Medical Informatics
University of Minnesota Medical School
Creating the clinician's workstation for better decision making
Reproduced with permission from NeXT
Computer, Inc.
A Reference
Guide to NeXT in Higher Education, Fall 1992
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1992 NeXT Computer, Inc
Hospitals are data-rich environments. Doctors can turn to
numerous sources to determine a patient's diagnosis and
treatment. Unfortunately, this information is typically
spread across many areas of the hospital and arrives in
bits and pieces throughout a patient's stay. That makes it
difficult to access data quickly or to review key data that
might be buried in a flood of paper.
"Forced to make speedy decisions, doctors often find
themselves relying heavily on the vagaries of memory,
making decisions with less than all the available and
relevant data," says Donald Connelly, M.D., associate
professor of laboratory medicine and pathology.
Recently, though, Connelly and other medical information
scientists in the Department of Laboratory Medicine and
Pathology at the University of Minnesota Medical School
have begun to develop a method for doctors to obtain more
quickly the objective information they need, as well as
feedback that encourages student physicians to follow
practices that are recommended by the medical staff. With
funding from the National Institutes of Health and the
University of Minnesota Hospital and Clinic, a team of
medical informatics researchers, physicians, nurses, and
laboratorians are creating a NeXT computer-based
clinicians' workstation to provide doctors and nurses with
ready access to a variety of information-in this case,
pertaining to transfusion medicine and clinical laboratory
test results.
"Our intent is to provide our clinicians easy access to
laboratory results in a form that makes the data easy to
review and use," says Connelly. "We then hope to improve
transfusion medicine practices at our hospital."
The workstation is connected to the hospital's laboratory
information system and automatically receives and stores
results as soon as they are completed in the laboratory.
Physicians can review a patient's status at a glance and
order platelet transfusions and other laboratory tests for
patients with hematological disorders. The workstation then
gives instant feedback on the appropriateness of the order,
based on clinical guidelines developed by the local medical
staff. These guidelines have been incorporated into the
knowledge base of the workstation's expert system, Expert
System for Platelet Request Evaluation, or ESPRE.
According to co-investigator Bruce Sielaff, Ph.D., "As with
many expert systems, ESPRE was originally developed in
LISP. The flexibility of the LISP environment greatly
simplifies the incremental development characteristic of
expert systems. On the other hand, to simplify integration
of the expert system into the clinical workstation
application, when the design stabilized, ESPRE was
rewritten in Objective C. The object-oriented environment
allowed the conversion to be relatively painless."
After analyzing the situation, ESPRE indicates which
laboratory-based criteria for transfusion have been met. If
no laboratory-based criteria seem to be satisfied, the
expert system asks for additional clinical information that
might satisfy other criteria for transfusion. Since
guidelines cannot cover all possible clinical situations,
physicians can also type in a reason why transfusion might
be necessary.
Connelly says the development team has relied extensively
on NeXT's Interface Builder in working with physicians,
laboratorians, and nurses to develop the application.
"Interface Builder has been very valuable in working with
clinicians," he says. "We bring our workstation prototype
to introductory meetings with our clinicians. Within 20
minutes we can cover the basic concepts underlying the
project and be actively working on critiquing and improving
the prototype. It's much easier for busy clinicians to
consider and critique a model of the workstation than
having to wade through a long list of technical
specifications."
He continues, "We wouldn't be able to complete the
workstation in time if we were working in any other
development environment. We'd have to do everything on
paper first; get people to sign off on specifications; and
then, six months later, come back hoping we had created
what was asked for, as well as hoping they asked for what
they needed."
Connelly says, "The modern hospital environment is too
complex and dynamic for conventional development
approaches." He adds that because of the flexibility of the
NeXT platform, the development team has incorporated a
comments button so clinical users can easily send
developers suggestions for improvement.
This summer, the workstation will be implemented in four
patient-care units at the University of Minnesota Hospital.
A crossover trial will be conducted to determine the effect
of feedback on interns' knowledge of transfusion medicine
principles and on platelet transfusion practice. The
acceptability of the workstation to clinicians will also be
assessed.
Connelly adds that the application is not limited to use in
transfusion medicine, but can be adapted to other areas of
medicine as well. "We have already expanded it to ordering
and scheduling laboratory tests that are part of bone
marrow transplantation research protocols," he says. "This
is the beauty of working on the NeXT machine. We develop
building blocks in a short amount of time and can then use
them for other projects. Interface Builder has been a real
lever for us. If we had been working on any other system,
I'm sure we'd still be specifying functions and worrying
how we were going to implement them. Instead, we are
concentrating on how we can help our clinical colleagues do
their very important tasks better and easier."
For more information, please contact:
Donald P. Connelly, M.D., Ph.D.
Associate Professor of Laboratory Medicine and Pathology
University of Minnesota Medical School
BOX 198 UMHC
Minneapolis, MN 55455
(612) 624-4689
doncon@tahiti.umhc.umn.edu