Transcript Shock of the Old 2005 | Prescribing

Developing a
knowledge
base of
interactive
cases
teaching
prescribing in
hospitals
• Presentation Aims
• Project Aims
• Who’s Involved
• Use Cases
• Initial Position
• Technical Challenges
• Approach
• Achievements
• Demo
• Questions
Shock of the Old 2005 | Prescriptions | [email protected]
Presentation
Aims
Raise Awareness
• Educators
– Ease with which online
content can be created
– Potential use of knowledge
bases in learning contexts
• Technologists
– Small, structured, interactive
components can EASILY be
incorporated into online
content management systems
– Large applications with
suitable APIs have potential
educational use and value
Shock of the Old 2005 | Prescriptions | [email protected]
Education
by
Questioning
Shockingly
Old
Can it be, Ischomachus,
that asking questions is
teaching? I am just
beginning to see what is
behind all your questions.
You lead me on by means
of things I know, point to
things that resemble them,
and persuade me that I
know things that I thought
I had no knowledge of.
— Socrates (Quoted in
Xenophon's "Economics”)
Shock of the Old 2005 | Prescriptions | [email protected]
TASK
Minor
Childhood
Medical
Condition
• Think back to your childhood
• Pick a minor medical condition that you
had then e.g.
–
–
–
–
Bad belly
Bumped elbow
Scraped knee
Bit of a cold
• On your card write
–
–
–
–
Your name (optional)
The name of the condition
Something that made it feel better
Something that would have made it feel
worse
• We’ll be using the information on your
card in a later exercise
Shock of the Old 2005 | Prescriptions | [email protected]
Project
Aims
• Interactive case studies
• Medical students
• Spot errors in
prescriptions
• Correct the errors
• Get feedback
• Realistic as possible
Shock of the Old 2005 | Prescriptions | [email protected]
Project
Aims
Challenges
• Lots of forms
• Lots of boxes on the
forms
• Different form designs in
different hospitals
• The completed forms
need to be meaningful
and correct
• Need to give feedback
on all forms in a case
Shock of the Old 2005 | Prescriptions | [email protected]
Who’s
Involved
• NHS
– Bee Wee
– Rhagib Ali
– Diane Evans
• MSD Teaching and
Learning
– Vivien Sieber
– Andrew Stenhouse
– Phil Rees
Shock of the Old 2005 | Prescriptions | [email protected]
Use Cases
Create Editing Framework
Developer
Read Scenario
Create Knowledge Base
View Forms
Create/Edit Scenario
Correct Errors
Create/Edit Forms
Suggest Additional Therapies
Create/Edit Case
Answer Supplimentary Questions
Domain
Expert
Create/Edit Supplimentary Questions
Student
Obtain Feedback
Release Case
Shock of the Old 2005 | Prescriptions | [email protected]
Initial
Position
• QuestionMark
Perception/TOIA
– Questions with Feedback
– Different question types
– Questions don’t interact
• Flash
– Control of visual design
• WebLearn
– Central Navigation
Shock of the Old 2005 | Prescriptions | [email protected]
Technical
Challenges
• Forms
– Look real
– Capture data effectively
– Change appearance
without changing function
• Feedback
– Complex set of choices
and interactions
• Content Authoring
– Easy and intuitive
– No bottlenecks
Shock of the Old 2005 | Prescriptions | [email protected]
Approach
• Forms
– Visual Design
– Data Handling
• Marking and Feedback
• Content Creation
Shock of the Old 2005 | Prescriptions | [email protected]
Approach
Forms
Design in
Flash
• Screen versions look like
paper versions
• Basic validation of data
can be handled in Flash
Shock of the Old 2005 | Prescriptions | [email protected]
A Flash
Version of a
Standard
Form
Shock of the Old 2005 | Prescriptions | [email protected]
Approach
Forms
Data in XML
• XML = Extensible
Markup Language
• Separates how
something looks from
what it means
• Same XML can be used
for two different designs
of the same form
• <readable>
<by>humans</by>
<by>machines</by>
</readable>
Shock of the Old 2005 | Prescriptions | [email protected]
A Sample of
XML
Generated
by Flash
<?xml version="1.0" encoding="utf-8"?>
<WQN255>
<Identification>
<Name>Name</Name>
<Address>
<Line1>1</Line1>
<Line2>2</Line2>
<Line3>3</Line3>
</Address>
<Consultant>4</Consultant>
<HospitalNumber>klj</HospitalNumber>
<AreaCode>kljlkj</AreaCode>
<Sex>lklkj</Sex>
<DateOfBirth>lkjkjlk</DateOfBirth>
<Weight>lkjlk</Weight>
</Identification>
<Medication>
<Item>
<Drug>lklklk</Drug>
<Dose>jlkj</Dose>
<Route>lkjlkj</Route>
<Continue>lkjlk</Continue>
<Pharmacy>lkjl</Pharmacy>
</Item>
Shock of the Old 2005 | Prescriptions | [email protected]
The Cool
Web
Robert
Graves
Children are dumb to say how hot the day is,
How hot the scent is of the summer rose,
How dreadful the black wastes of evening sky,
How dreadful the tall soldiers drumming by.
But we have speech, to chill the angry day,
And speech, to dull the rose’s cruel scent.
We spell away the overhanging night,
We spell away the soldiers and the fright. …
Shock of the Old 2005 | Prescriptions | [email protected]
Approach
Creating a
Knowledge
Base for
Marking,
Feedback
and
Questioning
• Protégé
• Ontology Editor
• Knowledge Base
Framework
• National Library of
Medicine
• Stanford Medical
Informatics
Shock of the Old 2005 | Prescriptions | [email protected]
Approach
Knowledge
Base
What do we
mean by
Ontology?
• An ontology is a
specification of a
conceptualization.
Tom Gruber, Stanford
• Contains
– Classes (types of thing)
– Instances (individual
things)
– Relationships
– Constraints
Shock of the Old 2005 | Prescriptions | [email protected]
Shock of the Old 2005 | Prescriptions | [email protected]
Approach
Knowledge
Base
Ontology
• People
– Patient
– Doctor
– Pharmacist
• Condition
• Drug
• Signs
• Symptoms
• Indication
• Contra-Indication
• Side Effect
Shock of the Old 2005 | Prescriptions | [email protected]
Approach
Knowledge
Base
Ontology
• Patient have underlying Conditions
• Conditions may be treatable by Drug
therapies
• Patients may exhibit signs
• Patients may exhibit symptoms
• Signs and symptoms may inform
diagnoses
• Diagnoses, signs and symptoms may
indicate the appropriateness of
particular drug therapies
• Prescribing particular drugs may be
contra-indicated by the prescription of
other drugs or by the existence of
signs, symptoms or additional
diagnoses
• Particular drugs may cause side effects
etc. etc. etc. . . . . . .
Shock of the Old 2005 | Prescriptions | [email protected]
Approach
User
Interface
for Content
Creation
• Magnolia
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–
–
–
–
Content Management System
Page Templates
Paragraph Templates*
Custom Controls*
Standards Based (JSR-170)
• Flash
– WYSIWYG Form Editing
• Magnolia + Flash
– Easy Interface
– Case Creation
– Prescription Form Generation
Shock of the Old 2005 | Prescriptions | [email protected]
Shock of the Old 2005 | Prescriptions | [email protected]
Achieved
So Far
• Ontology – initial
version
• Flash XML libraries
• Content Creation
framework
• Developed Case Content
Shock of the Old 2005 | Prescriptions | [email protected]
Demo
N.B. This is
the backend.
We’re seeing
the model,
not the final
application.
• Quick tour of a small
knowledge base
• Group construction of a
knowledge base (have
your cards ready)
http://www.cmaj.ca/cgi/content/full/169/12/1294
• Constraint Checking
• Two visualisation tools
Shock of the Old 2005 | Prescriptions | [email protected]
Potential
Generating
Follow-up
Questions
A return to
the
Socratic?
• You’ve prescribed Drug X which
signs and symptoms led to you
this choice?
• What other drug could you
prescribe for Condition Y?
• What other conditions could
Drug X be prescribed for?
• Some of the drugs you’ve
prescribed have interactions.
Identify them.
• Your patient is now showing
Sign Y. Which of your drugs
could be causing this? What
alternatives are there?
Shock of the Old 2005 | Prescriptions | [email protected]
Links
• Protégé
Ontology editor
http://www.protege.stanford.edu
• Magnolia
Content Management System
http://www.magnolia.info
• Flash
Graphical Web Interactions
http://www.macromedia.com
• Flash XPath Libraries
Manipulating XML in Flash
http://www.xfactorstudio.com
Shock of the Old 2005 | Prescriptions | [email protected]
Questions
and
Discussion
• Who has the first
question?
Shock of the Old 2005 | Prescriptions | [email protected]