William R. Hersh

OHSUMED: an interactive retrieval evaluation and new large test collection for research

A series of information retrieval experiments was carried out with a computer installed in a medical practice setting for relatively inexperienced physician end-users. Using a commercial MEDLINE product based on the vector space model, these physicians searched just as effectively as more experienced searchers using Boolean searching. The results of this experiment were subsequently used to create a new large medical test collection, which was used in experiments with the SMART retrieval system to obtain baseline performance data as well as compare SMART with the other searchers.

Computerized Physician Order Entry in U.S. Hospitals: Results of a 2002 Survey

OBJECTIVE To determine the availability of inpatient computerized physician order entry in U.S. hospitals and the degree to which physicians are using it. DESIGN Combined mail and telephone survey of 964 randomly selected hospitals, contrasting 2002 data and results of a survey conducted in 1997. MEASUREMENTS AVAILABILITY computerized order entry has been installed and is available for use by physicians; inducement: the degree to which use of computers to enter orders is required of physicians; participation: the proportion of physicians at an institution who enter orders by computer; and saturation: the proportion of total orders at an institution entered by a physician using a computer. RESULTS The response rate was 65%. Computerized order entry was not available to physicians at 524 (83.7%) of 626 hospitals responding, whereas 60 (9.6%) reported complete availability and 41 (6.5%) reported partial availability. Of 91 hospitals providing data about inducement/requirement to use the system, it was optional at 31 (34.1%), encouraged at 18 (19.8%), and required at 42 (46.2%). At 36 hospitals (45.6%), more than 90% of physicians on staff use the system, whereas six (7.6%) reported 51-90% participation and 37 (46.8%) reported participation by fewer than half of physicians. Saturation was bimodal, with 25 (35%) hospitals reporting that more than 90% of all orders are entered by physicians using a computer and 20 (28.2%) reporting that less than 10% of all orders are entered this way. CONCLUSION Despite increasing consensus about the desirability of computerized physician order entry (CPOE) use, these data indicate that only 9.6% of U.S. hospitals presently have CPOE completely available. In those hospitals that have CPOE, its use is frequently required. In approximately half of those hospitals, more than 90% of physicians use CPOE; in one-third of them, more than 90% of orders are entered via CPOE.

A categorization and analysis of the criticisms of Evidence-Based Medicine

The major criticisms and limitations of Evidence-Based Medicine (EBM) appearing in the literature over the past decade can be summarized and categorized into five recurring themes. The themes include: reliance on empiricism, narrow definition of evidence, lack of evidence of efficacy, limited usefulness for individual patients, and threats to the autonomy of the doctor/patient relationship. Analysis of EBM according to these themes leads to the conclusion that EBM can be a useful tool, but has severe drawbacks when used in isolation in the practice of individual patient care. Modern medicine must strive to balance an extremely complex set of priorities. To be an effective aid in achieving this balance, the theory and practice of EBM must expand to include new methods of study design and integration, and must adapt to the needs of both patients and the health care system in order to provide patients with the best care at the lowest cost.

Clinical outcomes resulting from telemedicine interventions: a systematic review

BackgroundThe use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based.MethodsData sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis). All included articles were abstracted and graded for quality and direction of the evidence.ResultsA total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery.ConclusionsDespite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

The CLEF 2004 cross-language image retrieval track

The purpose of this paper is to outline efforts from the 2004 CLEF cross–language image retrieval campaign (ImageCLEF). The aim of this CLEF track is to explore the use of both text and content–based retrieval methods for cross–language image retrieval. Three tasks were offered in the ImageCLEF track: a TREC–style ad-hoc retrieval task, retrieval from a medical collection, and a user–centered (interactive) evaluation task. Eighteen research groups from a variety of backgrounds and nationalities participated in ImageCLEF. In this paper we describe the ImageCLEF tasks, submissions from participating groups and summarise the main findings.

Caveats for the use of operational electronic health record data in comparative effectiveness research.

The growing amount of data in operational electronic health record systems provides unprecedented opportunity for its reuse for many tasks, including comparative effectiveness research. However, there are many caveats to the use of such data. Electronic health record data from clinical settings may be inaccurate, incomplete, transformed in ways that undermine their meaning, unrecoverable for research, of unknown provenance, of insufficient granularity, and incompatible with research protocols. However, the quantity and real-world nature of these data provide impetus for their use, and we develop a list of caveats to inform would-be users of such data as well as provide an informatics roadmap that aims to insure this opportunity to augment comparative effectiveness research can be best leveraged.

Factors associated with successful answering of clinical questions using an information retrieval system

OBJECTIVES This study sought to assess the ability of medical and nurse practitioner students to use MEDLINE to obtain evidence for answering clinical questions and to identify factors associated with the successful answering of questions. METHODS A convenience sample of medical and nurse practitioner students was recruited. After completing instruments measuring demographic variables, computer and searching attitudes and experience, and cognitive traits, the subjects were given a brief orientation to MEDLINE searching and the techniques of evidence-based medicine. The subjects were then given 5 questions (from a pool of 20) to answer in two sessions using the Ovid MEDLINE system and the Oregon Health & Science University library collection. Each question was answered using three possible responses that reflected the quality of the evidence. All actions capable of being logged by the Ovid system were captured. Statistical analysis was performed using a model based on generalized estimating equations. The relevance-based measures of recall and precision were measured by defining end queries and having relevance judgments made by physicians who were not associated with the study. RESULTS Forty-five medical and 21 nurse practitioner students provided usable answers to 324 questions. The rate of correctness increased from 32.3 to 51.6 percent for medical students and from 31.7 to 34.7 percent for nurse practitioner students. Ability to answer questions correctly was most strongly associated with correctness of the answer before searching, user experience with MEDLINE features, the evidence-based medicine question type, and the spatial visualization score. The spatial visualization score showed multi-colinearity with student type (medical vs. nurse practitioner). Medical and nurse practitioner students obtained comparable recall and precision, neither of which was associated with correctness of the answer. CONCLUSIONS Medical and nurse practitioner students in this study were at best moderately successful at answering clinical questions correctly with the assistance of literature searching. The results confirm the importance of evaluating both search ability and the ability to use the resulting information to accomplish a clinical task.

Why batch and user evaluations do not give the same results

Much system-oriented evaluation of information retrieval systems has used the Cranfield approach based upon queries run against test collections in a batch mode. Some researchers have questioned whether this approach can be applied to the real world, but little data exists for or against that assertion. We have studied this question in the context of the TREC Interactive Track. Previous results demonstrated that improved performance as measured by relevance-based metrics in batch studies did not correspond with the results of outcomes based on real user searching tasks. The experiments in this paper analyzed those results to determine why this occurred. Our assessment showed that while the queries entered by real users into systems yielding better results in batch studies gave comparable gains in ranking of relevant documents for those users, they did not translate into better performance on specific tasks. This was most likely due to users being able to adequately find and utilize relevant documents ranked further down the output list.

Reducing Workload in Systematic Review Preparation Using Automated Citation Classification

OBJECTIVE To determine whether automated classification of document citations can be useful in reducing the time spent by experts reviewing journal articles for inclusion in updating systematic reviews of drug class efficacy for treatment of disease. DESIGN A test collection was built using the annotated reference files from 15 systematic drug class reviews. A voting perceptron-based automated citation classification system was constructed to classify each article as containing high-quality, drug class-specific evidence or not. Cross-validation experiments were performed to evaluate performance. MEASUREMENTS Precision, recall, and F-measure were evaluated at a range of sample weightings. Work saved over sampling at 95% recall was used as the measure of value to the review process. RESULTS A reduction in the number of articles needing manual review was found for 11 of the 15 drug review topics studied. For three of the topics, the reduction was 50% or greater. CONCLUSION Automated document citation classification could be a useful tool in maintaining systematic reviews of the efficacy of drug therapy. Further work is needed to refine the classification system and determine the best manner to integrate the system into the production of systematic reviews.

A Day in the Life of PubMed: Analysis of a Typical Day's Query Log

OBJECTIVE To characterize PubMed usage over a typical day and compare it to previous studies of user behavior on Web search engines. DESIGN We performed a lexical and semantic analysis of 2,689,166 queries issued on PubMed over 24 consecutive hours on a typical day. MEASUREMENTS We measured the number of queries, number of distinct users, queries per user, terms per query, common terms, Boolean operator use, common phrases, result set size, MeSH categories, used semantic measurements to group queries into sessions, and studied the addition and removal of terms from consecutive queries to gauge search strategies. RESULTS The size of the result sets from a sample of queries showed a bimodal distribution, with peaks at approximately 3 and 100 results, suggesting that a large group of queries was tightly focused and another was broad. Like Web search engine sessions, most PubMed sessions consisted of a single query. However, PubMed queries contained more terms. CONCLUSION PubMeds usage profile should be considered when educating users, building user interfaces, and developing future biomedical information retrieval systems.