Bruce I. Blum

A vocabulary for medical informatics

The terminology in medical informatics is evolving rapidly. The organizers of MEDINFO and SCAMC have used different sets of keywords to index their documents. Recognizing the limitations of this approach, members of those organizations joined with the National Library of Medicine in the creation of a better terminology for medical informatics. A hierarchical structure was placed on the terms to produce a thesaurus typical of the sort often used in the indexing and retrieving of documents. The building of this thesaurus began with an automatic merging of the thesaurus used by the Association of Computing Machinery and the Information Sciences component of the Medical Subject Headings. This product was pruned by eliminating terms not related to those in the MEDINFO keyword list or not in the medical informatics literature. Further refinement of the thesaurus resulted from extensive discussions among the authors of this paper. The first major application of this terminology has been to the indexing of the articles in MEDINFO-86 Proceedings. Major components of this medical informatics thesaurus also have been incorporated into the Medical Subject Headings. This paper describes the process of preparing the thesaurus and presents an evaluation of its coverage of the MEDINFO-86 Proceedings.

An Integrated Data Model for Patient Care

The Johns Hopkins Oncology Center has been using a clinical information system since 1977 to assist in medical decision making and protocol directed patient management. This paper describes how these functions have been implemented in terms of their data model. The intent is to 1) facilitate transfer of the concepts used at Johns Hopkins to other clinical systems, and 2) illustrate the power of data modeling as a design technique.

Some philosophic foundations for an environment for system building

This paper considers the philosophic foundations for a system which automatically produces interactive information systems (IIS). Based upon an interpretation of the software process, a review of the knowledge domains used during the process, a description of the models represented by the process, and a consideration of the biases imposed by the cognitive process, two assertions are made: (1) it is possible to build a knowledge base that completely specifies an IIS application, and (2) it is possible to generate an operational IIS from that knowledge base automatically. A research system dedicated to demonstrating this-the Environment for Building Systems-is then briefly described. 1. Intmchxtion This paper examines issues in system development and constructs some philosophic foundations for an environment that can automatically generate systems within that framework. We start by establishing the reasonableness of the following assumptions:. The objects to be implemented are systems and not programs; most programming issues, therefore, are irrelevant.. The process of system development is one of modeling. It involves transformations from one model to another. The process begins with a conceptual model of the target system which then is refined until an operational system exists.. There are three model categories: models of the real world needs, models of the target system, and the cog-nitive models used by the analysts during the transformation. The software process involves all three.. There are two knowledge domains used in the software process: an application domain and the domain of the software transformations. Any knowledge-based development approach must operate in both domains. Using the context of these assumptions, the software process can be described as two major transformations: from the real world into a problem statement, and from a problem statement into an implementation statement. The last is isomorphic to the target sys-Permission to copy without fee all or part of this material is granted provided that the copies are not made or distributed for direct commercial advantage, the ACM copyright notice and the title of the publication and its date appear, and notice is given that copying is by permission of the Association for Computing Machinery. To copy otherwise, or to republish, requires a fee and/or specific permission.

Resolving the software maintenance paradox

00.75 tern. Because the software process is a function of the class of application being developed, the paper limits itself to consideration of an application class in which the greatest risks are associated with the first transformation. Once the assumptions have …

Three paradigms for developing information systems

This paper explores the apparent paradox that, although performance improves with experience, the maintenance of a software system becomes more difficult as experience with it accumulates. It is asserted that this phenomenon is a side effect of the environment used to maintain the software. A decade of experience with a large and complex clinical information system is summarized to demonstrate that software maintenance may be inherently less difficult than original development. It is shown that a highly integrated, million-line, operational system, used in life-threatening situations, has been maintained effectively by a staff of six. During the past five years, the size of the system increased by 167%. In addition to maintaining a growing number of programs, the staff produced new programs at a rate of 0.64 programs per effort-day. Moreover, the case study also demonstrates that this level of performance can be transported to other sites. The paper concludes with some observations regarding changes to the software process that will resolve the paradox.