Engineering Approach to Individually Tailored Medicine

个体化医疗的工程方法

• 批准号: 6749459
• 负责人: ALEX BUI
• 金额: $ 59.46万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 1984
• 资助国家: 美国
• 起止时间: 1984-08-01 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6749459
• 关键词: automated medical record system; clinical research; computer assisted medical decision making; data collection methodology /evaluation; human data; informatics; information display; information system analysis; mathematical model; medical records; outcomes research; patient care management; performance

DESCRIPTION (provided by applicant): Technological advances in medicine, particularly imaging, have resulted in early detection, objective documentation, and overall better insight into medical conditions. These advances, however, have also led to an increasingly complex medical record. Physicians now spend a significant portion of their time retrieving, structuring, organizing, and analyzing patient data, inaccurately and inefficiently: current information management systems in clinical medicine do not adequately support these functions, critical to the real-world practice of evidence-based medicine. Objective evidence, tailored to an individual patient, must be readily available to physicians as part of routine practice if true evidence-based medical practice is to become a reality. This proposal details the development and evaluation of several innovative technologies, providing solutions for the information management problems faced by physicians: 1) a distributed XML-based peer-to-peer medical record architecture, to enable portability and accessibility of patient information, regardless of geographical location; 2) a natural language processing (NLP) system for free-text medical reports, to automatically structure and characterize the contents of medical documents; 3) a phenomenon-centric data model, which supports the problem-solving tasks of the physician through explicit linking of objective findings (e.g., images, lab values) to medical problems; and 4) a time-based, problem-centric, context-sensitive visualization of the medical record, supporting a "gestalt" view of the patient, with access to detailed patient data when needed. Together, these technologies will form a comprehensive system facilitating evidence-based medicine in a real-world environment. System evaluation will proceed in two parts. Technical evaluation focuses on each of the proposed technologies individually, gauging classical performance metrics: scalability of the distributed medical record; NLP precision/recall; expressibility/comprehensibility of the data model; and the usability of the new medical record user interface. Clinical evaluation will follow a time series study design ("off-on-off"), with implementation of the entire system in a real-world clinical environment, the UCLA Clark Urological Center. Clinical evaluation will measure the effectiveness of the system as a whole on intermediate outcomes (process of care) including the number of visits, number of procedures performed, and time to final diagnosis (disposition), as well as the impact on physician efficiency (time required to gather information and review charts).

描述（由申请人提供）： 医学方面的技术进步，尤其是成像，导致了早期发现，客观文档以及对医疗状况的更好洞察力。但是，这些进步也导致了日益复杂的病历。现在，医师花费了很大一部分时间来检索，结构，组织和分析患者数据的不准确和效率低下：临床医学中当前的信息管理系统不能充分支持这些功能，这对循证医学的现实实践至关重要。如果真正的基于证据的医学实践成为现实，则必须为医生量身定制的客观证据，以便医生很容易为常规实践提供。该建议详细介绍了几种创新技术的开发和评估，为医生面临的信息管理问题提供解决方案：1）分布式的基于XML的点对点医疗记录体系结构，以实现患者信息的可移植性和可访问性，无论地理位置如何； 2）自由文本医学报告的自然语言处理（NLP）系统，以自动构建和表征医疗文档的内容； 3）以现象为中心的数据模型，该模型通过将客观发现（例如，图像，实验室值）与医学问题进行明确联系来支持医师解决问题的任务； 4）对病历的基于时间的，以问题为中心的，上下文敏感的可视化，支持患者的“格式塔”视图，并在需要时访问详细的患者数据。这些技术将共同形成一个全面的系统，促进现实世界中的循证医学。系统评估将分为两部分。技术评估重点介绍了每个提出的技术，分别测量了经典性能指标：分布式病历的可伸缩性； NLP精度/召回；数据模型的表达性/可理解性；以及新的病历用户界面的可用性。临床评估将遵循时间序列研究设计（“关闭”），并在现实世界中的临床环境（UCLA Clark Clark泌尿科中心）中实施整个系统。临床评估将衡量整个系统对中间结果（护理过程）的有效性，包括访问的数量，执行的程序数量以及最终诊断时间（处理）以及对医师效率的影响（收集信息和审查图表所需的时间）。