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Information and expert system interaction in a hospital environment
Information and expert system interaction in a hospital environment A. Fandak, M. Popper, M. Guregova, K. Fand~,kovd and M. Sykora
Medical Bionics Research Institute, Jedl'ova 6, 83308 Bratislava, CSSR The contribution outlines some features relating to information and expert systems in the perspective of their mutual relations. Based on them we attempt to specify some possible and appropriate ways of information and expert system co-operation. An example based on interaction between the clinical information system MEDAS and the expert system CODEX is given. Keywords: Expertsystem,informationsystem,database, knowledgebase
Information and expert system relations The relations between data, information and knowledge could be considered as the underlying framework for determining the relations between an information system and an expert system. A possible understanding of the former relations is as follows:
data (facts) correspond to singular statements about the world
information corresponds to (composite) statements derived from data, usually in a given context, suggesting some action to be taken knowledge is a result of information processing taking the form of definitions, descriptions, generic statements, models and methods enabling information to be inferred from data as well as making prescriptions for performing actions. For example, the age, weight, height and sex of a person are data from which the body surface of the person can be derived (information) based on the knowledge relating the somatic parameters of the person, his age and sex to its body surface. An information system (IS) is primarily doncerned with storing and processing great amounts of (mostly) uniform data in its database. The user of it, exploiting its functions, may gain from the data sufficient information for his decision and control activities. An expert system has in its knowledge base an organised collection of pieces of knowledge representing together some of the knowledge related to a specific problem domain and in its inference engine it embodies some general strategic knowledge in the form of algorithms. Its user may utilise this knowledge for processing the information the ES currently possesses to gain the interpretation and/or instructions for carrying out decision and control activities. Both kinds of systems are designed so as to support and improve the quality of their users' actions. However, there are significant differences in the principles and methods incorporated in ISs and ESs in order to
118
fulfil their functions. While the former has tools (usually in the database management part) for creating and maintaining large databases covering vast problem areas, usually concerning a particular population, they are seldom, if at all, able to produce more than well organised printouts from various kinds of data in explicitly specified relations. Their successive analysis and resolution of implicit inter-relations or causal dependencies - i e, goal-oriented interpretation - is left to the user. In contrast, the ESs are nowadays equipped with rather limited knowledge bases, operating on a rich variety of non-uniform data related to specific entities, and serve as a tool for interpreting the given facts and thus for solving a particular problem. The knowledge about the world represented in their knowledge base creates the ground for considering the associations, causalities, contexts, conditions, taxonomies, etc, for relating the given data in the domain from which the problem is originating. This results in instructions, with explanations, for carrying out decision activities even in cases when the data are incomplete, uncertain, imprecise and the problem at hand is ill-structured. From those differences some of the common features pertaining to the functional use of the IS and ES could be derived. In our case we are considering the expected possible mutual support and co-operation of these systems as follows: (a) The IS is hosting the ES which is then a means for broadening its functional reach by knowledgeable information interpretation; the level of performance capability of the IS is raised in this manner. (b) The ES is interfaced with the IS in order to drain from its database the data needed for solving the given particular problem thus avoiding the need to request information from the ES user when it is available in the attached source. (c) The database in the IS can serve as a source for acquiring pieces of knowledge for the knowledge base design and simultaneously as a verifications tool for ES performance.
MeasurementVol 8 No 3. JuI-Sep1990
Fandak et al Based on our own experience as well as on a general assessment of medical informatics we suppose that incorporating the knowledge features and programming style of ESs into ISs will in the near future become the reality facilitating successful evolution of both kinds of systems. We expect that in this respect a major influence will develop from the side of the IS community their users and developers - and that requirements and needs stemming from IS environments will lead to development of sophisticated intelligent interfacing mechanisms between those systems. This expectation is being supported by the contemporary situation of IS applications: • The number of IS applications is steadily growing; we are witnessing the proliferation of renewed and second generation IS applications in a vast spectrum of problem areas. • The IS users' community in general has considerable experience with computers and rather clear ideas as to what, why and how to profit from existing databases. • The long established IS use leads to rich databases and files containing abundant historical data enabling trends to be traced, historical connections made, casual relations revealed, influencing contexts traced, etc. • The ISs are in the process of extensive technological development to a higher quality level (e g, nets, distributed systems, parallel processors, database machines) and their further development is supported by rather a solid theoretical background. A practical e x a m p l e of IS and ES interconnection Since 1985 we have been engaged with practical problems of IS and ES interconnection. The goal of our effort is to reach an efficient level in interfacing the clinical information system MEDAS and the diagnostic expert system CODEX, both developed at the Research Institute of Medical Bionics, Bratislava, Czechoslovakia (Fand~ik et al, 1985). MEDAS (MEdical DAtabase System) is a modular clinical information system used by the staff of a clinical department (physicians and nurses). Its purpose is recording and processing the patient's data during his hospital stay - e g, medical history, current patient state, working diagnoses, daily progress record, lab examinations, therapy and medications, etc. The results of data processing are, among others, daily care plans for nurses and orders for procedures and examinations, as well as various print-outs as .a record of departmental performance. At the time of the patient's discharge, the patient data are stored in archival files. There are two ways of processing archival data files: in the case of the patient being re-admitted to hospital his archival data could be reactivated and archival files reviewed searching for various data and their respective evaluation (Fand~ik et al, 1984). CODEX is an expert system incorporating the principles of artificial intelligence with data structures representing medical knowledge. The system is designed to parallel human reasoning in solving medical problems such as diagnosis, treatment planning and predicting patient outcome. Measurement Vol 8 No 3, JuI-Sep 1990
For the basic system CODEX several knowledge bases have been developed. Their aim is to provide diagnostic assistance in various fields of medicine. Currently there are available knowledge bases for neurology, physiology, biochemistry, psychiatry and histology. Despite the fact that some of the knowledge bases cover a large number of diagnoses (more than two hundred) they still cover rather narrow problem domains. For the diagnosis of cerebellum syndromes and localised lesions and entrapments of the nerves of the peripheral limbs, two neurological knowledge bases have been designed. The ES CODEX with those knowledge bases is in regular practical use at the first neurology clinic of the Comenius University Medical School. Besides this, the medical staff of this clinic are daily exploiting the services of the MEDAS information system which makes it possible to store and process inpatient data. The implementation of the CODEX system took place several years after the MEDAS system had been introduced to this clinic. Very soon after the CODEX implementation it became obvious that it was very annoying for physicians to have to input some of the patient data twice, as both of the systems did not know about each other. As a natural result, the idea of interconnecting both systems originated. From several possible approaches the clinical staff decided to pursue the following means of system cooperation. After acquiring the patient data gained from objective neurological examination (current status) with the assistance of MEDAS on the clinical ward, the CODEX is to be activated (automatically) in the background to process these data and to complete the database with its diagnostic results. In addition, the MEDAS should enable CODEX to be activated in the foreground which means in direct user-system interaction whenever it is needed to process the MEDAS data completed with those available (even supposedly) from its user. Naturally, the independent use of CODEX, especially for knowledge base development and maintenance, is to be preserved. This decision was accepted and the resulting interconnection carried out. The program solution was rather complicated. As both systems were developed completely independently, their inter-connection necessitated the development of a special programming interface. This interface receives and analyses CODEX data requests and selects, from MEDAS database, the appropriate information. To fulfil this task, special procedures had to be worked out enabling, for every CODEX request, access to the current patient state specifying parts of the MEDAS database (in the case of a non-trivial request sets of alternative structures could be taken into consideration) where the information could be found. The integral interface function is then the transformation of the selected information into the form accepted by CODEX. The consequence of parallel but independent development of both systems is a serious drawback as regards interface design. In the situation where amendment or changes in relevant parts of MEDAS or CODEX are to be carried out, there is also the need to make appropriate adjustments in the interface and its procedures. The time needed for CODEX to run through the data of one patient is considerable (up to 8 minutes), but in the case of its being used in the background this does not 119
Fandak et al require any presence of or contact with the user. That is why we regard the designed interconnection as the best choice under existing conditions. Both systems - MEDAS and CODEX alike - are written in STANDARD MUMPS language.
machine of the ES thereby enabling the ES to be used over data stored in the IS database. • To design external features of IS and ES interconnection in such a way that the IS will be able to use the ES directly without the need for ES activity to be initialised by the user.
Conclusion
References
We would like to use our experiences from the interconnection of IS and ES in new applications. According to experience gained from our first experiment it seems to be appropriate to proceed in the following series of steps: • On the basis of analysis of the IS application area (data types, user. environment requirements) to specify problems suitable for being supported by the ES. • To specify (in selected areas) requirements on data structures and knowledge base. • To develop simultaneously the database management system of the IS and the knowledge base of the ES, application programs of the IS and the inference
Fand~ik, A., et al. 1984. MEDAS - Medical Database System of Hospital Department, Technical Report, Medical Bionics Research Institute. Bratislava. Fanddk, A., Popper, M., S~kora, M., Guregov~i, M., and Fanddkovd, K. 1985. MEDAS and CODEX: Connecting a Clinical Information System with a Diagnostic Expert System. In: Van Bemmel, Grrmy and Zv~irovfi (Eds), Medical Decision Making, Elsevier Science Publishers, Amsterdam, 361-364. Popper, M. and Gy,'trfii~, F. 1984. CODEX: A Computer Based Diagnostic Expert System. In: Plander, I. (Ed), Artificial Intelligence and Information-control Systems of Robots, North-Holland, Amsterdam, 297-300.
TEMPMEKO 90/Technical Diagnostics 17-19 September 1990, Helsinki, Finland Technical diagnostics The symposia on Technical Diagnostics are the main events of IMEKO TC 10. The aim of this Symposium is to report and review the state of the art of technical diagnostics. Special emphasis is put on the advancements in: on-line condition monitoring systems, future trends in expert systems in diagnostics and applications in process industries. The general theme will be new methods and technologies for on-line diagnostic systems. Topics will include:
1. 2. 3. 4. 5. 6.
Applications in process industries New hardware and software for diagnostic systems Expert systems and artificial intelligence Model based methods New sensors and measurement devices Technical diagnostics in electronics and computers
methods, but also to the use of electronics and microcomputers in temperature and thermal measurement and control systems. Emphasis is given to the improvement of efficiency in industrial and nonindustrial applications. Main topics will include: • Temperature measurement with contact and contactless thermometers. • Temperature sensors and their calibration. • Realisation and improvement of the International Temperature Scale. • Dynamic behaviour and correction of thermometers and of temperature measuring systems. • Radiation temperature measurement and thermography. • Optical, spectroscopic and acoustic temperature measurement. • Measurement of thermophysical properties of materials.
T E M P M E K O 90
The TEMPMEKO symposia are the main events of IMEKO TC-12 every three years. They provide international exchange of opinions in the whole field of temperature and thermal measurements, and offer an opportunity to discuss the main trends of research, development and applications. Attention is not only paid to metrology, sensors and to new measurement 120
Venue
The Symposium will take place at the Helsinki Fair Centre where Automation Days 90, an exhibition and congress event, will be held during the same week. They are being organised by: Finnish Automation Support Ltd, H~hneentie 6 A 15, SF-00530 Helsinki, Finland. MeasurementVol 8 No 3, JuI-Sep1990
Medical Bionics Research Institute, Jedl'ova 6, 83308 Bratislava, CSSR The contribution outlines some features relating to information and expert systems in the perspective of their mutual relations. Based on them we attempt to specify some possible and appropriate ways of information and expert system co-operation. An example based on interaction between the clinical information system MEDAS and the expert system CODEX is given. Keywords: Expertsystem,informationsystem,database, knowledgebase
Information and expert system relations The relations between data, information and knowledge could be considered as the underlying framework for determining the relations between an information system and an expert system. A possible understanding of the former relations is as follows:
data (facts) correspond to singular statements about the world
information corresponds to (composite) statements derived from data, usually in a given context, suggesting some action to be taken knowledge is a result of information processing taking the form of definitions, descriptions, generic statements, models and methods enabling information to be inferred from data as well as making prescriptions for performing actions. For example, the age, weight, height and sex of a person are data from which the body surface of the person can be derived (information) based on the knowledge relating the somatic parameters of the person, his age and sex to its body surface. An information system (IS) is primarily doncerned with storing and processing great amounts of (mostly) uniform data in its database. The user of it, exploiting its functions, may gain from the data sufficient information for his decision and control activities. An expert system has in its knowledge base an organised collection of pieces of knowledge representing together some of the knowledge related to a specific problem domain and in its inference engine it embodies some general strategic knowledge in the form of algorithms. Its user may utilise this knowledge for processing the information the ES currently possesses to gain the interpretation and/or instructions for carrying out decision and control activities. Both kinds of systems are designed so as to support and improve the quality of their users' actions. However, there are significant differences in the principles and methods incorporated in ISs and ESs in order to
118
fulfil their functions. While the former has tools (usually in the database management part) for creating and maintaining large databases covering vast problem areas, usually concerning a particular population, they are seldom, if at all, able to produce more than well organised printouts from various kinds of data in explicitly specified relations. Their successive analysis and resolution of implicit inter-relations or causal dependencies - i e, goal-oriented interpretation - is left to the user. In contrast, the ESs are nowadays equipped with rather limited knowledge bases, operating on a rich variety of non-uniform data related to specific entities, and serve as a tool for interpreting the given facts and thus for solving a particular problem. The knowledge about the world represented in their knowledge base creates the ground for considering the associations, causalities, contexts, conditions, taxonomies, etc, for relating the given data in the domain from which the problem is originating. This results in instructions, with explanations, for carrying out decision activities even in cases when the data are incomplete, uncertain, imprecise and the problem at hand is ill-structured. From those differences some of the common features pertaining to the functional use of the IS and ES could be derived. In our case we are considering the expected possible mutual support and co-operation of these systems as follows: (a) The IS is hosting the ES which is then a means for broadening its functional reach by knowledgeable information interpretation; the level of performance capability of the IS is raised in this manner. (b) The ES is interfaced with the IS in order to drain from its database the data needed for solving the given particular problem thus avoiding the need to request information from the ES user when it is available in the attached source. (c) The database in the IS can serve as a source for acquiring pieces of knowledge for the knowledge base design and simultaneously as a verifications tool for ES performance.
MeasurementVol 8 No 3. JuI-Sep1990
Fandak et al Based on our own experience as well as on a general assessment of medical informatics we suppose that incorporating the knowledge features and programming style of ESs into ISs will in the near future become the reality facilitating successful evolution of both kinds of systems. We expect that in this respect a major influence will develop from the side of the IS community their users and developers - and that requirements and needs stemming from IS environments will lead to development of sophisticated intelligent interfacing mechanisms between those systems. This expectation is being supported by the contemporary situation of IS applications: • The number of IS applications is steadily growing; we are witnessing the proliferation of renewed and second generation IS applications in a vast spectrum of problem areas. • The IS users' community in general has considerable experience with computers and rather clear ideas as to what, why and how to profit from existing databases. • The long established IS use leads to rich databases and files containing abundant historical data enabling trends to be traced, historical connections made, casual relations revealed, influencing contexts traced, etc. • The ISs are in the process of extensive technological development to a higher quality level (e g, nets, distributed systems, parallel processors, database machines) and their further development is supported by rather a solid theoretical background. A practical e x a m p l e of IS and ES interconnection Since 1985 we have been engaged with practical problems of IS and ES interconnection. The goal of our effort is to reach an efficient level in interfacing the clinical information system MEDAS and the diagnostic expert system CODEX, both developed at the Research Institute of Medical Bionics, Bratislava, Czechoslovakia (Fand~ik et al, 1985). MEDAS (MEdical DAtabase System) is a modular clinical information system used by the staff of a clinical department (physicians and nurses). Its purpose is recording and processing the patient's data during his hospital stay - e g, medical history, current patient state, working diagnoses, daily progress record, lab examinations, therapy and medications, etc. The results of data processing are, among others, daily care plans for nurses and orders for procedures and examinations, as well as various print-outs as .a record of departmental performance. At the time of the patient's discharge, the patient data are stored in archival files. There are two ways of processing archival data files: in the case of the patient being re-admitted to hospital his archival data could be reactivated and archival files reviewed searching for various data and their respective evaluation (Fand~ik et al, 1984). CODEX is an expert system incorporating the principles of artificial intelligence with data structures representing medical knowledge. The system is designed to parallel human reasoning in solving medical problems such as diagnosis, treatment planning and predicting patient outcome. Measurement Vol 8 No 3, JuI-Sep 1990
For the basic system CODEX several knowledge bases have been developed. Their aim is to provide diagnostic assistance in various fields of medicine. Currently there are available knowledge bases for neurology, physiology, biochemistry, psychiatry and histology. Despite the fact that some of the knowledge bases cover a large number of diagnoses (more than two hundred) they still cover rather narrow problem domains. For the diagnosis of cerebellum syndromes and localised lesions and entrapments of the nerves of the peripheral limbs, two neurological knowledge bases have been designed. The ES CODEX with those knowledge bases is in regular practical use at the first neurology clinic of the Comenius University Medical School. Besides this, the medical staff of this clinic are daily exploiting the services of the MEDAS information system which makes it possible to store and process inpatient data. The implementation of the CODEX system took place several years after the MEDAS system had been introduced to this clinic. Very soon after the CODEX implementation it became obvious that it was very annoying for physicians to have to input some of the patient data twice, as both of the systems did not know about each other. As a natural result, the idea of interconnecting both systems originated. From several possible approaches the clinical staff decided to pursue the following means of system cooperation. After acquiring the patient data gained from objective neurological examination (current status) with the assistance of MEDAS on the clinical ward, the CODEX is to be activated (automatically) in the background to process these data and to complete the database with its diagnostic results. In addition, the MEDAS should enable CODEX to be activated in the foreground which means in direct user-system interaction whenever it is needed to process the MEDAS data completed with those available (even supposedly) from its user. Naturally, the independent use of CODEX, especially for knowledge base development and maintenance, is to be preserved. This decision was accepted and the resulting interconnection carried out. The program solution was rather complicated. As both systems were developed completely independently, their inter-connection necessitated the development of a special programming interface. This interface receives and analyses CODEX data requests and selects, from MEDAS database, the appropriate information. To fulfil this task, special procedures had to be worked out enabling, for every CODEX request, access to the current patient state specifying parts of the MEDAS database (in the case of a non-trivial request sets of alternative structures could be taken into consideration) where the information could be found. The integral interface function is then the transformation of the selected information into the form accepted by CODEX. The consequence of parallel but independent development of both systems is a serious drawback as regards interface design. In the situation where amendment or changes in relevant parts of MEDAS or CODEX are to be carried out, there is also the need to make appropriate adjustments in the interface and its procedures. The time needed for CODEX to run through the data of one patient is considerable (up to 8 minutes), but in the case of its being used in the background this does not 119
Fandak et al require any presence of or contact with the user. That is why we regard the designed interconnection as the best choice under existing conditions. Both systems - MEDAS and CODEX alike - are written in STANDARD MUMPS language.
machine of the ES thereby enabling the ES to be used over data stored in the IS database. • To design external features of IS and ES interconnection in such a way that the IS will be able to use the ES directly without the need for ES activity to be initialised by the user.
Conclusion
References
We would like to use our experiences from the interconnection of IS and ES in new applications. According to experience gained from our first experiment it seems to be appropriate to proceed in the following series of steps: • On the basis of analysis of the IS application area (data types, user. environment requirements) to specify problems suitable for being supported by the ES. • To specify (in selected areas) requirements on data structures and knowledge base. • To develop simultaneously the database management system of the IS and the knowledge base of the ES, application programs of the IS and the inference
Fand~ik, A., et al. 1984. MEDAS - Medical Database System of Hospital Department, Technical Report, Medical Bionics Research Institute. Bratislava. Fanddk, A., Popper, M., S~kora, M., Guregov~i, M., and Fanddkovd, K. 1985. MEDAS and CODEX: Connecting a Clinical Information System with a Diagnostic Expert System. In: Van Bemmel, Grrmy and Zv~irovfi (Eds), Medical Decision Making, Elsevier Science Publishers, Amsterdam, 361-364. Popper, M. and Gy,'trfii~, F. 1984. CODEX: A Computer Based Diagnostic Expert System. In: Plander, I. (Ed), Artificial Intelligence and Information-control Systems of Robots, North-Holland, Amsterdam, 297-300.
TEMPMEKO 90/Technical Diagnostics 17-19 September 1990, Helsinki, Finland Technical diagnostics The symposia on Technical Diagnostics are the main events of IMEKO TC 10. The aim of this Symposium is to report and review the state of the art of technical diagnostics. Special emphasis is put on the advancements in: on-line condition monitoring systems, future trends in expert systems in diagnostics and applications in process industries. The general theme will be new methods and technologies for on-line diagnostic systems. Topics will include:
1. 2. 3. 4. 5. 6.
Applications in process industries New hardware and software for diagnostic systems Expert systems and artificial intelligence Model based methods New sensors and measurement devices Technical diagnostics in electronics and computers
methods, but also to the use of electronics and microcomputers in temperature and thermal measurement and control systems. Emphasis is given to the improvement of efficiency in industrial and nonindustrial applications. Main topics will include: • Temperature measurement with contact and contactless thermometers. • Temperature sensors and their calibration. • Realisation and improvement of the International Temperature Scale. • Dynamic behaviour and correction of thermometers and of temperature measuring systems. • Radiation temperature measurement and thermography. • Optical, spectroscopic and acoustic temperature measurement. • Measurement of thermophysical properties of materials.
T E M P M E K O 90
The TEMPMEKO symposia are the main events of IMEKO TC-12 every three years. They provide international exchange of opinions in the whole field of temperature and thermal measurements, and offer an opportunity to discuss the main trends of research, development and applications. Attention is not only paid to metrology, sensors and to new measurement 120
Venue
The Symposium will take place at the Helsinki Fair Centre where Automation Days 90, an exhibition and congress event, will be held during the same week. They are being organised by: Finnish Automation Support Ltd, H~hneentie 6 A 15, SF-00530 Helsinki, Finland. MeasurementVol 8 No 3, JuI-Sep1990