Marius Fieschi

Virtual biomedical universities and e-learning

In this special issue on virtual biomedical universities and e-learning we will make a survey on the principal existing teaching applications of ICT used in medical Schools around the world. In the following we identify five types of research and experiments in this field of medical e-learning and virtual medical universities. The topics of this special issue goes from educational computer program to create and simulate virtual patients with a wide variety of medical conditions in different clinical settings and over different time frames to using distance learning in developed and developing countries program training medical informatics of clinicians. We also present the necessity of good indexing and research tools for training resources together with workflows to manage the multiple source content of virtual campus or universities and the virtual digital video resources. A special attention is given to training new generations of clinicians in ICT tools and methods to be used in clinical settings as well as in medical schools.

Information technology is changing the way society sees health care delivery

The development of Information and Communication Technologies (ICT) shall have a high impact on health care and patient management. Some of the factors underlying this development as well as the recommendations made for optimum use of those technologies are discussed in this article.

Health search engine with e-document analysis for reliable search results.

OBJECTIVE After a review of the existing practical solution available to the citizen to retrieve eHealth document, the paper describes an original specialized search engine WRAPIN. METHOD WRAPIN uses advanced cross lingual information retrieval technologies to check information quality by synthesizing medical concepts, conclusions and references contained in the health literature, to identify accurate, relevant sources. Thanks to MeSH terminology [1] (Medical Subject Headings from the U.S. National Library of Medicine) and advanced approaches such as conclusion extraction from structured document, reformulation of the query, WRAPIN offers to the user a privileged access to navigate through multilingual documents without language or medical prerequisites. RESULTS The results of an evaluation conducted on the WRAPIN prototype show that results of the WRAPIN search engine are perceived as informative 65% (59% for a general-purpose search engine), reliable and trustworthy 72% (41% for the other engine) by users. But it leaves room for improvement such as the increase of database coverage, the explanation of the original functionalities and an audience adaptability. CONCLUSION Thanks to evaluation outcomes, WRAPIN is now in exploitation on the HON web site (http://www.healthonnet.org), free of charge. Intended to the citizen it is a good alternative to general-purpose search engines when the user looks up trustworthy health and medical information or wants to check automatically a doubtful content of a Web page.

Experimenting with new paradigms for medical education and the emergence of a distance learning degree using the internet: teaching evidence-based medicine

This paper is focused on designing and developing a teaching environment associated with an introductory course in evidence-based medicine designed for undergraduates. Attempting to break away from the traditional educational model based on acquisition of factual knowledge, we developed a software tool centred on content management, student assessment and feedback. We ran this course on an educational website, using chat rooms and electronic mail for trainer-trainee communication over one academic year. The website served as a repository for knowledge and information and presented freestanding web-based interactive study modules and a non-interactive degree course. Trainers and trainees responded favourably to the computer applications and the Internet. This project demonstrated the feasibility of computer-aided learning and the advantages of distance teaching over the Internet.

UMLS-based Conceptual Queries to Biomedical Information Databases:

Objective: The aim of the project ARIANE is to model and implement seamless, natural and easy to use interfaces with various kinds of heterogeneous biomedical information databases. Design: A conceptual model of some of the Unified Medical Language System (UMLS) knowledge sources has been developed to help end-users to query information databases. A query is represented by a conceptual graph that translates the deep structure of an end-users interest in a topic. A computational model exploits this conceptual conceptual model to build a query interactively represented as query graph. A query graph is then matched to the data graph built with data issued from each record of a database by means of a pattern-matching (projection) rule that applies to conceptual graphs. Results: Prototypes have been implemented to test the feasability of the model with different kinds of information databases. Three cases are studied: 1) information in records is structured according to the UMLS knowledge sources, 2) information is able to be structured without error in the frame of the UMLS knowledge, 3) information cannot be structured. In each case the pattern-matching is processed by the projection rule according to the structure of information that has been implemented in the databases. Conclusion: The conceptual graphs theory provides with a homogeneous and powerful formalism able to represent both concepts, instances of concepts in medical contexts, associations by means of relationships, and to represent data at some levels of details. The conceptual graphs formalism allows powerful capabilities to operate a semantic integration of information databases using the UMLS knowledge sources.

A semantic approach for the homogeneous identification of events in eight patient databases: A contribution to the European eu-ADR project

The overall objective of the eu-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four different terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.

A Web Terminology Server Using UMLS for the Description of Medical Procedures

The Model for Assistance in the Orientation of a User within Coding Systems (MAOUSSC) project has been designed to provide a representation for medical and surgical procedures that allows several applications to be developed from several viewpoints. It is based on a conceptual model, a controlled set of terms, and Web server development. The design includes the UMLS knowledge sources associated with additional knowledge about medico-surgical procedures. The model was implemented using a relational database. The authors developed a complete interface for the Web presentation, with the intermediary layer being written in PERL. The server has been used for the representation of medico-surgical procedures that occur in the discharge summaries of the national survey of hospital activities that is performed by the French Health Statistics Agency in order to produce inpatient profiles. The authors describe the current status of the MAOUSSC server and discuss their interest in using such a server to assist in the coordination of terminology tasks and in the sharing of controlled terminologies.

Design and evaluation of a semantic approach for the homogeneous identification of events in eight patient databases: a contribution to the European EU-ADR project

The overall objective of the EU-ADR project is the design, development, and validation of a computerised system that exploits data from electronic health records and biomedical databases for the early detection of adverse drug reactions. Eight different databases, containing health records of more than 30 million European citizens, are involved in the project. Unique queries cannot be performed across different databases because of their heterogeneity: Medical record and Claims databases, four different terminologies for coding diagnoses, and two languages for the information described in free text. The aim of our study was to provide database owners with a common basis for the construction of their queries. Using the UMLS, we provided a list of medical concepts, with their corresponding terms and codes in the four terminologies, which should be considered to retrieve the relevant information for the events of interest from the databases.

Sharing knowledge in medicine: semantic and ontologic facets of medical concepts

The problem of making medical knowledge and medical data sharable over applications and reusable for several purposes is crucial. Ontologies can be used as a common framework for several systems. Principles for the construction of ontologies have been proposed: parsimony, clarity, categories versus terms, and coherence. Difficulties arise from the fact that medical concepts are empirical rather than perfectly defined, leading to semantic and conceptual adaptation. Medical knowledge has been built by the richness of meticulous patient observations, described by subtle attributes; e.g., ADM, a French program that assists the user in the diagnostic process, contains 1859 items for pain. Medical concepts are not fixed: the plague was well-identified by the XVIlth doctors but knowledge about the plague has changed. Medical terminology may be specific or vague although it is supposed to be universal. Moreover a medical concept occurs in a conceptual representation, so reference to several models is needed even for basic and a priori universal knowledge such as anatomy in medicine. As well as for concepts, sharable basic categories are difficult to obtain: this is illustrated by the SNOMED axes and the UMLS semantic types. Efficient computerised tools adapted to the biomedical domain must implement a sophisticated representation of biomedical concepts, based on some principles, taking into account the richness of medical semantics, and different levels of expertise in medical knowledge, separating roles and concepts, building a multifaceted concept space, modelling the relations between the concepts in order to compensate for the lack of a general theoretical basis of the domain.

Designing and implementing health data and information providers

OBJECTIVES To model and implement web portals providing access to certified and high-quality information in the domain of health. MATERIAL AND METHODS The Unified Medical Language System (UMLS) knowledge sources of the U.S. National Library of Medicine and principles of implementation resulting from the previous ARIANE project are described. The XML technology that allows files transformations by the means of XSLT is briefly presented. RESULTS The design and implementation of software modules that exploit knowledge sources, operate the translation of a users query to selected information sources, and wrap obtained results are detailed. Querying documentary and factual medical databases are presented. DISCUSSION Current implementation and wrapping perspectives are discussed in terms of integration and interoperability of health information and data resources.