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Evolution and Revolution in Knowledge-Driven Health IT: A 50-Year Perspective and a Look Ahead

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Knowledge Representation for Health Care (AIME 2015)

Part of the book series: Lecture Notes in Computer Science ((LNAI,volume 9485))

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Abstract

In this keynote presentation, my intent is to explore the evolution of the field of computer-based clinical decision support (CDS) – and its associated tasks of knowledge acquisition, knowledge modeling, knowledge representation, knowledge management, and knowledge integration into care processes – over the past five decades. I believe that we are now in a period of significant disruption – both in the health care system itself and in the technology to support it. As a result of these disruptors, I am convinced that we will need to not only continue the efforts that have proved useful in the past but also to develop some new strategies to meet the new challenges.

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References

  1. Warner, H.R., Toronto, A.F., Veasy, L.G.: Experience With Baye’s theorem for computer diagnosis of congenital heart disease. Ann. N. Y. Acad. Sci. 115, 558–567 (1964)

    Article  Google Scholar 

  2. Lodwick, G.S.: A probabilistic approach to the diagnosis of bone tumors. Radiol. Clin. North Am. 3, 487–497 (1965)

    Google Scholar 

  3. Greenes, R.A.: Clinical Decision Support: The Road to Broad Adoption, 2nd edn. Elsevier, New York (2014)

    Google Scholar 

  4. Kohn, L., Corrigan, J., Donaldson, M.: Committee on Quality of Health Care in America IoM. To Err Is Human: Building a Safer Health System. National Academies Press, Washington, D.C. (1999)

    Google Scholar 

  5. IOM. Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington D.C. (2001)

    Google Scholar 

  6. Ledley, R.S., Lusted, L.B.: Reasoning foundations of medical diagnosis; symbolic logic, probability, and value theory aid our understanding of how physicians reason. Science 130, 9–21 (1959)

    Article  Google Scholar 

  7. Bleich, H.L.: Computer evaluation of acid-base disorders. J. Clin. Invest. 48, 1689–1696 (1969)

    Article  Google Scholar 

  8. Greenes, R.A., Sidel, V.W.: The use of computer mapping in health research. Health Serv. Res. 2, 243–258 (1967)

    Google Scholar 

  9. Greenes, R.A., Pappalardo, A.N., Marble, C.W., Barnett, G.O.: Design and implementation of a clinical data management system. Comput. Biomed. Res. 2, 469–485 (1969)

    Article  Google Scholar 

  10. Greenes, R.A., Barnett, G.O., Klein, S.W., Robbins, A., Prior, R.E.: Recording, retrieval and review of medical data by physician-computer interaction. N. Engl. J. Med. 282, 307–315 (1970)

    Article  Google Scholar 

  11. Weed, L.L.: Medical records that guide and teach. N. Engl. J. Med. 278, 593–600 (1968)

    Article  Google Scholar 

  12. Pendergrass, H.P., Greenes, R.A., Barnett, G.O., Poitras, J.W., Pappalardo, A.N., Marble, C.W.: An on-line computer facility for systematized input of radiology reports. Radiology 92, 709–713 (1969)

    Article  Google Scholar 

  13. McDonald, C.J.: Protocol-based computer reminders, the quality of care and the non-perfectability of man. N. Engl. J. Med. 295, 1351–1355 (1976)

    Article  Google Scholar 

  14. Shortliffe, E.H., Davis, R., Axline, S.G., Buchanan, B.G., Green, C.C., Cohen, S.N.: Computer-based consultations in clinical therapeutics: explanation and rule acquisition capabilities of the MYCIN system. Comput. Biomed. Res. 8, 303–320 (1975)

    Article  Google Scholar 

  15. Miller, R.A., Pople Jr., H.E., Myers, J.D.: Internist-1, an experimental computer-based diagnostic consultant for general internal medicine. N. Engl. J. Med. 307, 468–476 (1982)

    Article  Google Scholar 

  16. Pauker, S.G., Gorry, G.A., Kassirer, J.P., Schwartz, W.B.: Towards the simulation of clinical cognition. Taking a present illness by computer. Am. J. Med. 60, 981–996 (1976)

    Article  Google Scholar 

  17. van Melle, W., Shortliffe, E.H., Buchanan, B.G.: EMYCIN: a knowledge engineer’s tool for constructing rule-based expert systems. In: Buchanan, B.G., Shortliffe, E.H. (eds.) Rule-Based Expert Systems: The MYCIN Experiments of the Stanford Heuristic Programming Project, pp. 302–313. Addison Wesley, Reading (1984)

    Google Scholar 

  18. Kawamoto, K., Honey, A., Rubin, K.: The HL7-OMG Healthcare Services Specification Project: motivation, methodology, and deliverables for enabling a semantically interoperable service-oriented architecture for healthcare. J. Am. Med. Inform. Assoc. 16, 874–881 (2009)

    Article  Google Scholar 

  19. Schwartz, W.B.: Decision analysis. N. Engl. J. Med. 301, 54 (1979)

    Google Scholar 

  20. Greenes, R.A.: OBUS: a microcomputer system for measurement, calculation, reporting, and retrieval of obstetric ultrasound examinations. Radiology 144, 879–883 (1982)

    Article  Google Scholar 

  21. Greenes, R.A.: Computer-aided diagnostic strategy selection. Radiol. Clin. North Am. 24, 105–120 (1986)

    Google Scholar 

  22. Greenes, R.A.: “Desktop knowledge”: a new focus for medical education and decision support. Methods Inf. Med. 28, 332–339 (1989)

    Google Scholar 

  23. Greenes, R.A.: Interactive microcomputer-based graphical tools for physician decision support. Aids to test selection and interpretation and use of Bayes’ theorem. Med. Decis. Making 3, 15–21 (1983)

    Article  Google Scholar 

  24. Lindberg, D.A., Humphreys, B.L., McCray, A.T.: The unified medical language system. Methods Inf. Med. 32, 281–291 (1993)

    Google Scholar 

  25. Sato, L., McClure, R.C., Rouse, R.L., Schatz, C.A., Greenes, R.A.: Enhancing the Metathesaurus with clinically relevant concepts: anatomic representations. In: Proceedings of the Annual Symposium on Computer Applications in Medical Care, pp. 388–391 (1992)

    Google Scholar 

  26. Greenes, R.A., McClure, R.C., Pattison-Gordon, E., Sato, L.: The findings–diagnosis continuum: implications for image descriptions and clinical databases. In: Proceedings of the Annual Symposium on Computer Applications in Medical Care, pp. 383–387 (1992)

    Google Scholar 

  27. Greenes, R.A., Deibel, S.R.: Application development in the DeSyGNER environment: dynamic assembly of independent information resources via direct manipulation authoring. In: Proceedings of the Annual Symposium on Computer Applications in Medical Care, pp. 913–915 (1991)

    Google Scholar 

  28. Karson, T.H., Perkins, C., Dixon, C., Ehresman, J.P., Mammone, G.L., Sato, L., Schaffer, J.L., Greenes, R.A.: The PartnerWeb Project: a component-based approach to enterprise-wide information integration and dissemination. In: Proceedings of the AMIA Annual Fall Symposium, pp. 359–363 (1997)

    Google Scholar 

  29. Shareck, E.P., Greenes, R.A.: Publishing biomedical journals on the World-Wide Web using an open architecture model. In: Proceedings of the AMIA Annual Fall Symposium, pp. 343–347 (1996)

    Google Scholar 

  30. Greenes, R.: Harvard’s HealthAware project guides patients through healthcare decisions. Internet Healthc. Strateg. 3, 4–5 (2001)

    Google Scholar 

  31. Hripcsak, G.: Arden syntax for medical logic modules. MD Comput. 8(76), 78 (1991)

    Google Scholar 

  32. Peleg, M., Boxwala, A.A., Tu, S., Zeng, Q., Ogunyemi, O., Wang, D., Patel, V.L., Greenes, R.A., Shortliffe, E.H.: The InterMed approach to sharable computer-interpretable guidelines: a review. J. Am. Med. Inform. Assoc. 11, 1–10 (2004)

    Article  Google Scholar 

  33. Shortliffe, E.H., Barnett, G.O., Cimino, J.J., Greenes, R.A., Huff, S.M., Patel, V.L.: Collaborative medical informatics research using the Internet and the World Wide Web. In: Proceedings of the AMIA Annual Fall Symposium, pp. 125–129 (1996)

    Google Scholar 

  34. Ohno-Machado, L., Gennari, J.H., Murphy, S.N., Jain, N.L., Tu, S.W., Oliver, D.E., Pattison-Gordon, E., Greenes, R.A., Shortliffe, E.H., Barnett, G.O.: The guideline interchange format: a model for representing guidelines. J. Am. Med. Inform. Assoc. 5, 357–372 (1998)

    Article  Google Scholar 

  35. Peleg, M., Boxwala, A.A., Ogunyemi, O., Zeng, Q., Tu, S., Lacson, R., Bernstam, E., Ash, N., Mork, P., Ohno-Machado, L., Shortliffe, E.H., Greenes, R.A.: GLIF3: the evolution of a guideline representation format. In: Proceedings of the AMIA Symposium, pp. 645–649 (2000)

    Google Scholar 

  36. Boxwala, A.A., Peleg, M., Tu, S., Ogunyemi, O., Zeng, Q.T., Wang, D., Patel, V.L., Greenes, R.A., Shortliffe, E.H.: GLIF3: a representation format for sharable computer-interpretable clinical practice guidelines. J. Biomed. Inform. 37, 147–161 (2004)

    Article  Google Scholar 

  37. Sordo, M., Boxwala, A.A., Ogunyemi, O., Greenes, R.A.: Description and status update on GELLO: a proposed standardized object-oriented expression language for clinical decision support. Medinfo 11, 164–168 (2004)

    Google Scholar 

  38. Greenes, R.A., Sordo, M., Zaccagnini, D., Meyer, M., Kuperman, G.J.: Design of a standards-based external rules engine for decision support in a variety of application contexts: report of a feasibility study at Partners HealthCare System. Medinfo 11, 611–615 (2004)

    Google Scholar 

  39. Greenes, R.A.: Health Information Systems 2025. In: Weaver, C., Ball, M., Kim, G., et al. (eds.) Healthcare Information Management Systems: Reality, Visions and Future Roadmaps, 4th edn. Springer, Switzerland (2016)

    Google Scholar 

  40. Greenes, R.A.: Clinical Decision Support: The Road Ahead. Elsevier, New York (2007)

    Google Scholar 

  41. Friedman, C.P., Wong, A.K., Blumenthal, D.: Achieving a nationwide learning health system. Sci. Transl. Med. 2: 57cm29 (2010)

    Google Scholar 

  42. FHIR. FHIR DSTU 1 (V0.0.82): Welcome to FHIR (2014). http://www.hl7.org/implement/standards/fhir/. Accessed 21 March 2015

  43. Mandl, K.D., Mandel, J.C., Murphy, S.N., Bernstam, E.V., Ramoni, R.L., Kreda, D.A., McCoy, J.M., Adida, B., Kohane, I.S.: The SMART Platform: early experience enabling substitutable applications for electronic health records. J. Am. Med. Inform. Assoc. 19, 597–603 (2012)

    Article  Google Scholar 

  44. SMART: SMART: Tech Stack for Health Apps (2015). http://docs.smarthealthit.org/. Accessed 21 March 2015

  45. Lowell, K.H., Bertko, J.: The Accountable Care Organization (ACO) model: building blocks for success. J. Ambul. Care Manage. 33, 81–88 (2010)

    Article  Google Scholar 

  46. HSPC. The Healthcare Services Platform Consortium (2015). https://healthservices.atlassian.net/wiki/display/HSPC/Healthcare+Services+Platform+Consortium. Accessed 29 July 2015

  47. Greenes, R.A., Boxwala, A.: AppWorks - An innovative design and delivery tool for interoperable health apps (2015). https://sites.google.com/site/appworkshealth/home. Accessed 21 March 2015

  48. HeD. Health eDecisions Homepage (2014). http://wiki.siframework.org/Health+eDecisions+Homepage. Accessed 21 March 2015

  49. Greenes, R.A., Sottara, D., Haug, P.J.: Authoring and Editing of Decision Support Knowledge. In: Zhang, J., Walji, M. (eds.) Better EHR: usability, workflow and cognitive support in electronic health records. University of Texas, Houston, Houston (2014)

    Google Scholar 

  50. Middleton, B.: The clinical decision support consortium. Stud. Health Technol. Inform. 150, 26–30 (2009)

    Google Scholar 

  51. Greenes, R., Bloomrosen, M., Brown-Connolly, N.E., Curtis, C., Detmer, D.E., Enberg, R., Fridsma, D., Fry, E., Goldstein, M.K., Haug, P., Hulse, N., Hongsermeier, T., Maviglia, S., Robbins, C.W., Shah, H.: The Morningside Initiative: collaborative development of a knowledge repository to accelerate adoption of clinical decision support. Open Med. Inform. J. 4, 278–290 (2010)

    Article  Google Scholar 

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Correspondence to Robert A. Greenes .

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Greenes, R.A. (2015). Evolution and Revolution in Knowledge-Driven Health IT: A 50-Year Perspective and a Look Ahead. In: Riaño, D., Lenz, R., Miksch, S., Peleg, M., Reichert, M., ten Teije, A. (eds) Knowledge Representation for Health Care. AIME 2015. Lecture Notes in Computer Science(), vol 9485. Springer, Cham. https://doi.org/10.1007/978-3-319-26585-8_1

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  • DOI: https://doi.org/10.1007/978-3-319-26585-8_1

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