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Providing Concept-oriented Views for Clinical Data Using a Knowledge-based System

An Evaluation

Affiliations of the authors: Harvard Medical School, Boston, Massachusetts (QZ, KHZ); Columbia University, New York, New York (JJC).

Correspondence and reprints: Qing Zeng, PhD, Decision System Group, Thorn Building #309, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail: <Qzeng{at}dsg.harvard.edu>.

Objective: Clinical information systems typically present patient data in chronologic order, organized by the source of the information (e.g., laboratory, radiology). This study evaluates the functionality and utility of a knowledge-based system that generates concept-oriented views (organized around clinical concepts such as disease or organ system) of clinical data.

Design: The authors have developed a system that uses a knowledge base of interrelationships between medical concepts to infer relationships between data in electronic medical records. They use these inferences to produce summaries, or views, of the data that are relevant to a specific concept of interest. They evaluated the ability of the system to select relevant information, reduce information overload, and support physician information retrieval.

Measurements: The sensitivity and specificity of the system for identifying relevant patient information were calculated. Effect on information overload was assessed by comparing the amount of information in each view with the amount of information in the entire record. Information retrieval accuracy and cost (time) were used to measure the effect of using conceptoriented views on the efficiency and effectiveness of retrievals.

Results: The sensitivity and specificity of the system for identifying relevant clinical information were generally in the range of 70 to 80 percent. Concept-oriented views are effective in reducing the amount of information retrieved (over 80 percent reduction) and, compared with sourceoriented views, are able to improve physician retrieval accuracy (p=0.04).

Conclusion: Computer-generated, concept-oriented views can be used to reduce clinician information overload and improve the accuracy of clinical data retrieval.

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