o n s / P u b l i c a t i o n sAll Registrants $25 $25 $

T u t o r i a l R e g i s t r a t i o n ( f e e f o r e a c h ) AMlA Dessert Reception $ 2 5 $ 2 5 $ (additional t~ckets)

AMlA Member $150 $175 $ Proceedings $65 $ 6 5 $

Non-Member $200 $225 $ (additional copies) Student Member $150 $175 $ (Please add appropriate postage and handling if mailed: Student Non-Member $200 $225 $ U.S., add $4; Canada and Mexico, add $8

Please circle appropriate tutorials. Only one tutorial per all other countries, add $34.) time period. Registration Primary $ 75 $ 7 5 $

T u t o r i a l s - Saturday, O c t o b e r 28 Care lnformatics Standards

M o r n i n g - l 3 5 7 9 11 13 15 17 19 2 1 23 Conference (Nov. 1 and 2) Af ternoon-2 4 6 8 10 12 14 16 18 20 22 24 S u b t o t a l ( r e g i s t r a t i o n f o r m ) S T u t o r i a l s - Sunday, O c t o b e r 29 S u b t o t a l ( m e m b e r s h i p a p p l i c a t i o n ) $ Morning - 25 27 29 33 35 37 39 41 43 45 47

T o t a l e n c l o s e d o r t o b e c h a r g e d $Afternoon - 26 28 30 32 34 36 38 40 42 44 46 48

M o n d a y , O c t o b e r 30 Afternoon - 49 Join AMlA n o w a n d s a v e up to $100!Tuesday. O c t o b e r 31 Morning - 50

Wednesday , N o v e m b e r 1 Morning - 51 52 Non-Members: If you join AMlA today, you may register for the program at the discounted member rate. Simply fill out the Membership Application on page 65 and return it with your registration. (Non-member registrations received without the membership application and payment wil l be charged the non-member rate.)

J This is my first SCAMC.

111 1 need special assistance. (If you require special accommodation to participate fully in the symposium, please check here and enclose a

description of your needs.)

2 Please do not include my name on mailing lists given to other organizations.

(Tills s lhow you1 ba~iqe w ~ i l reat1 the same as opposite, sklp thls sect1011.I

Organization

(please check al l that apply) J Physlclan J Programmer P

J Dletlclan J Systems Analyst J Pharmacist J Computer Sclentlst 1J Phys~calTherapist -1 Busmess Admlnlstrator J Educator J Technologist--I Englneer J Hospltal Admlnlstrator -I Nurse -I Medlcal Llbrarlan J Oent~st h Health lnfo Professional

J Undergrad Student J Vendor/Consultant r-1 Fellow J Veterinary Medlclne J Graduate Student

P

J Sc~ent~stlResearcher Other (please speclfy)

Medical Specialty J Anestheslology J Oncology P

J Cardiology J Ophthalmology J Gastroenterology J Orthopedics A Hematology 3 Ped~atr~cs i Internal Medlclne J Prlmary Care -1 Nephrology J Radiology -J Neurology !JOther J ObIGyn

Reg~s t ra t~o~ iscannot be processed u n l l payment IS

received. Payment must be in U.S. dollars payable through a U.S. bank. Registrations MUST arrive in the AMlA office by October 14, 1995. Registrations received after this date wil l be processed on site. D0 NOT send this form if AMlA wil l not receive it by October 14,1995. Make checks payable to AMIA.

Check enclosed in the amount of $

Please charge my credit card in the amount of $

Q VISA 3 Mastercard 3 Am. Express

Card Number

Exp. Date: I

Signature

AMlA WILL NOT PROCESS REGISTRATIONS RECEIVED WITHOUT PAYMENT.

American Medical lnformatics Association 4915 St. Elmo Avenue, Suite 401 Bethesda, Maryland 20814 Fax: 301-657-1296 Phone: 301-657-1291 E-mail: (Internet) [email protected] WWW: http:llamia2.amia.org

1.; uri~i i totir iatI f

towards cost-effective clinical computing. nineteenth

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