Intelligent Decision Support System for

retrieval of patient’s information

Index  Annotational
tools for
building
 Abstract
patient profiles
 Introduction
 Case retrival
 System
 Evalution
description
 Conclusion
 Image retrival
 Bibiliography
 wireless computing to
improve the quality and
ABSTRACT
reduce the cost of
healthcare. We are
The majority of
developing a mobile
healthcare workers in
application that allows
hospitals continue to record,
doctors to efficiently access
access and update important
accurate real-time patient
patient information using
information at the point-of-
paper charts.
care.
Disparatepatientdata
(clinicalinformation,
laboratory results and
medical imagery) is entered
by different caregivers and
stored at different
locationsaround the hospital.
This is a cumbersome,
timeconsuming process that
can result in critical medical
errorssuch as documents
being mislaid or
prescriptions
beingmisinterpreted due to
illegible handwriting.
Hospitals
everywhereare moving to
integrate health data sources
usingElectronic Health
Record (EHR) systems as
well as takingadvantage of
the flexibility and speed of
The system can assist
caregivers in automatically
searching through very large
repositories of previous
patient cases as increasingly
large hospital databases are
making manual searches of INTRODUCTI
such information
ON
unfeasible.The system
performs computational
Healthcare technology
prognosis by providing
is entering a new
decision support for pre-
evolutionary phase. The
screening of medical
medical community has an
diagnosis.
obligation to the public to
provide the safest, most
A presenting patient's
effective healthcare
symptoms can be input to a
possible.This is evermore
portabledevice and the
achievable with the use of
application can quickly
portable electronic devices
retrieve the most similar
and new medical
profiles with known
applications that can be
diagnoses from large
delivered over wireless
databases which can be used
networks. Caregivers
to compare treatments,
equipped with mobile
diagnosis, test results and
computers now have levels
other information.
of interaction at the bedside
not possible with paper
charts and can leverage
accurate real-time patient
information at the point-of-
care to make decisions and
take actions more Health Record systems also
efficiently. play an important role in
Electronic Health Record long-term healthcare.
systems allow disparate We propose an
patient information often innovative application that
entered by different allows doctors to efficiently
caregivers to be stored input, query, update, analyse
together as encapsulated and compare electronic
patient cases in medical patient records including
databases. Using portable associated medical imagery
devices such as Personal (e.g. X-Rays) on any mobile
Digital Assistants (PDA's) or desktop device. Our
and Tablet PC's, all integrated EHR system can
caregivers can access vital be used wirelessly by
patientinformation as well as caregivers at different
other resources including locations in the hospital
drugreferences, relevant setting to record and input
medical imagery and online all important patient data,
medical encyclopedias including clinical
directly at the bedside. information, up-to-date
In addition to Electronic status reports, laboratory
Health Records, the advent results, medication and
of new wireless technologies medical imagery.
is providing many new and The type of
exciting opportunities. functionality weare
Healthcare providers may providing in the application
now move freely in hospital includes a Graphical
buildings with constant UserInterface (GUI) where
access to realtime vital caregivers can input and
patient record all patient
information.Electronic information in a
straightforward manner and The radiologist employs a
multimedia annotation tools suite of image processing
for medical imagery to tools provided by the
support Communication and desktop application to
collaboration between annotate any images they
different caregivers.These have just acquired with
annotations and other patient relevant notes and
data can be information regarding the
used to support retrieval of patient's condition. The
patient case histories for system can be queried to
comparisonof diagnoses and display previously annotated
treatment procedures and patient images from a
effective integration of knowledge base of previous
image data with other patient profiles for
patient information both comparative studies to aid
within a database and within with more effective medical
an adaptive Graphical User diagnosis and treatment.
Interface. Once an interaction with a
patient is complete the
SYSTEM current patient's images are

DESCRIPTION added to their profile in a

central repository and the
The system is based
images and/or their
on a three-tier architecture:
annotations can be
client, server and
retrieved/updated at a later
database.There are two
date either
primary client components:
by the radiologist or another
a desktop application that is
doctor examining the
used by radiologists and a
patient. Physicians can use
mobile component that is
the mobile application on a
used by physicians.
Personal
Digital Assistant (PDA) or a updated accordingly. Both
Tablet PC to retrieve and the PDA and the Tablet PC
131 view patient profiles can be used wirelessly at
and to quickly enter different locations around
information about the hospital or in other
patient progress into situations where such
electronic charts in real- facilities
time. are not normally available
The PDA allows (e.g. in an ambulance).They
physicians to view textual may also be used to access
abstractions of current other resources such as
patient data as well as other online drug references or
patient case histories and medical encyclopedias.The
allows for improved mobile devices may also be
mobility due to its reduced used to query the central
size and weight. The Tablet repository of patient profiles
PC provides a more with information specific to
comprehensive user aparticular illness to retrieve
interface and additional similar patient case histories
functionality such as the that may help with a
ability to view and annotate diagnosis by providing
medical imagery due to the comparative assistance.
larger screen size and higher
processing power.All of the IMAGE
information for each patient RETRIEVAL
is stored as an integrated
The majority of
patient profile in a database.
current medical image
All interactions with the
retrieval techniques retrieve
patient profile by healthcare
images by similarity of
workers are recorded by the
appearance,using low-level
system and the profile is
features such as shapes or by
natural language . The selected. .
biggest problem arising from
these techniques is the so-
called semantic gap -the
mismatch between the
capabilities of the retrieval
system and user needs. In
order to bridge this gap our
application aims to unite
information about
underlying visual data with
more high-level concepts. For
example, capturing a measure
of the human expertise and
proficiency involved in Fig. 1. Search for Patient
Information and medical
making a diagnosis from an
imagery
X-Ray us to relevant image
allows information was
(e.g. the highlighting a
particular body organ)and
also how it was employed in
the context of that specific
diagnosis (e.g. inferred from
an added annotation).
The approach
allows us to capture and
reuse best practice
techniques.Using our
application, the caregiver
can retrieve relevant
patient imagery by entering
relevant patient data and by
clicking on the "Search previous case histories to try
Patient Images" button on to find any similarities. If
the interface depicted in any of the similar images
Figure1 . The user can adjust had been annotated while
the weights of the relevant those patients
search fields by using the were being diagnosed the
slider bars to indicate which radiologist may study these
of the parameters are most notes for extra information
relevant. For example a regarding the specific injury
radiologist may be viewing or illness.
an X-Ray image and may ANNOTATION
be having difficulty in TOOLS FOR
diagnosing the problem from BUILDING
the particular image. The X- PATIENT
Ray, however may remind PROFILES
The annotation tools
him of a similar image he
provided by the application
viewed previously and he
are used by radiologists to
may remember some of the
annotate medical imagery
details of the previous
with relevant diagnostic
patient.In this scenario the
information. When a
radiologist could input the
radiologist takes a patient
details of the
X-Ray or scan the image
previous patient as search
can be displayed in the
parameters to the
screen depicted in Figure 2.
application.The application
Using the tools provided the
will then filter out this
radiologist can annotate the
patient's profile as well as
image in an
any similar profiles from the
appropriatefashion while
EHRS. The radiologist can
then compare the current
image to images from these
diagnosing the patient . implicitly to shield the
radiographer from the
burden of explicit
knowledge
engineering.From their
perspective, the image
interaction tools support
them in carrying out their
task (e.g., a radiologist
producing a report on the
current patient) by making it
easier for them to select
and highlight relevant
features, to store insights
and to summarize aspects of
their work progress.
We have developed
tools for direct image
manipulation, including
filters, transformation,
highlighting, sketching and
By providing an post-it type tools. The user
interface such as this one we can add media annotations
have achieved the goal of to images as a whole or to
capturing important particular highlighted image
contextual patient/diagnostic aspects. Currently, the
information by situating system supports annotation
intelligent support for by text audio and video. All
gathering it inside a flexible textual, audio and video
environment. This annotations can be
information is collected previewed before being
incorporated as part of the radiologist to look for
knowledge base, and once previous patient analyses .
recorded they can be saved
and uploaded to the image as
a knowledge parcel
associated with the patient in
question. The system also
supports annotation by cut,
copy and paste between a
given image and other
images in the dataset, as
well as any application that
supports clipboard
functionality.
The caregiver can
Once the radiologist
retrieve relevant patient case
has finished interacting with
histories by entering the
the medical imagery their
relevant patient details to the
entire work process is stored
interface and by clicking on
along with all the other
the "Search for Patient
patient data as an
Profiles" button. As in image
encapsulated patient profile
retrieval the user may adjust
in the knowledge base.
the relevance of the search
CASE fields by moving the
RETRIEVAL associated slider bars.

As the system builds One

up encapsulated user challenge in retrieving

interactions,another type of previous case histories

retrieval is enabled, has been how to present an

retrieving entire previous entire case history in a

patient case histories. This manner that is compact

enables a physician or enough to allow multiple

results to be viewed capable of capturing and
simultaneously.. Figure 3 deciphering expert medical
shows knowledge and we were
an example of our results for aiming to show that
retrieved case histories.Each recommendations made by
row represents a patient case the system based on similar
history It includes the patient data. We were also
matching percentage score interested in demonstrating
between the ability of the application
the current query and the to facilitate effective
similar patient profile. The knowledge and data sharing.
user can click on the "Open The 6
Profile" button to view the selected cases were then
full case history (including input as search parameters
any medical imagery) of that to application.The
patient. information, symptoms,
diagnosis and treatments for

EVALUATI each case was entered to the

system and similar cases
ON
were retrieved by pressing
In an initial
the "Find Similar Cases"
evaluation we have
button. The cases retrieved
conducted testing with a
by the application and
dataset of 100 encapsulated
displayed in the results
patient profiles . In this
screen were then analysed.
preliminary evaluation we
Each returned case was
conducted experiments to
marked as either "relevant"
test the previous patient case
or "not relevant" to the
retrieval capabilities of the
search query. These ratings
application. In this approach
were then compared to the
we were interested in
clusters we had outlined
showing that the system is
earlier to examine if the relavent cases are being
results were appearing in the retrieved for each query.
relevant categories. CONCL
USION
The
current system in
hospitals where by
doctors enter
patient information using
papercharts
is cumbersome, time-
consuming and
does not facilitate
This process was repeated knowledge sharing.types of
for each of the 6 cases .In information, including
order to graph the results for imagery, are stored in
our prior case retrieval different locations and
algorithms we employed valuable time is often lost
precision and recall trying to correlate data in
metrics. order to diagnose and treat
Figure 4 shows the average patients.This system can
precision and recall values address such issues by
for the results of the 6 providing doctors with
queries. From the graph we instant access to information
observe that that will allow them to make
the system is performing critical decisions and
case retrieval accurately. we prognoses with greater speed
also observe a linear and efficiency.
increase in recall as the It facilitates knowledge
number of results returned sharing and supports
increases indicating that all effective communication
about the most effective the usability of the
ways in which to treat application for the expert
patients by linking similar users.
patient case histories using
case-based reasoning BIBILIOGRAPHY
techniques.It adds more
1:www.medicalimagecomputin
value to imagery and image
g.com
transmission by combining it 2:www.medical-image-
with patient records to processing.info

support more thorough

communication,
examination and diagnosis.
Our initial evaluation of the
system has produced very
promising results. The
system can effectively
capture important patient
information and can be
sucessfuly used retrieve
similar previous patient case
histories that can offer
useful realtime
decision support to
physicians at any location in
the hospital setting. We
intend to conduct trials with
domain experts in the near
future. We intend to
incorportate a facility to
record relevance feedback
from physicians to improve